Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG RBC LEUKOREDUCED IRRADIATED EA UNIT

Facility

$1,632.00

Service Code	HCPCS P9040
Hospital Charge Code	H3900246
Hospital Revenue Code	390
Min. Negotiated Rate	$191.85
Max. Negotiated Rate	$1,583.04
Rate for Payer: AlohaCare Medicaid	$306.89
Rate for Payer: AlohaCare Medicare	$306.89
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Cash Price	$1,060.80
Rate for Payer: Devoted Health Medicare	$337.58
Rate for Payer: Hawaii Medical Service Association Commercial	$383.61
Rate for Payer: Hawaii Medical Service Association Medicare	$306.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,550.40
Rate for Payer: Health Management Network Commercial	$1,387.20
Rate for Payer: Humana Medicare	$306.89
Rate for Payer: Kaiser Permanente Commercial	$1,028.16
Rate for Payer: Kaiser Permanente Medicaid	$832.32
Rate for Payer: Kaiser Permanente Medicare	$306.89
Rate for Payer: MDX Hawaii PPO	$1,583.04
Rate for Payer: Ohana Health Plan Medicaid	$337.58
Rate for Payer: Ohana Health Plan Medicare	$306.89
Rate for Payer: UnitedHealthcare Medicaid	$191.85
Rate for Payer: UnitedHealthcare Medicare	$306.89
Rate for Payer: University Health Alliance Commercial	$1,189.56

HCHG RECOVERY EACH 15 MIN

Facility

$78.00

Hospital Charge Code	K7100000
Hospital Revenue Code	710
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$49.14
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: University Health Alliance Commercial	$56.85

HCHG RECOVERY EACH 15 MIN

Facility

$78.00

Hospital Charge Code	K7100000
Hospital Revenue Code	710
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 RECOVERY EACH ADDITIONAL 15 MIN

Facility

$99.00

Hospital Charge Code	K7100002
Hospital Revenue Code	710
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: University Health Alliance Commercial	$72.16

HCHG RECOVERY EACH ADDITIONAL 15 MIN

Facility

$99.00

Hospital Charge Code	K7100002
Hospital Revenue Code	710
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

HCHG RECOVERY FIRST 15 MIN

Facility

$161.00

Hospital Charge Code	K7100001
Hospital Revenue Code	710
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 RECOVERY FIRST 15 MIN

Facility

$161.00

Hospital Charge Code	K7100001
Hospital Revenue Code	710
Min. Negotiated Rate	$82.11
Max. Negotiated Rate	$156.17
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: University Health Alliance Commercial	$117.35

HCHG REDUCTION OF PROCIDENTIA UNDER ANESTH

Facility

$4,631.00

Service Code	HCPCS 45900
Hospital Charge Code	H4501099
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,492.07
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$3,010.15
Rate for Payer: Cash Price	$3,010.15
Rate for Payer: Cash Price	$3,010.15
Rate for Payer: Cash Price	$3,010.15
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,399.45
Rate for Payer: Health Management Network Commercial	$3,936.35
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,917.53
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$4,492.07
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$3,375.54

HCHG REDUCTION OF PROCIDENTIA UNDER ANESTH

Facility

$4,631.00

Service Code	HCPCS 45900
Hospital Charge Code	H4501099
Hospital Revenue Code	450
Min. Negotiated Rate	$3,936.35
Max. Negotiated Rate	$4,492.07
Rate for Payer: Cash Price	$3,010.15
Rate for Payer: Health Management Network Commercial	$3,936.35
Rate for Payer: MDX Hawaii PPO	$4,492.07

HCHG REFERENCE CONSULT 90

Facility

$283.00

Service Code	HCPCS 88321
Hospital Charge Code	H3120194
Hospital Revenue Code	312
Min. Negotiated Rate	$44.12
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$44.12
Rate for Payer: Cash Price	$183.95
Rate for Payer: Cash Price	$183.95
Rate for Payer: Devoted Health Medicare	$48.53
Rate for Payer: Hawaii Medical Service Association ABD	$72.29
Rate for Payer: Hawaii Medical Service Association Commercial	$55.15
Rate for Payer: Hawaii Medical Service Association Medicare	$44.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70.99
Rate for Payer: Hawaii Western Management Group Commercial	$44.12
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$44.12
Rate for Payer: Kaiser Permanente Commercial	$178.29
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$44.12
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$48.53
Rate for Payer: Ohana Health Plan Medicare	$44.12
Rate for Payer: UnitedHealthcare Medicaid	$70.99
Rate for Payer: UnitedHealthcare Medicare	$44.12
Rate for Payer: University Health Alliance Commercial	$164.21

HCHG REFERENCE CONSULT 90

Facility

$283.00

Service Code	HCPCS 88321
Hospital Charge Code	H3120194
Hospital Revenue Code	312
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$183.95
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: MDX Hawaii PPO	$274.51

HCHG REFERENCE CONSULT & REPORT 90

Facility

$314.00

Service Code	HCPCS 88323
Hospital Charge Code	H3120192
Hospital Revenue Code	312
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$304.58
Rate for Payer: AlohaCare Medicaid	$61.56
Rate for Payer: AlohaCare Medicare	$61.56
Rate for Payer: Cash Price	$204.10
Rate for Payer: Cash Price	$204.10
Rate for Payer: Devoted Health Medicare	$67.72
Rate for Payer: Hawaii Medical Service Association ABD	$31.88
Rate for Payer: Hawaii Medical Service Association Commercial	$76.95
Rate for Payer: Hawaii Medical Service Association Medicare	$61.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.51
Rate for Payer: Hawaii Western Management Group Commercial	$61.56
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: Humana Medicare	$61.56
Rate for Payer: Kaiser Permanente Commercial	$197.82
Rate for Payer: Kaiser Permanente Medicaid	$160.14
Rate for Payer: Kaiser Permanente Medicare	$61.56
Rate for Payer: MDX Hawaii PPO	$304.58
Rate for Payer: Ohana Health Plan Medicaid	$67.72
Rate for Payer: Ohana Health Plan Medicare	$61.56
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: UnitedHealthcare Medicare	$61.56
Rate for Payer: University Health Alliance Commercial	$277.37

HCHG REFERENCE CONSULT & REPORT 90

Facility

$314.00

Service Code	HCPCS 88323
Hospital Charge Code	H3120192
Hospital Revenue Code	312
Min. Negotiated Rate	$266.90
Max. Negotiated Rate	$304.58
Rate for Payer: Cash Price	$204.10
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: MDX Hawaii PPO	$304.58

HCHG REMOVAL FOREIGN BODY INTRAOCCULAR

Facility

$9,088.00

Service Code	HCPCS 65235
Hospital Charge Code	H4501119
Hospital Revenue Code	450
Min. Negotiated Rate	$7,724.80
Max. Negotiated Rate	$8,815.36
Rate for Payer: Cash Price	$5,907.20
Rate for Payer: Health Management Network Commercial	$7,724.80
Rate for Payer: MDX Hawaii PPO	$8,815.36

HCHG REMOVAL FOREIGN BODY INTRAOCCULAR

Facility

$9,088.00

Service Code	HCPCS 65235
Hospital Charge Code	H4501119
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$2,726.34
Rate for Payer: AlohaCare Medicare	$2,726.34
Rate for Payer: Cash Price	$5,907.20
Rate for Payer: Cash Price	$5,907.20
Rate for Payer: Cash Price	$5,907.20
Rate for Payer: Devoted Health Medicare	$2,998.97
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	$2,726.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Hawaii Western Management Group Commercial	$8,633.60
Rate for Payer: Health Management Network Commercial	$7,724.80
Rate for Payer: Humana Medicare	$2,726.34
Rate for Payer: Kaiser Permanente Commercial	$5,725.44
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,726.34
Rate for Payer: MDX Hawaii PPO	$8,815.36
Rate for Payer: Ohana Health Plan Medicaid	$2,998.97
Rate for Payer: Ohana Health Plan Medicare	$2,726.34
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,726.34
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG REMOVAL IMPACTED EAR WAX, UNILATERAL

Facility

$428.00

Service Code	HCPCS 69209
Hospital Charge Code	H4501106
Hospital Revenue Code	450
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: MDX Hawaii PPO	$415.16

HCHG REMOVAL IMPACTED EAR WAX, UNILATERAL

Facility

$428.00

Service Code	HCPCS 69209
Hospital Charge Code	H4501106
Hospital Revenue Code	450
Min. Negotiated Rate	$69.69
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$76.66
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	$69.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$269.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$311.97

HCHG REMOVAL INTRAUTERINE DEVICE IUD

Facility

$1,766.00

Service Code	HCPCS 58301
Hospital Charge Code	H4501071
Hospital Revenue Code	450
Min. Negotiated Rate	$359.99
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$359.99
Rate for Payer: AlohaCare Medicare	$359.99
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Devoted Health Medicare	$395.99
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	$359.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,677.70
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: Humana Medicare	$359.99
Rate for Payer: Kaiser Permanente Commercial	$1,112.58
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$359.99
Rate for Payer: MDX Hawaii PPO	$1,713.02
Rate for Payer: Ohana Health Plan Medicaid	$395.99
Rate for Payer: Ohana Health Plan Medicare	$359.99
Rate for Payer: UnitedHealthcare Medicare	$359.99
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG REMOVAL INTRAUTERINE DEVICE IUD

Facility

$1,766.00

Service Code	HCPCS 58301
Hospital Charge Code	H4501071
Hospital Revenue Code	450
Min. Negotiated Rate	$1,501.10
Max. Negotiated Rate	$1,713.02
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: MDX Hawaii PPO	$1,713.02

HCHG REMOVAL OF FECAL IMPACT OR FB

Facility

$4,060.00

Service Code	HCPCS 45915
Hospital Charge Code	H4501050
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,938.20
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,857.00
Rate for Payer: Health Management Network Commercial	$3,451.00
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,557.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$3,938.20
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65
Rate for Payer: University Health Alliance Commercial	$2,959.33

HCHG REMOVAL OF FECAL IMPACT OR FB

Facility

$4,060.00

Service Code	HCPCS 45915
Hospital Charge Code	H4501050
Hospital Revenue Code	450
Min. Negotiated Rate	$3,451.00
Max. Negotiated Rate	$3,938.20
Rate for Payer: Cash Price	$2,639.00
Rate for Payer: Health Management Network Commercial	$3,451.00
Rate for Payer: MDX Hawaii PPO	$3,938.20

HCHG REMOVAL OF FOREIGN BODY - SIMPLE

Facility

$6,663.00

Service Code	HCPCS 20520
Hospital Charge Code	H4500927
Hospital Revenue Code	450
Min. Negotiated Rate	$5,663.55
Max. Negotiated Rate	$6,463.11
Rate for Payer: Cash Price	$4,330.95
Rate for Payer: Health Management Network Commercial	$5,663.55
Rate for Payer: MDX Hawaii PPO	$6,463.11

HCHG REMOVAL OF FOREIGN BODY - SIMPLE

Facility

$6,663.00

Service Code	HCPCS 20520
Hospital Charge Code	H4500927
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,463.11
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$4,330.95
Rate for Payer: Cash Price	$4,330.95
Rate for Payer: Cash Price	$4,330.95
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: Hawaii Western Management Group Commercial	$6,329.85
Rate for Payer: Health Management Network Commercial	$5,663.55
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,197.69
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,463.11
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,856.66

HCHG REMOVAL OF PILONIDAL LESION

Facility

$7,263.00

Service Code	HCPCS 11770
Hospital Charge Code	H4500923
Hospital Revenue Code	450
Min. Negotiated Rate	$6,173.55
Max. Negotiated Rate	$7,045.11
Rate for Payer: Cash Price	$4,720.95
Rate for Payer: Health Management Network Commercial	$6,173.55
Rate for Payer: MDX Hawaii PPO	$7,045.11

HCHG REMOVAL OF PILONIDAL LESION

Facility

$7,263.00

Service Code	HCPCS 11770
Hospital Charge Code	H4500923
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,045.11
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$4,720.95
Rate for Payer: Cash Price	$4,720.95
Rate for Payer: Cash Price	$4,720.95
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$6,899.85
Rate for Payer: Health Management Network Commercial	$6,173.55
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$4,575.69
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$7,045.11
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$6,743.44

Know your out-of-pocket cost for care.

All Charges