Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG US ABD AORTA AAA SCREENING

Facility

$708.00

Service Code	HCPCS 76706
Hospital Charge Code	H4020293
Hospital Revenue Code	402
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 U/S ABD B-SCAN W IMAG DOC LTD ABD

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020148
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$726.53
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$486.85
Rate for Payer: Cash Price	$486.85
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
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	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$471.87
Rate for Payer: Kaiser Permanente Medicaid	$381.99
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$726.53
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$200.93

HCHG U/S ABD B-SCAN W IMAG DOC LTD ABD

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020148
Hospital Revenue Code	402
Min. Negotiated Rate	$636.65
Max. Negotiated Rate	$726.53
Rate for Payer: Cash Price	$486.85
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: MDX Hawaii PPO	$726.53

HCHG U/S ABD B-SCAN W IMAG DOC LTD APPENDIX

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020156
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$726.53
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$486.85
Rate for Payer: Cash Price	$486.85
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
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	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$471.87
Rate for Payer: Kaiser Permanente Medicaid	$381.99
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$726.53
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$200.93

HCHG U/S ABD B-SCAN W IMAG DOC LTD APPENDIX

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020156
Hospital Revenue Code	402
Min. Negotiated Rate	$636.65
Max. Negotiated Rate	$726.53
Rate for Payer: Cash Price	$486.85
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: MDX Hawaii PPO	$726.53

HCHG U/S ABD B-SCAN W IMAG DOC LTD LIVER

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020152
Hospital Revenue Code	402
Min. Negotiated Rate	$636.65
Max. Negotiated Rate	$726.53
Rate for Payer: Cash Price	$486.85
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: MDX Hawaii PPO	$726.53

HCHG U/S ABD B-SCAN W IMAG DOC LTD LIVER

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020152
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$726.53
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$486.85
Rate for Payer: Cash Price	$486.85
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
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	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$471.87
Rate for Payer: Kaiser Permanente Medicaid	$381.99
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$726.53
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$200.93

HCHG U/S ABD COMP

Facility

$758.00

Service Code	HCPCS 76700
Hospital Charge Code	H4020144
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: MDX Hawaii PPO	$735.26

HCHG U/S ABD COMP

Facility

$758.00

Service Code	HCPCS 76700
Hospital Charge Code	H4020144
Hospital Revenue Code	402
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$64.94
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	$70.56
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$477.54
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$268.45

HCHG U/S ABD LTD

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020146
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$726.53
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$486.85
Rate for Payer: Cash Price	$486.85
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
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	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$471.87
Rate for Payer: Kaiser Permanente Medicaid	$381.99
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$726.53
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$200.93

HCHG U/S ABD LTD

Facility

$749.00

Service Code	HCPCS 76705
Hospital Charge Code	H4020146
Hospital Revenue Code	402
Min. Negotiated Rate	$636.65
Max. Negotiated Rate	$726.53
Rate for Payer: Cash Price	$486.85
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: MDX Hawaii PPO	$726.53

HCHG U/S BLADDER

Facility

$708.00

Service Code	HCPCS 76857
Hospital Charge Code	H4020160
Hospital Revenue Code	402
Min. Negotiated Rate	$44.29
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	$44.29
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	$69.53
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	$44.29
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$161.45

HCHG U/S BLADDER

Facility

$708.00

Service Code	HCPCS 76857
Hospital Charge Code	H4020160
Hospital Revenue Code	402
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 US BREAST W/IMAGE COMP

Facility

$591.00

Service Code	HCPCS 76641
Hospital Charge Code	H4020288
Hospital Revenue Code	402
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$384.15
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: MDX Hawaii PPO	$573.27

HCHG US BREAST W/IMAGE COMP

Facility

$591.00

Service Code	HCPCS 76641
Hospital Charge Code	H4020288
Hospital Revenue Code	402
Min. Negotiated Rate	$34.94
Max. Negotiated Rate	$573.27
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$384.15
Rate for Payer: Cash Price	$384.15
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$34.94
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	$37.51
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$372.33
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$67.92
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$223.66

HCHG US BREAST W/IMAGE LTD

Facility

$583.00

Service Code	HCPCS 76642
Hospital Charge Code	H4020289
Hospital Revenue Code	402
Min. Negotiated Rate	$495.55
Max. Negotiated Rate	$565.51
Rate for Payer: Cash Price	$378.95
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: MDX Hawaii PPO	$565.51

HCHG US BREAST W/IMAGE LTD

Facility

$583.00

Service Code	HCPCS 76642
Hospital Charge Code	H4020289
Hospital Revenue Code	402
Min. Negotiated Rate	$34.94
Max. Negotiated Rate	$565.51
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cash Price	$378.95
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$34.94
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	$37.51
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$367.29
Rate for Payer: Kaiser Permanente Medicaid	$297.33
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$565.51
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$55.91
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$182.63

HCHG U/S BUBBLE STUDY

Facility

$670.00

Service Code	HCPCS 93893
Hospital Charge Code	H9210158
Hospital Revenue Code	921
Min. Negotiated Rate	$569.50
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$435.50
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: MDX Hawaii PPO	$649.90

HCHG U/S BUBBLE STUDY

Facility

$670.00

Service Code	HCPCS 93893
Hospital Charge Code	H9210158
Hospital Revenue Code	921
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$649.90
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$435.50
Rate for Payer: Cash Price	$435.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$147.92
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	$171.83
Rate for Payer: Hawaii Western Management Group Commercial	$636.50
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$341.70
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$649.90
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$147.92
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$488.36

HCHG U/S CHEST

Facility

$708.00

Service Code	HCPCS 76604
Hospital Charge Code	H4020166
Hospital Revenue Code	402
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 U/S CHEST

Facility

$708.00

Service Code	HCPCS 76604
Hospital Charge Code	H4020166
Hospital Revenue Code	402
Min. Negotiated Rate	$42.98
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	$42.98
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	$46.81
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	$42.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$171.44

HCHG US EXAM INFANT HIPS DYNAMIC

Facility

$499.00

Service Code	HCPCS 76885
Hospital Charge Code	H4020291
Hospital Revenue Code	402
Min. Negotiated Rate	$424.15
Max. Negotiated Rate	$484.03
Rate for Payer: Cash Price	$324.35
Rate for Payer: Health Management Network Commercial	$424.15
Rate for Payer: MDX Hawaii PPO	$484.03

HCHG US EXAM INFANT HIPS DYNAMIC

Facility

$499.00

Service Code	HCPCS 76885
Hospital Charge Code	H4020291
Hospital Revenue Code	402
Min. Negotiated Rate	$50.35
Max. Negotiated Rate	$484.03
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$324.35
Rate for Payer: Cash Price	$324.35
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$50.35
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	$54.65
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$424.15
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$314.37
Rate for Payer: Kaiser Permanente Medicaid	$254.49
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$484.03
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$50.35
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$192.77

HCHG US, EXTREMITY, NONVAS, RT W IMAGE DOC, COMPLETE

Facility

$758.00

Service Code	HCPCS 76881
Hospital Charge Code	H4020284
Hospital Revenue Code	402
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
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	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$477.54
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$246.33

HCHG US, EXTREMITY, NONVAS, RT W IMAGE DOC, COMPLETE

Facility

$758.00

Service Code	HCPCS 76881
Hospital Charge Code	H4020284
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: MDX Hawaii PPO	$735.26

Know your out-of-pocket cost for care.

All Charges