Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG E&M EST PT-(INTERMEDIATE)

Facility

$488.00

Service Code	HCPCS 99213
Hospital Charge Code	H7200186
Hospital Revenue Code	720
Min. Negotiated Rate	$36.31
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$317.20
Rate for Payer: Cash Price	$317.20
Rate for Payer: Hawaii Western Management Group Commercial	$463.60
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Kaiser Permanente Commercial	$307.44
Rate for Payer: Kaiser Permanente Medicaid	$248.88
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: UnitedHealthcare Medicaid	$36.31
Rate for Payer: University Health Alliance Commercial	$355.70

HCHG E&M EST PT-(INTERMEDIATE)

Facility

$424.00

Service Code	HCPCS 99213
Hospital Charge Code	H5100154
Hospital Revenue Code	510
Min. Negotiated Rate	$360.40
Max. Negotiated Rate	$411.28
Rate for Payer: Cash Price	$275.60
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: MDX Hawaii PPO	$411.28

HCHG E&M EST PT-(INTERMEDIATE)

Facility

$424.00

Service Code	HCPCS 99213
Hospital Charge Code	H5100154
Hospital Revenue Code	510
Min. Negotiated Rate	$36.31
Max. Negotiated Rate	$411.28
Rate for Payer: Cash Price	$275.60
Rate for Payer: Cash Price	$275.60
Rate for Payer: Hawaii Western Management Group Commercial	$402.80
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: Kaiser Permanente Commercial	$267.12
Rate for Payer: Kaiser Permanente Medicaid	$216.24
Rate for Payer: MDX Hawaii PPO	$411.28
Rate for Payer: UnitedHealthcare Medicaid	$36.31
Rate for Payer: University Health Alliance Commercial	$309.05

HCHG E&M EST PT-(INTERMEDIATE)

Facility

$488.00

Service Code	HCPCS 99213
Hospital Charge Code	H7200186
Hospital Revenue Code	720
Min. Negotiated Rate	$414.80
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$317.20
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: MDX Hawaii PPO	$473.36

HCHG E&M EST PT-(LIMITED)

Facility

$338.00

Service Code	HCPCS 99212
Hospital Charge Code	H5100152
Hospital Revenue Code	510
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-(LIMITED)

Facility

$338.00

Service Code	HCPCS 99212
Hospital Charge Code	H5100152
Hospital Revenue Code	510
Min. Negotiated Rate	$24.13
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	$24.13
Rate for Payer: University Health Alliance Commercial	$246.37

HCHG E&M EST PT-(LIMITED)

Facility

$389.00

Service Code	HCPCS 99212
Hospital Charge Code	H7200185
Hospital Revenue Code	720
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$252.85
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HCHG E&M EST PT-(LIMITED)

Facility

$389.00

Service Code	HCPCS 99212
Hospital Charge Code	H7200185
Hospital Revenue Code	720
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$252.85
Rate for Payer: Cash Price	$252.85
Rate for Payer: Hawaii Western Management Group Commercial	$369.55
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: UnitedHealthcare Medicaid	$24.13
Rate for Payer: University Health Alliance Commercial	$283.54

HCHG ENDOMYSIAL AB IGG, RFLX TO TITER

Facility

$149.00

Service Code	HCPCS 86231
Hospital Charge Code	H3021043
Hospital Revenue Code	302
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

HCHG ENDOMYSIAL AB IGG, RFLX TO TITER

Facility

$149.00

Service Code	HCPCS 86231
Hospital Charge Code	H3021043
Hospital Revenue Code	302
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$12.09
Rate for Payer: AlohaCare Medicare	$12.09
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$13.30
Rate for Payer: Hawaii Medical Service Association ABD	$16.70
Rate for Payer: Hawaii Medical Service Association Commercial	$15.11
Rate for Payer: Hawaii Medical Service Association Medicare	$12.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.54
Rate for Payer: Hawaii Western Management Group Commercial	$12.09
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$12.09
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$12.09
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$13.30
Rate for Payer: Ohana Health Plan Medicare	$12.09
Rate for Payer: UnitedHealthcare Medicaid	$7.25
Rate for Payer: UnitedHealthcare Medicare	$12.09
Rate for Payer: University Health Alliance Commercial	$108.61

HCHG ENTEROVIRUS DETECT AMP PROBE - 90

Facility

$475.00

Service Code	HCPCS 87498
Hospital Charge Code	H3060724
Hospital Revenue Code	306
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$460.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: MDX Hawaii PPO	$460.75

HCHG ENTEROVIRUS DETECT AMP PROBE - 90

Facility

$475.00

Service Code	HCPCS 87498
Hospital Charge Code	H3060724
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$460.75
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$308.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$49.04
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$299.25
Rate for Payer: Kaiser Permanente Medicaid	$242.25
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$460.75
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$49.04
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG ENTEROVIRUS PROBE & REVRS TRNS - 90

Facility

$475.00

Service Code	HCPCS 87498
Hospital Charge Code	H3060795
Hospital Revenue Code	306
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$460.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: MDX Hawaii PPO	$460.75

HCHG ENTEROVIRUS PROBE & REVRS TRNS - 90

Facility

$475.00

Service Code	HCPCS 87498
Hospital Charge Code	H3060795
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$460.75
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$308.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$49.04
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$299.25
Rate for Payer: Kaiser Permanente Medicaid	$242.25
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$460.75
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$49.04
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG ENUCLEATE/EXCISE HEMORRHOID

Facility

$4,060.00

Service Code	HCPCS 46320
Hospital Charge Code	H4500430
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$3,938.20
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,857.00
Rate for Payer: Health Management Network Commercial	$3,451.00
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,557.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$3,938.20
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65
Rate for Payer: University Health Alliance Commercial	$2,959.33

HCHG ENUCLEATE/EXCISE HEMORRHOID

Facility

$4,060.00

Service Code	HCPCS 46320
Hospital Charge Code	H4500430
Hospital Revenue Code	450
Min. Negotiated Rate	$3,451.00
Max. Negotiated Rate	$3,938.20
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Health Management Network Commercial	$3,451.00
Rate for Payer: MDX Hawaii PPO	$3,938.20

HCHG EOSIN COUNT

Facility

$32.00

Service Code	HCPCS 85048
Hospital Charge Code	H3050132
Hospital Revenue Code	305
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: MDX Hawaii PPO	$31.04

HCHG EOSIN COUNT

Facility

$32.00

Service Code	HCPCS 85048
Hospital Charge Code	H3050132
Hospital Revenue Code	305
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$2.54
Rate for Payer: AlohaCare Medicare	$2.54
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Devoted Health Medicare	$2.79
Rate for Payer: Hawaii Medical Service Association ABD	$3.52
Rate for Payer: Hawaii Medical Service Association Commercial	$3.17
Rate for Payer: Hawaii Medical Service Association Medicare	$2.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.70
Rate for Payer: Hawaii Western Management Group Commercial	$2.54
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$2.54
Rate for Payer: Kaiser Permanente Commercial	$20.16
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$2.54
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.54
Rate for Payer: UnitedHealthcare Medicaid	$3.52
Rate for Payer: UnitedHealthcare Medicare	$2.54
Rate for Payer: University Health Alliance Commercial	$6.57

HCHG EOSIN NASAL OR SPUTUM

Facility

$41.00

Service Code	HCPCS 89190
Hospital Charge Code	H3090114
Hospital Revenue Code	309
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: MDX Hawaii PPO	$39.77

HCHG EOSIN NASAL OR SPUTUM

Facility

$41.00

Service Code	HCPCS 89190
Hospital Charge Code	H3090114
Hospital Revenue Code	309
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$5.79
Rate for Payer: AlohaCare Medicare	$5.79
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$6.37
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$7.24
Rate for Payer: Hawaii Medical Service Association Medicare	$5.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$5.79
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$5.79
Rate for Payer: Kaiser Permanente Commercial	$25.83
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$5.79
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$6.37
Rate for Payer: Ohana Health Plan Medicare	$5.79
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$5.79
Rate for Payer: University Health Alliance Commercial	$12.28

HCHG EOSIN OTHER SOURCE

Facility

$65.00

Service Code	HCPCS 87205
Hospital Charge Code	H3060186
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$40.95
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG EOSIN OTHER SOURCE

Facility

$65.00

Service Code	HCPCS 87205
Hospital Charge Code	H3060186
Hospital Revenue Code	306
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: MDX Hawaii PPO	$63.05

HCHG ERX DRUGS/INCIDENT RAD (UBC 255)

Facility

$1.00

Hospital Charge Code	H2550005
Hospital Revenue Code	255
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

HCHG ERX DRUGS/INCIDENT RAD (UBC 255)

Facility

$1.00

Hospital Charge Code	H2550005
Hospital Revenue Code	255
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

HCHG ERX IV SOLUTIONS (UBC 258)

Facility

$0.01

Hospital Charge Code	H2580000
Hospital Revenue Code	258
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.01
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: MDX Hawaii PPO	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

Know your out-of-pocket cost for care.

All Charges