Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG T CELLS TOTAL COUNT

Facility

$389.00

Service Code	HCPCS 86359
Hospital Charge Code	H3110114
Hospital Revenue Code	302
Min. Negotiated Rate	$330.65
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$252.85
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: MDX Hawaii PPO	$377.33

HCHG TELETHERAPY ISODONE PLAN CMPLX

Facility

$2,079.00

Service Code	HCPCS 77307
Hospital Charge Code	H3330235
Hospital Revenue Code	333
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$2,016.63
Rate for Payer: AlohaCare Medicaid	$442.33
Rate for Payer: AlohaCare Medicare	$442.33
Rate for Payer: Cash Price	$1,351.35
Rate for Payer: Cash Price	$1,351.35
Rate for Payer: Devoted Health Medicare	$486.56
Rate for Payer: Hawaii Medical Service Association ABD	$187.98
Rate for Payer: Hawaii Medical Service Association Commercial	$552.91
Rate for Payer: Hawaii Medical Service Association Medicare	$442.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$98.69
Rate for Payer: Hawaii Western Management Group Commercial	$442.33
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Humana Medicare	$442.33
Rate for Payer: Kaiser Permanente Commercial	$1,309.77
Rate for Payer: Kaiser Permanente Medicaid	$1,060.29
Rate for Payer: Kaiser Permanente Medicare	$442.33
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: Ohana Health Plan Medicaid	$486.56
Rate for Payer: Ohana Health Plan Medicare	$442.33
Rate for Payer: UnitedHealthcare Medicaid	$187.31
Rate for Payer: UnitedHealthcare Medicare	$442.33
Rate for Payer: University Health Alliance Commercial	$572.22

HCHG TELETHERAPY ISODONE PLAN CMPLX

Facility

$2,079.00

Service Code	HCPCS 77307
Hospital Charge Code	H3330235
Hospital Revenue Code	333
Min. Negotiated Rate	$1,767.15
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,351.35
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: MDX Hawaii PPO	$2,016.63

HCHG TELETHERAPY PORT PLAN SPECIAL

Facility

$2,005.00

Service Code	HCPCS 77321
Hospital Charge Code	H3330194
Hospital Revenue Code	333
Min. Negotiated Rate	$146.41
Max. Negotiated Rate	$1,944.85
Rate for Payer: AlohaCare Medicaid	$442.33
Rate for Payer: AlohaCare Medicare	$442.33
Rate for Payer: Cash Price	$1,303.25
Rate for Payer: Cash Price	$1,303.25
Rate for Payer: Devoted Health Medicare	$486.56
Rate for Payer: Hawaii Medical Service Association ABD	$153.52
Rate for Payer: Hawaii Medical Service Association Commercial	$552.91
Rate for Payer: Hawaii Medical Service Association Medicare	$442.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$146.41
Rate for Payer: Hawaii Western Management Group Commercial	$442.33
Rate for Payer: Health Management Network Commercial	$1,704.25
Rate for Payer: Humana Medicare	$442.33
Rate for Payer: Kaiser Permanente Commercial	$1,263.15
Rate for Payer: Kaiser Permanente Medicaid	$1,022.55
Rate for Payer: Kaiser Permanente Medicare	$442.33
Rate for Payer: MDX Hawaii PPO	$1,944.85
Rate for Payer: Ohana Health Plan Medicaid	$486.56
Rate for Payer: Ohana Health Plan Medicare	$442.33
Rate for Payer: UnitedHealthcare Medicaid	$153.52
Rate for Payer: UnitedHealthcare Medicare	$442.33
Rate for Payer: University Health Alliance Commercial	$307.29

HCHG TELETHERAPY PORT PLAN SPECIAL

Facility

$2,005.00

Service Code	HCPCS 77321
Hospital Charge Code	H3330194
Hospital Revenue Code	333
Min. Negotiated Rate	$1,704.25
Max. Negotiated Rate	$1,944.85
Rate for Payer: Cash Price	$1,303.25
Rate for Payer: Health Management Network Commercial	$1,704.25
Rate for Payer: MDX Hawaii PPO	$1,944.85

HCHG TEMP TRANSV PACEMKR INSERT+CF

Facility

$15,299.00

Service Code	HCPCS 33210
Hospital Charge Code	H3610386
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$14,840.03
Rate for Payer: AlohaCare Medicaid	$9,776.09
Rate for Payer: AlohaCare Medicare	$9,776.09
Rate for Payer: Cash Price	$9,944.35
Rate for Payer: Cash Price	$9,944.35
Rate for Payer: Cash Price	$9,944.35
Rate for Payer: Devoted Health Medicare	$10,753.70
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	$9,776.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Health Management Network Commercial	$13,004.15
Rate for Payer: Humana Medicare	$9,776.09
Rate for Payer: Kaiser Permanente Commercial	$9,638.37
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$9,776.09
Rate for Payer: MDX Hawaii PPO	$14,840.03
Rate for Payer: Ohana Health Plan Medicaid	$10,753.70
Rate for Payer: Ohana Health Plan Medicare	$9,776.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$9,776.09
Rate for Payer: University Health Alliance Commercial	$11,151.44

HCHG TEMP TRANSV PACEMKR INSERT+CF

Facility

$15,299.00

Service Code	HCPCS 33210
Hospital Charge Code	H3610386
Hospital Revenue Code	361
Min. Negotiated Rate	$13,004.15
Max. Negotiated Rate	$14,840.03
Rate for Payer: Cash Price	$9,944.35
Rate for Payer: Health Management Network Commercial	$13,004.15
Rate for Payer: MDX Hawaii PPO	$14,840.03

HCHG TEMP TRANSV PACEMKR INSERT+CF

Facility

$19,124.00

Service Code	HCPCS 33210
Hospital Charge Code	H4501036
Hospital Revenue Code	450
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$18,550.28
Rate for Payer: AlohaCare Medicaid	$9,776.09
Rate for Payer: AlohaCare Medicare	$9,776.09
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Devoted Health Medicare	$10,753.70
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	$9,776.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$18,167.80
Rate for Payer: Health Management Network Commercial	$16,255.40
Rate for Payer: Humana Medicare	$9,776.09
Rate for Payer: Kaiser Permanente Commercial	$12,048.12
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,776.09
Rate for Payer: MDX Hawaii PPO	$18,550.28
Rate for Payer: Ohana Health Plan Medicaid	$10,753.70
Rate for Payer: Ohana Health Plan Medicare	$9,776.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$9,776.09
Rate for Payer: University Health Alliance Commercial	$13,939.48

HCHG TEMP TRANSV PACEMKR INSERT+CF

Facility

$19,124.00

Service Code	HCPCS 33210
Hospital Charge Code	H4501036
Hospital Revenue Code	450
Min. Negotiated Rate	$16,255.40
Max. Negotiated Rate	$18,550.28
Rate for Payer: Cash Price	$12,430.60
Rate for Payer: Health Management Network Commercial	$16,255.40
Rate for Payer: MDX Hawaii PPO	$18,550.28

HCHG TESTOSTERONE FREE 90

Facility

$313.00

Service Code	HCPCS 84402
Hospital Charge Code	H3011210
Hospital Revenue Code	301
Min. Negotiated Rate	$25.47
Max. Negotiated Rate	$303.61
Rate for Payer: AlohaCare Medicaid	$25.47
Rate for Payer: AlohaCare Medicare	$25.47
Rate for Payer: Cash Price	$203.45
Rate for Payer: Cash Price	$203.45
Rate for Payer: Devoted Health Medicare	$28.02
Rate for Payer: Hawaii Medical Service Association ABD	$35.19
Rate for Payer: Hawaii Medical Service Association Commercial	$31.84
Rate for Payer: Hawaii Medical Service Association Medicare	$25.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.95
Rate for Payer: Hawaii Western Management Group Commercial	$25.47
Rate for Payer: Health Management Network Commercial	$266.05
Rate for Payer: Humana Medicare	$25.47
Rate for Payer: Kaiser Permanente Commercial	$197.19
Rate for Payer: Kaiser Permanente Medicaid	$159.63
Rate for Payer: Kaiser Permanente Medicare	$25.47
Rate for Payer: MDX Hawaii PPO	$303.61
Rate for Payer: Ohana Health Plan Medicaid	$28.02
Rate for Payer: Ohana Health Plan Medicare	$25.47
Rate for Payer: UnitedHealthcare Medicaid	$35.19
Rate for Payer: UnitedHealthcare Medicare	$25.47
Rate for Payer: University Health Alliance Commercial	$65.80

HCHG TESTOSTERONE FREE 90

Facility

$313.00

Service Code	HCPCS 84402
Hospital Charge Code	H3011210
Hospital Revenue Code	301
Min. Negotiated Rate	$266.05
Max. Negotiated Rate	$303.61
Rate for Payer: Cash Price	$203.45
Rate for Payer: Health Management Network Commercial	$266.05
Rate for Payer: MDX Hawaii PPO	$303.61

HCHG TESTOSTERONE SERUM TOTAL

Facility

$317.00

Service Code	HCPCS 84403
Hospital Charge Code	H3011212
Hospital Revenue Code	301
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: MDX Hawaii PPO	$307.49

HCHG TESTOSTERONE SERUM TOTAL

Facility

$317.00

Service Code	HCPCS 84403
Hospital Charge Code	H3011212
Hospital Revenue Code	301
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$25.81
Rate for Payer: AlohaCare Medicare	$25.81
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$28.39
Rate for Payer: Hawaii Medical Service Association ABD	$35.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.26
Rate for Payer: Hawaii Medical Service Association Medicare	$25.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.46
Rate for Payer: Hawaii Western Management Group Commercial	$25.81
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$25.81
Rate for Payer: Kaiser Permanente Commercial	$199.71
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$25.81
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$28.39
Rate for Payer: Ohana Health Plan Medicare	$25.81
Rate for Payer: UnitedHealthcare Medicaid	$35.68
Rate for Payer: UnitedHealthcare Medicare	$25.81
Rate for Payer: University Health Alliance Commercial	$66.75

HCHG THEOPHYLLINE

Facility

$174.00

Service Code	HCPCS 80198
Hospital Charge Code	H3011218
Hospital Revenue Code	301
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: MDX Hawaii PPO	$168.78

HCHG THEOPHYLLINE

Facility

$174.00

Service Code	HCPCS 80198
Hospital Charge Code	H3011218
Hospital Revenue Code	301
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$14.14
Rate for Payer: AlohaCare Medicare	$14.14
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Devoted Health Medicare	$15.55
Rate for Payer: Hawaii Medical Service Association ABD	$19.56
Rate for Payer: Hawaii Medical Service Association Commercial	$17.68
Rate for Payer: Hawaii Medical Service Association Medicare	$14.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.54
Rate for Payer: Hawaii Western Management Group Commercial	$14.14
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$14.14
Rate for Payer: Kaiser Permanente Commercial	$109.62
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$14.14
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$15.55
Rate for Payer: Ohana Health Plan Medicare	$14.14
Rate for Payer: UnitedHealthcare Medicaid	$19.56
Rate for Payer: UnitedHealthcare Medicare	$14.14
Rate for Payer: University Health Alliance Commercial	$36.57

HCHG THERAPEUTIC PHLEBOTOMY

Facility

$330.00

Service Code	HCPCS 99195
Hospital Charge Code	H9400128
Hospital Revenue Code	940
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$320.10
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$214.50
Rate for Payer: Cash Price	$214.50
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$313.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$168.30
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$320.10
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$14.85
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$240.54

HCHG THERAPEUTIC PHLEBOTOMY

Facility

$330.00

Service Code	HCPCS 99195
Hospital Charge Code	H9400128
Hospital Revenue Code	940
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$320.10
Rate for Payer: Cash Price	$214.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: MDX Hawaii PPO	$320.10

HCHG THIN SMEAR

Facility

$111.00

Service Code	HCPCS 87207
Hospital Charge Code	H3060670
Hospital Revenue Code	306
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$72.15
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67

HCHG THIN SMEAR

Facility

$111.00

Service Code	HCPCS 87207
Hospital Charge Code	H3060670
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$5.99
Rate for Payer: AlohaCare Medicare	$5.99
Rate for Payer: Cash Price	$72.15
Rate for Payer: Cash Price	$72.15
Rate for Payer: Devoted Health Medicare	$6.59
Rate for Payer: Hawaii Medical Service Association ABD	$8.37
Rate for Payer: Hawaii Medical Service Association Commercial	$7.49
Rate for Payer: Hawaii Medical Service Association Medicare	$5.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.99
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$5.99
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$5.99
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$6.59
Rate for Payer: Ohana Health Plan Medicare	$5.99
Rate for Payer: UnitedHealthcare Medicaid	$8.37
Rate for Payer: UnitedHealthcare Medicare	$5.99
Rate for Payer: University Health Alliance Commercial	$15.48

HCHG THORACIC/LUMB JCT 2 VIEWS

Facility

$604.00

Service Code	HCPCS 72080
Hospital Charge Code	H3200790
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 THORACIC/LUMB JCT 2 VIEWS

Facility

$604.00

Service Code	HCPCS 72080
Hospital Charge Code	H3200790
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 THORACOTOMY W CARDIAC MASSAGE

Facility

$5,871.00

Service Code	HCPCS 32160
Hospital Charge Code	H4500816
Hospital Revenue Code	450
Min. Negotiated Rate	$4,990.35
Max. Negotiated Rate	$5,694.87
Rate for Payer: Cash Price	$3,816.15
Rate for Payer: Health Management Network Commercial	$4,990.35
Rate for Payer: MDX Hawaii PPO	$5,694.87

HCHG THORACOTOMY W CARDIAC MASSAGE

Facility

$5,871.00

Service Code	HCPCS 32160
Hospital Charge Code	H4500816
Hospital Revenue Code	450
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$14,715.00
Rate for Payer: Cash Price	$3,816.15
Rate for Payer: Cash Price	$3,816.15
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Hawaii Western Management Group Commercial	$5,577.45
Rate for Payer: Health Management Network Commercial	$4,990.35
Rate for Payer: Kaiser Permanente Commercial	$3,698.73
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$5,694.87
Rate for Payer: University Health Alliance Commercial	$4,279.37

HCHG THROMB COAG TIME

Facility

$58.00

Service Code	HCPCS 85670
Hospital Charge Code	H3050256
Hospital Revenue Code	305
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$5.77
Rate for Payer: AlohaCare Medicare	$5.77
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Devoted Health Medicare	$6.35
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Commercial	$7.21
Rate for Payer: Hawaii Medical Service Association Medicare	$5.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.38
Rate for Payer: Hawaii Western Management Group Commercial	$5.77
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$5.77
Rate for Payer: Kaiser Permanente Commercial	$36.54
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$5.77
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$6.35
Rate for Payer: Ohana Health Plan Medicare	$5.77
Rate for Payer: UnitedHealthcare Medicaid	$7.98
Rate for Payer: UnitedHealthcare Medicare	$5.77
Rate for Payer: University Health Alliance Commercial	$14.93

HCHG THROMB COAG TIME

Facility

$58.00

Service Code	HCPCS 85670
Hospital Charge Code	H3050256
Hospital Revenue Code	305
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$37.70
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$56.26

Know your out-of-pocket cost for care.

All Charges