Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG STRAPPING THORAX

Facility

$1,040.00

Service Code	HCPCS 29200
Hospital Charge Code	H4500706
Hospital Revenue Code	450
Min. Negotiated Rate	$191.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Devoted Health Medicare	$211.17
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	$191.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$988.00
Rate for Payer: Health Management Network Commercial	$884.00
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$1,008.80
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$758.06

HCHG STRAPPING TOES

Facility

$431.00

Service Code	HCPCS 29550
Hospital Charge Code	H4500708
Hospital Revenue Code	450
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

HCHG STRAPPING TOES

Facility

$431.00

Service Code	HCPCS 29550
Hospital Charge Code	H4500708
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	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
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	$409.45
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$418.07
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	$314.16

HCHG STRAPPING UNNA BOOT

Facility

$944.00

Service Code	HCPCS 29580
Hospital Charge Code	H4500710
Hospital Revenue Code	450
Min. Negotiated Rate	$191.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$613.60
Rate for Payer: Devoted Health Medicare	$211.17
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	$191.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$896.80
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$594.72
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$915.68
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$688.08

HCHG STRAPPING UNNA BOOT

Facility

$944.00

Service Code	HCPCS 29580
Hospital Charge Code	H4500710
Hospital Revenue Code	450
Min. Negotiated Rate	$802.40
Max. Negotiated Rate	$915.68
Rate for Payer: Cash Price	$613.60
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: MDX Hawaii PPO	$915.68

HCHG STREP A ASSAY W/OPTIC

Facility

$243.00

Service Code	HCPCS 87880
Hospital Charge Code	H3060775
Hospital Revenue Code	306
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$16.53
Rate for Payer: AlohaCare Medicare	$16.53
Rate for Payer: Cash Price	$157.95
Rate for Payer: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$18.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.66
Rate for Payer: Hawaii Medical Service Association Medicare	$16.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.53
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$16.53
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$16.53
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$18.18
Rate for Payer: Ohana Health Plan Medicare	$16.53
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.53
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG STREP A ASSAY W/OPTIC

Facility

$243.00

Service Code	HCPCS 87880
Hospital Charge Code	H3060775
Hospital Revenue Code	306
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$157.95
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

HCHG STREP B DNA AMP PROBE - 90

Facility

$475.00

Service Code	HCPCS 87653
Hospital Charge Code	H3060797
Hospital Revenue Code	306
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$460.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: MDX Hawaii PPO	$460.75

HCHG STREP B DNA AMP PROBE - 90

Facility

$475.00

Service Code	HCPCS 87653
Hospital Charge Code	H3060797
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$460.75
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$308.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$49.04
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$299.25
Rate for Payer: Kaiser Permanente Medicaid	$242.25
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$460.75
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$49.04
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG STREP GRP B AMP PROBE

Facility

$475.00

Service Code	HCPCS 87653
Hospital Charge Code	K3060041
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$460.75
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$308.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$49.04
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$299.25
Rate for Payer: Kaiser Permanente Medicaid	$242.25
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$460.75
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$49.04
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG STREP GRP B AMP PROBE

Facility

$475.00

Service Code	HCPCS 87653
Hospital Charge Code	K3060041
Hospital Revenue Code	306
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$460.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: MDX Hawaii PPO	$460.75

HCHG STREPTOCOCCUS GRP A, AMP PROBE - 90

Facility

$255.00

Service Code	HCPCS 87651
Hospital Charge Code	H3060718
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$247.35
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$165.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$160.65
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG STREPTOCOCCUS GRP A, AMP PROBE - 90

Facility

$255.00

Service Code	HCPCS 87651
Hospital Charge Code	H3060718
Hospital Revenue Code	306
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: MDX Hawaii PPO	$247.35

HCHG STRESS EKG PHARMACOLOGIC

Facility

$1,561.00

Service Code	HCPCS 93017
Hospital Charge Code	H4820104
Hospital Revenue Code	482
Min. Negotiated Rate	$1,326.85
Max. Negotiated Rate	$1,514.17
Rate for Payer: Cash Price	$1,014.65
Rate for Payer: Health Management Network Commercial	$1,326.85
Rate for Payer: MDX Hawaii PPO	$1,514.17

HCHG STRESS EKG PHARMACOLOGIC

Facility

$1,561.00

Service Code	HCPCS 93017
Hospital Charge Code	H4820104
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,514.17
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$1,014.65
Rate for Payer: Cash Price	$1,014.65
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,482.95
Rate for Payer: Health Management Network Commercial	$1,326.85
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$983.43
Rate for Payer: Kaiser Permanente Medicaid	$796.11
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,514.17
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,137.81

HCHG STRIATED MUSCLE AB TITER

Facility

$163.00

Service Code	HCPCS 86256
Hospital Charge Code	H3020981
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$16.66
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$31.15

HCHG STRIATED MUSCLE AB TITER

Facility

$163.00

Service Code	HCPCS 86256
Hospital Charge Code	H3020981
Hospital Revenue Code	302
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: MDX Hawaii PPO	$158.11

HCHG SURGERY LEVEL 1 EACH 15 MIN

Facility

$501.00

Hospital Charge Code	K3600000
Hospital Revenue Code	360
Min. Negotiated Rate	$425.85
Max. Negotiated Rate	$485.97
Rate for Payer: Cash Price	$325.65
Rate for Payer: Health Management Network Commercial	$425.85
Rate for Payer: MDX Hawaii PPO	$485.97

HCHG SURGERY LEVEL 1 EACH 15 MIN

Facility

$501.00

Hospital Charge Code	K3600000
Hospital Revenue Code	360
Min. Negotiated Rate	$315.63
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$325.65
Rate for Payer: Cash Price	$325.65
Rate for Payer: Health Management Network Commercial	$425.85
Rate for Payer: Kaiser Permanente Commercial	$315.63
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$485.97
Rate for Payer: University Health Alliance Commercial	$365.18

HCHG SURGERY LEVEL 1 EACH ADDITIONAL 15 MIN

Facility

$576.00

Hospital Charge Code	K3600007
Hospital Revenue Code	360
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$558.72
Rate for Payer: Cash Price	$374.40
Rate for Payer: Health Management Network Commercial	$489.60
Rate for Payer: MDX Hawaii PPO	$558.72

HCHG SURGERY LEVEL 1 EACH ADDITIONAL 15 MIN

Facility

$576.00

Hospital Charge Code	K3600007
Hospital Revenue Code	360
Min. Negotiated Rate	$362.88
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Health Management Network Commercial	$489.60
Rate for Payer: Kaiser Permanente Commercial	$362.88
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$558.72
Rate for Payer: University Health Alliance Commercial	$419.85

HCHG SURGERY LEVEL 1 FIRST 15 MIN

Facility

$960.00

Hospital Charge Code	K3600006
Hospital Revenue Code	360
Min. Negotiated Rate	$604.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$624.00
Rate for Payer: Cash Price	$624.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HCHG SURGERY LEVEL 1 FIRST 15 MIN

Facility

$960.00

Hospital Charge Code	K3600006
Hospital Revenue Code	360
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$624.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HCHG SURGERY LEVEL 2 EACH 15 MIN

Facility

$835.00

Hospital Charge Code	K3600001
Hospital Revenue Code	360
Min. Negotiated Rate	$709.75
Max. Negotiated Rate	$809.95
Rate for Payer: Cash Price	$542.75
Rate for Payer: Health Management Network Commercial	$709.75
Rate for Payer: MDX Hawaii PPO	$809.95

HCHG SURGERY LEVEL 2 EACH 15 MIN

Facility

$835.00

Hospital Charge Code	K3600001
Hospital Revenue Code	360
Min. Negotiated Rate	$526.05
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$542.75
Rate for Payer: Cash Price	$542.75
Rate for Payer: Health Management Network Commercial	$709.75
Rate for Payer: Kaiser Permanente Commercial	$526.05
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$809.95
Rate for Payer: University Health Alliance Commercial	$608.63

Know your out-of-pocket cost for care.

All Charges