Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG JO-1 AB

Facility

$219.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020626
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.93
Rate for Payer: AlohaCare Medicare	$17.93
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.72
Rate for Payer: Hawaii Medical Service Association ABD	$24.78
Rate for Payer: Hawaii Medical Service Association Commercial	$22.41
Rate for Payer: Hawaii Medical Service Association Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.93
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.93
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.72
Rate for Payer: Ohana Health Plan Medicare	$17.93
Rate for Payer: UnitedHealthcare Medicaid	$24.78
Rate for Payer: UnitedHealthcare Medicare	$17.93
Rate for Payer: University Health Alliance Commercial	$46.36

HCHG JO-1 AB

Facility

$219.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020626
Hospital Revenue Code	302
Min. Negotiated Rate	$186.15
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$142.35
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: MDX Hawaii PPO	$212.43

HCHG KAPPA AND LAMBDA LIGHT CHAINS, FREE

Facility

$129.00

Service Code	HCPCS 83521
Hospital Charge Code	H3011736
Hospital Revenue Code	301
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: MDX Hawaii PPO	$125.13

HCHG KAPPA AND LAMBDA LIGHT CHAINS, FREE

Facility

$129.00

Service Code	HCPCS 83521
Hospital Charge Code	H3011736
Hospital Revenue Code	301
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$81.27
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$94.03

HCHG KAPPA LT CHAIN QUANT SERUM

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011549
Hospital Revenue Code	301
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HCHG KAPPA LT CHAIN QUANT SERUM

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011549
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$13.60
Rate for Payer: AlohaCare Medicare	$13.60
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$14.96
Rate for Payer: Hawaii Medical Service Association ABD	$18.79
Rate for Payer: Hawaii Medical Service Association Commercial	$17.00
Rate for Payer: Hawaii Medical Service Association Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.73
Rate for Payer: Hawaii Western Management Group Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$13.60
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$14.96
Rate for Payer: Ohana Health Plan Medicare	$13.60
Rate for Payer: UnitedHealthcare Medicaid	$18.79
Rate for Payer: UnitedHealthcare Medicare	$13.60
Rate for Payer: University Health Alliance Commercial	$35.15

HCHG KAPPA LT CHAIN QUANT U

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011337
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$13.60
Rate for Payer: AlohaCare Medicare	$13.60
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$14.96
Rate for Payer: Hawaii Medical Service Association ABD	$18.79
Rate for Payer: Hawaii Medical Service Association Commercial	$17.00
Rate for Payer: Hawaii Medical Service Association Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.73
Rate for Payer: Hawaii Western Management Group Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$13.60
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$14.96
Rate for Payer: Ohana Health Plan Medicare	$13.60
Rate for Payer: UnitedHealthcare Medicaid	$18.79
Rate for Payer: UnitedHealthcare Medicare	$13.60
Rate for Payer: University Health Alliance Commercial	$35.15

HCHG KAPPA LT CHAIN QUANT U

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011337
Hospital Revenue Code	301
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HCHG KETONES UR

Facility

$58.00

Service Code	HCPCS 81002
Hospital Charge Code	K3070001
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$3.48
Rate for Payer: AlohaCare Medicare	$3.48
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Devoted Health Medicare	$3.83
Rate for Payer: Hawaii Medical Service Association ABD	$3.54
Rate for Payer: Hawaii Medical Service Association Commercial	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.48
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$3.48
Rate for Payer: Kaiser Permanente Commercial	$36.54
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$3.48
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$3.83
Rate for Payer: Ohana Health Plan Medicare	$3.48
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$3.48
Rate for Payer: University Health Alliance Commercial	$6.60

HCHG KETONES UR

Facility

$58.00

Service Code	HCPCS 81002
Hospital Charge Code	K3070001
Hospital Revenue Code	307
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$37.70
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$56.26

HCHG KLEIHAUER-BETKE (FETADEX) 90

Facility

$96.00

Service Code	HCPCS 85460
Hospital Charge Code	H3050178
Hospital Revenue Code	305
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$7.73
Rate for Payer: AlohaCare Medicare	$7.73
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$8.50
Rate for Payer: Hawaii Medical Service Association ABD	$10.69
Rate for Payer: Hawaii Medical Service Association Commercial	$9.66
Rate for Payer: Hawaii Medical Service Association Medicare	$7.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.22
Rate for Payer: Hawaii Western Management Group Commercial	$7.73
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$7.73
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$7.73
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$8.50
Rate for Payer: Ohana Health Plan Medicare	$7.73
Rate for Payer: UnitedHealthcare Medicaid	$10.69
Rate for Payer: UnitedHealthcare Medicare	$7.73
Rate for Payer: University Health Alliance Commercial	$20.00

HCHG KLEIHAUER-BETKE (FETADEX) 90

Facility

$96.00

Service Code	HCPCS 85460
Hospital Charge Code	H3050178
Hospital Revenue Code	305
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

HCHG KNEE (1-2) VIEWS

Facility

$609.00

Service Code	HCPCS 73560
Hospital Charge Code	H3200514
Hospital Revenue Code	320
Min. Negotiated Rate	$517.65
Max. Negotiated Rate	$590.73
Rate for Payer: Cash Price	$395.85
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: MDX Hawaii PPO	$590.73

HCHG KNEE (1-2) VIEWS

Facility

$609.00

Service Code	HCPCS 73560
Hospital Charge Code	H3200514
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$590.73
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$395.85
Rate for Payer: Cash Price	$395.85
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
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	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$383.67
Rate for Payer: Kaiser Permanente Medicaid	$310.59
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$590.73
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$58.59

HCHG KNEE 2 VIEWS PORT

Facility

$609.00

Service Code	HCPCS 73560
Hospital Charge Code	H3200516
Hospital Revenue Code	320
Min. Negotiated Rate	$517.65
Max. Negotiated Rate	$590.73
Rate for Payer: Cash Price	$395.85
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: MDX Hawaii PPO	$590.73

HCHG KNEE 2 VIEWS PORT

Facility

$609.00

Service Code	HCPCS 73560
Hospital Charge Code	H3200516
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$590.73
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$395.85
Rate for Payer: Cash Price	$395.85
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
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	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$383.67
Rate for Payer: Kaiser Permanente Medicaid	$310.59
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$590.73
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$58.59

HCHG KNEE 3 VIEWS

Facility

$573.00

Service Code	HCPCS 73562
Hospital Charge Code	H3200520
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
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	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$360.99
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$68.32

HCHG KNEE 3 VIEWS

Facility

$573.00

Service Code	HCPCS 73562
Hospital Charge Code	H3200520
Hospital Revenue Code	320
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: MDX Hawaii PPO	$555.81

HCHG KNEE BILAT STANDING

Facility

$604.00

Service Code	HCPCS 73565
Hospital Charge Code	H3200518
Hospital Revenue Code	320
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$392.60
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG KNEE BILAT STANDING

Facility

$604.00

Service Code	HCPCS 73565
Hospital Charge Code	H3200518
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$585.88
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
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	$513.40
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$585.88
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	$60.18

HCHG KNEE NOTCH 1-2 VIEWS

Facility

$609.00

Service Code	HCPCS 73560
Hospital Charge Code	H3200524
Hospital Revenue Code	320
Min. Negotiated Rate	$517.65
Max. Negotiated Rate	$590.73
Rate for Payer: Cash Price	$395.85
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: MDX Hawaii PPO	$590.73

HCHG KNEE NOTCH 1-2 VIEWS

Facility

$609.00

Service Code	HCPCS 73560
Hospital Charge Code	H3200524
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$590.73
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$395.85
Rate for Payer: Cash Price	$395.85
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
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	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$383.67
Rate for Payer: Kaiser Permanente Medicaid	$310.59
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$590.73
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$58.59

HCHG KNEE W OBLIQUES 4>VIEWS

Facility

$598.00

Service Code	HCPCS 73564
Hospital Charge Code	H3200526
Hospital Revenue Code	320
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$580.06
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$388.70
Rate for Payer: Cash Price	$388.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$22.13
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	$23.24
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$508.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$376.74
Rate for Payer: Kaiser Permanente Medicaid	$304.98
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$580.06
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$22.13
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$77.64

HCHG KNEE W OBLIQUES 4>VIEWS

Facility

$598.00

Service Code	HCPCS 73564
Hospital Charge Code	H3200526
Hospital Revenue Code	320
Min. Negotiated Rate	$508.30
Max. Negotiated Rate	$580.06
Rate for Payer: Cash Price	$388.70
Rate for Payer: Health Management Network Commercial	$508.30
Rate for Payer: MDX Hawaii PPO	$580.06

HCHG KOH SKIN HAIR NAILS

Facility

$88.00

Service Code	HCPCS 87220
Hospital Charge Code	K3060002
Hospital Revenue Code	306
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: MDX Hawaii PPO	$85.36

Know your out-of-pocket cost for care.

All Charges