Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG PLATELETS, PHERESIS, EA UNIT

Facility

$2,235.00

Service Code	HCPCS P9034
Hospital Charge Code	H3900204
Hospital Revenue Code	390
Min. Negotiated Rate	$1,899.75
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,452.75
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: MDX Hawaii PPO	$2,167.95

HCHG PLATE PHERES LEUKOREDU IRRAD EA UNIT

Facility

$3,749.00

Service Code	HCPCS P9037
Hospital Charge Code	H3900248
Hospital Revenue Code	390
Min. Negotiated Rate	$506.75
Max. Negotiated Rate	$3,636.53
Rate for Payer: AlohaCare Medicaid	$786.99
Rate for Payer: AlohaCare Medicare	$786.99
Rate for Payer: Cash Price	$2,436.85
Rate for Payer: Cash Price	$2,436.85
Rate for Payer: Devoted Health Medicare	$865.69
Rate for Payer: Hawaii Medical Service Association Commercial	$983.74
Rate for Payer: Hawaii Medical Service Association Medicare	$786.99
Rate for Payer: Hawaii Western Management Group Commercial	$3,561.55
Rate for Payer: Health Management Network Commercial	$3,186.65
Rate for Payer: Humana Medicare	$786.99
Rate for Payer: Kaiser Permanente Commercial	$2,361.87
Rate for Payer: Kaiser Permanente Medicaid	$1,911.99
Rate for Payer: Kaiser Permanente Medicare	$786.99
Rate for Payer: MDX Hawaii PPO	$3,636.53
Rate for Payer: Ohana Health Plan Medicaid	$865.69
Rate for Payer: Ohana Health Plan Medicare	$786.99
Rate for Payer: UnitedHealthcare Medicaid	$506.75
Rate for Payer: UnitedHealthcare Medicare	$786.99
Rate for Payer: University Health Alliance Commercial	$2,732.65

HCHG PLATE PHERES LEUKOREDU IRRAD EA UNIT

Facility

$3,749.00

Service Code	HCPCS P9037
Hospital Charge Code	H3900248
Hospital Revenue Code	390
Min. Negotiated Rate	$3,186.65
Max. Negotiated Rate	$3,636.53
Rate for Payer: Cash Price	$2,436.85
Rate for Payer: Health Management Network Commercial	$3,186.65
Rate for Payer: MDX Hawaii PPO	$3,636.53

HCHG PNEUMOCOCCAL IGG VACC RESP 90

Facility

$167.00

Service Code	HCPCS 86609
Hospital Charge Code	H3020692
Hospital Revenue Code	302
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$108.55
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: MDX Hawaii PPO	$161.99

HCHG PNEUMOCOCCAL IGG VACC RESP 90

Facility

$167.00

Service Code	HCPCS 86609
Hospital Charge Code	H3020692
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$105.21
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG PNEUMOCYSTIS CARINII, FM

Facility

$91.00

Service Code	HCPCS 87281
Hospital Charge Code	H3011626
Hospital Revenue Code	300
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$10.06
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.57
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$10.06
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG PNEUMOCYSTIS CARINII, FM

Facility

$91.00

Service Code	HCPCS 87281
Hospital Charge Code	H3011626
Hospital Revenue Code	300
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

HCHG PNEUMO JIROVECII AG SO

Facility

$162.00

Service Code	HCPCS 87299
Hospital Charge Code	K3060026
Hospital Revenue Code	306
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$16.10
Rate for Payer: AlohaCare Medicare	$16.10
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Devoted Health Medicare	$17.71
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.12
Rate for Payer: Hawaii Medical Service Association Medicare	$16.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.10
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$16.10
Rate for Payer: Kaiser Permanente Commercial	$102.06
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$16.10
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$17.71
Rate for Payer: Ohana Health Plan Medicare	$16.10
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.10
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG PNEUMO JIROVECII AG SO

Facility

$162.00

Service Code	HCPCS 87299
Hospital Charge Code	K3060026
Hospital Revenue Code	306
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$105.30
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$157.14

HCHG PNUEMOCOCCAL AB PNL SO

Facility

$78.00

Service Code	HCPCS 86317
Hospital Charge Code	K3020006
Hospital Revenue Code	302
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$14.99
Rate for Payer: AlohaCare Medicare	$14.99
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Devoted Health Medicare	$16.49
Rate for Payer: Hawaii Medical Service Association ABD	$20.72
Rate for Payer: Hawaii Medical Service Association Commercial	$18.74
Rate for Payer: Hawaii Medical Service Association Medicare	$14.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.76
Rate for Payer: Hawaii Western Management Group Commercial	$14.99
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$14.99
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$14.99
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$16.49
Rate for Payer: Ohana Health Plan Medicare	$14.99
Rate for Payer: UnitedHealthcare Medicaid	$20.72
Rate for Payer: UnitedHealthcare Medicare	$14.99
Rate for Payer: University Health Alliance Commercial	$38.76

HCHG PNUEMOCOCCAL AB PNL SO

Facility

$78.00

Service Code	HCPCS 86317
Hospital Charge Code	K3020006
Hospital Revenue Code	302
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: MDX Hawaii PPO	$75.66

HCHG POCT SKIN TEST TUBERCULOSIS INTRADERMAL

Facility

$187.00

Service Code	HCPCS 86580
Hospital Charge Code	H3021054
Hospital Revenue Code	302
Min. Negotiated Rate	$158.95
Max. Negotiated Rate	$181.39
Rate for Payer: Cash Price	$121.55
Rate for Payer: Health Management Network Commercial	$158.95
Rate for Payer: MDX Hawaii PPO	$181.39

HCHG POCT SKIN TEST TUBERCULOSIS INTRADERMAL

Facility

$187.00

Service Code	HCPCS 86580
Hospital Charge Code	H3021054
Hospital Revenue Code	302
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$181.39
Rate for Payer: AlohaCare Medicaid	$34.17
Rate for Payer: AlohaCare Medicare	$34.17
Rate for Payer: Cash Price	$121.55
Rate for Payer: Cash Price	$121.55
Rate for Payer: Devoted Health Medicare	$37.59
Rate for Payer: Hawaii Medical Service Association ABD	$6.68
Rate for Payer: Hawaii Medical Service Association Commercial	$42.71
Rate for Payer: Hawaii Medical Service Association Medicare	$34.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.23
Rate for Payer: Hawaii Western Management Group Commercial	$34.17
Rate for Payer: Health Management Network Commercial	$158.95
Rate for Payer: Humana Medicare	$34.17
Rate for Payer: Kaiser Permanente Commercial	$117.81
Rate for Payer: Kaiser Permanente Medicaid	$95.37
Rate for Payer: Kaiser Permanente Medicare	$34.17
Rate for Payer: MDX Hawaii PPO	$181.39
Rate for Payer: Ohana Health Plan Medicaid	$37.59
Rate for Payer: Ohana Health Plan Medicare	$34.17
Rate for Payer: UnitedHealthcare Medicaid	$6.68
Rate for Payer: UnitedHealthcare Medicare	$34.17
Rate for Payer: University Health Alliance Commercial	$17.04

HCHG PORPHOBILINOGEN QNT URINE 90

Facility

$109.00

Service Code	HCPCS 84110
Hospital Charge Code	H3011056
Hospital Revenue Code	301
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$8.44
Rate for Payer: AlohaCare Medicare	$8.44
Rate for Payer: Cash Price	$70.85
Rate for Payer: Cash Price	$70.85
Rate for Payer: Devoted Health Medicare	$9.28
Rate for Payer: Hawaii Medical Service Association ABD	$11.68
Rate for Payer: Hawaii Medical Service Association Commercial	$10.55
Rate for Payer: Hawaii Medical Service Association Medicare	$8.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.26
Rate for Payer: Hawaii Western Management Group Commercial	$8.44
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$8.44
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$8.44
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$9.28
Rate for Payer: Ohana Health Plan Medicare	$8.44
Rate for Payer: UnitedHealthcare Medicaid	$11.68
Rate for Payer: UnitedHealthcare Medicare	$8.44
Rate for Payer: University Health Alliance Commercial	$21.83

HCHG PORPHOBILINOGEN QNT URINE 90

Facility

$109.00

Service Code	HCPCS 84110
Hospital Charge Code	H3011056
Hospital Revenue Code	301
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$70.85
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: MDX Hawaii PPO	$105.73

HCHG PORTABLE PUMP REFILL/MAINT

Facility

$1,226.00

Service Code	HCPCS 96521
Hospital Charge Code	H9400124
Hospital Revenue Code	940
Min. Negotiated Rate	$101.13
Max. Negotiated Rate	$1,189.22
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$796.90
Rate for Payer: Cash Price	$796.90
Rate for Payer: Devoted Health Medicare	$276.41
Rate for Payer: Hawaii Medical Service Association Commercial	$314.10
Rate for Payer: Hawaii Medical Service Association Medicare	$251.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.70
Rate for Payer: Health Management Network Commercial	$1,042.10
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$772.38
Rate for Payer: Kaiser Permanente Medicaid	$625.26
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$1,189.22
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicaid	$101.13
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$893.63

HCHG PORTABLE PUMP REFILL/MAINT

Facility

$1,226.00

Service Code	HCPCS 96521
Hospital Charge Code	H9400124
Hospital Revenue Code	940
Min. Negotiated Rate	$1,042.10
Max. Negotiated Rate	$1,189.22
Rate for Payer: Cash Price	$796.90
Rate for Payer: Health Management Network Commercial	$1,042.10
Rate for Payer: MDX Hawaii PPO	$1,189.22

HCHG PORT FILM

Facility

$215.00

Service Code	HCPCS 77417
Hospital Charge Code	H3330144
Hospital Revenue Code	333
Min. Negotiated Rate	$21.11
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$139.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Hawaii Medical Service Association ABD	$21.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.17
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$135.45
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: UnitedHealthcare Medicaid	$21.11
Rate for Payer: University Health Alliance Commercial	$40.50

HCHG PORT FILM

Facility

$215.00

Service Code	HCPCS 77417
Hospital Charge Code	H3330144
Hospital Revenue Code	333
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$139.75
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: MDX Hawaii PPO	$208.55

HCHG PORT / HICK / PICC REMOVE

Facility

$3,214.00

Service Code	HCPCS 36589
Hospital Charge Code	H3600450
Hospital Revenue Code	360
Min. Negotiated Rate	$2,731.90
Max. Negotiated Rate	$3,117.58
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Health Management Network Commercial	$2,731.90
Rate for Payer: MDX Hawaii PPO	$3,117.58

HCHG PORT / HICK / PICC REMOVE

Facility

$3,214.00

Service Code	HCPCS 36589
Hospital Charge Code	H3600450
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,117.58
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Cash Price	$2,089.10
Rate for Payer: Devoted Health Medicare	$815.17
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	$741.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,731.90
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$2,024.82
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$3,117.58
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$2,342.68

HCHG POTASSIUM FECES

Facility

$119.00

Service Code	HCPCS 84999
Hospital Charge Code	H3011072
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 POTASSIUM FECES

Facility

$119.00

Service Code	HCPCS 84999
Hospital Charge Code	H3011072
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 POTASSIUM FECES SO

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	K3010045
Hospital Revenue Code	301
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: MDX Hawaii PPO	$83.42

HCHG POTASSIUM FECES SO

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	K3010045
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$8.10
Rate for Payer: AlohaCare Medicare	$8.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$8.91
Rate for Payer: Hawaii Medical Service Association ABD	$9.66
Rate for Payer: Hawaii Medical Service Association Commercial	$10.12
Rate for Payer: Hawaii Medical Service Association Medicare	$8.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.14
Rate for Payer: Hawaii Western Management Group Commercial	$8.10
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$8.10
Rate for Payer: Kaiser Permanente Commercial	$54.18
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$8.10
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$8.91
Rate for Payer: Ohana Health Plan Medicare	$8.10
Rate for Payer: UnitedHealthcare Medicaid	$9.66
Rate for Payer: UnitedHealthcare Medicare	$8.10
Rate for Payer: University Health Alliance Commercial	$18.07

Know your out-of-pocket cost for care.

All Charges