Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG PT INIT EVAL LOW

Facility

$583.00

Service Code	HCPCS 97161
Hospital Charge Code	H4240135
Hospital Revenue Code	424
Min. Negotiated Rate	$495.55
Max. Negotiated Rate	$565.51
Rate for Payer: Cash Price	$378.95
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: MDX Hawaii PPO	$565.51

HCHG PT INIT EVAL LOW

Facility

$583.00

Service Code	HCPCS 97161
Hospital Charge Code	H4240135
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$565.51
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cash Price	$378.95
Rate for Payer: Hawaii Western Management Group Commercial	$553.85
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: Kaiser Permanente Commercial	$367.29
Rate for Payer: Kaiser Permanente Medicaid	$297.33
Rate for Payer: MDX Hawaii PPO	$565.51
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: University Health Alliance Commercial	$424.95

HCHG PT INIT EVAL MOD

Facility

$620.00

Service Code	HCPCS 97162
Hospital Charge Code	H4240137
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 MOD

Facility

$620.00

Service Code	HCPCS 97162
Hospital Charge Code	H4240137
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

HCHG PT MANUAL THERAPY 15 MIN

Facility

$194.00

Service Code	HCPCS 97140
Hospital Charge Code	H4200108
Hospital Revenue Code	420
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$126.10
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: MDX Hawaii PPO	$188.18

HCHG PT MANUAL THERAPY 15 MIN

Facility

$194.00

Service Code	HCPCS 97140
Hospital Charge Code	H4200108
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Hawaii Western Management Group Commercial	$184.30
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: UnitedHealthcare Medicaid	$20.55
Rate for Payer: University Health Alliance Commercial	$141.41

HCHG PT MASSAGE 15 MIN

Facility

$161.00

Service Code	HCPCS 97124
Hospital Charge Code	H4200148
Hospital Revenue Code	420
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG PT MASSAGE 15 MIN

Facility

$161.00

Service Code	HCPCS 97124
Hospital Charge Code	H4200148
Hospital Revenue Code	420
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Hawaii Western Management Group Commercial	$152.95
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: UnitedHealthcare Medicaid	$15.39
Rate for Payer: University Health Alliance Commercial	$117.35

HCHG PT NEUROMUSC RE-ED 15 MIN

Facility

$225.00

Service Code	HCPCS 97112
Hospital Charge Code	H4200260
Hospital Revenue Code	420
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 PT NEUROMUSC RE-ED 15 MIN

Facility

$225.00

Service Code	HCPCS 97112
Hospital Charge Code	H4200260
Hospital Revenue Code	420
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: University Health Alliance Commercial	$164.00

HCHG PT PROSTHETIC TRAINING 15 MIN

Facility

$193.00

Service Code	HCPCS 97761
Hospital Charge Code	H4200465
Hospital Revenue Code	420
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$183.35
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$121.59
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: UnitedHealthcare Medicaid	$17.70
Rate for Payer: University Health Alliance Commercial	$140.68

HCHG PT PROSTHETIC TRAINING 15 MIN

Facility

$193.00

Service Code	HCPCS 97761
Hospital Charge Code	H4200465
Hospital Revenue Code	420
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: MDX Hawaii PPO	$187.21

HCHG PT RE-EVAL

Facility

$413.00

Service Code	HCPCS 97164
Hospital Charge Code	H4240147
Hospital Revenue Code	424
Min. Negotiated Rate	$351.05
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$268.45
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: MDX Hawaii PPO	$400.61

HCHG PT RE-EVAL

Facility

$413.00

Service Code	HCPCS 97164
Hospital Charge Code	H4240147
Hospital Revenue Code	424
Min. Negotiated Rate	$74.59
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$268.45
Rate for Payer: Cash Price	$268.45
Rate for Payer: Hawaii Western Management Group Commercial	$392.35
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$260.19
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: UnitedHealthcare Medicaid	$74.59
Rate for Payer: University Health Alliance Commercial	$301.04

HCHG PT THER ADAPT FU 15 MIN

Facility

$326.00

Service Code	HCPCS 97763
Hospital Charge Code	H4200483
Hospital Revenue Code	420
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$316.22
Rate for Payer: Cash Price	$211.90
Rate for Payer: Cash Price	$211.90
Rate for Payer: Hawaii Western Management Group Commercial	$309.70
Rate for Payer: Health Management Network Commercial	$277.10
Rate for Payer: Kaiser Permanente Commercial	$205.38
Rate for Payer: Kaiser Permanente Medicaid	$166.26
Rate for Payer: MDX Hawaii PPO	$316.22
Rate for Payer: UnitedHealthcare Medicaid	$57.47
Rate for Payer: University Health Alliance Commercial	$237.62

HCHG PT THER ADAPT FU 15 MIN

Facility

$326.00

Service Code	HCPCS 97763
Hospital Charge Code	H4200483
Hospital Revenue Code	420
Min. Negotiated Rate	$277.10
Max. Negotiated Rate	$316.22
Rate for Payer: Cash Price	$211.90
Rate for Payer: Health Management Network Commercial	$277.10
Rate for Payer: MDX Hawaii PPO	$316.22

HCHG PT THERAPEUTIC ACTIV 15 MIN

Facility

$246.00

Service Code	HCPCS 97530
Hospital Charge Code	H4200268
Hospital Revenue Code	420
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$154.98
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: University Health Alliance Commercial	$179.31

HCHG PT THERAPEUTIC ACTIV 15 MIN

Facility

$246.00

Service Code	HCPCS 97530
Hospital Charge Code	H4200268
Hospital Revenue Code	420
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: MDX Hawaii PPO	$238.62

HCHG PTT (INHIBITOR SCRN)

Facility

$44.00

Service Code	HCPCS 85730
Hospital Charge Code	H3050234
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$6.01
Rate for Payer: AlohaCare Medicare	$6.01
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Devoted Health Medicare	$6.61
Rate for Payer: Hawaii Medical Service Association ABD	$8.30
Rate for Payer: Hawaii Medical Service Association Commercial	$7.51
Rate for Payer: Hawaii Medical Service Association Medicare	$6.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.01
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$6.01
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$6.01
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$6.61
Rate for Payer: Ohana Health Plan Medicare	$6.01
Rate for Payer: UnitedHealthcare Medicaid	$8.30
Rate for Payer: UnitedHealthcare Medicare	$6.01
Rate for Payer: University Health Alliance Commercial	$15.50

HCHG PTT (INHIBITOR SCRN)

Facility

$44.00

Service Code	HCPCS 85730
Hospital Charge Code	H3050234
Hospital Revenue Code	305
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 PTT MIX/INCUB PTT MIX

Facility

$64.00

Service Code	HCPCS 85732
Hospital Charge Code	H3050238
Hospital Revenue Code	305
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: MDX Hawaii PPO	$62.08

HCHG PTT MIX/INCUB PTT MIX

Facility

$64.00

Service Code	HCPCS 85732
Hospital Charge Code	H3050238
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$62.08
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$40.32
Rate for Payer: Kaiser Permanente Medicaid	$32.64
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$62.08
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$16.72

HCHG PT WHEELCHAIR MGT 15 MIN

Facility

$213.00

Service Code	HCPCS 97542
Hospital Charge Code	H4200288
Hospital Revenue Code	420
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$138.45
Rate for Payer: Cash Price	$138.45
Rate for Payer: Hawaii Western Management Group Commercial	$202.35
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$134.19
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: UnitedHealthcare Medicaid	$17.54
Rate for Payer: University Health Alliance Commercial	$155.26

HCHG PT WHEELCHAIR MGT 15 MIN

Facility

$213.00

Service Code	HCPCS 97542
Hospital Charge Code	H4200288
Hospital Revenue Code	420
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$138.45
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

HCHG PULMONARY STRESS TEST

Facility

$714.00

Service Code	HCPCS 94618
Hospital Charge Code	H4600138
Hospital Revenue Code	460
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$692.58
Rate for Payer: Cash Price	$464.10
Rate for Payer: Health Management Network Commercial	$606.90
Rate for Payer: MDX Hawaii PPO	$692.58

Know your out-of-pocket cost for care.

All Charges