Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG OP INTRAOP CHOLANGIO PORT

Facility

$680.00

Service Code	HCPCS 74300
Hospital Charge Code	H3200600
Hospital Revenue Code	320
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$659.60
Rate for Payer: Cash Price	$442.00
Rate for Payer: Cash Price	$442.00
Rate for Payer: Hawaii Medical Service Association ABD	$18.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.20
Rate for Payer: Hawaii Western Management Group Commercial	$646.00
Rate for Payer: Health Management Network Commercial	$578.00
Rate for Payer: Kaiser Permanente Commercial	$428.40
Rate for Payer: Kaiser Permanente Medicaid	$346.80
Rate for Payer: MDX Hawaii PPO	$659.60
Rate for Payer: UnitedHealthcare Medicaid	$18.78
Rate for Payer: University Health Alliance Commercial	$495.65

HCHG OPTIME IMPLANTS

Facility

$2,399.90

Service Code	HCPCS C1713
Hospital Charge Code	H2789011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,343.94
Max. Negotiated Rate	$2,327.90
Rate for Payer: Cash Price	$1,559.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,679.93
Rate for Payer: Health Management Network Commercial	$2,039.91
Rate for Payer: MDX Hawaii PPO	$2,327.90
Rate for Payer: University Health Alliance Commercial	$1,343.94

HCHG OPTIME IMPLANTS

Facility

$6,537.50

Service Code	HCPCS C1713
Hospital Charge Code	H2789010
Hospital Revenue Code	278
Min. Negotiated Rate	$3,334.12
Max. Negotiated Rate	$6,341.38
Rate for Payer: Cash Price	$4,249.38
Rate for Payer: Hawaii Western Management Group Commercial	$4,576.25
Rate for Payer: Health Management Network Commercial	$5,556.88
Rate for Payer: Kaiser Permanente Commercial	$4,118.62
Rate for Payer: Kaiser Permanente Medicaid	$3,334.12
Rate for Payer: MDX Hawaii PPO	$6,341.38
Rate for Payer: University Health Alliance Commercial	$3,661.00

HCHG OPTIME IMPLANTS

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	H2789030
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

HCHG OPTIME IMPLANTS

Facility

$2,399.90

Service Code	HCPCS C1713
Hospital Charge Code	H2789011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.95
Max. Negotiated Rate	$2,327.90
Rate for Payer: Cash Price	$1,559.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,679.93
Rate for Payer: Health Management Network Commercial	$2,039.91
Rate for Payer: Kaiser Permanente Commercial	$1,511.94
Rate for Payer: Kaiser Permanente Medicaid	$1,223.95
Rate for Payer: MDX Hawaii PPO	$2,327.90
Rate for Payer: University Health Alliance Commercial	$1,343.94

HCHG OPTIME IMPLANTS

Facility

$6,537.50

Service Code	HCPCS C1713
Hospital Charge Code	H2789010
Hospital Revenue Code	278
Min. Negotiated Rate	$3,661.00
Max. Negotiated Rate	$6,341.38
Rate for Payer: Cash Price	$4,249.38
Rate for Payer: Hawaii Western Management Group Commercial	$4,576.25
Rate for Payer: Health Management Network Commercial	$5,556.88
Rate for Payer: MDX Hawaii PPO	$6,341.38
Rate for Payer: University Health Alliance Commercial	$3,661.00

HCHG OPTIME IMPLANTS

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	H2789030
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

HCHG OPTIME PACEMAKER

Facility

$63,448.13

Service Code	HCPCS C1722
Hospital Charge Code	H2789013
Hospital Revenue Code	275
Min. Negotiated Rate	$32,358.55
Max. Negotiated Rate	$61,544.69
Rate for Payer: Cash Price	$41,241.28
Rate for Payer: Hawaii Western Management Group Commercial	$44,413.69
Rate for Payer: Health Management Network Commercial	$53,930.91
Rate for Payer: Kaiser Permanente Commercial	$39,972.32
Rate for Payer: Kaiser Permanente Medicaid	$32,358.55
Rate for Payer: MDX Hawaii PPO	$61,544.69
Rate for Payer: University Health Alliance Commercial	$35,530.95

HCHG OPTIME PACEMAKER

Facility

$63,448.13

Service Code	HCPCS C1722
Hospital Charge Code	H2789013
Hospital Revenue Code	275
Min. Negotiated Rate	$35,530.95
Max. Negotiated Rate	$61,544.69
Rate for Payer: Cash Price	$41,241.28
Rate for Payer: Hawaii Western Management Group Commercial	$44,413.69
Rate for Payer: Health Management Network Commercial	$53,930.91
Rate for Payer: MDX Hawaii PPO	$61,544.69
Rate for Payer: University Health Alliance Commercial	$35,530.95

HCHG OPTIME STERILE SUPPLY

Facility

$27,536.00

Service Code	HCPCS C1713
Hospital Charge Code	H2729011
Hospital Revenue Code	272
Min. Negotiated Rate	$14,043.36
Max. Negotiated Rate	$26,709.92
Rate for Payer: Cash Price	$17,898.40
Rate for Payer: Hawaii Western Management Group Commercial	$26,159.20
Rate for Payer: Health Management Network Commercial	$23,405.60
Rate for Payer: Kaiser Permanente Commercial	$17,347.68
Rate for Payer: Kaiser Permanente Medicaid	$14,043.36
Rate for Payer: MDX Hawaii PPO	$26,709.92
Rate for Payer: University Health Alliance Commercial	$20,070.99

HCHG OPTIME STERILE SUPPLY

Facility

$27,536.00

Service Code	HCPCS C1713
Hospital Charge Code	H2729011
Hospital Revenue Code	272
Min. Negotiated Rate	$23,405.60
Max. Negotiated Rate	$26,709.92
Rate for Payer: Cash Price	$17,898.40
Rate for Payer: Health Management Network Commercial	$23,405.60
Rate for Payer: MDX Hawaii PPO	$26,709.92

HCHG ORBITS MIN 4 VIEWS

Facility

$414.00

Service Code	HCPCS 70200
Hospital Charge Code	H3200606
Hospital Revenue Code	320
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$401.58
Rate for Payer: Cash Price	$269.10
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: MDX Hawaii PPO	$401.58

HCHG ORBITS MIN 4 VIEWS

Facility

$414.00

Service Code	HCPCS 70200
Hospital Charge Code	H3200606
Hospital Revenue Code	320
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$401.58
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
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	$351.90
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$260.82
Rate for Payer: Kaiser Permanente Medicaid	$211.14
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$401.58
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	$90.41

HCHG ORGANISM ID UR1

Facility

$117.00

Service Code	HCPCS 87088
Hospital Charge Code	H3060665
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$113.49
Rate for Payer: AlohaCare Medicaid	$8.09
Rate for Payer: AlohaCare Medicare	$8.09
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cash Price	$76.05
Rate for Payer: Devoted Health Medicare	$8.90
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$8.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Humana Medicare	$8.09
Rate for Payer: Kaiser Permanente Commercial	$73.71
Rate for Payer: Kaiser Permanente Medicaid	$59.67
Rate for Payer: Kaiser Permanente Medicare	$8.09
Rate for Payer: MDX Hawaii PPO	$113.49
Rate for Payer: Ohana Health Plan Medicaid	$8.90
Rate for Payer: Ohana Health Plan Medicare	$8.09
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$8.09
Rate for Payer: University Health Alliance Commercial	$19.74

HCHG ORGANISM ID UR1

Facility

$117.00

Service Code	HCPCS 87088
Hospital Charge Code	H3060665
Hospital Revenue Code	306
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$76.05
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: MDX Hawaii PPO	$113.49

HCHG OSMOLALITY FECES

Facility

$119.00

Service Code	HCPCS 84999
Hospital Charge Code	H3011002
Hospital Revenue Code	301
Min. Negotiated Rate	$60.69
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: University Health Alliance Commercial	$86.74

HCHG OSMOLALITY FECES

Facility

$119.00

Service Code	HCPCS 84999
Hospital Charge Code	H3011002
Hospital Revenue Code	301
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HCHG OSMOLALITY-SERUM

Facility

$114.00

Service Code	HCPCS 83930
Hospital Charge Code	H3011006
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$6.61
Rate for Payer: AlohaCare Medicare	$6.61
Rate for Payer: Cash Price	$74.10
Rate for Payer: Cash Price	$74.10
Rate for Payer: Devoted Health Medicare	$7.27
Rate for Payer: Hawaii Medical Service Association ABD	$9.13
Rate for Payer: Hawaii Medical Service Association Commercial	$8.26
Rate for Payer: Hawaii Medical Service Association Medicare	$6.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.59
Rate for Payer: Hawaii Western Management Group Commercial	$6.61
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$6.61
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$6.61
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$7.27
Rate for Payer: Ohana Health Plan Medicare	$6.61
Rate for Payer: UnitedHealthcare Medicaid	$9.13
Rate for Payer: UnitedHealthcare Medicare	$6.61
Rate for Payer: University Health Alliance Commercial	$17.09

HCHG OSMOLALITY-SERUM

Facility

$114.00

Service Code	HCPCS 83930
Hospital Charge Code	H3011006
Hospital Revenue Code	301
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HCHG OSMOLALITY-URINE

Facility

$93.00

Service Code	HCPCS 83935
Hospital Charge Code	H3011008
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$6.82
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$7.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.42
Rate for Payer: Hawaii Medical Service Association Commercial	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.89
Rate for Payer: Hawaii Western Management Group Commercial	$6.82
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$7.50
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicaid	$9.42
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: University Health Alliance Commercial	$17.61

HCHG OSMOLALITY-URINE

Facility

$93.00

Service Code	HCPCS 83935
Hospital Charge Code	H3011008
Hospital Revenue Code	301
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 OT ADAPT ORTHO FABRICA 15 MIN

Facility

$250.00

Service Code	HCPCS 97760
Hospital Charge Code	H4300122
Hospital Revenue Code	430
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: MDX Hawaii PPO	$242.50

HCHG OT ADAPT ORTHO FABRICA 15 MIN

Facility

$250.00

Service Code	HCPCS 97760
Hospital Charge Code	H4300122
Hospital Revenue Code	430
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Hawaii Western Management Group Commercial	$237.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: UnitedHealthcare Medicaid	$17.21
Rate for Payer: University Health Alliance Commercial	$182.22

HCHG OT AQUATIC THRPY 15M

Facility

$289.00

Service Code	HCPCS 97113
Hospital Charge Code	K4300002
Hospital Revenue Code	430
Min. Negotiated Rate	$245.65
Max. Negotiated Rate	$280.33
Rate for Payer: Cash Price	$187.85
Rate for Payer: Health Management Network Commercial	$245.65
Rate for Payer: MDX Hawaii PPO	$280.33

HCHG OT AQUATIC THRPY 15M

Facility

$289.00

Service Code	HCPCS 97113
Hospital Charge Code	K4300002
Hospital Revenue Code	430
Min. Negotiated Rate	$20.09
Max. Negotiated Rate	$280.33
Rate for Payer: Cash Price	$187.85
Rate for Payer: Cash Price	$187.85
Rate for Payer: Hawaii Western Management Group Commercial	$274.55
Rate for Payer: Health Management Network Commercial	$245.65
Rate for Payer: Kaiser Permanente Commercial	$182.07
Rate for Payer: Kaiser Permanente Medicaid	$147.39
Rate for Payer: MDX Hawaii PPO	$280.33
Rate for Payer: UnitedHealthcare Medicaid	$20.09
Rate for Payer: University Health Alliance Commercial	$210.65

Know your out-of-pocket cost for care.

All Charges