Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG IMRT DELIVERY CMPLX

Facility

$3,210.00

Service Code	HCPCS 77386
Hospital Charge Code	H3330232
Hospital Revenue Code	333
Min. Negotiated Rate	$2,728.50
Max. Negotiated Rate	$3,113.70
Rate for Payer: Cash Price	$2,086.50
Rate for Payer: Health Management Network Commercial	$2,728.50
Rate for Payer: MDX Hawaii PPO	$3,113.70

HCHG IMRT DELIVERY SIMP

Facility

$3,038.00

Service Code	HCPCS 77385
Hospital Charge Code	H3330231
Hospital Revenue Code	333
Min. Negotiated Rate	$2,582.30
Max. Negotiated Rate	$2,946.86
Rate for Payer: Cash Price	$1,974.70
Rate for Payer: Health Management Network Commercial	$2,582.30
Rate for Payer: MDX Hawaii PPO	$2,946.86

HCHG IMRT DELIVERY SIMP

Facility

$3,038.00

Service Code	HCPCS 77385
Hospital Charge Code	H3330231
Hospital Revenue Code	333
Min. Negotiated Rate	$433.85
Max. Negotiated Rate	$2,946.86
Rate for Payer: Cash Price	$1,974.70
Rate for Payer: Cash Price	$1,974.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,886.10
Rate for Payer: Health Management Network Commercial	$2,582.30
Rate for Payer: Kaiser Permanente Commercial	$1,913.94
Rate for Payer: Kaiser Permanente Medicaid	$1,549.38
Rate for Payer: MDX Hawaii PPO	$2,946.86
Rate for Payer: UnitedHealthcare Medicaid	$433.85
Rate for Payer: University Health Alliance Commercial	$846.15

HCHG IMRT DELIVERY TRACKING

Facility

$1,074.00

Service Code	HCPCS 77387
Hospital Charge Code	H3330233
Hospital Revenue Code	333
Min. Negotiated Rate	$912.90
Max. Negotiated Rate	$1,041.78
Rate for Payer: Cash Price	$698.10
Rate for Payer: Health Management Network Commercial	$912.90
Rate for Payer: MDX Hawaii PPO	$1,041.78

HCHG IMRT DELIVERY TRACKING

Facility

$1,074.00

Service Code	HCPCS 77387
Hospital Charge Code	H3330233
Hospital Revenue Code	333
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$1,041.78
Rate for Payer: Cash Price	$698.10
Rate for Payer: Cash Price	$698.10
Rate for Payer: Hawaii Medical Service Association ABD	$96.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$116.13
Rate for Payer: Hawaii Western Management Group Commercial	$1,020.30
Rate for Payer: Health Management Network Commercial	$912.90
Rate for Payer: Kaiser Permanente Commercial	$676.62
Rate for Payer: Kaiser Permanente Medicaid	$547.74
Rate for Payer: MDX Hawaii PPO	$1,041.78
Rate for Payer: University Health Alliance Commercial	$782.84

HCHG IMRT PLAN

Facility

$6,490.00

Service Code	HCPCS 77301
Hospital Charge Code	H3330128
Hospital Revenue Code	333
Min. Negotiated Rate	$781.61
Max. Negotiated Rate	$6,295.30
Rate for Payer: AlohaCare Medicaid	$1,635.14
Rate for Payer: AlohaCare Medicare	$1,635.14
Rate for Payer: Cash Price	$4,218.50
Rate for Payer: Cash Price	$4,218.50
Rate for Payer: Devoted Health Medicare	$1,798.65
Rate for Payer: Hawaii Medical Service Association ABD	$781.61
Rate for Payer: Hawaii Medical Service Association Commercial	$2,043.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,635.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$999.97
Rate for Payer: Hawaii Western Management Group Commercial	$1,635.14
Rate for Payer: Health Management Network Commercial	$5,516.50
Rate for Payer: Humana Medicare	$1,635.14
Rate for Payer: Kaiser Permanente Commercial	$4,088.70
Rate for Payer: Kaiser Permanente Medicaid	$3,309.90
Rate for Payer: Kaiser Permanente Medicare	$1,635.14
Rate for Payer: MDX Hawaii PPO	$6,295.30
Rate for Payer: Ohana Health Plan Medicaid	$1,798.65
Rate for Payer: Ohana Health Plan Medicare	$1,635.14
Rate for Payer: UnitedHealthcare Medicaid	$781.61
Rate for Payer: UnitedHealthcare Medicare	$1,635.14
Rate for Payer: University Health Alliance Commercial	$4,116.93

HCHG IMRT PLAN

Facility

$6,490.00

Service Code	HCPCS 77301
Hospital Charge Code	H3330128
Hospital Revenue Code	333
Min. Negotiated Rate	$5,516.50
Max. Negotiated Rate	$6,295.30
Rate for Payer: Cash Price	$4,218.50
Rate for Payer: Health Management Network Commercial	$5,516.50
Rate for Payer: MDX Hawaii PPO	$6,295.30

HCHG INCAL BX SKN SINGLE LES

Facility

$3,017.00

Service Code	HCPCS 11106
Hospital Charge Code	H4501163
Hospital Revenue Code	450
Min. Negotiated Rate	$2,564.45
Max. Negotiated Rate	$2,926.49
Rate for Payer: Cash Price	$1,961.05
Rate for Payer: Health Management Network Commercial	$2,564.45
Rate for Payer: MDX Hawaii PPO	$2,926.49

HCHG INCAL BX SKN SINGLE LES

Facility

$3,017.00

Service Code	HCPCS 11106
Hospital Charge Code	H4501163
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,926.49
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Cash Price	$1,961.05
Rate for Payer: Cash Price	$1,961.05
Rate for Payer: Cash Price	$1,961.05
Rate for Payer: Cash Price	$1,961.05
Rate for Payer: Devoted Health Medicare	$960.41
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	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,866.15
Rate for Payer: Health Management Network Commercial	$2,564.45
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Commercial	$1,900.71
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: MDX Hawaii PPO	$2,926.49
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$2,199.09

HCHG INCISION OF RECTAL ABSCESS

Facility

$4,060.00

Service Code	HCPCS 46040
Hospital Charge Code	H4500981
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 INCISION OF RECTAL ABSCESS

Facility

$4,060.00

Service Code	HCPCS 46040
Hospital Charge Code	H4500981
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
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: Devoted Health Medicare	$1,555.02
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
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	$6,743.44

HCHG INCISION THROMBOSED HEMORRHOID

Facility

$1,410.00

Service Code	HCPCS 46083
Hospital Charge Code	H4500498
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$916.50
Rate for Payer: Cash Price	$916.50
Rate for Payer: Cash Price	$916.50
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,339.50
Rate for Payer: Health Management Network Commercial	$1,198.50
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$888.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$1,367.70
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$1,027.75

HCHG INCISION THROMBOSED HEMORRHOID

Facility

$1,410.00

Service Code	HCPCS 46083
Hospital Charge Code	H4500498
Hospital Revenue Code	450
Min. Negotiated Rate	$1,198.50
Max. Negotiated Rate	$1,367.70
Rate for Payer: Cash Price	$916.50
Rate for Payer: Health Management Network Commercial	$1,198.50
Rate for Payer: MDX Hawaii PPO	$1,367.70

HCHG INDIRECT COOMBS

Facility

$351.00

Service Code	HCPCS 86885
Hospital Charge Code	H3020610
Hospital Revenue Code	302
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: MDX Hawaii PPO	$340.47

HCHG INDIRECT COOMBS

Facility

$351.00

Service Code	HCPCS 86885
Hospital Charge Code	H3020610
Hospital Revenue Code	302
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$340.47
Rate for Payer: AlohaCare Medicaid	$5.72
Rate for Payer: AlohaCare Medicare	$5.72
Rate for Payer: Cash Price	$228.15
Rate for Payer: Cash Price	$228.15
Rate for Payer: Devoted Health Medicare	$6.29
Rate for Payer: Hawaii Medical Service Association ABD	$7.90
Rate for Payer: Hawaii Medical Service Association Commercial	$7.15
Rate for Payer: Hawaii Medical Service Association Medicare	$5.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.30
Rate for Payer: Hawaii Western Management Group Commercial	$5.72
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$5.72
Rate for Payer: Kaiser Permanente Commercial	$221.13
Rate for Payer: Kaiser Permanente Medicaid	$179.01
Rate for Payer: Kaiser Permanente Medicare	$5.72
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$6.29
Rate for Payer: Ohana Health Plan Medicare	$5.72
Rate for Payer: UnitedHealthcare Medicaid	$7.90
Rate for Payer: UnitedHealthcare Medicare	$5.72
Rate for Payer: University Health Alliance Commercial	$14.78

HCHG INDIUM-111 DTPA (0.5 MCI)

Facility

$894.00

Service Code	HCPCS A9548
Hospital Charge Code	H2550102
Hospital Revenue Code	343
Min. Negotiated Rate	$455.94
Max. Negotiated Rate	$932.02
Rate for Payer: AlohaCare Medicaid	$745.62
Rate for Payer: AlohaCare Medicare	$745.62
Rate for Payer: Cash Price	$581.10
Rate for Payer: Cash Price	$581.10
Rate for Payer: Devoted Health Medicare	$820.18
Rate for Payer: Hawaii Medical Service Association Commercial	$932.02
Rate for Payer: Hawaii Medical Service Association Medicare	$745.62
Rate for Payer: Hawaii Western Management Group Commercial	$849.30
Rate for Payer: Health Management Network Commercial	$759.90
Rate for Payer: Humana Medicare	$745.62
Rate for Payer: Kaiser Permanente Commercial	$563.22
Rate for Payer: Kaiser Permanente Medicaid	$455.94
Rate for Payer: Kaiser Permanente Medicare	$745.62
Rate for Payer: MDX Hawaii PPO	$867.18
Rate for Payer: Ohana Health Plan Medicaid	$820.18
Rate for Payer: Ohana Health Plan Medicare	$745.62
Rate for Payer: UnitedHealthcare Medicaid	$536.47
Rate for Payer: UnitedHealthcare Medicare	$745.62
Rate for Payer: University Health Alliance Commercial	$651.64

HCHG INDIUM-111 DTPA (0.5 MCI)

Facility

$894.00

Service Code	HCPCS A9548
Hospital Charge Code	H2550102
Hospital Revenue Code	343
Min. Negotiated Rate	$759.90
Max. Negotiated Rate	$867.18
Rate for Payer: Cash Price	$581.10
Rate for Payer: Health Management Network Commercial	$759.90
Rate for Payer: MDX Hawaii PPO	$867.18

HCHG INF DETECT BARTON AMP PRB

Facility

$453.00

Service Code	HCPCS 87471
Hospital Charge Code	H3060661
Hospital Revenue Code	306
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$294.45
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: MDX Hawaii PPO	$439.41

HCHG INF DETECT BARTON AMP PRB

Facility

$453.00

Service Code	HCPCS 87471
Hospital Charge Code	H3060661
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$439.41
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$294.45
Rate for Payer: Cash Price	$294.45
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
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	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$285.39
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG INFLUENZA A & B BY ID NOW

Facility

$781.00

Service Code	HCPCS 87502
Hospital Charge Code	H3060757
Hospital Revenue Code	306
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$757.57
Rate for Payer: AlohaCare Medicaid	$95.80
Rate for Payer: AlohaCare Medicare	$95.80
Rate for Payer: Cash Price	$507.65
Rate for Payer: Cash Price	$507.65
Rate for Payer: Devoted Health Medicare	$105.38
Rate for Payer: Hawaii Medical Service Association ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Medicare	$95.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$117.54
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Humana Medicare	$95.80
Rate for Payer: Kaiser Permanente Commercial	$492.03
Rate for Payer: Kaiser Permanente Medicaid	$398.31
Rate for Payer: Kaiser Permanente Medicare	$95.80
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: Ohana Health Plan Medicaid	$105.38
Rate for Payer: Ohana Health Plan Medicare	$95.80
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: UnitedHealthcare Medicare	$95.80
Rate for Payer: University Health Alliance Commercial	$221.54

HCHG INFLUENZA A & B BY ID NOW

Facility

$781.00

Service Code	HCPCS 87502
Hospital Charge Code	H3060757
Hospital Revenue Code	306
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: MDX Hawaii PPO	$757.57

HCHG INFLUENZA AG

Facility

$163.00

Service Code	HCPCS 87804
Hospital Charge Code	H3060653
Hospital Revenue Code	306
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 INFLUENZA AG

Facility

$163.00

Service Code	HCPCS 87804
Hospital Charge Code	H3060653
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$16.55
Rate for Payer: AlohaCare Medicare	$16.55
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$18.20
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$16.55
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$16.55
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$18.20
Rate for Payer: Ohana Health Plan Medicare	$16.55
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.55
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG INFLUENZA DNA AMP PROBE

Facility

$781.00

Service Code	HCPCS 87502
Hospital Charge Code	H3060621
Hospital Revenue Code	306
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$757.57
Rate for Payer: AlohaCare Medicaid	$95.80
Rate for Payer: AlohaCare Medicare	$95.80
Rate for Payer: Cash Price	$507.65
Rate for Payer: Cash Price	$507.65
Rate for Payer: Devoted Health Medicare	$105.38
Rate for Payer: Hawaii Medical Service Association ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Medicare	$95.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$117.54
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Humana Medicare	$95.80
Rate for Payer: Kaiser Permanente Commercial	$492.03
Rate for Payer: Kaiser Permanente Medicaid	$398.31
Rate for Payer: Kaiser Permanente Medicare	$95.80
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: Ohana Health Plan Medicaid	$105.38
Rate for Payer: Ohana Health Plan Medicare	$95.80
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: UnitedHealthcare Medicare	$95.80
Rate for Payer: University Health Alliance Commercial	$221.54

HCHG INFLUENZA DNA AMP PROBE

Facility

$781.00

Service Code	HCPCS 87502
Hospital Charge Code	H3060621
Hospital Revenue Code	306
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: MDX Hawaii PPO	$757.57

Know your out-of-pocket cost for care.

All Charges