Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG PT CANALITH REPOSITIONING PROCEDURE

Facility

$208.00

Service Code	HCPCS 95992
Hospital Charge Code	H4200454
Hospital Revenue Code	420
Min. Negotiated Rate	$25.72
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: UnitedHealthcare Medicaid	$25.72
Rate for Payer: University Health Alliance Commercial	$151.61

HCHG PT ELEC STIM ATT 15 MIN

Facility

$105.00

Service Code	HCPCS 97032
Hospital Charge Code	H4200116
Hospital Revenue Code	420
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Hawaii Western Management Group Commercial	$99.75
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$66.15
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: UnitedHealthcare Medicaid	$13.64
Rate for Payer: University Health Alliance Commercial	$76.53

HCHG PT ELEC STIM ATT 15 MIN

Facility

$105.00

Service Code	HCPCS 97032
Hospital Charge Code	H4200116
Hospital Revenue Code	420
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: MDX Hawaii PPO	$101.85

HCHG PT ELEC STIM UNATT

Facility

$127.00

Service Code	HCPCS 97014
Hospital Charge Code	H4200192
Hospital Revenue Code	420
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: MDX Hawaii PPO	$123.19

HCHG PT ELEC STIM UNATT

Facility

$127.00

Service Code	HCPCS 97014
Hospital Charge Code	H4200192
Hospital Revenue Code	420
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$80.01
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: UnitedHealthcare Medicaid	$11.85
Rate for Payer: University Health Alliance Commercial	$92.57

HCHG PT EXERCISE 15 MIN

Facility

$209.00

Service Code	HCPCS 97110
Hospital Charge Code	H4200122
Hospital Revenue Code	420
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: MDX Hawaii PPO	$202.73

HCHG PT EXERCISE 15 MIN

Facility

$209.00

Service Code	HCPCS 97110
Hospital Charge Code	H4200122
Hospital Revenue Code	420
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$131.67
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: University Health Alliance Commercial	$152.34

HCHG PT-FOCUSED HLTH RISK ASSMT

Facility

$124.00

Service Code	HCPCS 96160
Hospital Charge Code	H4501159
Hospital Revenue Code	450
Min. Negotiated Rate	$44.26
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$44.26
Rate for Payer: AlohaCare Medicare	$44.26
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Devoted Health Medicare	$48.69
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 Medicare	$44.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$44.26
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$44.26
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$48.69
Rate for Payer: Ohana Health Plan Medicare	$44.26
Rate for Payer: UnitedHealthcare Medicare	$44.26
Rate for Payer: University Health Alliance Commercial	$90.38

HCHG PT-FOCUSED HLTH RISK ASSMT

Facility

$124.00

Service Code	HCPCS 96160
Hospital Charge Code	H4501159
Hospital Revenue Code	450
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$80.60
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: MDX Hawaii PPO	$120.28

HCHG PT GAIT TRAINING 15 MIN

Facility

$199.00

Service Code	HCPCS 97116
Hospital Charge Code	H4200132
Hospital Revenue Code	420
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$193.03
Rate for Payer: Cash Price	$129.35
Rate for Payer: Cash Price	$129.35
Rate for Payer: Hawaii Western Management Group Commercial	$189.05
Rate for Payer: Health Management Network Commercial	$169.15
Rate for Payer: Kaiser Permanente Commercial	$125.37
Rate for Payer: Kaiser Permanente Medicaid	$101.49
Rate for Payer: MDX Hawaii PPO	$193.03
Rate for Payer: UnitedHealthcare Medicaid	$16.70
Rate for Payer: University Health Alliance Commercial	$145.05

HCHG PT GAIT TRAINING 15 MIN

Facility

$199.00

Service Code	HCPCS 97116
Hospital Charge Code	H4200132
Hospital Revenue Code	420
Min. Negotiated Rate	$169.15
Max. Negotiated Rate	$193.03
Rate for Payer: Cash Price	$129.35
Rate for Payer: Health Management Network Commercial	$169.15
Rate for Payer: MDX Hawaii PPO	$193.03

HCHG PTH INTACT

Facility

$507.00

Service Code	HCPCS 83970
Hospital Charge Code	H3010792
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$491.79
Rate for Payer: AlohaCare Medicaid	$41.28
Rate for Payer: AlohaCare Medicare	$41.28
Rate for Payer: Cash Price	$329.55
Rate for Payer: Cash Price	$329.55
Rate for Payer: Devoted Health Medicare	$45.41
Rate for Payer: Hawaii Medical Service Association ABD	$57.04
Rate for Payer: Hawaii Medical Service Association Commercial	$51.60
Rate for Payer: Hawaii Medical Service Association Medicare	$41.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.89
Rate for Payer: Hawaii Western Management Group Commercial	$41.28
Rate for Payer: Health Management Network Commercial	$430.95
Rate for Payer: Humana Medicare	$41.28
Rate for Payer: Kaiser Permanente Commercial	$319.41
Rate for Payer: Kaiser Permanente Medicaid	$258.57
Rate for Payer: Kaiser Permanente Medicare	$41.28
Rate for Payer: MDX Hawaii PPO	$491.79
Rate for Payer: Ohana Health Plan Medicaid	$45.41
Rate for Payer: Ohana Health Plan Medicare	$41.28
Rate for Payer: UnitedHealthcare Medicaid	$57.04
Rate for Payer: UnitedHealthcare Medicare	$41.28
Rate for Payer: University Health Alliance Commercial	$106.69

HCHG PTH INTACT

Facility

$507.00

Service Code	HCPCS 83970
Hospital Charge Code	H3010792
Hospital Revenue Code	301
Min. Negotiated Rate	$430.95
Max. Negotiated Rate	$491.79
Rate for Payer: Cash Price	$329.55
Rate for Payer: Health Management Network Commercial	$430.95
Rate for Payer: MDX Hawaii PPO	$491.79

HCHG PTH, INTACT (IRMA)

Facility

$507.00

Service Code	HCPCS 83970
Hospital Charge Code	H3011114
Hospital Revenue Code	301
Min. Negotiated Rate	$430.95
Max. Negotiated Rate	$491.79
Rate for Payer: Cash Price	$329.55
Rate for Payer: Health Management Network Commercial	$430.95
Rate for Payer: MDX Hawaii PPO	$491.79

HCHG PTH, INTACT (IRMA)

Facility

$507.00

Service Code	HCPCS 83970
Hospital Charge Code	H3011114
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$491.79
Rate for Payer: AlohaCare Medicaid	$41.28
Rate for Payer: AlohaCare Medicare	$41.28
Rate for Payer: Cash Price	$329.55
Rate for Payer: Cash Price	$329.55
Rate for Payer: Devoted Health Medicare	$45.41
Rate for Payer: Hawaii Medical Service Association ABD	$57.04
Rate for Payer: Hawaii Medical Service Association Commercial	$51.60
Rate for Payer: Hawaii Medical Service Association Medicare	$41.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.89
Rate for Payer: Hawaii Western Management Group Commercial	$41.28
Rate for Payer: Health Management Network Commercial	$430.95
Rate for Payer: Humana Medicare	$41.28
Rate for Payer: Kaiser Permanente Commercial	$319.41
Rate for Payer: Kaiser Permanente Medicaid	$258.57
Rate for Payer: Kaiser Permanente Medicare	$41.28
Rate for Payer: MDX Hawaii PPO	$491.79
Rate for Payer: Ohana Health Plan Medicaid	$45.41
Rate for Payer: Ohana Health Plan Medicare	$41.28
Rate for Payer: UnitedHealthcare Medicaid	$57.04
Rate for Payer: UnitedHealthcare Medicare	$41.28
Rate for Payer: University Health Alliance Commercial	$106.69

HCHG PTH-RELATED PROTEIN

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3011118
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association ABD	$18.67
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.60
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$114.66
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$18.67
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG PTH-RELATED PROTEIN

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3011118
Hospital Revenue Code	301
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: MDX Hawaii PPO	$176.54

HCHG PTH-RELATED PROTEIN 90

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	H3011120
Hospital Revenue Code	301
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

HCHG PTH-RELATED PROTEIN 90

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	H3011120
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$18.64
Rate for Payer: AlohaCare Medicare	$18.64
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$20.50
Rate for Payer: Hawaii Medical Service Association ABD	$18.92
Rate for Payer: Hawaii Medical Service Association Commercial	$23.30
Rate for Payer: Hawaii Medical Service Association Medicare	$18.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$18.64
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$18.64
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$18.64
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$18.64
Rate for Payer: UnitedHealthcare Medicaid	$18.92
Rate for Payer: UnitedHealthcare Medicare	$18.64
Rate for Payer: University Health Alliance Commercial	$35.39

HCHG PT IND DAILY LIV SKILLS 15 MIN

Facility

$226.00

Service Code	HCPCS 97535
Hospital Charge Code	H4200464
Hospital Revenue Code	420
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Cash Price	$146.90
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: University Health Alliance Commercial	$164.73

HCHG PT IND DAILY LIV SKILLS 15 MIN

Facility

$226.00

Service Code	HCPCS 97535
Hospital Charge Code	H4200464
Hospital Revenue Code	420
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: MDX Hawaii PPO	$219.22

HCHG PT (INHIBITOR SCRN)

Facility

$55.00

Service Code	HCPCS 85610
Hospital Charge Code	H3000372
Hospital Revenue Code	300
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$35.75
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: MDX Hawaii PPO	$53.35

HCHG PT (INHIBITOR SCRN)

Facility

$55.00

Service Code	HCPCS 85610
Hospital Charge Code	H3000372
Hospital Revenue Code	300
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$4.29
Rate for Payer: AlohaCare Medicare	$4.29
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$4.72
Rate for Payer: Hawaii Medical Service Association ABD	$5.43
Rate for Payer: Hawaii Medical Service Association Commercial	$5.36
Rate for Payer: Hawaii Medical Service Association Medicare	$4.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.29
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$4.29
Rate for Payer: Kaiser Permanente Commercial	$34.65
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$4.29
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$4.72
Rate for Payer: Ohana Health Plan Medicare	$4.29
Rate for Payer: UnitedHealthcare Medicaid	$5.43
Rate for Payer: UnitedHealthcare Medicare	$4.29
Rate for Payer: University Health Alliance Commercial	$10.16

HCHG PT INIT EVAL HIGH

Facility

$620.00

Service Code	HCPCS 97163
Hospital Charge Code	H4240140
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$601.40
Rate for Payer: Cash Price	$403.00
Rate for Payer: Cash Price	$403.00
Rate for Payer: Hawaii Western Management Group Commercial	$589.00
Rate for Payer: Health Management Network Commercial	$527.00
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: Kaiser Permanente Medicaid	$316.20
Rate for Payer: MDX Hawaii PPO	$601.40
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: University Health Alliance Commercial	$451.92

HCHG PT INIT EVAL HIGH

Facility

$620.00

Service Code	HCPCS 97163
Hospital Charge Code	H4240140
Hospital Revenue Code	424
Min. Negotiated Rate	$527.00
Max. Negotiated Rate	$601.40
Rate for Payer: Cash Price	$403.00
Rate for Payer: Health Management Network Commercial	$527.00
Rate for Payer: MDX Hawaii PPO	$601.40

Know your out-of-pocket cost for care.

All Charges