Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG MRA CHEST WO CONTR

Facility

$1,455.00

Service Code	HCPCS 71555
Hospital Charge Code	H6100134
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,411.35
Rate for Payer: Cash Price	$945.75
Rate for Payer: Cash Price	$945.75
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.25
Rate for Payer: Health Management Network Commercial	$1,236.75
Rate for Payer: Kaiser Permanente Commercial	$916.65
Rate for Payer: Kaiser Permanente Medicaid	$742.05
Rate for Payer: MDX Hawaii PPO	$1,411.35
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.97

HCHG MRA CHEST WO CONTR

Facility

$1,455.00

Service Code	HCPCS 71555
Hospital Charge Code	H6100134
Hospital Revenue Code	610
Min. Negotiated Rate	$1,236.75
Max. Negotiated Rate	$1,411.35
Rate for Payer: Cash Price	$945.75
Rate for Payer: Health Management Network Commercial	$1,236.75
Rate for Payer: MDX Hawaii PPO	$1,411.35

HCHG MRA CHEST WO FOL W CONTR

Facility

$2,961.00

Service Code	HCPCS 71555
Hospital Charge Code	H6100136
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$2,872.17
Rate for Payer: Cash Price	$1,924.65
Rate for Payer: Cash Price	$1,924.65
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,812.95
Rate for Payer: Health Management Network Commercial	$2,516.85
Rate for Payer: Kaiser Permanente Commercial	$1,865.43
Rate for Payer: Kaiser Permanente Medicaid	$1,510.11
Rate for Payer: MDX Hawaii PPO	$2,872.17
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.97

HCHG MRA CHEST WO FOL W CONTR

Facility

$2,961.00

Service Code	HCPCS 71555
Hospital Charge Code	H6100136
Hospital Revenue Code	610
Min. Negotiated Rate	$2,516.85
Max. Negotiated Rate	$2,872.17
Rate for Payer: Cash Price	$1,924.65
Rate for Payer: Health Management Network Commercial	$2,516.85
Rate for Payer: MDX Hawaii PPO	$2,872.17

HCHG MRA HEAD W CONTR

Facility

$2,279.00

Service Code	HCPCS 70545
Hospital Charge Code	H6100140
Hospital Revenue Code	610
Min. Negotiated Rate	$1,937.15
Max. Negotiated Rate	$2,210.63
Rate for Payer: Cash Price	$1,481.35
Rate for Payer: Health Management Network Commercial	$1,937.15
Rate for Payer: MDX Hawaii PPO	$2,210.63

HCHG MRA HEAD W CONTR

Facility

$2,279.00

Service Code	HCPCS 70545
Hospital Charge Code	H6100140
Hospital Revenue Code	610
Min. Negotiated Rate	$322.35
Max. Negotiated Rate	$2,210.63
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,481.35
Rate for Payer: Cash Price	$1,481.35
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$322.35
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,937.15
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,435.77
Rate for Payer: Kaiser Permanente Medicaid	$1,162.29
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$2,210.63
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$322.35
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$932.22

HCHG MRA HEAD WO CONTR

Facility

$2,334.00

Service Code	HCPCS 70544
Hospital Charge Code	H6100142
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,263.98
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,517.10
Rate for Payer: Cash Price	$1,517.10
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$322.35
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	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,983.90
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,470.42
Rate for Payer: Kaiser Permanente Medicaid	$1,190.34
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,263.98
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$322.35
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$821.79

HCHG MRA HEAD WO CONTR

Facility

$2,334.00

Service Code	HCPCS 70544
Hospital Charge Code	H6100142
Hospital Revenue Code	610
Min. Negotiated Rate	$1,983.90
Max. Negotiated Rate	$2,263.98
Rate for Payer: Cash Price	$1,517.10
Rate for Payer: Health Management Network Commercial	$1,983.90
Rate for Payer: MDX Hawaii PPO	$2,263.98

HCHG MRA LOW EXTREM WO CONTR

Facility

$2,350.00

Service Code	HCPCS 73725
Hospital Charge Code	H6100146
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,232.50
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Kaiser Permanente Commercial	$1,480.50
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HCHG MRA LOW EXTREM WO CONTR

Facility

$2,350.00

Service Code	HCPCS 73725
Hospital Charge Code	H6100146
Hospital Revenue Code	610
Min. Negotiated Rate	$1,997.50
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: MDX Hawaii PPO	$2,279.50

HCHG MRA LOW EXTREM WO FOL W CONTR

Facility

$2,350.00

Service Code	HCPCS 73725
Hospital Charge Code	H6100148
Hospital Revenue Code	610
Min. Negotiated Rate	$1,997.50
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: MDX Hawaii PPO	$2,279.50

HCHG MRA LOW EXTREM WO FOL W CONTR

Facility

$2,350.00

Service Code	HCPCS 73725
Hospital Charge Code	H6100148
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,232.50
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Kaiser Permanente Commercial	$1,480.50
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$988.88

HCHG MRA NECK W CONTR ONLY

Facility

$2,261.00

Service Code	HCPCS 70548
Hospital Charge Code	H6100152
Hospital Revenue Code	610
Min. Negotiated Rate	$1,921.85
Max. Negotiated Rate	$2,193.17
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: MDX Hawaii PPO	$2,193.17

HCHG MRA NECK W CONTR ONLY

Facility

$2,261.00

Service Code	HCPCS 70548
Hospital Charge Code	H6100152
Hospital Revenue Code	610
Min. Negotiated Rate	$322.35
Max. Negotiated Rate	$2,193.17
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$322.35
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,424.43
Rate for Payer: Kaiser Permanente Medicaid	$1,153.11
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$2,193.17
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$322.35
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$933.31

HCHG MRA NECK WO CONTR

Facility

$2,121.00

Service Code	HCPCS 70547
Hospital Charge Code	H6100154
Hospital Revenue Code	610
Min. Negotiated Rate	$1,802.85
Max. Negotiated Rate	$2,057.37
Rate for Payer: Cash Price	$1,378.65
Rate for Payer: Health Management Network Commercial	$1,802.85
Rate for Payer: MDX Hawaii PPO	$2,057.37

HCHG MRA NECK WO CONTR

Facility

$2,121.00

Service Code	HCPCS 70547
Hospital Charge Code	H6100154
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,057.37
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,378.65
Rate for Payer: Cash Price	$1,378.65
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$322.35
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	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,802.85
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,336.23
Rate for Payer: Kaiser Permanente Medicaid	$1,081.71
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,057.37
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$322.35
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$820.99

HCHG MRA NECK W/WO CONTR

Facility

$3,381.00

Service Code	HCPCS 70549
Hospital Charge Code	H6100150
Hospital Revenue Code	610
Min. Negotiated Rate	$2,873.85
Max. Negotiated Rate	$3,279.57
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Health Management Network Commercial	$2,873.85
Rate for Payer: MDX Hawaii PPO	$3,279.57

HCHG MRA NECK W/WO CONTR

Facility

$3,381.00

Service Code	HCPCS 70549
Hospital Charge Code	H6100150
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,279.57
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$634.35
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$789.35
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,873.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$2,130.03
Rate for Payer: Kaiser Permanente Medicaid	$1,724.31
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,279.57
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$634.35
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,259.74

HCHG MRA PELVIS WO CONTR

Facility

$1,613.00

Service Code	HCPCS 72198
Hospital Charge Code	H6100158
Hospital Revenue Code	610
Min. Negotiated Rate	$1,371.05
Max. Negotiated Rate	$1,564.61
Rate for Payer: Cash Price	$1,048.45
Rate for Payer: Health Management Network Commercial	$1,371.05
Rate for Payer: MDX Hawaii PPO	$1,564.61

HCHG MRA PELVIS WO CONTR

Facility

$1,613.00

Service Code	HCPCS 72198
Hospital Charge Code	H6100158
Hospital Revenue Code	610
Min. Negotiated Rate	$326.65
Max. Negotiated Rate	$1,564.61
Rate for Payer: Cash Price	$1,048.45
Rate for Payer: Cash Price	$1,048.45
Rate for Payer: Hawaii Medical Service Association ABD	$326.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,532.35
Rate for Payer: Health Management Network Commercial	$1,371.05
Rate for Payer: Kaiser Permanente Commercial	$1,016.19
Rate for Payer: Kaiser Permanente Medicaid	$822.63
Rate for Payer: MDX Hawaii PPO	$1,564.61
Rate for Payer: UnitedHealthcare Medicaid	$326.65
Rate for Payer: University Health Alliance Commercial	$987.38

HCHG MRA PELVIS WO FOL W CONTR

Facility

$1,613.00

Service Code	HCPCS 72198
Hospital Charge Code	H6100160
Hospital Revenue Code	610
Min. Negotiated Rate	$326.65
Max. Negotiated Rate	$1,564.61
Rate for Payer: Cash Price	$1,048.45
Rate for Payer: Cash Price	$1,048.45
Rate for Payer: Hawaii Medical Service Association ABD	$326.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,532.35
Rate for Payer: Health Management Network Commercial	$1,371.05
Rate for Payer: Kaiser Permanente Commercial	$1,016.19
Rate for Payer: Kaiser Permanente Medicaid	$822.63
Rate for Payer: MDX Hawaii PPO	$1,564.61
Rate for Payer: UnitedHealthcare Medicaid	$326.65
Rate for Payer: University Health Alliance Commercial	$987.38

HCHG MRA PELVIS WO FOL W CONTR

Facility

$1,613.00

Service Code	HCPCS 72198
Hospital Charge Code	H6100160
Hospital Revenue Code	610
Min. Negotiated Rate	$1,371.05
Max. Negotiated Rate	$1,564.61
Rate for Payer: Cash Price	$1,048.45
Rate for Payer: Health Management Network Commercial	$1,371.05
Rate for Payer: MDX Hawaii PPO	$1,564.61

HCHG MRA W/O CONT, ABD

Facility

$1,460.00

Service Code	HCPCS 74185
Hospital Charge Code	H6100128
Hospital Revenue Code	610
Min. Negotiated Rate	$1,241.00
Max. Negotiated Rate	$1,416.20
Rate for Payer: Cash Price	$949.00
Rate for Payer: Health Management Network Commercial	$1,241.00
Rate for Payer: MDX Hawaii PPO	$1,416.20

HCHG MRA W/O CONT, ABD

Facility

$1,460.00

Service Code	HCPCS 74185
Hospital Charge Code	H6100128
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$1,416.20
Rate for Payer: Cash Price	$949.00
Rate for Payer: Cash Price	$949.00
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,387.00
Rate for Payer: Health Management Network Commercial	$1,241.00
Rate for Payer: Kaiser Permanente Commercial	$919.80
Rate for Payer: Kaiser Permanente Medicaid	$744.60
Rate for Payer: MDX Hawaii PPO	$1,416.20
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$987.38

HCHG MRA W/O FOL W/CONT, ABD

Facility

$2,820.00

Service Code	HCPCS 74185
Hospital Charge Code	H6100130
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,679.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$1,776.60
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$987.38

Know your out-of-pocket cost for care.

All Charges