Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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: Health Management Network Commercial	$0.01
Rate for Payer: MDX Hawaii PPO	$0.01

HCHG ERX PHARMACY (UBC 250)

Facility

$0.01

Hospital Charge Code	H2500000
Hospital Revenue Code	250
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: UnitedHealthcare Medicaid	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

HCHG ERX PHARMACY (UBC 250)

Facility

$0.01

Hospital Charge Code	H2500000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: MDX Hawaii PPO	$0.01

HCHG ERX PHARMACY (UBC 250/636)

Facility

$0.01

Hospital Charge Code	H2500005
Hospital Revenue Code	250
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: UnitedHealthcare Medicaid	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

HCHG ERX PHARMACY (UBC 250/636)

Facility

$0.01

Hospital Charge Code	H2500005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: MDX Hawaii PPO	$0.01

HCHG ERYTHROPOIETIN 90

Facility

$243.00

Service Code	HCPCS 82668
Hospital Charge Code	H3010570
Hospital Revenue Code	301
Min. Negotiated Rate	$18.79
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$18.79
Rate for Payer: AlohaCare Medicare	$18.79
Rate for Payer: Cash Price	$157.95
Rate for Payer: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$20.67
Rate for Payer: Hawaii Medical Service Association ABD	$25.97
Rate for Payer: Hawaii Medical Service Association Commercial	$23.49
Rate for Payer: Hawaii Medical Service Association Medicare	$18.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.27
Rate for Payer: Hawaii Western Management Group Commercial	$18.79
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$18.79
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$18.79
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$20.67
Rate for Payer: Ohana Health Plan Medicare	$18.79
Rate for Payer: UnitedHealthcare Medicaid	$25.97
Rate for Payer: UnitedHealthcare Medicare	$18.79
Rate for Payer: University Health Alliance Commercial	$48.58

HCHG ERYTHROPOIETIN 90

Facility

$243.00

Service Code	HCPCS 82668
Hospital Charge Code	H3010570
Hospital Revenue Code	301
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$157.95
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

HCHG ESOPHAGRAM

Facility

$963.00

Service Code	HCPCS 74220
Hospital Charge Code	H3200342
Hospital Revenue Code	320
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$934.11
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$625.95
Rate for Payer: Cash Price	$625.95
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$39.30
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.37
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$606.69
Rate for Payer: Kaiser Permanente Medicaid	$491.13
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$934.11
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$39.30
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$167.61

HCHG ESOPHAGRAM

Facility

$963.00

Service Code	HCPCS 74220
Hospital Charge Code	H3200342
Hospital Revenue Code	320
Min. Negotiated Rate	$818.55
Max. Negotiated Rate	$934.11
Rate for Payer: Cash Price	$625.95
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: MDX Hawaii PPO	$934.11

HCHG ESOPHAGRAM DOUBLE CONTRAST

Facility

$1,116.00

Service Code	HCPCS 74221
Hospital Charge Code	H3201001
Hospital Revenue Code	320
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$1,082.52
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$725.40
Rate for Payer: Cash Price	$725.40
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$102.34
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.73
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$703.08
Rate for Payer: Kaiser Permanente Medicaid	$569.16
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,082.52
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$72.83
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$225.92

HCHG ESOPHAGRAM DOUBLE CONTRAST

Facility

$1,116.00

Service Code	HCPCS 74221
Hospital Charge Code	H3201001
Hospital Revenue Code	320
Min. Negotiated Rate	$948.60
Max. Negotiated Rate	$1,082.52
Rate for Payer: Cash Price	$725.40
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: MDX Hawaii PPO	$1,082.52

HCHG ESPHOGRAM VIDEO

Facility

$856.00

Service Code	HCPCS 74230
Hospital Charge Code	H3200344
Hospital Revenue Code	320
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$830.32
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$556.40
Rate for Payer: Cash Price	$556.40
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$42.98
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.81
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$727.60
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$539.28
Rate for Payer: Kaiser Permanente Medicaid	$436.56
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$830.32
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$42.98
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$175.55

HCHG ESPHOGRAM VIDEO

Facility

$856.00

Service Code	HCPCS 74230
Hospital Charge Code	H3200344
Hospital Revenue Code	320
Min. Negotiated Rate	$727.60
Max. Negotiated Rate	$830.32
Rate for Payer: Cash Price	$556.40
Rate for Payer: Health Management Network Commercial	$727.60
Rate for Payer: MDX Hawaii PPO	$830.32

HCHG ESR

Facility

$61.00

Service Code	HCPCS 85651
Hospital Charge Code	K3050006
Hospital Revenue Code	305
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: MDX Hawaii PPO	$59.17

HCHG ESR

Facility

$61.00

Service Code	HCPCS 85651
Hospital Charge Code	K3050006
Hospital Revenue Code	305
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$4.91
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	$5.16
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$38.43
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$4.91
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$9.18

HCHG ESTRADIOL SERUM

Facility

$344.00

Service Code	HCPCS 82670
Hospital Charge Code	H3010572
Hospital Revenue Code	301
Min. Negotiated Rate	$27.94
Max. Negotiated Rate	$333.68
Rate for Payer: AlohaCare Medicaid	$27.94
Rate for Payer: AlohaCare Medicare	$27.94
Rate for Payer: Cash Price	$223.60
Rate for Payer: Cash Price	$223.60
Rate for Payer: Devoted Health Medicare	$30.73
Rate for Payer: Hawaii Medical Service Association ABD	$38.62
Rate for Payer: Hawaii Medical Service Association Commercial	$34.92
Rate for Payer: Hawaii Medical Service Association Medicare	$27.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.55
Rate for Payer: Hawaii Western Management Group Commercial	$27.94
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Humana Medicare	$27.94
Rate for Payer: Kaiser Permanente Commercial	$216.72
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: Kaiser Permanente Medicare	$27.94
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: Ohana Health Plan Medicaid	$30.73
Rate for Payer: Ohana Health Plan Medicare	$27.94
Rate for Payer: UnitedHealthcare Medicaid	$38.62
Rate for Payer: UnitedHealthcare Medicare	$27.94
Rate for Payer: University Health Alliance Commercial	$72.22

HCHG ESTRADIOL SERUM

Facility

$344.00

Service Code	HCPCS 82670
Hospital Charge Code	H3010572
Hospital Revenue Code	301
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$223.60
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: MDX Hawaii PPO	$333.68

HCHG ESTRIOL SERUM UNCONJ

Facility

$173.00

Service Code	HCPCS 82677
Hospital Charge Code	H3010574
Hospital Revenue Code	301
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$24.18
Rate for Payer: AlohaCare Medicare	$24.18
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Devoted Health Medicare	$26.60
Rate for Payer: Hawaii Medical Service Association ABD	$33.43
Rate for Payer: Hawaii Medical Service Association Commercial	$30.23
Rate for Payer: Hawaii Medical Service Association Medicare	$24.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.10
Rate for Payer: Hawaii Western Management Group Commercial	$24.18
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$24.18
Rate for Payer: Kaiser Permanente Commercial	$108.99
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$24.18
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$26.60
Rate for Payer: Ohana Health Plan Medicare	$24.18
Rate for Payer: UnitedHealthcare Medicaid	$33.43
Rate for Payer: UnitedHealthcare Medicare	$24.18
Rate for Payer: University Health Alliance Commercial	$62.51

HCHG ESTRIOL SERUM UNCONJ

Facility

$173.00

Service Code	HCPCS 82677
Hospital Charge Code	H3010574
Hospital Revenue Code	301
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: MDX Hawaii PPO	$167.81

HCHG ESTROGEN-SERUM TOTAL 90

Facility

$152.00

Service Code	HCPCS 82672
Hospital Charge Code	H3010578
Hospital Revenue Code	301
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$21.70
Rate for Payer: AlohaCare Medicare	$21.70
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Devoted Health Medicare	$23.87
Rate for Payer: Hawaii Medical Service Association ABD	$29.97
Rate for Payer: Hawaii Medical Service Association Commercial	$27.12
Rate for Payer: Hawaii Medical Service Association Medicare	$21.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.47
Rate for Payer: Hawaii Western Management Group Commercial	$21.70
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$21.70
Rate for Payer: Kaiser Permanente Commercial	$95.76
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$21.70
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$23.87
Rate for Payer: Ohana Health Plan Medicare	$21.70
Rate for Payer: UnitedHealthcare Medicaid	$29.97
Rate for Payer: UnitedHealthcare Medicare	$21.70
Rate for Payer: University Health Alliance Commercial	$56.05

HCHG ESTROGEN-SERUM TOTAL 90

Facility

$152.00

Service Code	HCPCS 82672
Hospital Charge Code	H3010578
Hospital Revenue Code	301
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

HCHG ETHYLENE GLYCOL

Facility

$193.00

Service Code	HCPCS 82693
Hospital Charge Code	H3010592
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$14.90
Rate for Payer: AlohaCare Medicare	$14.90
Rate for Payer: Cash Price	$125.45
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$16.39
Rate for Payer: Hawaii Medical Service Association ABD	$20.59
Rate for Payer: Hawaii Medical Service Association Commercial	$18.62
Rate for Payer: Hawaii Medical Service Association Medicare	$14.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.62
Rate for Payer: Hawaii Western Management Group Commercial	$14.90
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$14.90
Rate for Payer: Kaiser Permanente Commercial	$121.59
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$14.90
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$16.39
Rate for Payer: Ohana Health Plan Medicare	$14.90
Rate for Payer: UnitedHealthcare Medicaid	$20.59
Rate for Payer: UnitedHealthcare Medicare	$14.90
Rate for Payer: University Health Alliance Commercial	$38.52

HCHG ETHYLENE GLYCOL

Facility

$193.00

Service Code	HCPCS 82693
Hospital Charge Code	H3010592
Hospital Revenue Code	301
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: MDX Hawaii PPO	$187.21

HCHG EVAC SUBUNGUAL HEMATOMA

Facility

$816.00

Service Code	HCPCS 11740
Hospital Charge Code	H4500438
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG EVAC SUBUNGUAL HEMATOMA

Facility

$816.00

Service Code	HCPCS 11740
Hospital Charge Code	H4500438
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
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	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

Know your out-of-pocket cost for care.

All Charges