Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG PEP MASK INIT

Facility

$344.00

Service Code	HCPCS 94667
Hospital Charge Code	H4120320
Hospital Revenue Code	412
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$223.60
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: MDX Hawaii PPO	$333.68

HCHG PEP MASK THERAPY SUBSEQ

Facility

$250.00

Service Code	HCPCS 94668
Hospital Charge Code	H4120322
Hospital Revenue Code	412
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$237.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$182.22

HCHG PEP MASK THERAPY SUBSEQ

Facility

$250.00

Service Code	HCPCS 94668
Hospital Charge Code	H4120322
Hospital Revenue Code	412
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 PERC BX LIVER

Facility

$3,673.00

Service Code	HCPCS 47000
Hospital Charge Code	H3610134
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,562.81
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$2,387.45
Rate for Payer: Cash Price	$2,387.45
Rate for Payer: Cash Price	$2,387.45
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$3,122.05
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$2,313.99
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$3,562.81
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$2,677.25

HCHG PERC BX LIVER

Facility

$3,673.00

Service Code	HCPCS 47000
Hospital Charge Code	H3610134
Hospital Revenue Code	361
Min. Negotiated Rate	$3,122.05
Max. Negotiated Rate	$3,562.81
Rate for Payer: Cash Price	$2,387.45
Rate for Payer: Health Management Network Commercial	$3,122.05
Rate for Payer: MDX Hawaii PPO	$3,562.81

HCHG PERC BX PANCREAS

Facility

$7,662.00

Service Code	HCPCS 48102
Hospital Charge Code	H3610142
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,432.14
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$4,980.30
Rate for Payer: Cash Price	$4,980.30
Rate for Payer: Cash Price	$4,980.30
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Health Management Network Commercial	$6,512.70
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,827.06
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$7,432.14
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,584.83

HCHG PERC BX PANCREAS

Facility

$7,662.00

Service Code	HCPCS 48102
Hospital Charge Code	H3610142
Hospital Revenue Code	361
Min. Negotiated Rate	$6,512.70
Max. Negotiated Rate	$7,432.14
Rate for Payer: Cash Price	$4,980.30
Rate for Payer: Health Management Network Commercial	$6,512.70
Rate for Payer: MDX Hawaii PPO	$7,432.14

HCHG PERC BX RETROP OR ABD

Facility

$2,918.00

Service Code	HCPCS 49180
Hospital Charge Code	H3610380
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$1,896.70
Rate for Payer: Cash Price	$1,896.70
Rate for Payer: Cash Price	$1,896.70
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Health Management Network Commercial	$2,480.30
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$1,838.34
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$2,830.46
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$2,126.93

HCHG PERC BX RETROP OR ABD

Facility

$2,918.00

Service Code	HCPCS 49180
Hospital Charge Code	H3610380
Hospital Revenue Code	361
Min. Negotiated Rate	$2,480.30
Max. Negotiated Rate	$2,830.46
Rate for Payer: Cash Price	$1,896.70
Rate for Payer: Health Management Network Commercial	$2,480.30
Rate for Payer: MDX Hawaii PPO	$2,830.46

HCHG PERC CHOLESYSTOSTOMY

Facility

$7,971.00

Service Code	HCPCS 47490
Hospital Charge Code	H3600398
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Cash Price	$5,181.15
Rate for Payer: Cash Price	$5,181.15
Rate for Payer: Cash Price	$5,181.15
Rate for Payer: Devoted Health Medicare	$4,652.66
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Health Management Network Commercial	$6,775.35
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Commercial	$5,021.73
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: MDX Hawaii PPO	$7,731.87
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69
Rate for Payer: University Health Alliance Commercial	$5,810.06

HCHG PERC CHOLESYSTOSTOMY

Facility

$7,971.00

Service Code	HCPCS 47490
Hospital Charge Code	H3600398
Hospital Revenue Code	360
Min. Negotiated Rate	$6,775.35
Max. Negotiated Rate	$7,731.87
Rate for Payer: Cash Price	$5,181.15
Rate for Payer: Health Management Network Commercial	$6,775.35
Rate for Payer: MDX Hawaii PPO	$7,731.87

HCHG PERICARD W/CONGEN ANOM

Facility

$6,046.00

Service Code	HCPCS 33018
Hospital Charge Code	H4810310
Hospital Revenue Code	481
Min. Negotiated Rate	$272.90
Max. Negotiated Rate	$5,864.62
Rate for Payer: Cash Price	$3,929.90
Rate for Payer: Cash Price	$3,929.90
Rate for Payer: Hawaii Western Management Group Commercial	$5,743.70
Rate for Payer: Health Management Network Commercial	$5,139.10
Rate for Payer: Kaiser Permanente Commercial	$3,808.98
Rate for Payer: Kaiser Permanente Medicaid	$3,083.46
Rate for Payer: MDX Hawaii PPO	$5,864.62
Rate for Payer: UnitedHealthcare Medicaid	$272.90
Rate for Payer: University Health Alliance Commercial	$4,406.93

HCHG PERICARD W/CONGEN ANOM

Facility

$6,046.00

Service Code	HCPCS 33018
Hospital Charge Code	H4810310
Hospital Revenue Code	481
Min. Negotiated Rate	$5,139.10
Max. Negotiated Rate	$5,864.62
Rate for Payer: Cash Price	$3,929.90
Rate for Payer: Health Management Network Commercial	$5,139.10
Rate for Payer: MDX Hawaii PPO	$5,864.62

HCHG PERITONEAL LAVAGE, INCL IMG GUID

Facility

$4,535.00

Service Code	HCPCS 49084
Hospital Charge Code	H4501047
Hospital Revenue Code	450
Min. Negotiated Rate	$3,854.75
Max. Negotiated Rate	$4,398.95
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Health Management Network Commercial	$3,854.75
Rate for Payer: MDX Hawaii PPO	$4,398.95

HCHG PERITONEAL LAVAGE, INCL IMG GUID

Facility

$4,535.00

Service Code	HCPCS 49084
Hospital Charge Code	H4501047
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,398.95
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Cash Price	$2,947.75
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,308.25
Rate for Payer: Health Management Network Commercial	$3,854.75
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,857.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$4,398.95
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$3,305.56

HCHG PERQ DEV BREAST 1ST LESION INCL US IMAG

Facility

$2,160.00

Service Code	HCPCS 19285
Hospital Charge Code	H3610590
Hospital Revenue Code	361
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,095.20
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: MDX Hawaii PPO	$2,095.20

HCHG PERQ DEV BREAST 1ST LESION INCL US IMAG

Facility

$2,160.00

Service Code	HCPCS 19285
Hospital Charge Code	H3610590
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,360.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,095.20
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$1,574.42

HCHG PH-BODY FLD

Facility

$44.00

Service Code	HCPCS 83986
Hospital Charge Code	H3011036
Hospital Revenue Code	301
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

HCHG PH-BODY FLD

Facility

$44.00

Service Code	HCPCS 83986
Hospital Charge Code	H3011036
Hospital Revenue Code	301
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$3.58
Rate for Payer: AlohaCare Medicare	$3.58
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Devoted Health Medicare	$3.94
Rate for Payer: Hawaii Medical Service Association ABD	$4.95
Rate for Payer: Hawaii Medical Service Association Commercial	$4.47
Rate for Payer: Hawaii Medical Service Association Medicare	$3.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$3.58
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$3.58
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$3.58
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$3.94
Rate for Payer: Ohana Health Plan Medicare	$3.58
Rate for Payer: UnitedHealthcare Medicaid	$4.95
Rate for Payer: UnitedHealthcare Medicare	$3.58
Rate for Payer: University Health Alliance Commercial	$9.25

HCHG PHENOBARBITAL

Facility

$141.00

Service Code	HCPCS 80184
Hospital Charge Code	H3011040
Hospital Revenue Code	301
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

HCHG PHENOBARBITAL

Facility

$141.00

Service Code	HCPCS 80184
Hospital Charge Code	H3011040
Hospital Revenue Code	301
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$15.30
Rate for Payer: AlohaCare Medicare	$15.30
Rate for Payer: Cash Price	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$16.83
Rate for Payer: Hawaii Medical Service Association ABD	$15.83
Rate for Payer: Hawaii Medical Service Association Commercial	$19.12
Rate for Payer: Hawaii Medical Service Association Medicare	$15.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.62
Rate for Payer: Hawaii Western Management Group Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$15.30
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$15.30
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$16.83
Rate for Payer: Ohana Health Plan Medicare	$15.30
Rate for Payer: UnitedHealthcare Medicaid	$15.83
Rate for Payer: UnitedHealthcare Medicare	$15.30
Rate for Payer: University Health Alliance Commercial	$29.62

HCHG PH FECES 90

Facility

$44.00

Service Code	HCPCS 83986
Hospital Charge Code	H3011034
Hospital Revenue Code	301
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$3.58
Rate for Payer: AlohaCare Medicare	$3.58
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Devoted Health Medicare	$3.94
Rate for Payer: Hawaii Medical Service Association ABD	$4.95
Rate for Payer: Hawaii Medical Service Association Commercial	$4.47
Rate for Payer: Hawaii Medical Service Association Medicare	$3.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$3.58
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$3.58
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$3.58
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$3.94
Rate for Payer: Ohana Health Plan Medicare	$3.58
Rate for Payer: UnitedHealthcare Medicaid	$4.95
Rate for Payer: UnitedHealthcare Medicare	$3.58
Rate for Payer: University Health Alliance Commercial	$9.25

HCHG PH FECES 90

Facility

$44.00

Service Code	HCPCS 83986
Hospital Charge Code	H3011034
Hospital Revenue Code	301
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

HCHG PHOSPHATYLSERINE IGG AB

Facility

$218.00

Service Code	HCPCS 86148
Hospital Charge Code	H3020674
Hospital Revenue Code	302
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$141.70
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: MDX Hawaii PPO	$211.46

HCHG PHOSPHATYLSERINE IGG AB

Facility

$218.00

Service Code	HCPCS 86148
Hospital Charge Code	H3020674
Hospital Revenue Code	302
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$16.07
Rate for Payer: AlohaCare Medicare	$16.07
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cash Price	$141.70
Rate for Payer: Devoted Health Medicare	$17.68
Rate for Payer: Hawaii Medical Service Association ABD	$22.20
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$16.07
Rate for Payer: Kaiser Permanente Commercial	$137.34
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$16.07
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$17.68
Rate for Payer: Ohana Health Plan Medicare	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$16.07
Rate for Payer: University Health Alliance Commercial	$41.51

Know your out-of-pocket cost for care.

All Charges