Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG NERVOUS SYSTEM SURGERY

Facility

$2,830.00

Service Code	HCPCS 64999
Hospital Charge Code	H3610840
Hospital Revenue Code	361
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$1,839.50
Rate for Payer: Cash Price	$1,839.50
Rate for Payer: Cash Price	$1,839.50
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Health Management Network Commercial	$2,405.50
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$1,782.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$2,745.10
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$932.99
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$2,062.79

HCHG NERVOUS SYSTEM SURGERY

Facility

$2,830.00

Service Code	HCPCS 64999
Hospital Charge Code	H3610840
Hospital Revenue Code	361
Min. Negotiated Rate	$2,405.50
Max. Negotiated Rate	$2,745.10
Rate for Payer: Cash Price	$1,839.50
Rate for Payer: Health Management Network Commercial	$2,405.50
Rate for Payer: MDX Hawaii PPO	$2,745.10

HCHG NEUROMUSCULAR RE-EDUC 15 MIN

Facility

$225.00

Service Code	HCPCS 97112
Hospital Charge Code	H4300118
Hospital Revenue Code	430
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

HCHG NEUROMUSCULAR RE-EDUC 15 MIN

Facility

$225.00

Service Code	HCPCS 97112
Hospital Charge Code	H4300118
Hospital Revenue Code	430
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: University Health Alliance Commercial	$164.00

HCHG NFCT DS BV RNA VAG FLU ALG - 90

Facility

$1,051.00

Service Code	HCPCS 81513
Hospital Charge Code	H3100256
Hospital Revenue Code	310
Min. Negotiated Rate	$893.35
Max. Negotiated Rate	$1,019.47
Rate for Payer: Cash Price	$683.15
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: MDX Hawaii PPO	$1,019.47

HCHG NFCT DS BV RNA VAG FLU ALG - 90

Facility

$1,051.00

Service Code	HCPCS 81513
Hospital Charge Code	H3100256
Hospital Revenue Code	310
Min. Negotiated Rate	$106.97
Max. Negotiated Rate	$1,019.47
Rate for Payer: AlohaCare Medicaid	$142.63
Rate for Payer: AlohaCare Medicare	$142.63
Rate for Payer: Cash Price	$683.15
Rate for Payer: Cash Price	$683.15
Rate for Payer: Devoted Health Medicare	$156.89
Rate for Payer: Hawaii Medical Service Association ABD	$174.58
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$142.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$177.81
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Humana Medicare	$142.63
Rate for Payer: Kaiser Permanente Commercial	$662.13
Rate for Payer: Kaiser Permanente Medicaid	$536.01
Rate for Payer: Kaiser Permanente Medicare	$142.63
Rate for Payer: MDX Hawaii PPO	$1,019.47
Rate for Payer: Ohana Health Plan Medicaid	$156.89
Rate for Payer: Ohana Health Plan Medicare	$142.63
Rate for Payer: UnitedHealthcare Medicaid	$106.97
Rate for Payer: UnitedHealthcare Medicare	$142.63
Rate for Payer: University Health Alliance Commercial	$766.07

HCHG N.GONORRHOEAE DNA AMP PROB - 90

Facility

$593.00

Service Code	HCPCS 87591
Hospital Charge Code	H3060787
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$575.21
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$385.45
Rate for Payer: Cash Price	$385.45
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
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	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$373.59
Rate for Payer: Kaiser Permanente Medicaid	$302.43
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$575.21
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG N.GONORRHOEAE DNA AMP PROB - 90

Facility

$593.00

Service Code	HCPCS 87591
Hospital Charge Code	H3060787
Hospital Revenue Code	306
Min. Negotiated Rate	$504.05
Max. Negotiated Rate	$575.21
Rate for Payer: Cash Price	$385.45
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: MDX Hawaii PPO	$575.21

HCHG NG TUBE PLCMT W FLUORO

Facility

$2,404.00

Service Code	HCPCS 43752
Hospital Charge Code	H3600328
Hospital Revenue Code	360
Min. Negotiated Rate	$36.91
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$1,562.60
Rate for Payer: Cash Price	$1,562.60
Rate for Payer: Cash Price	$1,562.60
Rate for Payer: Devoted Health Medicare	$580.51
Rate for Payer: Hawaii Medical Service Association Commercial	$659.67
Rate for Payer: Hawaii Medical Service Association Medicare	$527.74
Rate for Payer: Health Management Network Commercial	$2,043.40
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,514.52
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$2,331.88
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicaid	$36.91
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,752.28

HCHG NG TUBE PLCMT W FLUORO

Facility

$2,404.00

Service Code	HCPCS 43752
Hospital Charge Code	H3600328
Hospital Revenue Code	360
Min. Negotiated Rate	$2,043.40
Max. Negotiated Rate	$2,331.88
Rate for Payer: Cash Price	$1,562.60
Rate for Payer: Health Management Network Commercial	$2,043.40
Rate for Payer: MDX Hawaii PPO	$2,331.88

HCHG N-INVAS EST C FFR SW ALY CTA

Facility

$4,644.00

Service Code	HCPCS 75580
Hospital Charge Code	H4800258
Hospital Revenue Code	350
Min. Negotiated Rate	$619.07
Max. Negotiated Rate	$4,504.68
Rate for Payer: AlohaCare Medicaid	$1,014.47
Rate for Payer: AlohaCare Medicare	$1,014.47
Rate for Payer: Cash Price	$3,018.60
Rate for Payer: Cash Price	$3,018.60
Rate for Payer: Devoted Health Medicare	$1,115.92
Rate for Payer: Hawaii Medical Service Association Commercial	$1,268.09
Rate for Payer: Hawaii Medical Service Association Medicare	$1,014.47
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.47
Rate for Payer: Health Management Network Commercial	$3,947.40
Rate for Payer: Humana Medicare	$1,014.47
Rate for Payer: Kaiser Permanente Commercial	$2,925.72
Rate for Payer: Kaiser Permanente Medicaid	$2,368.44
Rate for Payer: Kaiser Permanente Medicare	$1,014.47
Rate for Payer: MDX Hawaii PPO	$4,504.68
Rate for Payer: Ohana Health Plan Medicaid	$1,115.92
Rate for Payer: Ohana Health Plan Medicare	$1,014.47
Rate for Payer: UnitedHealthcare Medicaid	$619.07
Rate for Payer: UnitedHealthcare Medicare	$1,014.47
Rate for Payer: University Health Alliance Commercial	$3,385.01

HCHG N-INVAS EST C FFR SW ALY CTA

Facility

$4,644.00

Service Code	HCPCS 75580
Hospital Charge Code	H4800258
Hospital Revenue Code	350
Min. Negotiated Rate	$3,947.40
Max. Negotiated Rate	$4,504.68
Rate for Payer: Cash Price	$3,018.60
Rate for Payer: Health Management Network Commercial	$3,947.40
Rate for Payer: MDX Hawaii PPO	$4,504.68

HCHG NJX AA&/STRD FEMORAL NERVE

Facility

$4,033.00

Service Code	HCPCS 64447
Hospital Charge Code	H3610851
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$3,428.05
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,540.79
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,912.01
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG NJX AA&/STRD FEMORAL NERVE

Facility

$4,033.00

Service Code	HCPCS 64447
Hospital Charge Code	H3610851
Hospital Revenue Code	361
Min. Negotiated Rate	$3,428.05
Max. Negotiated Rate	$3,912.01
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Health Management Network Commercial	$3,428.05
Rate for Payer: MDX Hawaii PPO	$3,912.01

HCHG NJX AA&/STRD NTRCOST NRV 1

Facility

$1,933.00

Service Code	HCPCS 64420
Hospital Charge Code	H7610153
Hospital Revenue Code	761
Min. Negotiated Rate	$1,643.05
Max. Negotiated Rate	$1,875.01
Rate for Payer: Cash Price	$1,256.45
Rate for Payer: Health Management Network Commercial	$1,643.05
Rate for Payer: MDX Hawaii PPO	$1,875.01

HCHG NJX AA&/STRD NTRCOST NRV 1

Facility

$1,933.00

Service Code	HCPCS 64420
Hospital Charge Code	H7610153
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$1,875.01
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,256.45
Rate for Payer: Cash Price	$1,256.45
Rate for Payer: Cash Price	$1,256.45
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association Commercial	$1,042.36
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,836.35
Rate for Payer: Health Management Network Commercial	$1,643.05
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,217.79
Rate for Payer: Kaiser Permanente Medicaid	$985.83
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$1,875.01
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$1,408.96

HCHG NJX AA&/STRD SCIATIC NERVE

Facility

$3,310.00

Service Code	HCPCS 64445
Hospital Charge Code	H3610850
Hospital Revenue Code	361
Min. Negotiated Rate	$2,813.50
Max. Negotiated Rate	$3,210.70
Rate for Payer: Cash Price	$2,151.50
Rate for Payer: Health Management Network Commercial	$2,813.50
Rate for Payer: MDX Hawaii PPO	$3,210.70

HCHG NJX AA&/STRD SCIATIC NERVE

Facility

$3,310.00

Service Code	HCPCS 64445
Hospital Charge Code	H3610850
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,210.70
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,151.50
Rate for Payer: Cash Price	$2,151.50
Rate for Payer: Cash Price	$2,151.50
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,813.50
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,210.70
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,412.66

HCHG NJX AA&/STRD SPRSCAP NRV

Facility

$4,033.00

Service Code	HCPCS 64418
Hospital Charge Code	H3610830
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association Commercial	$1,042.36
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Health Management Network Commercial	$3,428.05
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,540.79
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,912.01
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG NJX AA&/STRD SPRSCAP NRV

Facility

$4,033.00

Service Code	HCPCS 64418
Hospital Charge Code	H3610830
Hospital Revenue Code	361
Min. Negotiated Rate	$3,428.05
Max. Negotiated Rate	$3,912.01
Rate for Payer: Cash Price	$2,621.45
Rate for Payer: Health Management Network Commercial	$3,428.05
Rate for Payer: MDX Hawaii PPO	$3,912.01

HCHG NJX CNTRST KNE ARTHG/CT/MRI

Facility

$259.00

Service Code	HCPCS 27369
Hospital Charge Code	H3610692
Hospital Revenue Code	361
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$168.35
Rate for Payer: Cash Price	$168.35
Rate for Payer: Cash Price	$168.35
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 Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$163.17
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: UnitedHealthcare Medicaid	$39.93
Rate for Payer: University Health Alliance Commercial	$188.79

HCHG NJX CNTRST KNE ARTHG/CT/MRI

Facility

$259.00

Service Code	HCPCS 27369
Hospital Charge Code	H3610692
Hospital Revenue Code	361
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$168.35
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: MDX Hawaii PPO	$251.23

HCHG NJX INTERLAMINAR LMBR/SAC

Facility

$4,316.00

Service Code	HCPCS 62326
Hospital Charge Code	H3610849
Hospital Revenue Code	361
Min. Negotiated Rate	$3,668.60
Max. Negotiated Rate	$4,186.52
Rate for Payer: Cash Price	$2,805.40
Rate for Payer: Health Management Network Commercial	$3,668.60
Rate for Payer: MDX Hawaii PPO	$4,186.52

HCHG NJX INTERLAMINAR LMBR/SAC

Facility

$4,316.00

Service Code	HCPCS 62326
Hospital Charge Code	H3610849
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,186.52
Rate for Payer: AlohaCare Medicaid	$1,044.87
Rate for Payer: AlohaCare Medicare	$1,044.87
Rate for Payer: Cash Price	$2,805.40
Rate for Payer: Cash Price	$2,805.40
Rate for Payer: Cash Price	$2,805.40
Rate for Payer: Devoted Health Medicare	$1,149.36
Rate for Payer: Hawaii Medical Service Association Commercial	$1,306.09
Rate for Payer: Hawaii Medical Service Association Medicare	$1,044.87
Rate for Payer: Health Management Network Commercial	$3,668.60
Rate for Payer: Humana Medicare	$1,044.87
Rate for Payer: Kaiser Permanente Commercial	$2,719.08
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,044.87
Rate for Payer: MDX Hawaii PPO	$4,186.52
Rate for Payer: Ohana Health Plan Medicaid	$1,149.36
Rate for Payer: Ohana Health Plan Medicare	$1,044.87
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,044.87
Rate for Payer: University Health Alliance Commercial	$3,145.93

HCHG NON-ENTERIC ISO, DISK METHOD PER PLATE

Facility

$93.00

Service Code	HCPCS 87184
Hospital Charge Code	H3060695
Hospital Revenue Code	306
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$7.48
Rate for Payer: AlohaCare Medicare	$7.48
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$8.23
Rate for Payer: Hawaii Medical Service Association ABD	$9.53
Rate for Payer: Hawaii Medical Service Association Commercial	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.01
Rate for Payer: Hawaii Western Management Group Commercial	$7.48
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$7.48
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$7.48
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$8.23
Rate for Payer: Ohana Health Plan Medicare	$7.48
Rate for Payer: UnitedHealthcare Medicaid	$9.53
Rate for Payer: UnitedHealthcare Medicare	$7.48
Rate for Payer: University Health Alliance Commercial	$17.82

Know your out-of-pocket cost for care.

All Charges