Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG INSERTION CATHETER ARTERY

Facility

$273.00

Service Code	HCPCS 36620
Hospital Charge Code	H7610177
Hospital Revenue Code	761
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$177.45
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: MDX Hawaii PPO	$264.81

HCHG INSERTION OF CATHETER VEIN

Facility

$445.00

Service Code	HCPCS 36510
Hospital Charge Code	H7610176
Hospital Revenue Code	761
Min. Negotiated Rate	$378.25
Max. Negotiated Rate	$431.65
Rate for Payer: Cash Price	$289.25
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: MDX Hawaii PPO	$431.65

HCHG INSERTION OF CATHETER VEIN

Facility

$445.00

Service Code	HCPCS 36510
Hospital Charge Code	H7610176
Hospital Revenue Code	761
Min. Negotiated Rate	$42.29
Max. Negotiated Rate	$431.65
Rate for Payer: Cash Price	$289.25
Rate for Payer: Cash Price	$289.25
Rate for Payer: Hawaii Western Management Group Commercial	$422.75
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Kaiser Permanente Commercial	$280.35
Rate for Payer: Kaiser Permanente Medicaid	$226.95
Rate for Payer: MDX Hawaii PPO	$431.65
Rate for Payer: UnitedHealthcare Medicaid	$42.29
Rate for Payer: University Health Alliance Commercial	$324.36

HCHG INSERT IUD

Facility

$188.00

Service Code	HCPCS 58300
Hospital Charge Code	H4501157
Hospital Revenue Code	450
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$122.20
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: MDX Hawaii PPO	$182.36

HCHG INSERT IUD

Facility

$188.00

Service Code	HCPCS 58300
Hospital Charge Code	H4501157
Hospital Revenue Code	450
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$4,035.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$178.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Kaiser Permanente Commercial	$118.44
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG INSERT NON INDWELL BLAD CATH

Facility

$816.00

Service Code	HCPCS 51701
Hospital Charge Code	H4500526
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 INSERT NON INDWELL BLAD CATH

Facility

$816.00

Service Code	HCPCS 51701
Hospital Charge Code	H4500526
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

HCHG INSERT NON-TUNNL CNTRL CVC:5>

Facility

$8,375.00

Service Code	HCPCS 36556
Hospital Charge Code	H3610246
Hospital Revenue Code	361
Min. Negotiated Rate	$7,118.75
Max. Negotiated Rate	$8,123.75
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Health Management Network Commercial	$7,118.75
Rate for Payer: MDX Hawaii PPO	$8,123.75

HCHG INSERT NON-TUNNL CNTRL CVC:5>

Facility

$8,375.00

Service Code	HCPCS 36556
Hospital Charge Code	H3610246
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$8,123.75
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$7,118.75
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$5,276.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$8,123.75
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,104.54

HCHG INSERT NON-TUNNL CVP<5YO

Facility

$8,735.00

Service Code	HCPCS 36555
Hospital Charge Code	H4500528
Hospital Revenue Code	450
Min. Negotiated Rate	$7,424.75
Max. Negotiated Rate	$8,472.95
Rate for Payer: Cash Price	$5,677.75
Rate for Payer: Health Management Network Commercial	$7,424.75
Rate for Payer: MDX Hawaii PPO	$8,472.95

HCHG INSERT NON-TUNNL CVP<5YO

Facility

$8,735.00

Service Code	HCPCS 36555
Hospital Charge Code	H4500528
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$8,472.95
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$5,677.75
Rate for Payer: Cash Price	$5,677.75
Rate for Payer: Cash Price	$5,677.75
Rate for Payer: Cash Price	$5,677.75
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,298.25
Rate for Payer: Health Management Network Commercial	$7,424.75
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$5,503.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$8,472.95
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,366.94

HCHG INSERT NON-TUNNL CVP>5YO

Facility

$8,375.00

Service Code	HCPCS 36556
Hospital Charge Code	H4500530
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$8,123.75
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,956.25
Rate for Payer: Health Management Network Commercial	$7,118.75
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$5,276.25
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$8,123.75
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,104.54

HCHG INSERT NON-TUNNL CVP>5YO

Facility

$8,375.00

Service Code	HCPCS 36556
Hospital Charge Code	H4500530
Hospital Revenue Code	450
Min. Negotiated Rate	$7,118.75
Max. Negotiated Rate	$8,123.75
Rate for Payer: Cash Price	$5,443.75
Rate for Payer: Health Management Network Commercial	$7,118.75
Rate for Payer: MDX Hawaii PPO	$8,123.75

HCHG INSERT PACING LEAD-CS(NEW GEN)

Facility

$4,779.00

Service Code	HCPCS 33225
Hospital Charge Code	H3600280
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$4,635.63
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Health Management Network Commercial	$4,062.15
Rate for Payer: Kaiser Permanente Commercial	$3,010.77
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$4,635.63
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: University Health Alliance Commercial	$3,483.41

HCHG INSERT PACING LEAD-CS(NEW GEN)

Facility

$4,779.00

Service Code	HCPCS 33225
Hospital Charge Code	H3600280
Hospital Revenue Code	360
Min. Negotiated Rate	$4,062.15
Max. Negotiated Rate	$4,635.63
Rate for Payer: Cash Price	$3,106.35
Rate for Payer: Health Management Network Commercial	$4,062.15
Rate for Payer: MDX Hawaii PPO	$4,635.63

HCHG INSERT PICC WO PORT/PUMP 5YR>

Facility

$3,598.00

Service Code	HCPCS 36569
Hospital Charge Code	H4500532
Hospital Revenue Code	450
Min. Negotiated Rate	$3,058.30
Max. Negotiated Rate	$3,490.06
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Health Management Network Commercial	$3,058.30
Rate for Payer: MDX Hawaii PPO	$3,490.06

HCHG INSERT PICC WO PORT/PUMP 5YR>

Facility

$3,598.00

Service Code	HCPCS 36569
Hospital Charge Code	H4500532
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,490.06
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Devoted Health Medicare	$2,045.58
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	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,418.10
Rate for Payer: Health Management Network Commercial	$3,058.30
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$2,266.74
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$3,490.06
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$2,622.58

HCHG INSERT THORACOSTOMY TUBE OPEN

Facility

$4,880.00

Service Code	HCPCS 32551
Hospital Charge Code	H4501058
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,733.60
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Devoted Health Medicare	$2,045.58
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	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,636.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$3,074.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$4,733.60
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$3,557.03

HCHG INSERT THORACOSTOMY TUBE OPEN

Facility

$4,880.00

Service Code	HCPCS 32551
Hospital Charge Code	H4501058
Hospital Revenue Code	450
Min. Negotiated Rate	$4,148.00
Max. Negotiated Rate	$4,733.60
Rate for Payer: Cash Price	$3,172.00
Rate for Payer: Health Management Network Commercial	$4,148.00
Rate for Payer: MDX Hawaii PPO	$4,733.60

HCHG INSITU HYBRID EA ADDL SNGL

Facility

$349.00

Service Code	HCPCS 88364
Hospital Charge Code	H3120329
Hospital Revenue Code	312
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$226.85
Rate for Payer: Cash Price	$226.85
Rate for Payer: Hawaii Medical Service Association ABD	$113.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.73
Rate for Payer: Hawaii Western Management Group Commercial	$331.55
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Kaiser Permanente Commercial	$219.87
Rate for Payer: Kaiser Permanente Medicaid	$177.99
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: UnitedHealthcare Medicaid	$89.48
Rate for Payer: University Health Alliance Commercial	$203.04

HCHG INSITU HYBRID EA ADDL SNGL

Facility

$349.00

Service Code	HCPCS 88364
Hospital Charge Code	H3120329
Hospital Revenue Code	312
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$226.85
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: MDX Hawaii PPO	$338.53

HCHG INSITU HYBRID EA MULTIPLEX

Facility

$1,078.00

Service Code	HCPCS 88366
Hospital Charge Code	H3120330
Hospital Revenue Code	312
Min. Negotiated Rate	$916.30
Max. Negotiated Rate	$1,045.66
Rate for Payer: Cash Price	$700.70
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: MDX Hawaii PPO	$1,045.66

HCHG INSITU HYBRID EA MULTIPLEX

Facility

$1,078.00

Service Code	HCPCS 88366
Hospital Charge Code	H3120330
Hospital Revenue Code	312
Min. Negotiated Rate	$86.17
Max. Negotiated Rate	$1,045.66
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$700.70
Rate for Payer: Cash Price	$700.70
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$86.17
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$679.14
Rate for Payer: Kaiser Permanente Medicaid	$549.78
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,045.66
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$182.87
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$608.67

HCHG IN SITU HYBRIDIZATION

Facility

$733.00

Service Code	HCPCS 88365
Hospital Charge Code	H3100137
Hospital Revenue Code	310
Min. Negotiated Rate	$623.05
Max. Negotiated Rate	$711.01
Rate for Payer: Cash Price	$476.45
Rate for Payer: Health Management Network Commercial	$623.05
Rate for Payer: MDX Hawaii PPO	$711.01

HCHG IN SITU HYBRIDIZATION

Facility

$733.00

Service Code	HCPCS 88365
Hospital Charge Code	H3100137
Hospital Revenue Code	310
Min. Negotiated Rate	$52.74
Max. Negotiated Rate	$711.01
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$476.45
Rate for Payer: Cash Price	$476.45
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$82.14
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52.74
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$623.05
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$461.79
Rate for Payer: Kaiser Permanente Medicaid	$373.83
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$711.01
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$82.14
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$296.04

Know your out-of-pocket cost for care.

All Charges