Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SPECIAL TRTMT PROCED

Facility

$3,098.00

Service Code	HCPCS 77470
Hospital Charge Code	H3330180
Hospital Revenue Code	333
Min. Negotiated Rate	$2,633.30
Max. Negotiated Rate	$3,005.06
Rate for Payer: Cash Price	$2,013.70
Rate for Payer: Health Management Network Commercial	$2,633.30
Rate for Payer: MDX Hawaii PPO	$3,005.06

HCHG SPECIAL TRTMT PROCED

Facility

$3,098.00

Service Code	HCPCS 77470
Hospital Charge Code	H3330180
Hospital Revenue Code	333
Min. Negotiated Rate	$393.73
Max. Negotiated Rate	$3,005.06
Rate for Payer: AlohaCare Medicaid	$652.74
Rate for Payer: AlohaCare Medicare	$652.74
Rate for Payer: Cash Price	$2,013.70
Rate for Payer: Cash Price	$2,013.70
Rate for Payer: Devoted Health Medicare	$718.01
Rate for Payer: Hawaii Medical Service Association ABD	$393.73
Rate for Payer: Hawaii Medical Service Association Commercial	$815.92
Rate for Payer: Hawaii Medical Service Association Medicare	$652.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$404.84
Rate for Payer: Hawaii Western Management Group Commercial	$652.74
Rate for Payer: Health Management Network Commercial	$2,633.30
Rate for Payer: Humana Medicare	$652.74
Rate for Payer: Kaiser Permanente Commercial	$1,951.74
Rate for Payer: Kaiser Permanente Medicaid	$1,579.98
Rate for Payer: Kaiser Permanente Medicare	$652.74
Rate for Payer: MDX Hawaii PPO	$3,005.06
Rate for Payer: Ohana Health Plan Medicaid	$718.01
Rate for Payer: Ohana Health Plan Medicare	$652.74
Rate for Payer: UnitedHealthcare Medicaid	$393.73
Rate for Payer: UnitedHealthcare Medicare	$652.74
Rate for Payer: University Health Alliance Commercial	$716.76

HCHG SPECIFIC GRAVITY-BODY FLD

Facility

$41.00

Service Code	HCPCS 84315
Hospital Charge Code	H3011178
Hospital Revenue Code	301
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$3.28
Rate for Payer: AlohaCare Medicare	$3.28
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$3.61
Rate for Payer: Hawaii Medical Service Association ABD	$2.10
Rate for Payer: Hawaii Medical Service Association Commercial	$4.10
Rate for Payer: Hawaii Medical Service Association Medicare	$3.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.46
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$3.28
Rate for Payer: Kaiser Permanente Commercial	$25.83
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$3.28
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$3.61
Rate for Payer: Ohana Health Plan Medicare	$3.28
Rate for Payer: UnitedHealthcare Medicaid	$2.10
Rate for Payer: UnitedHealthcare Medicare	$3.28
Rate for Payer: University Health Alliance Commercial	$6.47

HCHG SPECIFIC GRAVITY-BODY FLD

Facility

$41.00

Service Code	HCPCS 84315
Hospital Charge Code	H3011178
Hospital Revenue Code	301
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: MDX Hawaii PPO	$39.77

HCHG SPECIFIC GRAVITY UR AUTO

Facility

$51.00

Service Code	HCPCS 81003
Hospital Charge Code	K3070003
Hospital Revenue Code	307
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$2.25
Rate for Payer: AlohaCare Medicare	$2.25
Rate for Payer: Cash Price	$33.15
Rate for Payer: Cash Price	$33.15
Rate for Payer: Devoted Health Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association ABD	$3.10
Rate for Payer: Hawaii Medical Service Association Commercial	$2.81
Rate for Payer: Hawaii Medical Service Association Medicare	$2.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.25
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$2.25
Rate for Payer: Kaiser Permanente Commercial	$32.13
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$2.25
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.25
Rate for Payer: UnitedHealthcare Medicaid	$3.10
Rate for Payer: UnitedHealthcare Medicare	$2.25
Rate for Payer: University Health Alliance Commercial	$5.81

HCHG SPECIFIC GRAVITY UR AUTO

Facility

$51.00

Service Code	HCPCS 81003
Hospital Charge Code	K3070003
Hospital Revenue Code	307
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$33.15
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: MDX Hawaii PPO	$49.47

HCHG SPECIFIC GRAVITY, URINE

Facility

$39.00

Service Code	HCPCS 81003
Hospital Charge Code	H3011453
Hospital Revenue Code	301
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$25.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: MDX Hawaii PPO	$37.83

HCHG SPECIFIC GRAVITY, URINE

Facility

$39.00

Service Code	HCPCS 81003
Hospital Charge Code	H3011453
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$2.25
Rate for Payer: AlohaCare Medicare	$2.25
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Devoted Health Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association ABD	$3.10
Rate for Payer: Hawaii Medical Service Association Commercial	$2.81
Rate for Payer: Hawaii Medical Service Association Medicare	$2.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.25
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$2.25
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$2.25
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.25
Rate for Payer: UnitedHealthcare Medicaid	$3.10
Rate for Payer: UnitedHealthcare Medicare	$2.25
Rate for Payer: University Health Alliance Commercial	$5.81

HCHG SPECIMEN INFECT AGNT CONCNTJ

Facility

$114.00

Service Code	HCPCS 87015
Hospital Charge Code	H3060140
Hospital Revenue Code	306
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HCHG SPECIMEN INFECT AGNT CONCNTJ

Facility

$114.00

Service Code	HCPCS 87015
Hospital Charge Code	H3060140
Hospital Revenue Code	306
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$6.68
Rate for Payer: AlohaCare Medicare	$6.68
Rate for Payer: Cash Price	$74.10
Rate for Payer: Cash Price	$74.10
Rate for Payer: Devoted Health Medicare	$7.35
Rate for Payer: Hawaii Medical Service Association ABD	$9.23
Rate for Payer: Hawaii Medical Service Association Commercial	$8.35
Rate for Payer: Hawaii Medical Service Association Medicare	$6.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.69
Rate for Payer: Hawaii Western Management Group Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$6.68
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$6.68
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$7.35
Rate for Payer: Ohana Health Plan Medicare	$6.68
Rate for Payer: UnitedHealthcare Medicaid	$9.23
Rate for Payer: UnitedHealthcare Medicare	$6.68
Rate for Payer: University Health Alliance Commercial	$17.26

HCHG SPECTROPHOTOMETRY ANALYTE NES (FOCUS) 90

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011595
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 SPECTROPHOTOMETRY ANALYTE NES (FOCUS) 90

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011595
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

HCHG SPECT SINGLE DAY/AREA

Facility

$6,462.00

Service Code	HCPCS 78803
Hospital Charge Code	H3410324
Hospital Revenue Code	341
Min. Negotiated Rate	$5,492.70
Max. Negotiated Rate	$6,268.14
Rate for Payer: Cash Price	$4,200.30
Rate for Payer: Health Management Network Commercial	$5,492.70
Rate for Payer: MDX Hawaii PPO	$6,268.14

HCHG SPECT SINGLE DAY/AREA

Facility

$6,462.00

Service Code	HCPCS 78803
Hospital Charge Code	H3410324
Hospital Revenue Code	341
Min. Negotiated Rate	$216.28
Max. Negotiated Rate	$6,268.14
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$4,200.30
Rate for Payer: Cash Price	$4,200.30
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$216.28
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$234.83
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$5,492.70
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$4,071.06
Rate for Payer: Kaiser Permanente Medicaid	$3,295.62
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$6,268.14
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$216.28
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$708.25

HCHG SPEECH PRODUCTION W LANG COMPREHEN EVAL

Facility

$1,185.00

Service Code	HCPCS 92523
Hospital Charge Code	H4400345
Hospital Revenue Code	444
Min. Negotiated Rate	$240.61
Max. Negotiated Rate	$1,149.45
Rate for Payer: Cash Price	$770.25
Rate for Payer: Cash Price	$770.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,125.75
Rate for Payer: Health Management Network Commercial	$1,007.25
Rate for Payer: Kaiser Permanente Commercial	$746.55
Rate for Payer: Kaiser Permanente Medicaid	$604.35
Rate for Payer: MDX Hawaii PPO	$1,149.45
Rate for Payer: UnitedHealthcare Medicaid	$240.61
Rate for Payer: University Health Alliance Commercial	$863.75

HCHG SPEECH PRODUCTION W LANG COMPREHEN EVAL

Facility

$1,185.00

Service Code	HCPCS 92523
Hospital Charge Code	H4400345
Hospital Revenue Code	444
Min. Negotiated Rate	$1,007.25
Max. Negotiated Rate	$1,149.45
Rate for Payer: Cash Price	$770.25
Rate for Payer: Health Management Network Commercial	$1,007.25
Rate for Payer: MDX Hawaii PPO	$1,149.45

HCHG SPEECH SOUND PRODUCTION EVAL

Facility

$665.00

Service Code	HCPCS 92522
Hospital Charge Code	H4400339
Hospital Revenue Code	444
Min. Negotiated Rate	$116.85
Max. Negotiated Rate	$645.05
Rate for Payer: Cash Price	$432.25
Rate for Payer: Cash Price	$432.25
Rate for Payer: Hawaii Western Management Group Commercial	$631.75
Rate for Payer: Health Management Network Commercial	$565.25
Rate for Payer: Kaiser Permanente Commercial	$418.95
Rate for Payer: Kaiser Permanente Medicaid	$339.15
Rate for Payer: MDX Hawaii PPO	$645.05
Rate for Payer: UnitedHealthcare Medicaid	$116.85
Rate for Payer: University Health Alliance Commercial	$484.72

HCHG SPEECH SOUND PRODUCTION EVAL

Facility

$665.00

Service Code	HCPCS 92522
Hospital Charge Code	H4400339
Hospital Revenue Code	444
Min. Negotiated Rate	$565.25
Max. Negotiated Rate	$645.05
Rate for Payer: Cash Price	$432.25
Rate for Payer: Health Management Network Commercial	$565.25
Rate for Payer: MDX Hawaii PPO	$645.05

HCHG SP EVAL VOICE PROSTHETIC DEV

Facility

$806.00

Service Code	HCPCS 92597
Hospital Charge Code	H4440123
Hospital Revenue Code	444
Min. Negotiated Rate	$685.10
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$523.90
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: MDX Hawaii PPO	$781.82

HCHG SP EVAL VOICE PROSTHETIC DEV

Facility

$806.00

Service Code	HCPCS 92597
Hospital Charge Code	H4440123
Hospital Revenue Code	444
Min. Negotiated Rate	$49.72
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$523.90
Rate for Payer: Cash Price	$523.90
Rate for Payer: Hawaii Western Management Group Commercial	$765.70
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$507.78
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: UnitedHealthcare Medicaid	$49.72
Rate for Payer: University Health Alliance Commercial	$587.49

HCHG SP FEES W CINE & VIDEO

Facility

$974.00

Service Code	HCPCS 92612
Hospital Charge Code	H4440137
Hospital Revenue Code	444
Min. Negotiated Rate	$49.97
Max. Negotiated Rate	$944.78
Rate for Payer: Cash Price	$633.10
Rate for Payer: Cash Price	$633.10
Rate for Payer: Hawaii Western Management Group Commercial	$925.30
Rate for Payer: Health Management Network Commercial	$827.90
Rate for Payer: Kaiser Permanente Commercial	$613.62
Rate for Payer: Kaiser Permanente Medicaid	$496.74
Rate for Payer: MDX Hawaii PPO	$944.78
Rate for Payer: UnitedHealthcare Medicaid	$49.97
Rate for Payer: University Health Alliance Commercial	$709.95

HCHG SP FEES W CINE & VIDEO

Facility

$974.00

Service Code	HCPCS 92612
Hospital Charge Code	H4440137
Hospital Revenue Code	444
Min. Negotiated Rate	$827.90
Max. Negotiated Rate	$944.78
Rate for Payer: Cash Price	$633.10
Rate for Payer: Health Management Network Commercial	$827.90
Rate for Payer: MDX Hawaii PPO	$944.78

HCHG SPINAL PUNC LUMBAR DX

Facility

$3,543.00

Service Code	HCPCS 62270
Hospital Charge Code	H4500682
Hospital Revenue Code	450
Min. Negotiated Rate	$3,011.55
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: MDX Hawaii PPO	$3,436.71

HCHG SPINAL PUNC LUMBAR DX

Facility

$3,543.00

Service Code	HCPCS 62270
Hospital Charge Code	H4500682
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.85
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,232.09
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG SPINE ENTIRE (EG SCOLIOSIS EVAL) 1 VIEW

Facility

$456.00

Service Code	HCPCS 72081
Hospital Charge Code	H3200982
Hospital Revenue Code	320
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$442.32
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$296.40
Rate for Payer: Cash Price	$296.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.62
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.05
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$387.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$287.28
Rate for Payer: Kaiser Permanente Medicaid	$232.56
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$442.32
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$28.37
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$80.07

Know your out-of-pocket cost for care.

All Charges