Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: MDX Hawaii PPO	$90.21

HCHG NON-ENTERIC SENSITIVITY ISO EA PER PLATE

Facility

$194.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060697
Hospital Revenue Code	306
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$126.10
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: MDX Hawaii PPO	$188.18

HCHG NON-ENTERIC SENSITIVITY ISO EA PER PLATE

Facility

$194.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060697
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG NONINVAS OXIMETRY MULT

Facility

$172.00

Service Code	HCPCS 94761
Hospital Charge Code	H4600120
Hospital Revenue Code	460
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Hawaii Western Management Group Commercial	$163.40
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$108.36
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: UnitedHealthcare Medicaid	$4.77
Rate for Payer: University Health Alliance Commercial	$125.37

HCHG NONINVAS OXIMETRY MULT

Facility

$172.00

Service Code	HCPCS 94761
Hospital Charge Code	H4600120
Hospital Revenue Code	460
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: MDX Hawaii PPO	$166.84

HCHG NONVASCULAR SHUNT X-RAY

Facility

$708.00

Service Code	HCPCS 75809
Hospital Charge Code	H3201016
Hospital Revenue Code	320
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: MDX Hawaii PPO	$686.76

HCHG NONVASCULAR SHUNT X-RAY

Facility

$708.00

Service Code	HCPCS 75809
Hospital Charge Code	H3201016
Hospital Revenue Code	320
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$25.96
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	$28.19
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$446.04
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$25.96
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$155.88

HCHG NO PRE-NOTIFICATION FULL TRAUMA

Facility

$4,645.00

Hospital Charge Code	H4501039
Hospital Revenue Code	450
Min. Negotiated Rate	$3,948.25
Max. Negotiated Rate	$4,505.65
Rate for Payer: Cash Price	$3,019.25
Rate for Payer: Health Management Network Commercial	$3,948.25
Rate for Payer: MDX Hawaii PPO	$4,505.65

HCHG NO PRE-NOTIFICATION FULL TRAUMA

Facility

$4,645.00

Hospital Charge Code	H4501039
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$4,505.65
Rate for Payer: Cash Price	$3,019.25
Rate for Payer: Cash Price	$3,019.25
Rate for Payer: Cash Price	$3,019.25
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	$4,412.75
Rate for Payer: Health Management Network Commercial	$3,948.25
Rate for Payer: Kaiser Permanente Commercial	$2,926.35
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$4,505.65
Rate for Payer: University Health Alliance Commercial	$3,385.74

HCHG NO PRE-NOTIFICATION MODIFIED TRAUMA

Facility

$4,086.00

Hospital Charge Code	H4501040
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$3,963.42
Rate for Payer: Cash Price	$2,655.90
Rate for Payer: Cash Price	$2,655.90
Rate for Payer: Cash Price	$2,655.90
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,881.70
Rate for Payer: Health Management Network Commercial	$3,473.10
Rate for Payer: Kaiser Permanente Commercial	$2,574.18
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$3,963.42
Rate for Payer: University Health Alliance Commercial	$2,978.29

HCHG NO PRE-NOTIFICATION MODIFIED TRAUMA

Facility

$4,086.00

Hospital Charge Code	H4501040
Hospital Revenue Code	450
Min. Negotiated Rate	$3,473.10
Max. Negotiated Rate	$3,963.42
Rate for Payer: Cash Price	$2,655.90
Rate for Payer: Health Management Network Commercial	$3,473.10
Rate for Payer: MDX Hawaii PPO	$3,963.42

HCHG NORVOVIRUS GRP 1 PCR SO

Facility

$589.00

Service Code	HCPCS 87798
Hospital Charge Code	K3060044
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$382.85
Rate for Payer: Cash Price	$382.85
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	$500.65
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$371.07
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$571.33
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 NORVOVIRUS GRP 1 PCR SO

Facility

$589.00

Service Code	HCPCS 87798
Hospital Charge Code	K3060044
Hospital Revenue Code	306
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$382.85
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: MDX Hawaii PPO	$571.33

HCHG NPPV INITIAL DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100284
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$912.77
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$611.65
Rate for Payer: Cash Price	$611.65
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Hawaii Western Management Group Commercial	$893.95
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$592.83
Rate for Payer: Kaiser Permanente Medicaid	$479.91
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$912.77
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$685.89

HCHG NPPV INITIAL DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100284
Hospital Revenue Code	410
Min. Negotiated Rate	$799.85
Max. Negotiated Rate	$912.77
Rate for Payer: MDX Hawaii PPO	$912.77
Rate for Payer: Cash Price	$611.65
Rate for Payer: Health Management Network Commercial	$799.85

HCHG NPPV SUBSEQUENT DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100281
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$912.77
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$611.65
Rate for Payer: Cash Price	$611.65
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Hawaii Western Management Group Commercial	$893.95
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$592.83
Rate for Payer: Kaiser Permanente Medicaid	$479.91
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$912.77
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$685.89

HCHG NPPV SUBSEQUENT DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100281
Hospital Revenue Code	410
Min. Negotiated Rate	$799.85
Max. Negotiated Rate	$912.77
Rate for Payer: Cash Price	$611.65
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: MDX Hawaii PPO	$912.77

HCHG NRAS EXON 1 & 2 SO

Facility

$453.00

Service Code	HCPCS 81404
Hospital Charge Code	K3090003
Hospital Revenue Code	309
Min. Negotiated Rate	$181.30
Max. Negotiated Rate	$439.41
Rate for Payer: AlohaCare Medicaid	$274.83
Rate for Payer: AlohaCare Medicare	$274.83
Rate for Payer: Cash Price	$294.45
Rate for Payer: Cash Price	$294.45
Rate for Payer: Devoted Health Medicare	$302.31
Rate for Payer: Hawaii Medical Service Association ABD	$274.83
Rate for Payer: Hawaii Medical Service Association Commercial	$343.54
Rate for Payer: Hawaii Medical Service Association Medicare	$274.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$274.83
Rate for Payer: Hawaii Western Management Group Commercial	$274.83
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Humana Medicare	$274.83
Rate for Payer: Kaiser Permanente Commercial	$285.39
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: Kaiser Permanente Medicare	$274.83
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: Ohana Health Plan Medicaid	$302.31
Rate for Payer: Ohana Health Plan Medicare	$274.83
Rate for Payer: UnitedHealthcare Medicaid	$181.30
Rate for Payer: UnitedHealthcare Medicare	$274.83
Rate for Payer: University Health Alliance Commercial	$330.19

HCHG NRAS EXON 1 & 2 SO

Facility

$453.00

Service Code	HCPCS 81404
Hospital Charge Code	K3090003
Hospital Revenue Code	309
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$294.45
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: MDX Hawaii PPO	$439.41

HCHG NRAS MOD 90

Facility

$1,450.00

Service Code	HCPCS 81311
Hospital Charge Code	H3011627
Hospital Revenue Code	310
Min. Negotiated Rate	$1,232.50
Max. Negotiated Rate	$1,406.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: MDX Hawaii PPO	$1,406.50

HCHG NRAS MOD 90

Facility

$1,450.00

Service Code	HCPCS 81311
Hospital Charge Code	H3011627
Hospital Revenue Code	310
Min. Negotiated Rate	$159.84
Max. Negotiated Rate	$1,406.50
Rate for Payer: AlohaCare Medicaid	$295.79
Rate for Payer: AlohaCare Medicare	$295.79
Rate for Payer: Cash Price	$942.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Devoted Health Medicare	$325.37
Rate for Payer: Hawaii Medical Service Association ABD	$218.88
Rate for Payer: Hawaii Medical Service Association Commercial	$369.74
Rate for Payer: Hawaii Medical Service Association Medicare	$295.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$218.88
Rate for Payer: Hawaii Western Management Group Commercial	$295.79
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: Humana Medicare	$295.79
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$739.50
Rate for Payer: Kaiser Permanente Medicare	$295.79
Rate for Payer: MDX Hawaii PPO	$1,406.50
Rate for Payer: Ohana Health Plan Medicaid	$325.37
Rate for Payer: Ohana Health Plan Medicare	$295.79
Rate for Payer: UnitedHealthcare Medicaid	$159.84
Rate for Payer: UnitedHealthcare Medicare	$295.79
Rate for Payer: University Health Alliance Commercial	$1,056.90

HCHG NT PROBNP

Facility

$459.00

Service Code	HCPCS 83880
Hospital Charge Code	H3011556
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$445.23
Rate for Payer: AlohaCare Medicaid	$39.26
Rate for Payer: AlohaCare Medicare	$39.26
Rate for Payer: Cash Price	$298.35
Rate for Payer: Cash Price	$298.35
Rate for Payer: Devoted Health Medicare	$43.19
Rate for Payer: Hawaii Medical Service Association ABD	$28.46
Rate for Payer: Hawaii Medical Service Association Commercial	$49.08
Rate for Payer: Hawaii Medical Service Association Medicare	$39.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.89
Rate for Payer: Hawaii Western Management Group Commercial	$39.26
Rate for Payer: Health Management Network Commercial	$390.15
Rate for Payer: Humana Medicare	$39.26
Rate for Payer: Kaiser Permanente Commercial	$289.17
Rate for Payer: Kaiser Permanente Medicaid	$234.09
Rate for Payer: Kaiser Permanente Medicare	$39.26
Rate for Payer: MDX Hawaii PPO	$445.23
Rate for Payer: Ohana Health Plan Medicaid	$43.19
Rate for Payer: Ohana Health Plan Medicare	$39.26
Rate for Payer: UnitedHealthcare Medicaid	$28.46
Rate for Payer: UnitedHealthcare Medicare	$39.26
Rate for Payer: University Health Alliance Commercial	$87.75

HCHG NT PROBNP

Facility

$459.00

Service Code	HCPCS 83880
Hospital Charge Code	H3011556
Hospital Revenue Code	301
Min. Negotiated Rate	$390.15
Max. Negotiated Rate	$445.23
Rate for Payer: Cash Price	$298.35
Rate for Payer: Health Management Network Commercial	$390.15
Rate for Payer: MDX Hawaii PPO	$445.23

HCHG NUTRITIONAL COUNSELING, DIETICIAN PER VISIT

Facility

$639.00

Service Code	HCPCS S9470
Hospital Charge Code	K9420004
Hospital Revenue Code	942
Min. Negotiated Rate	$543.15
Max. Negotiated Rate	$619.83
Rate for Payer: Cash Price	$415.35
Rate for Payer: Health Management Network Commercial	$543.15
Rate for Payer: MDX Hawaii PPO	$619.83

HCHG NUTRITIONAL COUNSELING, DIETICIAN PER VISIT

Facility

$639.00

Service Code	HCPCS S9470
Hospital Charge Code	K9420004
Hospital Revenue Code	942
Min. Negotiated Rate	$325.89
Max. Negotiated Rate	$619.83
Rate for Payer: Cash Price	$415.35
Rate for Payer: Hawaii Western Management Group Commercial	$607.05
Rate for Payer: Health Management Network Commercial	$543.15
Rate for Payer: Kaiser Permanente Commercial	$402.57
Rate for Payer: Kaiser Permanente Medicaid	$325.89
Rate for Payer: MDX Hawaii PPO	$619.83
Rate for Payer: University Health Alliance Commercial	$465.77

Know your out-of-pocket cost for care.

All Charges