Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG FEMUR 1 VIEW

Facility

$431.00

Service Code	HCPCS 73551
Hospital Charge Code	H3200992
Hospital Revenue Code	320
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$13.37
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.27
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$19.48
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$57.63

HCHG FEMUR 1 VIEW

Facility

$431.00

Service Code	HCPCS 73551
Hospital Charge Code	H3200992
Hospital Revenue Code	320
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

HCHG FERRITIN LEVEL RIA

Facility

$194.00

Service Code	HCPCS 82728
Hospital Charge Code	H3010600
Hospital Revenue Code	301
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$126.10
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: MDX Hawaii PPO	$188.18

HCHG FERRITIN LEVEL RIA

Facility

$194.00

Service Code	HCPCS 82728
Hospital Charge Code	H3010600
Hospital Revenue Code	301
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$13.63
Rate for Payer: AlohaCare Medicare	$13.63
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Devoted Health Medicare	$14.99
Rate for Payer: Hawaii Medical Service Association ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$17.04
Rate for Payer: Hawaii Medical Service Association Medicare	$13.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.60
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$13.63
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$13.63
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$14.99
Rate for Payer: Ohana Health Plan Medicare	$13.63
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$13.63
Rate for Payer: University Health Alliance Commercial	$29.56

HCHG FETAL BIOPHYS PROF W NST

Facility

$758.00

Service Code	HCPCS 76818
Hospital Charge Code	H4020126
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: MDX Hawaii PPO	$735.26

HCHG FETAL BIOPHYS PROF W NST

Facility

$758.00

Service Code	HCPCS 76818
Hospital Charge Code	H4020126
Hospital Revenue Code	402
Min. Negotiated Rate	$53.40
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$53.40
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.13
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$477.54
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$53.40
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$241.61

HCHG FETAL BIOPHYS PROF WO NST

Facility

$758.00

Service Code	HCPCS 76819
Hospital Charge Code	H4020128
Hospital Revenue Code	402
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.56
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.13
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$477.54
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.56
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$195.62

HCHG FETAL BIOPHYS PROF WO NST

Facility

$758.00

Service Code	HCPCS 76819
Hospital Charge Code	H4020128
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: MDX Hawaii PPO	$735.26

HCHG FETAL FIBRONECTIN

Facility

$742.00

Service Code	HCPCS 82731
Hospital Charge Code	H3010602
Hospital Revenue Code	301
Min. Negotiated Rate	$630.70
Max. Negotiated Rate	$719.74
Rate for Payer: Cash Price	$482.30
Rate for Payer: Health Management Network Commercial	$630.70
Rate for Payer: MDX Hawaii PPO	$719.74

HCHG FETAL FIBRONECTIN

Facility

$742.00

Service Code	HCPCS 82731
Hospital Charge Code	H3010602
Hospital Revenue Code	301
Min. Negotiated Rate	$64.41
Max. Negotiated Rate	$719.74
Rate for Payer: AlohaCare Medicaid	$64.41
Rate for Payer: AlohaCare Medicare	$64.41
Rate for Payer: Cash Price	$482.30
Rate for Payer: Cash Price	$482.30
Rate for Payer: Devoted Health Medicare	$70.85
Rate for Payer: Hawaii Medical Service Association ABD	$89.01
Rate for Payer: Hawaii Medical Service Association Commercial	$80.51
Rate for Payer: Hawaii Medical Service Association Medicare	$64.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$239.94
Rate for Payer: Hawaii Western Management Group Commercial	$64.41
Rate for Payer: Health Management Network Commercial	$630.70
Rate for Payer: Humana Medicare	$64.41
Rate for Payer: Kaiser Permanente Commercial	$467.46
Rate for Payer: Kaiser Permanente Medicaid	$378.42
Rate for Payer: Kaiser Permanente Medicare	$64.41
Rate for Payer: MDX Hawaii PPO	$719.74
Rate for Payer: Ohana Health Plan Medicaid	$70.85
Rate for Payer: Ohana Health Plan Medicare	$64.41
Rate for Payer: UnitedHealthcare Medicaid	$89.01
Rate for Payer: UnitedHealthcare Medicare	$64.41
Rate for Payer: University Health Alliance Commercial	$166.48

HCHG FETAL NON-STRESS TEST

Facility

$794.00

Service Code	HCPCS 59025
Hospital Charge Code	H9200112
Hospital Revenue Code	920
Min. Negotiated Rate	$674.90
Max. Negotiated Rate	$770.18
Rate for Payer: Cash Price	$516.10
Rate for Payer: Health Management Network Commercial	$674.90
Rate for Payer: MDX Hawaii PPO	$770.18

HCHG FETAL NON-STRESS TEST

Facility

$794.00

Service Code	HCPCS 59025
Hospital Charge Code	H9200112
Hospital Revenue Code	920
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$770.18
Rate for Payer: AlohaCare Medicaid	$238.83
Rate for Payer: AlohaCare Medicare	$238.83
Rate for Payer: Cash Price	$516.10
Rate for Payer: Cash Price	$516.10
Rate for Payer: Devoted Health Medicare	$262.71
Rate for Payer: Hawaii Medical Service Association ABD	$8.21
Rate for Payer: Hawaii Medical Service Association Commercial	$298.54
Rate for Payer: Hawaii Medical Service Association Medicare	$238.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.04
Rate for Payer: Hawaii Western Management Group Commercial	$754.30
Rate for Payer: Health Management Network Commercial	$674.90
Rate for Payer: Humana Medicare	$238.83
Rate for Payer: Kaiser Permanente Commercial	$500.22
Rate for Payer: Kaiser Permanente Medicaid	$404.94
Rate for Payer: Kaiser Permanente Medicare	$238.83
Rate for Payer: MDX Hawaii PPO	$770.18
Rate for Payer: Ohana Health Plan Medicaid	$262.71
Rate for Payer: Ohana Health Plan Medicare	$238.83
Rate for Payer: UnitedHealthcare Medicaid	$8.21
Rate for Payer: UnitedHealthcare Medicare	$238.83
Rate for Payer: University Health Alliance Commercial	$578.75

HCHG FETAL SCREEN

Facility

$112.00

Service Code	HCPCS 83030
Hospital Charge Code	K3010032
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$10.74
Rate for Payer: AlohaCare Medicare	$10.74
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Devoted Health Medicare	$11.81
Rate for Payer: Hawaii Medical Service Association ABD	$11.43
Rate for Payer: Hawaii Medical Service Association Commercial	$13.43
Rate for Payer: Hawaii Medical Service Association Medicare	$10.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$10.74
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$10.74
Rate for Payer: Kaiser Permanente Commercial	$70.56
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$10.74
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$11.81
Rate for Payer: Ohana Health Plan Medicare	$10.74
Rate for Payer: UnitedHealthcare Medicaid	$11.43
Rate for Payer: UnitedHealthcare Medicare	$10.74
Rate for Payer: University Health Alliance Commercial	$21.39

HCHG FETAL SCREEN

Facility

$112.00

Service Code	HCPCS 83030
Hospital Charge Code	K3010032
Hospital Revenue Code	301
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$72.80
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: MDX Hawaii PPO	$108.64

HCHG FETAL STRESS TEST

Facility

$631.00

Service Code	HCPCS 59020
Hospital Charge Code	H9200134
Hospital Revenue Code	720
Min. Negotiated Rate	$536.35
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$410.15
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: MDX Hawaii PPO	$612.07

HCHG FETAL STRESS TEST

Facility

$631.00

Service Code	HCPCS 59020
Hospital Charge Code	H9200134
Hospital Revenue Code	720
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$612.07
Rate for Payer: AlohaCare Medicaid	$238.83
Rate for Payer: AlohaCare Medicare	$238.83
Rate for Payer: Cash Price	$410.15
Rate for Payer: Cash Price	$410.15
Rate for Payer: Devoted Health Medicare	$262.71
Rate for Payer: Hawaii Medical Service Association ABD	$53.69
Rate for Payer: Hawaii Medical Service Association Commercial	$298.54
Rate for Payer: Hawaii Medical Service Association Medicare	$238.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.08
Rate for Payer: Hawaii Western Management Group Commercial	$599.45
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$238.83
Rate for Payer: Kaiser Permanente Commercial	$397.53
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$238.83
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$262.71
Rate for Payer: Ohana Health Plan Medicare	$238.83
Rate for Payer: UnitedHealthcare Medicaid	$53.69
Rate for Payer: UnitedHealthcare Medicare	$238.83
Rate for Payer: University Health Alliance Commercial	$459.94

HCHG FIBRIN DEGRAD SEMI QN

Facility

$85.00

Service Code	HCPCS 85362
Hospital Charge Code	K3050004
Hospital Revenue Code	305
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$55.25
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: MDX Hawaii PPO	$82.45

HCHG FIBRIN DEGRAD SEMI QN

Facility

$85.00

Service Code	HCPCS 85362
Hospital Charge Code	K3050004
Hospital Revenue Code	305
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$6.89
Rate for Payer: AlohaCare Medicare	$6.89
Rate for Payer: Cash Price	$55.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Devoted Health Medicare	$7.58
Rate for Payer: Hawaii Medical Service Association ABD	$9.52
Rate for Payer: Hawaii Medical Service Association Commercial	$8.61
Rate for Payer: Hawaii Medical Service Association Medicare	$6.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.00
Rate for Payer: Hawaii Western Management Group Commercial	$6.89
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$6.89
Rate for Payer: Kaiser Permanente Commercial	$53.55
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$6.89
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$7.58
Rate for Payer: Ohana Health Plan Medicare	$6.89
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: UnitedHealthcare Medicare	$6.89
Rate for Payer: University Health Alliance Commercial	$17.80

HCHG FIBRINOGEN ACTIVITY

Facility

$145.00

Service Code	HCPCS 85384
Hospital Charge Code	H3050154
Hospital Revenue Code	305
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HCHG FIBRINOGEN ACTIVITY

Facility

$145.00

Service Code	HCPCS 85384
Hospital Charge Code	H3050154
Hospital Revenue Code	305
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$9.72
Rate for Payer: AlohaCare Medicare	$9.72
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$10.69
Rate for Payer: Hawaii Medical Service Association ABD	$11.74
Rate for Payer: Hawaii Medical Service Association Commercial	$12.15
Rate for Payer: Hawaii Medical Service Association Medicare	$9.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.33
Rate for Payer: Hawaii Western Management Group Commercial	$9.72
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$9.72
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$9.72
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$10.69
Rate for Payer: Ohana Health Plan Medicare	$9.72
Rate for Payer: UnitedHealthcare Medicaid	$11.74
Rate for Payer: UnitedHealthcare Medicare	$9.72
Rate for Payer: University Health Alliance Commercial	$21.96

HCHG FIBROSCAN

Facility

$584.00

Service Code	HCPCS 91200
Hospital Charge Code	H5100443
Hospital Revenue Code	510
Min. Negotiated Rate	$496.40
Max. Negotiated Rate	$566.48
Rate for Payer: Cash Price	$379.60
Rate for Payer: Health Management Network Commercial	$496.40
Rate for Payer: MDX Hawaii PPO	$566.48

HCHG FIBROSCAN

Facility

$584.00

Service Code	HCPCS 91200
Hospital Charge Code	H5100443
Hospital Revenue Code	510
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$566.48
Rate for Payer: AlohaCare Medicaid	$152.01
Rate for Payer: AlohaCare Medicare	$152.01
Rate for Payer: Cash Price	$379.60
Rate for Payer: Cash Price	$379.60
Rate for Payer: Devoted Health Medicare	$167.21
Rate for Payer: Hawaii Medical Service Association ABD	$14.84
Rate for Payer: Hawaii Medical Service Association Commercial	$190.01
Rate for Payer: Hawaii Medical Service Association Medicare	$152.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.72
Rate for Payer: Hawaii Western Management Group Commercial	$554.80
Rate for Payer: Health Management Network Commercial	$496.40
Rate for Payer: Humana Medicare	$152.01
Rate for Payer: Kaiser Permanente Commercial	$367.92
Rate for Payer: Kaiser Permanente Medicaid	$297.84
Rate for Payer: Kaiser Permanente Medicare	$152.01
Rate for Payer: MDX Hawaii PPO	$566.48
Rate for Payer: Ohana Health Plan Medicaid	$167.21
Rate for Payer: Ohana Health Plan Medicare	$152.01
Rate for Payer: UnitedHealthcare Medicaid	$33.75
Rate for Payer: UnitedHealthcare Medicare	$152.01
Rate for Payer: University Health Alliance Commercial	$425.68

HCHG FILALRIOSIS AB 90

Facility

$119.00

Service Code	HCPCS 86682
Hospital Charge Code	H3020512
Hospital Revenue Code	302
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$13.01
Rate for Payer: AlohaCare Medicare	$13.01
Rate for Payer: Cash Price	$77.35
Rate for Payer: Cash Price	$77.35
Rate for Payer: Devoted Health Medicare	$14.31
Rate for Payer: Hawaii Medical Service Association ABD	$12.60
Rate for Payer: Hawaii Medical Service Association Commercial	$16.26
Rate for Payer: Hawaii Medical Service Association Medicare	$13.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.30
Rate for Payer: Hawaii Western Management Group Commercial	$13.01
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$13.01
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$13.01
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$14.31
Rate for Payer: Ohana Health Plan Medicare	$13.01
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicare	$13.01
Rate for Payer: University Health Alliance Commercial	$24.88

HCHG FILALRIOSIS AB 90

Facility

$119.00

Service Code	HCPCS 86682
Hospital Charge Code	H3020512
Hospital Revenue Code	302
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HCHG FILM OF BREAST BX TISSUE

Facility

$2,905.00

Service Code	HCPCS 76098
Hospital Charge Code	H3200372
Hospital Revenue Code	320
Min. Negotiated Rate	$2,469.25
Max. Negotiated Rate	$2,817.85
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Health Management Network Commercial	$2,469.25
Rate for Payer: MDX Hawaii PPO	$2,817.85

Know your out-of-pocket cost for care.

All Charges