Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG INSJ PICC RS&I 5 YR+

Facility

$7,935.00

Service Code	HCPCS 36573
Hospital Charge Code	H3610696
Hospital Revenue Code	361
Min. Negotiated Rate	$6,744.75
Max. Negotiated Rate	$7,696.95
Rate for Payer: Cash Price	$5,157.75
Rate for Payer: Health Management Network Commercial	$6,744.75
Rate for Payer: MDX Hawaii PPO	$7,696.95

HCHG INSJ PICC RS&I 5 YR+

Facility

$7,935.00

Service Code	HCPCS 36573
Hospital Charge Code	H3610696
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$7,696.95
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$5,157.75
Rate for Payer: Cash Price	$5,157.75
Rate for Payer: Cash Price	$5,157.75
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: Health Management Network Commercial	$6,744.75
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$4,999.05
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$7,696.95
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$5,783.82

HCHG INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE

Facility

$321.00

Service Code	HCPCS 51702
Hospital Charge Code	H5100453
Hospital Revenue Code	510
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$311.37
Rate for Payer: Cash Price	$208.65
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: MDX Hawaii PPO	$311.37

HCHG INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE

Facility

$321.00

Service Code	HCPCS 51702
Hospital Charge Code	H5100453
Hospital Revenue Code	510
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$311.37
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$208.65
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$304.95
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$202.23
Rate for Payer: Kaiser Permanente Medicaid	$163.71
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$311.37
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$233.98

HCHG INS TUNNELED CVAD WO PORT/PUMP >5Y

Facility

$8,731.00

Service Code	HCPCS 36558
Hospital Charge Code	H4501053
Hospital Revenue Code	450
Min. Negotiated Rate	$7,421.35
Max. Negotiated Rate	$8,469.07
Rate for Payer: Cash Price	$5,675.15
Rate for Payer: Health Management Network Commercial	$7,421.35
Rate for Payer: MDX Hawaii PPO	$8,469.07

HCHG INS TUNNELED CVAD WO PORT/PUMP >5Y

Facility

$8,731.00

Service Code	HCPCS 36558
Hospital Charge Code	H4501053
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,469.07
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$5,675.15
Rate for Payer: Cash Price	$5,675.15
Rate for Payer: Cash Price	$5,675.15
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$8,294.45
Rate for Payer: Health Management Network Commercial	$7,421.35
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$5,500.53
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$8,469.07
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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG INSULIN AUTOANTIBODY

Facility

$264.00

Service Code	HCPCS 86337
Hospital Charge Code	H3021000
Hospital Revenue Code	302
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$171.60
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: MDX Hawaii PPO	$256.08

HCHG INSULIN AUTOANTIBODY

Facility

$264.00

Service Code	HCPCS 86337
Hospital Charge Code	H3021000
Hospital Revenue Code	302
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$256.08
Rate for Payer: AlohaCare Medicaid	$21.41
Rate for Payer: AlohaCare Medicare	$21.41
Rate for Payer: Cash Price	$171.60
Rate for Payer: Cash Price	$171.60
Rate for Payer: Devoted Health Medicare	$23.55
Rate for Payer: Hawaii Medical Service Association ABD	$29.59
Rate for Payer: Hawaii Medical Service Association Commercial	$26.76
Rate for Payer: Hawaii Medical Service Association Medicare	$21.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.07
Rate for Payer: Hawaii Western Management Group Commercial	$21.41
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Humana Medicare	$21.41
Rate for Payer: Kaiser Permanente Commercial	$166.32
Rate for Payer: Kaiser Permanente Medicaid	$134.64
Rate for Payer: Kaiser Permanente Medicare	$21.41
Rate for Payer: MDX Hawaii PPO	$256.08
Rate for Payer: Ohana Health Plan Medicaid	$23.55
Rate for Payer: Ohana Health Plan Medicare	$21.41
Rate for Payer: UnitedHealthcare Medicaid	$29.59
Rate for Payer: UnitedHealthcare Medicare	$21.41
Rate for Payer: University Health Alliance Commercial	$55.35

HCHG INSULIN FREE SO

Facility

$160.00

Service Code	HCPCS 83527
Hospital Charge Code	K3010039
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$12.95
Rate for Payer: AlohaCare Medicare	$12.95
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$14.24
Rate for Payer: Hawaii Medical Service Association ABD	$10.85
Rate for Payer: Hawaii Medical Service Association Commercial	$16.19
Rate for Payer: Hawaii Medical Service Association Medicare	$12.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.95
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$12.95
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$12.95
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$14.24
Rate for Payer: Ohana Health Plan Medicare	$12.95
Rate for Payer: UnitedHealthcare Medicaid	$10.85
Rate for Payer: UnitedHealthcare Medicare	$12.95
Rate for Payer: University Health Alliance Commercial	$33.47

HCHG INSULIN FREE SO

Facility

$160.00

Service Code	HCPCS 83527
Hospital Charge Code	K3010039
Hospital Revenue Code	301
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

HCHG INSULIN TOTAL 90

Facility

$141.00

Service Code	HCPCS 83525
Hospital Charge Code	H3010788
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$11.43
Rate for Payer: AlohaCare Medicare	$11.43
Rate for Payer: Cash Price	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$12.57
Rate for Payer: Hawaii Medical Service Association ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$14.29
Rate for Payer: Hawaii Medical Service Association Medicare	$11.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.60
Rate for Payer: Hawaii Western Management Group Commercial	$11.43
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$11.43
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$11.43
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$12.57
Rate for Payer: Ohana Health Plan Medicare	$11.43
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$11.43
Rate for Payer: University Health Alliance Commercial	$29.56

HCHG INSULIN TOTAL 90

Facility

$141.00

Service Code	HCPCS 83525
Hospital Charge Code	H3010788
Hospital Revenue Code	301
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

HCHG INTERPHASE INSITU HYBRID, ANALYZE 90

Facility

$488.00

Service Code	HCPCS 88275
Hospital Charge Code	H3110287
Hospital Revenue Code	311
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$473.36
Rate for Payer: AlohaCare Medicaid	$51.19
Rate for Payer: AlohaCare Medicare	$51.19
Rate for Payer: Cash Price	$317.20
Rate for Payer: Cash Price	$317.20
Rate for Payer: Devoted Health Medicare	$56.31
Rate for Payer: Hawaii Medical Service Association ABD	$55.50
Rate for Payer: Hawaii Medical Service Association Commercial	$63.99
Rate for Payer: Hawaii Medical Service Association Medicare	$51.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.28
Rate for Payer: Hawaii Western Management Group Commercial	$51.19
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Humana Medicare	$51.19
Rate for Payer: Kaiser Permanente Commercial	$307.44
Rate for Payer: Kaiser Permanente Medicaid	$248.88
Rate for Payer: Kaiser Permanente Medicare	$51.19
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: Ohana Health Plan Medicaid	$56.31
Rate for Payer: Ohana Health Plan Medicare	$51.19
Rate for Payer: UnitedHealthcare Medicaid	$55.50
Rate for Payer: UnitedHealthcare Medicare	$51.19
Rate for Payer: University Health Alliance Commercial	$103.80

HCHG INTERPHASE INSITU HYBRID, ANALYZE 90

Facility

$488.00

Service Code	HCPCS 88275
Hospital Charge Code	H3110287
Hospital Revenue Code	311
Min. Negotiated Rate	$414.80
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$317.20
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: MDX Hawaii PPO	$473.36

HCHG INTRAORAL I&D TONGUE/MOUTH FLR

Facility

$2,569.00

Service Code	HCPCS 41000
Hospital Charge Code	H4500540
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,669.85
Rate for Payer: Cash Price	$1,669.85
Rate for Payer: Cash Price	$1,669.85
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,440.55
Rate for Payer: Health Management Network Commercial	$2,183.65
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,618.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$2,491.93
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$1,872.54

HCHG INTRAORAL I&D TONGUE/MOUTH FLR

Facility

$2,569.00

Service Code	HCPCS 41000
Hospital Charge Code	H4500540
Hospital Revenue Code	450
Min. Negotiated Rate	$2,183.65
Max. Negotiated Rate	$2,491.93
Rate for Payer: Cash Price	$1,669.85
Rate for Payer: Health Management Network Commercial	$2,183.65
Rate for Payer: MDX Hawaii PPO	$2,491.93

HCHG INTUBATION ENDOTRACHEAL

Facility

$1,402.00

Service Code	HCPCS 31500
Hospital Charge Code	H3601037
Hospital Revenue Code	360
Min. Negotiated Rate	$1,191.70
Max. Negotiated Rate	$1,359.94
Rate for Payer: Cash Price	$911.30
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: MDX Hawaii PPO	$1,359.94

HCHG INTUBATION ENDOTRACHEAL

Facility

$1,402.00

Service Code	HCPCS 31500
Hospital Charge Code	H3601037
Hospital Revenue Code	360
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$279.80
Rate for Payer: AlohaCare Medicare	$279.80
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: Humana Medicare	$279.80
Rate for Payer: Kaiser Permanente Commercial	$883.26
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$279.80
Rate for Payer: MDX Hawaii PPO	$1,359.94
Rate for Payer: Ohana Health Plan Medicaid	$307.78
Rate for Payer: Ohana Health Plan Medicare	$279.80
Rate for Payer: UnitedHealthcare Medicaid	$93.64
Rate for Payer: UnitedHealthcare Medicare	$279.80
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG INTUBATION ENDOTRACHEAL (EMERGENCY)

Facility

$1,402.00

Service Code	HCPCS 31500
Hospital Charge Code	H4500542
Hospital Revenue Code	450
Min. Negotiated Rate	$1,191.70
Max. Negotiated Rate	$1,359.94
Rate for Payer: Cash Price	$911.30
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: MDX Hawaii PPO	$1,359.94

HCHG INTUBATION ENDOTRACHEAL (EMERGENCY)

Facility

$1,402.00

Service Code	HCPCS 31500
Hospital Charge Code	H4500542
Hospital Revenue Code	450
Min. Negotiated Rate	$279.80
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$279.80
Rate for Payer: AlohaCare Medicare	$279.80
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Cash Price	$911.30
Rate for Payer: Devoted Health Medicare	$307.78
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	$279.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.90
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: Humana Medicare	$279.80
Rate for Payer: Kaiser Permanente Commercial	$883.26
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$279.80
Rate for Payer: MDX Hawaii PPO	$1,359.94
Rate for Payer: Ohana Health Plan Medicaid	$307.78
Rate for Payer: Ohana Health Plan Medicare	$279.80
Rate for Payer: UnitedHealthcare Medicare	$279.80
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG IODINE I-131 IODIDE CAP, DX

Facility

$233.00

Service Code	HCPCS A9528
Hospital Charge Code	H3430222
Hospital Revenue Code	343
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$151.45
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: MDX Hawaii PPO	$226.01

HCHG IODINE I-131 IODIDE CAP, DX

Facility

$233.00

Service Code	HCPCS A9528
Hospital Charge Code	H3430222
Hospital Revenue Code	343
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$151.45
Rate for Payer: Cash Price	$151.45
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$146.79
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: University Health Alliance Commercial	$169.83

HCHG IODINE I-131 IODIDE CAP, RX

Facility

$100.00

Service Code	HCPCS A9517
Hospital Charge Code	H3430224
Hospital Revenue Code	344
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: MDX Hawaii PPO	$97.00

HCHG IODINE I-131 IODIDE CAP, RX

Facility

$100.00

Service Code	HCPCS A9517
Hospital Charge Code	H3430224
Hospital Revenue Code	344
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$117.25
Rate for Payer: AlohaCare Medicaid	$24.07
Rate for Payer: AlohaCare Medicare	$24.07
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$26.48
Rate for Payer: Hawaii Medical Service Association Commercial	$30.09
Rate for Payer: Hawaii Medical Service Association Medicare	$24.07
Rate for Payer: Hawaii Western Management Group Commercial	$95.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$24.07
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$24.07
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$26.48
Rate for Payer: Ohana Health Plan Medicare	$24.07
Rate for Payer: UnitedHealthcare Medicaid	$117.25
Rate for Payer: UnitedHealthcare Medicare	$24.07
Rate for Payer: University Health Alliance Commercial	$72.89

HCHG I&R FB SIMP

Facility

$2,246.00

Service Code	HCPCS 10120
Hospital Charge Code	H4500490
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

Know your out-of-pocket cost for care.

All Charges