Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG FLUORO GUIDE NDL PLCMT

Facility

$538.00

Service Code	HCPCS 77002
Hospital Charge Code	H3200400
Hospital Revenue Code	320
Min. Negotiated Rate	$38.07
Max. Negotiated Rate	$2,833.00
Rate for Payer: Cash Price	$349.70
Rate for Payer: Cash Price	$349.70
Rate for Payer: Cash Price	$349.70
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$511.10
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Kaiser Permanente Commercial	$338.94
Rate for Payer: Kaiser Permanente Medicaid	$274.38
Rate for Payer: MDX Hawaii PPO	$521.86
Rate for Payer: UnitedHealthcare Medicaid	$38.07
Rate for Payer: University Health Alliance Commercial	$146.61

HCHG FLUORO GUIDE NDL PLCMT

Facility

$538.00

Service Code	HCPCS 77002
Hospital Charge Code	H3200400
Hospital Revenue Code	320
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$349.70
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: MDX Hawaii PPO	$521.86

HCHG FLUOROSCOPY UP TO 1 HR

Facility

$869.00

Service Code	HCPCS 76000
Hospital Charge Code	H3200981
Hospital Revenue Code	320
Min. Negotiated Rate	$738.65
Max. Negotiated Rate	$842.93
Rate for Payer: Cash Price	$564.85
Rate for Payer: Health Management Network Commercial	$738.65
Rate for Payer: MDX Hawaii PPO	$842.93

HCHG FLUOROSCOPY UP TO 1 HR

Facility

$869.00

Service Code	HCPCS 76000
Hospital Charge Code	H3200981
Hospital Revenue Code	320
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$842.93
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$564.85
Rate for Payer: Cash Price	$564.85
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$42.98
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.76
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$738.65
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$547.47
Rate for Payer: Kaiser Permanente Medicaid	$443.19
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$842.93
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$42.98
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$179.71

HCHG FLUORS NONINF AB TITER - 90

Facility

$163.00

Service Code	HCPCS 86256
Hospital Charge Code	H3001098
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$16.66
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$31.15

HCHG FLUORS NONINF AB TITER - 90

Facility

$163.00

Service Code	HCPCS 86256
Hospital Charge Code	H3001098
Hospital Revenue Code	300
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: MDX Hawaii PPO	$158.11

HCHG FLUORS NONINF AGENT AB - 90

Facility

$163.00

Service Code	HCPCS 86255
Hospital Charge Code	H3001096
Hospital Revenue Code	300
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: MDX Hawaii PPO	$158.11

HCHG FLUORS NONINF AGENT AB - 90

Facility

$163.00

Service Code	HCPCS 86255
Hospital Charge Code	H3001096
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$16.66
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$31.15

HCHG FNA BX W/CT GDN 1ST LES

Facility

$3,823.00

Service Code	HCPCS 10009
Hospital Charge Code	H3610685
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$3,249.55
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$2,408.49
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$3,708.31
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG FNA BX W/CT GDN 1ST LES

Facility

$3,823.00

Service Code	HCPCS 10009
Hospital Charge Code	H3610685
Hospital Revenue Code	361
Min. Negotiated Rate	$3,249.55
Max. Negotiated Rate	$3,708.31
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Health Management Network Commercial	$3,249.55
Rate for Payer: MDX Hawaii PPO	$3,708.31

HCHG FNA BX W/US GDN 1ST LES

Facility

$3,823.00

Service Code	HCPCS 10005
Hospital Charge Code	H3610681
Hospital Revenue Code	361
Min. Negotiated Rate	$3,249.55
Max. Negotiated Rate	$3,708.31
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Health Management Network Commercial	$3,249.55
Rate for Payer: MDX Hawaii PPO	$3,708.31

HCHG FNA BX W/US GDN 1ST LES

Facility

$3,823.00

Service Code	HCPCS 10005
Hospital Charge Code	H3610681
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,708.31
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Cash Price	$2,484.95
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$3,249.55
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$2,408.49
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$3,708.31
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$2,786.58

HCHG FNA BX W/US GDN EA ADDL

Facility

$1,147.00

Service Code	HCPCS 10006
Hospital Charge Code	H3610682
Hospital Revenue Code	361
Min. Negotiated Rate	$974.95
Max. Negotiated Rate	$1,112.59
Rate for Payer: Cash Price	$745.55
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: MDX Hawaii PPO	$1,112.59

HCHG FNA BX W/US GDN EA ADDL

Facility

$1,147.00

Service Code	HCPCS 10006
Hospital Charge Code	H3610682
Hospital Revenue Code	361
Min. Negotiated Rate	$49.69
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$745.55
Rate for Payer: Cash Price	$745.55
Rate for Payer: Cash Price	$745.55
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: Kaiser Permanente Commercial	$722.61
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: UnitedHealthcare Medicaid	$49.69
Rate for Payer: University Health Alliance Commercial	$836.05

HCHG FNA WO IMG GUID

Facility

$2,246.00

Service Code	HCPCS 10021
Hospital Charge Code	H4501092
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG FNA WO IMG GUID

Facility

$2,246.00

Service Code	HCPCS 10021
Hospital Charge Code	H4501092
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$2,178.62
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,414.98
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG FOLATE RBC

Facility

$213.00

Service Code	HCPCS 82747
Hospital Charge Code	H3010616
Hospital Revenue Code	301
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$206.61
Rate for Payer: AlohaCare Medicaid	$17.65
Rate for Payer: AlohaCare Medicare	$17.65
Rate for Payer: Cash Price	$138.45
Rate for Payer: Cash Price	$138.45
Rate for Payer: Devoted Health Medicare	$19.41
Rate for Payer: Hawaii Medical Service Association ABD	$23.93
Rate for Payer: Hawaii Medical Service Association Commercial	$22.06
Rate for Payer: Hawaii Medical Service Association Medicare	$17.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.13
Rate for Payer: Hawaii Western Management Group Commercial	$17.65
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Humana Medicare	$17.65
Rate for Payer: Kaiser Permanente Commercial	$134.19
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: Kaiser Permanente Medicare	$17.65
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: Ohana Health Plan Medicaid	$19.41
Rate for Payer: Ohana Health Plan Medicare	$17.65
Rate for Payer: UnitedHealthcare Medicaid	$23.93
Rate for Payer: UnitedHealthcare Medicare	$17.65
Rate for Payer: University Health Alliance Commercial	$44.77

HCHG FOLATE RBC

Facility

$213.00

Service Code	HCPCS 82747
Hospital Charge Code	H3010616
Hospital Revenue Code	301
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$138.45
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

HCHG FOLIC ACID-SERUM

Facility

$198.00

Service Code	HCPCS 82746
Hospital Charge Code	H3010620
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$192.06
Rate for Payer: AlohaCare Medicaid	$14.70
Rate for Payer: AlohaCare Medicare	$14.70
Rate for Payer: Cash Price	$128.70
Rate for Payer: Cash Price	$128.70
Rate for Payer: Devoted Health Medicare	$16.17
Rate for Payer: Hawaii Medical Service Association ABD	$20.32
Rate for Payer: Hawaii Medical Service Association Commercial	$18.38
Rate for Payer: Hawaii Medical Service Association Medicare	$14.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.34
Rate for Payer: Hawaii Western Management Group Commercial	$14.70
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Humana Medicare	$14.70
Rate for Payer: Kaiser Permanente Commercial	$124.74
Rate for Payer: Kaiser Permanente Medicaid	$100.98
Rate for Payer: Kaiser Permanente Medicare	$14.70
Rate for Payer: MDX Hawaii PPO	$192.06
Rate for Payer: Ohana Health Plan Medicaid	$16.17
Rate for Payer: Ohana Health Plan Medicare	$14.70
Rate for Payer: UnitedHealthcare Medicaid	$20.32
Rate for Payer: UnitedHealthcare Medicare	$14.70
Rate for Payer: University Health Alliance Commercial	$38.00

HCHG FOLIC ACID-SERUM

Facility

$198.00

Service Code	HCPCS 82746
Hospital Charge Code	H3010620
Hospital Revenue Code	301
Min. Negotiated Rate	$168.30
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$128.70
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: MDX Hawaii PPO	$192.06

HCHG FOOT (2 VIEWS)

Facility

$476.00

Service Code	HCPCS 73620
Hospital Charge Code	H3200408
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG FOOT (2 VIEWS)

Facility

$476.00

Service Code	HCPCS 73620
Hospital Charge Code	H3200408
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
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	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$54.67

HCHG FOOT 3 VIEWS

Facility

$476.00

Service Code	HCPCS 73630
Hospital Charge Code	H3200406
Hospital Revenue Code	320
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$19.08
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	$20.03
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$19.08
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$62.59

HCHG FOOT 3 VIEWS

Facility

$476.00

Service Code	HCPCS 73630
Hospital Charge Code	H3200406
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG FOOT PORT, 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73620
Hospital Charge Code	H3200410
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
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	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$54.67

Know your out-of-pocket cost for care.

All Charges