Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SURGERY LEVEL 6 EACH ADDITIONAL 15 MIN

Facility

$2,535.00

Hospital Charge Code	K3600017
Hospital Revenue Code	360
Min. Negotiated Rate	$2,154.75
Max. Negotiated Rate	$2,458.95
Rate for Payer: Cash Price	$1,647.75
Rate for Payer: Health Management Network Commercial	$2,154.75
Rate for Payer: MDX Hawaii PPO	$2,458.95

HCHG SURGERY LEVEL 6 FIRST 15 MIN

Facility

$5,387.00

Hospital Charge Code	K3600016
Hospital Revenue Code	360
Min. Negotiated Rate	$4,578.95
Max. Negotiated Rate	$5,225.39
Rate for Payer: Cash Price	$3,501.55
Rate for Payer: Health Management Network Commercial	$4,578.95
Rate for Payer: MDX Hawaii PPO	$5,225.39

HCHG SURGERY LEVEL 6 FIRST 15 MIN

Facility

$5,387.00

Hospital Charge Code	K3600016
Hospital Revenue Code	360
Min. Negotiated Rate	$2,837.00
Max. Negotiated Rate	$5,225.39
Rate for Payer: Cash Price	$3,501.55
Rate for Payer: Cash Price	$3,501.55
Rate for Payer: Health Management Network Commercial	$4,578.95
Rate for Payer: Kaiser Permanente Commercial	$3,393.81
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$5,225.39
Rate for Payer: University Health Alliance Commercial	$3,926.58

HCHG SUSCEPTIBILITY MIC MOLD SO

Facility

$194.00

Service Code	HCPCS 87186
Hospital Charge Code	K3060018
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG SUSCEPTIBILITY MIC MOLD SO

Facility

$194.00

Service Code	HCPCS 87186
Hospital Charge Code	K3060018
Hospital Revenue Code	306
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 SUSCEPTIBILITY PER AGENT

Facility

$36.00

Service Code	HCPCS 87181
Hospital Charge Code	K3060015
Hospital Revenue Code	306
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.75
Rate for Payer: AlohaCare Medicare	$4.75
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$5.22
Rate for Payer: Hawaii Medical Service Association ABD	$2.57
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.75
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.75
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$5.22
Rate for Payer: Ohana Health Plan Medicare	$4.75
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$4.75
Rate for Payer: University Health Alliance Commercial	$4.81

HCHG SUSCEPTIBILITY PER AGENT

Facility

$36.00

Service Code	HCPCS 87181
Hospital Charge Code	K3060015
Hospital Revenue Code	306
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

HCHG SUSCEPTIBILITY, YEAST, COMPREHENSIVE

Facility

$312.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060738
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$302.64
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$202.80
Rate for Payer: Cash Price	$202.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$196.56
Rate for Payer: Kaiser Permanente Medicaid	$159.12
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$302.64
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG SUSCEPTIBILITY, YEAST, COMPREHENSIVE

Facility

$312.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060738
Hospital Revenue Code	306
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$202.80
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: MDX Hawaii PPO	$302.64

HCHG SUSCEPT STUDIES, MACROBROTH DIL

Facility

$96.00

Service Code	HCPCS 87188
Hospital Charge Code	H3060730
Hospital Revenue Code	306
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$6.64
Rate for Payer: AlohaCare Medicare	$6.64
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$7.30
Rate for Payer: Hawaii Medical Service Association ABD	$5.56
Rate for Payer: Hawaii Medical Service Association Commercial	$8.30
Rate for Payer: Hawaii Medical Service Association Medicare	$6.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.17
Rate for Payer: Hawaii Western Management Group Commercial	$6.64
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$6.64
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$6.64
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$7.30
Rate for Payer: Ohana Health Plan Medicare	$6.64
Rate for Payer: UnitedHealthcare Medicaid	$5.56
Rate for Payer: UnitedHealthcare Medicare	$6.64
Rate for Payer: University Health Alliance Commercial	$17.15

HCHG SUSCEPT STUDIES, MACROBROTH DIL

Facility

$96.00

Service Code	HCPCS 87188
Hospital Charge Code	H3060730
Hospital Revenue Code	306
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: MDX Hawaii PPO	$93.12

HCHG SUTURE COMPLEX-EYEL+-1.1-2.5

Facility

$3,050.00

Service Code	HCPCS 13151
Hospital Charge Code	H4500716
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,958.50
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Devoted Health Medicare	$960.41
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	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,897.50
Rate for Payer: Health Management Network Commercial	$2,592.50
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Commercial	$1,921.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: MDX Hawaii PPO	$2,958.50
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$2,223.14

HCHG SUTURE COMPLEX-EYEL+-1.1-2.5

Facility

$3,050.00

Service Code	HCPCS 13151
Hospital Charge Code	H4500716
Hospital Revenue Code	450
Min. Negotiated Rate	$2,592.50
Max. Negotiated Rate	$2,958.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Health Management Network Commercial	$2,592.50
Rate for Payer: MDX Hawaii PPO	$2,958.50

HCHG SUTURE COMPLEX-EYEL+-2.6-7.5

Facility

$3,187.00

Service Code	HCPCS 13152
Hospital Charge Code	H4500718
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Devoted Health Medicare	$960.41
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	$873.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.65
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Commercial	$2,007.81
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: MDX Hawaii PPO	$3,091.39
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicare	$873.10
Rate for Payer: University Health Alliance Commercial	$6,743.44

HCHG SUTURE COMPLEX-EYEL+-2.6-7.5

Facility

$3,187.00

Service Code	HCPCS 13152
Hospital Charge Code	H4500718
Hospital Revenue Code	450
Min. Negotiated Rate	$2,708.95
Max. Negotiated Rate	$3,091.39
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: MDX Hawaii PPO	$3,091.39

HCHG SUTURE COMPLEX-EYEL+-ADDL 5

Facility

$2,034.00

Service Code	HCPCS 13153
Hospital Charge Code	H4500720
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,972.98
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Cash Price	$1,322.10
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.30
Rate for Payer: Health Management Network Commercial	$1,728.90
Rate for Payer: Kaiser Permanente Commercial	$1,281.42
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$1,972.98
Rate for Payer: University Health Alliance Commercial	$1,482.58

HCHG SUTURE COMPLEX-EYEL+-ADDL 5

Facility

$2,034.00

Service Code	HCPCS 13153
Hospital Charge Code	H4500720
Hospital Revenue Code	450
Min. Negotiated Rate	$1,728.90
Max. Negotiated Rate	$1,972.98
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Health Management Network Commercial	$1,728.90
Rate for Payer: MDX Hawaii PPO	$1,972.98

HCHG SUTURE COMPLEX-FOREH+-1.1-2.5

Facility

$2,246.00

Service Code	HCPCS 13131
Hospital Charge Code	H4500722
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG SUTURE COMPLEX-FOREH+-1.1-2.5

Facility

$2,246.00

Service Code	HCPCS 13131
Hospital Charge Code	H4500722
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$2,178.62
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,414.98
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,637.11

HCHG SUTURE COMPLEX-FOREH+-2.6-7.5

Facility

$3,187.00

Service Code	HCPCS 13132
Hospital Charge Code	H4500724
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.65
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$2,007.81
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$3,091.39
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$10,679.55

HCHG SUTURE COMPLEX-FOREH+-2.6-7.5

Facility

$3,187.00

Service Code	HCPCS 13132
Hospital Charge Code	H4500724
Hospital Revenue Code	450
Min. Negotiated Rate	$2,708.95
Max. Negotiated Rate	$3,091.39
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: MDX Hawaii PPO	$3,091.39

HCHG SUTURE COMPLEX-FOREH+-ADDL 5

Facility

$692.00

Service Code	HCPCS 13133
Hospital Charge Code	H4500726
Hospital Revenue Code	450
Min. Negotiated Rate	$435.96
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$449.80
Rate for Payer: Cash Price	$449.80
Rate for Payer: Cash Price	$449.80
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$657.40
Rate for Payer: Health Management Network Commercial	$588.20
Rate for Payer: Kaiser Permanente Commercial	$435.96
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$671.24
Rate for Payer: University Health Alliance Commercial	$504.40

HCHG SUTURE COMPLEX-FOREH+-ADDL 5

Facility

$692.00

Service Code	HCPCS 13133
Hospital Charge Code	H4500726
Hospital Revenue Code	450
Min. Negotiated Rate	$588.20
Max. Negotiated Rate	$671.24
Rate for Payer: Cash Price	$449.80
Rate for Payer: Health Management Network Commercial	$588.20
Rate for Payer: MDX Hawaii PPO	$671.24

HCHG SUTURE COMPLEX-SCALP+-1.1-2.5

Facility

$3,187.00

Service Code	HCPCS 13120
Hospital Charge Code	H4500728
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$3,091.39
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.65
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$2,007.81
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$3,091.39
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$2,323.00

HCHG SUTURE COMPLEX-SCALP+-1.1-2.5

Facility

$3,187.00

Service Code	HCPCS 13120
Hospital Charge Code	H4500728
Hospital Revenue Code	450
Min. Negotiated Rate	$2,708.95
Max. Negotiated Rate	$3,091.39
Rate for Payer: Cash Price	$2,071.55
Rate for Payer: Health Management Network Commercial	$2,708.95
Rate for Payer: MDX Hawaii PPO	$3,091.39

Know your out-of-pocket cost for care.

All Charges