Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG POTASSIUM SERUM/PLASMA/WHOLE BLOOD

Facility

$78.00

Service Code	HCPCS 84132
Hospital Charge Code	H3011066
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$4.76
Rate for Payer: AlohaCare Medicare	$4.76
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Devoted Health Medicare	$5.24
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$4.76
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$4.76
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$5.24
Rate for Payer: Ohana Health Plan Medicare	$4.76
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$4.76
Rate for Payer: University Health Alliance Commercial	$11.88

HCHG POTASSIUM SERUM/PLASMA/WHOLE BLOOD

Facility

$78.00

Service Code	HCPCS 84132
Hospital Charge Code	H3011066
Hospital Revenue Code	301
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 POTASSIUM-URINE

Facility

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	H3011076
Hospital Revenue Code	301
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: MDX Hawaii PPO	$51.41

HCHG POTASSIUM-URINE

Facility

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	H3011076
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$4.73
Rate for Payer: AlohaCare Medicare	$4.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$5.20
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.91
Rate for Payer: Hawaii Medical Service Association Medicare	$4.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.73
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$4.73
Rate for Payer: Kaiser Permanente Commercial	$33.39
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$4.73
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$5.20
Rate for Payer: Ohana Health Plan Medicare	$4.73
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: UnitedHealthcare Medicare	$4.73
Rate for Payer: University Health Alliance Commercial	$11.12

HCHG PREALBUMIN

Facility

$180.00

Service Code	HCPCS 84134
Hospital Charge Code	H3011078
Hospital Revenue Code	301
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

HCHG PREALBUMIN

Facility

$180.00

Service Code	HCPCS 84134
Hospital Charge Code	H3011078
Hospital Revenue Code	301
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$14.59
Rate for Payer: AlohaCare Medicare	$14.59
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$16.05
Rate for Payer: Hawaii Medical Service Association ABD	$20.16
Rate for Payer: Hawaii Medical Service Association Commercial	$18.24
Rate for Payer: Hawaii Medical Service Association Medicare	$14.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.17
Rate for Payer: Hawaii Western Management Group Commercial	$14.59
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$14.59
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$14.59
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$16.05
Rate for Payer: Ohana Health Plan Medicare	$14.59
Rate for Payer: UnitedHealthcare Medicaid	$20.16
Rate for Payer: UnitedHealthcare Medicare	$14.59
Rate for Payer: University Health Alliance Commercial	$37.70

HCHG PRENATAL HIV 1/2 COMBO

Facility

$342.00

Service Code	HCPCS 87389
Hospital Charge Code	K3060032
Hospital Revenue Code	306
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$331.74
Rate for Payer: AlohaCare Medicaid	$24.08
Rate for Payer: AlohaCare Medicare	$24.08
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cash Price	$222.30
Rate for Payer: Devoted Health Medicare	$26.49
Rate for Payer: Hawaii Medical Service Association ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$24.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Humana Medicare	$24.08
Rate for Payer: Kaiser Permanente Commercial	$215.46
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: Kaiser Permanente Medicare	$24.08
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: Ohana Health Plan Medicaid	$26.49
Rate for Payer: Ohana Health Plan Medicare	$24.08
Rate for Payer: UnitedHealthcare Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$24.08
Rate for Payer: University Health Alliance Commercial	$63.12

HCHG PRENATAL HIV 1/2 COMBO

Facility

$342.00

Service Code	HCPCS 87389
Hospital Charge Code	K3060032
Hospital Revenue Code	306
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$222.30
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: MDX Hawaii PPO	$331.74

HCHG PRE-NOTIFICATION FULL TRAUMA

Facility

$5,998.00

Service Code	HCPCS G0390
Hospital Charge Code	H6820102
Hospital Revenue Code	681
Min. Negotiated Rate	$5,098.30
Max. Negotiated Rate	$5,818.06
Rate for Payer: Cash Price	$3,898.70
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: MDX Hawaii PPO	$5,818.06

HCHG PRE-NOTIFICATION FULL TRAUMA

Facility

$5,998.00

Service Code	HCPCS G0390
Hospital Charge Code	H6820102
Hospital Revenue Code	681
Min. Negotiated Rate	$992.38
Max. Negotiated Rate	$5,818.06
Rate for Payer: AlohaCare Medicaid	$1,574.63
Rate for Payer: AlohaCare Medicare	$1,574.63
Rate for Payer: Cash Price	$3,898.70
Rate for Payer: Cash Price	$3,898.70
Rate for Payer: Devoted Health Medicare	$1,732.09
Rate for Payer: Hawaii Medical Service Association Commercial	$1,968.29
Rate for Payer: Hawaii Medical Service Association Medicare	$1,574.63
Rate for Payer: Hawaii Western Management Group Commercial	$5,698.10
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: Humana Medicare	$1,574.63
Rate for Payer: Kaiser Permanente Commercial	$3,778.74
Rate for Payer: Kaiser Permanente Medicaid	$3,058.98
Rate for Payer: Kaiser Permanente Medicare	$1,574.63
Rate for Payer: MDX Hawaii PPO	$5,818.06
Rate for Payer: Ohana Health Plan Medicaid	$1,732.09
Rate for Payer: Ohana Health Plan Medicare	$1,574.63
Rate for Payer: UnitedHealthcare Medicaid	$992.38
Rate for Payer: UnitedHealthcare Medicare	$1,574.63
Rate for Payer: University Health Alliance Commercial	$4,371.94

HCHG PRE-NOTIFICATION MODIFIED TRAUMA

Facility

$5,998.00

Service Code	HCPCS G0390
Hospital Charge Code	H6820104
Hospital Revenue Code	681
Min. Negotiated Rate	$5,098.30
Max. Negotiated Rate	$5,818.06
Rate for Payer: Cash Price	$3,898.70
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: MDX Hawaii PPO	$5,818.06

HCHG PRE-NOTIFICATION MODIFIED TRAUMA

Facility

$5,998.00

Service Code	HCPCS G0390
Hospital Charge Code	H6820104
Hospital Revenue Code	681
Min. Negotiated Rate	$992.38
Max. Negotiated Rate	$5,818.06
Rate for Payer: AlohaCare Medicaid	$1,574.63
Rate for Payer: AlohaCare Medicare	$1,574.63
Rate for Payer: Cash Price	$3,898.70
Rate for Payer: Cash Price	$3,898.70
Rate for Payer: Devoted Health Medicare	$1,732.09
Rate for Payer: Hawaii Medical Service Association Commercial	$1,968.29
Rate for Payer: Hawaii Medical Service Association Medicare	$1,574.63
Rate for Payer: Hawaii Western Management Group Commercial	$5,698.10
Rate for Payer: Health Management Network Commercial	$5,098.30
Rate for Payer: Humana Medicare	$1,574.63
Rate for Payer: Kaiser Permanente Commercial	$3,778.74
Rate for Payer: Kaiser Permanente Medicaid	$3,058.98
Rate for Payer: Kaiser Permanente Medicare	$1,574.63
Rate for Payer: MDX Hawaii PPO	$5,818.06
Rate for Payer: Ohana Health Plan Medicaid	$1,732.09
Rate for Payer: Ohana Health Plan Medicare	$1,574.63
Rate for Payer: UnitedHealthcare Medicaid	$992.38
Rate for Payer: UnitedHealthcare Medicare	$1,574.63
Rate for Payer: University Health Alliance Commercial	$4,371.94

HCHG PRETERM LABOR TRMT ADDL HR

Facility

$406.00

Hospital Charge Code	K7210004
Hospital Revenue Code	721
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$393.82
Rate for Payer: Cash Price	$263.90
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: MDX Hawaii PPO	$393.82

HCHG PRETERM LABOR TRMT ADDL HR

Facility

$406.00

Hospital Charge Code	K7210004
Hospital Revenue Code	721
Min. Negotiated Rate	$207.06
Max. Negotiated Rate	$393.82
Rate for Payer: Cash Price	$263.90
Rate for Payer: Hawaii Western Management Group Commercial	$385.70
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: Kaiser Permanente Commercial	$255.78
Rate for Payer: Kaiser Permanente Medicaid	$207.06
Rate for Payer: MDX Hawaii PPO	$393.82
Rate for Payer: University Health Alliance Commercial	$295.93

HCHG PRETERM LABOR TRMT INITIAL HR

Facility

$541.00

Hospital Charge Code	K7210005
Hospital Revenue Code	721
Min. Negotiated Rate	$275.91
Max. Negotiated Rate	$524.77
Rate for Payer: Cash Price	$351.65
Rate for Payer: Hawaii Western Management Group Commercial	$513.95
Rate for Payer: Health Management Network Commercial	$459.85
Rate for Payer: Kaiser Permanente Commercial	$340.83
Rate for Payer: Kaiser Permanente Medicaid	$275.91
Rate for Payer: MDX Hawaii PPO	$524.77
Rate for Payer: University Health Alliance Commercial	$394.33

HCHG PRETERM LABOR TRMT INITIAL HR

Facility

$541.00

Hospital Charge Code	K7210005
Hospital Revenue Code	721
Min. Negotiated Rate	$459.85
Max. Negotiated Rate	$524.77
Rate for Payer: Cash Price	$351.65
Rate for Payer: Health Management Network Commercial	$459.85
Rate for Payer: MDX Hawaii PPO	$524.77

HCHG PRETREAT INCUBATION W DRUGS EA SO

Facility

$631.00

Service Code	HCPCS 86975
Hospital Charge Code	K3020020
Hospital Revenue Code	302
Min. Negotiated Rate	$536.35
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$410.15
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: MDX Hawaii PPO	$612.07

HCHG PRETREAT INCUBATION W DRUGS EA SO

Facility

$631.00

Service Code	HCPCS 86975
Hospital Charge Code	K3020020
Hospital Revenue Code	302
Min. Negotiated Rate	$299.28
Max. Negotiated Rate	$659.67
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$410.15
Rate for Payer: Cash Price	$410.15
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: Hawaii Western Management Group Commercial	$527.74
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$397.53
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicaid	$299.28
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$459.94

HCHG PRETREAT RBC W DRUGS SO

Facility

$230.00

Service Code	HCPCS 86970
Hospital Charge Code	K3000003
Hospital Revenue Code	300
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$76.66
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$69.69
Rate for Payer: Hawaii Western Management Group Commercial	$69.69
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicaid	$44.55
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$167.65

HCHG PRETREAT RBC W DRUGS SO

Facility

$230.00

Service Code	HCPCS 86970
Hospital Charge Code	K3000003
Hospital Revenue Code	300
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: MDX Hawaii PPO	$223.10

HCHG PROCALCITONIN

Facility

$380.00

Service Code	HCPCS 84145
Hospital Charge Code	H3011547
Hospital Revenue Code	301
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$247.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: MDX Hawaii PPO	$368.60

HCHG PROCALCITONIN

Facility

$380.00

Service Code	HCPCS 84145
Hospital Charge Code	H3011547
Hospital Revenue Code	301
Min. Negotiated Rate	$27.22
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$27.22
Rate for Payer: AlohaCare Medicare	$27.22
Rate for Payer: Cash Price	$247.00
Rate for Payer: Cash Price	$247.00
Rate for Payer: Devoted Health Medicare	$29.94
Rate for Payer: Hawaii Medical Service Association ABD	$27.76
Rate for Payer: Hawaii Medical Service Association Commercial	$34.02
Rate for Payer: Hawaii Medical Service Association Medicare	$27.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$27.22
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$27.22
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$27.22
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$29.94
Rate for Payer: Ohana Health Plan Medicare	$27.22
Rate for Payer: UnitedHealthcare Medicaid	$27.76
Rate for Payer: UnitedHealthcare Medicare	$27.22
Rate for Payer: University Health Alliance Commercial	$51.36

HCHG PROGESTERONE

Facility

$257.00

Service Code	HCPCS 84144
Hospital Charge Code	H3011086
Hospital Revenue Code	301
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$167.05
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: MDX Hawaii PPO	$249.29

HCHG PROGESTERONE

Facility

$257.00

Service Code	HCPCS 84144
Hospital Charge Code	H3011086
Hospital Revenue Code	301
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$20.86
Rate for Payer: AlohaCare Medicare	$20.86
Rate for Payer: Cash Price	$167.05
Rate for Payer: Cash Price	$167.05
Rate for Payer: Devoted Health Medicare	$22.95
Rate for Payer: Hawaii Medical Service Association ABD	$28.83
Rate for Payer: Hawaii Medical Service Association Commercial	$26.07
Rate for Payer: Hawaii Medical Service Association Medicare	$20.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.27
Rate for Payer: Hawaii Western Management Group Commercial	$20.86
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$20.86
Rate for Payer: Kaiser Permanente Commercial	$161.91
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$20.86
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$22.95
Rate for Payer: Ohana Health Plan Medicare	$20.86
Rate for Payer: UnitedHealthcare Medicaid	$28.83
Rate for Payer: UnitedHealthcare Medicare	$20.86
Rate for Payer: University Health Alliance Commercial	$53.93

HCHG PROINSULIN

Facility

$230.00

Service Code	HCPCS 84206
Hospital Charge Code	H3011380
Hospital Revenue Code	301
Min. Negotiated Rate	$23.03
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$26.69
Rate for Payer: AlohaCare Medicare	$26.69
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$29.36
Rate for Payer: Hawaii Medical Service Association ABD	$23.03
Rate for Payer: Hawaii Medical Service Association Commercial	$33.36
Rate for Payer: Hawaii Medical Service Association Medicare	$26.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.61
Rate for Payer: Hawaii Western Management Group Commercial	$26.69
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$26.69
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$26.69
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$29.36
Rate for Payer: Ohana Health Plan Medicare	$26.69
Rate for Payer: UnitedHealthcare Medicaid	$23.03
Rate for Payer: UnitedHealthcare Medicare	$26.69
Rate for Payer: University Health Alliance Commercial	$46.05

Know your out-of-pocket cost for care.

All Charges