Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG EMERGENCY FEE 2 URGENT I

Facility

$1,004.00

Service Code	HCPCS 99282
Hospital Charge Code	H4500418
Hospital Revenue Code	450
Min. Negotiated Rate	$853.40
Max. Negotiated Rate	$973.88
Rate for Payer: Cash Price	$652.60
Rate for Payer: Health Management Network Commercial	$853.40
Rate for Payer: MDX Hawaii PPO	$973.88

HCHG EMERGENCY FEE 3 URGENT II

Facility

$1,628.00

Service Code	HCPCS 99283
Hospital Charge Code	H4500420
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$322.48
Rate for Payer: Cash Price	$1,058.20
Rate for Payer: Cash Price	$1,058.20
Rate for Payer: Cash Price	$1,058.20
Rate for Payer: Cash Price	$1,058.20
Rate for Payer: Devoted Health Medicare	$354.73
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$322.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,546.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Humana Medicare	$322.48
Rate for Payer: Kaiser Permanente Commercial	$1,025.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$322.48
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: Ohana Health Plan Medicaid	$354.73
Rate for Payer: Ohana Health Plan Medicare	$322.48
Rate for Payer: UnitedHealthcare Medicare	$322.48
Rate for Payer: University Health Alliance Commercial	$1,186.65

HCHG EMERGENCY FEE 3 URGENT II

Facility

$1,628.00

Service Code	HCPCS 99283
Hospital Charge Code	H4500420
Hospital Revenue Code	450
Min. Negotiated Rate	$1,383.80
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$1,058.20
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: MDX Hawaii PPO	$1,579.16

HCHG EMERGENCY FEE 4 EMERGENT I

Facility

$2,539.00

Service Code	HCPCS 99284
Hospital Charge Code	H4500422
Hospital Revenue Code	450
Min. Negotiated Rate	$2,158.15
Max. Negotiated Rate	$2,462.83
Rate for Payer: Cash Price	$1,650.35
Rate for Payer: Health Management Network Commercial	$2,158.15
Rate for Payer: MDX Hawaii PPO	$2,462.83

HCHG EMERGENCY FEE 4 EMERGENT I

Facility

$2,539.00

Service Code	HCPCS 99284
Hospital Charge Code	H4500422
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$2,462.83
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$492.93
Rate for Payer: Cash Price	$1,650.35
Rate for Payer: Cash Price	$1,650.35
Rate for Payer: Cash Price	$1,650.35
Rate for Payer: Cash Price	$1,650.35
Rate for Payer: Devoted Health Medicare	$542.22
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$492.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,412.05
Rate for Payer: Health Management Network Commercial	$2,158.15
Rate for Payer: Humana Medicare	$492.93
Rate for Payer: Kaiser Permanente Commercial	$1,599.57
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$492.93
Rate for Payer: MDX Hawaii PPO	$2,462.83
Rate for Payer: Ohana Health Plan Medicaid	$542.22
Rate for Payer: Ohana Health Plan Medicare	$492.93
Rate for Payer: UnitedHealthcare Medicare	$492.93
Rate for Payer: University Health Alliance Commercial	$1,850.68

HCHG EMERGENCY FEE 5 EMERGENT II

Facility

$3,457.00

Service Code	HCPCS 99285
Hospital Charge Code	H4500424
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$3,353.29
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$703.53
Rate for Payer: Cash Price	$2,247.05
Rate for Payer: Cash Price	$2,247.05
Rate for Payer: Cash Price	$2,247.05
Rate for Payer: Cash Price	$2,247.05
Rate for Payer: Devoted Health Medicare	$773.88
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$703.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,284.15
Rate for Payer: Health Management Network Commercial	$2,938.45
Rate for Payer: Humana Medicare	$703.53
Rate for Payer: Kaiser Permanente Commercial	$2,177.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$703.53
Rate for Payer: MDX Hawaii PPO	$3,353.29
Rate for Payer: Ohana Health Plan Medicaid	$773.88
Rate for Payer: Ohana Health Plan Medicare	$703.53
Rate for Payer: UnitedHealthcare Medicare	$703.53
Rate for Payer: University Health Alliance Commercial	$2,519.81

HCHG EMERGENCY FEE 5 EMERGENT II

Facility

$3,457.00

Service Code	HCPCS 99285
Hospital Charge Code	H4500424
Hospital Revenue Code	450
Min. Negotiated Rate	$2,938.45
Max. Negotiated Rate	$3,353.29
Rate for Payer: Cash Price	$2,247.05
Rate for Payer: Health Management Network Commercial	$2,938.45
Rate for Payer: MDX Hawaii PPO	$3,353.29

HCHG EMERGENCY FEE 6 CRITICAL CARE

Facility

$4,526.00

Service Code	HCPCS 99291
Hospital Charge Code	H4500426
Hospital Revenue Code	450
Min. Negotiated Rate	$3,847.10
Max. Negotiated Rate	$4,390.22
Rate for Payer: Cash Price	$2,941.90
Rate for Payer: Health Management Network Commercial	$3,847.10
Rate for Payer: MDX Hawaii PPO	$4,390.22

HCHG EMERGENCY FEE 6 CRITICAL CARE

Facility

$4,526.00

Service Code	HCPCS 99291
Hospital Charge Code	H4500426
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$4,390.22
Rate for Payer: AlohaCare Medicaid	$975.82
Rate for Payer: AlohaCare Medicare	$975.82
Rate for Payer: Cash Price	$2,941.90
Rate for Payer: Cash Price	$2,941.90
Rate for Payer: Cash Price	$2,941.90
Rate for Payer: Cash Price	$2,941.90
Rate for Payer: Devoted Health Medicare	$1,073.40
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$975.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,299.70
Rate for Payer: Health Management Network Commercial	$3,847.10
Rate for Payer: Humana Medicare	$975.82
Rate for Payer: Kaiser Permanente Commercial	$2,851.38
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$975.82
Rate for Payer: MDX Hawaii PPO	$4,390.22
Rate for Payer: Ohana Health Plan Medicaid	$1,073.40
Rate for Payer: Ohana Health Plan Medicare	$975.82
Rate for Payer: UnitedHealthcare Medicare	$975.82
Rate for Payer: University Health Alliance Commercial	$3,299.00

HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN

Facility

$804.00

Service Code	HCPCS 99292
Hospital Charge Code	H4501006
Hospital Revenue Code	450
Min. Negotiated Rate	$506.52
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$522.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$763.80
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Kaiser Permanente Commercial	$506.52
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$779.88
Rate for Payer: University Health Alliance Commercial	$586.04

HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN

Facility

$804.00

Service Code	HCPCS 99292
Hospital Charge Code	H4500427
Hospital Revenue Code	450
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN

Facility

$804.00

Service Code	HCPCS 99292
Hospital Charge Code	H4500427
Hospital Revenue Code	450
Min. Negotiated Rate	$506.52
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$522.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$763.80
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Kaiser Permanente Commercial	$506.52
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$779.88
Rate for Payer: University Health Alliance Commercial	$586.04

HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN

Facility

$804.00

Service Code	HCPCS 99292
Hospital Charge Code	H4501006
Hospital Revenue Code	450
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG E&M EST PT-(BRIEF)

Facility

$294.00

Service Code	HCPCS 99211
Hospital Charge Code	H5100150
Hospital Revenue Code	510
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$191.10
Rate for Payer: Cash Price	$191.10
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: UnitedHealthcare Medicaid	$9.17
Rate for Payer: University Health Alliance Commercial	$214.30

HCHG E&M EST PT-(BRIEF)

Facility

$294.00

Service Code	HCPCS 99211
Hospital Charge Code	H5100150
Hospital Revenue Code	510
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$191.10
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HCHG E&M EST PT-(BRIEF)

Facility

$338.00

Service Code	HCPCS 99211
Hospital Charge Code	H7200184
Hospital Revenue Code	720
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$219.70
Rate for Payer: Cash Price	$219.70
Rate for Payer: Hawaii Western Management Group Commercial	$321.10
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Kaiser Permanente Commercial	$212.94
Rate for Payer: Kaiser Permanente Medicaid	$172.38
Rate for Payer: MDX Hawaii PPO	$327.86
Rate for Payer: UnitedHealthcare Medicaid	$9.17
Rate for Payer: University Health Alliance Commercial	$246.37

HCHG E&M EST PT-(BRIEF)

Facility

$338.00

Service Code	HCPCS 99211
Hospital Charge Code	H7200184
Hospital Revenue Code	720
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$219.70
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: MDX Hawaii PPO	$327.86

HCHG E&M EST PT-(COMPLEX)

Facility

$860.00

Service Code	HCPCS 99215
Hospital Charge Code	H7200188
Hospital Revenue Code	720
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$834.20
Rate for Payer: Cash Price	$559.00
Rate for Payer: Health Management Network Commercial	$731.00
Rate for Payer: MDX Hawaii PPO	$834.20

HCHG E&M EST PT-(COMPLEX)

Facility

$748.00

Service Code	HCPCS 99215
Hospital Charge Code	H5100158
Hospital Revenue Code	510
Min. Negotiated Rate	$83.57
Max. Negotiated Rate	$725.56
Rate for Payer: Cash Price	$486.20
Rate for Payer: Cash Price	$486.20
Rate for Payer: Hawaii Western Management Group Commercial	$710.60
Rate for Payer: Health Management Network Commercial	$635.80
Rate for Payer: Kaiser Permanente Commercial	$471.24
Rate for Payer: Kaiser Permanente Medicaid	$381.48
Rate for Payer: MDX Hawaii PPO	$725.56
Rate for Payer: UnitedHealthcare Medicaid	$83.57
Rate for Payer: University Health Alliance Commercial	$545.22

HCHG E&M EST PT-(COMPLEX)

Facility

$860.00

Service Code	HCPCS 99215
Hospital Charge Code	H7200188
Hospital Revenue Code	720
Min. Negotiated Rate	$83.57
Max. Negotiated Rate	$834.20
Rate for Payer: Cash Price	$559.00
Rate for Payer: Cash Price	$559.00
Rate for Payer: Hawaii Western Management Group Commercial	$817.00
Rate for Payer: Health Management Network Commercial	$731.00
Rate for Payer: Kaiser Permanente Commercial	$541.80
Rate for Payer: Kaiser Permanente Medicaid	$438.60
Rate for Payer: MDX Hawaii PPO	$834.20
Rate for Payer: UnitedHealthcare Medicaid	$83.57
Rate for Payer: University Health Alliance Commercial	$626.85

HCHG E&M EST PT-(COMPLEX)

Facility

$748.00

Service Code	HCPCS 99215
Hospital Charge Code	H5100158
Hospital Revenue Code	510
Min. Negotiated Rate	$635.80
Max. Negotiated Rate	$725.56
Rate for Payer: Cash Price	$486.20
Rate for Payer: Health Management Network Commercial	$635.80
Rate for Payer: MDX Hawaii PPO	$725.56

HCHG E&M EST PT-(EXTENDED)

Facility

$536.00

Service Code	HCPCS 99214
Hospital Charge Code	H5100156
Hospital Revenue Code	510
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$348.40
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: MDX Hawaii PPO	$519.92

HCHG E&M EST PT-(EXTENDED)

Facility

$536.00

Service Code	HCPCS 99214
Hospital Charge Code	H5100156
Hospital Revenue Code	510
Min. Negotiated Rate	$56.46
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$348.40
Rate for Payer: Cash Price	$348.40
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$337.68
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: UnitedHealthcare Medicaid	$56.46
Rate for Payer: University Health Alliance Commercial	$390.69

HCHG E&M EST PT-(EXTENDED)

Facility

$616.00

Service Code	HCPCS 99214
Hospital Charge Code	H7200187
Hospital Revenue Code	720
Min. Negotiated Rate	$56.46
Max. Negotiated Rate	$597.52
Rate for Payer: Cash Price	$400.40
Rate for Payer: Cash Price	$400.40
Rate for Payer: Hawaii Western Management Group Commercial	$585.20
Rate for Payer: Health Management Network Commercial	$523.60
Rate for Payer: Kaiser Permanente Commercial	$388.08
Rate for Payer: Kaiser Permanente Medicaid	$314.16
Rate for Payer: MDX Hawaii PPO	$597.52
Rate for Payer: UnitedHealthcare Medicaid	$56.46
Rate for Payer: University Health Alliance Commercial	$449.00

HCHG E&M EST PT-(EXTENDED)

Facility

$616.00

Service Code	HCPCS 99214
Hospital Charge Code	H7200187
Hospital Revenue Code	720
Min. Negotiated Rate	$523.60
Max. Negotiated Rate	$597.52
Rate for Payer: Cash Price	$400.40
Rate for Payer: Health Management Network Commercial	$523.60
Rate for Payer: MDX Hawaii PPO	$597.52

Know your out-of-pocket cost for care.

All Charges