Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$387.60
Max. Negotiated Rate	$442.32
Rate for Payer: Cash Price	$296.40
Rate for Payer: Health Management Network Commercial	$387.60
Rate for Payer: MDX Hawaii PPO	$442.32

HCHG SPINE ENTIRE (EG, SCOLIOSIS EVAL) 2-3 VIEWS

Facility

$708.00

Service Code	HCPCS 72082
Hospital Charge Code	H3200983
Hospital Revenue Code	320
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: MDX Hawaii PPO	$686.76

HCHG SPINE ENTIRE (EG, SCOLIOSIS EVAL) 2-3 VIEWS

Facility

$708.00

Service Code	HCPCS 72082
Hospital Charge Code	H3200983
Hospital Revenue Code	320
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$32.11
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.87
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$446.04
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$47.15
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$130.35

HCHG SPINE ENTIRE (EG, SCOLIOSIS EVAL) 4-5 VIEWS

Facility

$810.00

Service Code	HCPCS 72083
Hospital Charge Code	H3200984
Hospital Revenue Code	320
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$785.70
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$34.85
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: Kaiser Permanente Medicaid	$413.10
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$53.34
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$166.83

HCHG SPINE ENTIRE (EG, SCOLIOSIS EVAL) 4-5 VIEWS

Facility

$810.00

Service Code	HCPCS 72083
Hospital Charge Code	H3200984
Hospital Revenue Code	320
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: MDX Hawaii PPO	$785.70

HCHG SPINE ENTIRE (EG, SCOLIOSIS EVAL) MIN 6 VIEWS

Facility

$810.00

Service Code	HCPCS 72084
Hospital Charge Code	H3200985
Hospital Revenue Code	320
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$785.70
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$41.85
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$57.17
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: Kaiser Permanente Medicaid	$413.10
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$66.24
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$205.85

HCHG SPINE ENTIRE (EG, SCOLIOSIS EVAL) MIN 6 VIEWS

Facility

$810.00

Service Code	HCPCS 72084
Hospital Charge Code	H3200985
Hospital Revenue Code	320
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: MDX Hawaii PPO	$785.70

HCHG SPINE THORACOLUMBAR, 2 VIEWS

Facility

$604.00

Service Code	HCPCS 72080
Hospital Charge Code	H3200734
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$585.88
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
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	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$72.83

HCHG SPINE THORACOLUMBAR, 2 VIEWS

Facility

$604.00

Service Code	HCPCS 72080
Hospital Charge Code	H3200734
Hospital Revenue Code	320
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$392.60
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG SP INITIAL COGNITIVE 15 MINUTES

Facility

$155.00

Service Code	HCPCS 97129
Hospital Charge Code	H4400359
Hospital Revenue Code	440
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$97.65
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: UnitedHealthcare Medicaid	$22.57
Rate for Payer: University Health Alliance Commercial	$112.98

HCHG SP INITIAL COGNITIVE 15 MINUTES

Facility

$155.00

Service Code	HCPCS 97129
Hospital Charge Code	H4400359
Hospital Revenue Code	440
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: MDX Hawaii PPO	$150.35

HCHG S. PNEUMONIAE AG DETECT

Facility

$132.00

Service Code	HCPCS 87899
Hospital Charge Code	H3020902
Hospital Revenue Code	306
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: MDX Hawaii PPO	$128.04

HCHG S. PNEUMONIAE AG DETECT

Facility

$132.00

Service Code	HCPCS 87899
Hospital Charge Code	H3020902
Hospital Revenue Code	306
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$16.07
Rate for Payer: AlohaCare Medicare	$16.07
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$17.68
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$16.07
Rate for Payer: Kaiser Permanente Commercial	$83.16
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$16.07
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$17.68
Rate for Payer: Ohana Health Plan Medicare	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.07
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG SP SPEECH GEN DEVICE TX

Facility

$588.00

Service Code	HCPCS 92609
Hospital Charge Code	H4720102
Hospital Revenue Code	440
Min. Negotiated Rate	$499.80
Max. Negotiated Rate	$570.36
Rate for Payer: Cash Price	$382.20
Rate for Payer: Health Management Network Commercial	$499.80
Rate for Payer: MDX Hawaii PPO	$570.36

HCHG SP SPEECH GEN DEVICE TX

Facility

$588.00

Service Code	HCPCS 92609
Hospital Charge Code	H4720102
Hospital Revenue Code	440
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$570.36
Rate for Payer: Cash Price	$382.20
Rate for Payer: Cash Price	$382.20
Rate for Payer: Hawaii Western Management Group Commercial	$558.60
Rate for Payer: Health Management Network Commercial	$499.80
Rate for Payer: Kaiser Permanente Commercial	$370.44
Rate for Payer: Kaiser Permanente Medicaid	$299.88
Rate for Payer: MDX Hawaii PPO	$570.36
Rate for Payer: UnitedHealthcare Medicaid	$47.70
Rate for Payer: University Health Alliance Commercial	$428.59

HCHG SP SPEECH-LANG-VOICE TREAT

Facility

$479.00

Service Code	HCPCS 92507
Hospital Charge Code	H4400140
Hospital Revenue Code	440
Min. Negotiated Rate	$407.15
Max. Negotiated Rate	$464.63
Rate for Payer: Cash Price	$311.35
Rate for Payer: Health Management Network Commercial	$407.15
Rate for Payer: MDX Hawaii PPO	$464.63

HCHG SP SPEECH-LANG-VOICE TREAT

Facility

$479.00

Service Code	HCPCS 92507
Hospital Charge Code	H4400140
Hospital Revenue Code	440
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$464.63
Rate for Payer: Cash Price	$311.35
Rate for Payer: Cash Price	$311.35
Rate for Payer: Hawaii Western Management Group Commercial	$455.05
Rate for Payer: Health Management Network Commercial	$407.15
Rate for Payer: Kaiser Permanente Commercial	$301.77
Rate for Payer: Kaiser Permanente Medicaid	$244.29
Rate for Payer: MDX Hawaii PPO	$464.63
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: University Health Alliance Commercial	$349.14

HCHG SP SWALLOW TREAT

Facility

$533.00

Service Code	HCPCS 92526
Hospital Charge Code	H4400148
Hospital Revenue Code	440
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Hawaii Western Management Group Commercial	$506.35
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Kaiser Permanente Commercial	$335.79
Rate for Payer: Kaiser Permanente Medicaid	$271.83
Rate for Payer: MDX Hawaii PPO	$517.01
Rate for Payer: UnitedHealthcare Medicaid	$22.46
Rate for Payer: University Health Alliance Commercial	$388.50

HCHG SP SWALLOW TREAT

Facility

$533.00

Service Code	HCPCS 92526
Hospital Charge Code	H4400148
Hospital Revenue Code	440
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: MDX Hawaii PPO	$517.01

HCHG SPUTUM GRAM STAIN

Facility

$65.00

Service Code	HCPCS 87205
Hospital Charge Code	H3060468
Hospital Revenue Code	306
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: MDX Hawaii PPO	$63.05

HCHG SPUTUM GRAM STAIN

Facility

$65.00

Service Code	HCPCS 87205
Hospital Charge Code	H3060468
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$40.95
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG SPUTUM SPECIMEN COLLECTION

Facility

$334.00

Service Code	HCPCS 89220
Hospital Charge Code	K4100000
Hospital Revenue Code	410
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$323.98
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$217.10
Rate for Payer: Cash Price	$217.10
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$11.23
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.80
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$210.42
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$11.23
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$33.06

HCHG SPUTUM SPECIMEN COLLECTION

Facility

$334.00

Service Code	HCPCS 89220
Hospital Charge Code	K4100000
Hospital Revenue Code	410
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$217.10
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: MDX Hawaii PPO	$323.98

HCHG SPUTUM SPECIMEN COLLECTION

Facility

$334.00

Service Code	HCPCS 89220
Hospital Charge Code	H4100305
Hospital Revenue Code	410
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$217.10
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: MDX Hawaii PPO	$323.98

HCHG SPUTUM SPECIMEN COLLECTION

Facility

$334.00

Service Code	HCPCS 89220
Hospital Charge Code	H4100305
Hospital Revenue Code	410
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$323.98
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$217.10
Rate for Payer: Cash Price	$217.10
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$11.23
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.80
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$210.42
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$11.23
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$33.06

Know your out-of-pocket cost for care.

All Charges