Kona Community Hospital

All Charges

Charge

Type

Setting

Price

SYNCHRONOUS AUDIO-ONLY VISIT EST HIGH MDM 40 MIN

Professional

Both

$259.46

Service Code	HCPCS 98015
Min. Negotiated Rate	$220.54
Max. Negotiated Rate	$220.54
Rate for Payer: Cash Price	$168.65
Rate for Payer: Health Management Network Commercial	$220.54

SYNCHRONOUS AUDIO-ONLY VISIT EST LOW MDM 20 MIN

Professional

Both

$122.76

Service Code	HCPCS 98013
Min. Negotiated Rate	$104.35
Max. Negotiated Rate	$104.35
Rate for Payer: Cash Price	$79.79
Rate for Payer: Health Management Network Commercial	$104.35

SYNCHRONOUS AUDIO-ONLY VISIT EST MOD MDM 30 MIN

Professional

Both

$178.47

Service Code	HCPCS 98014
Min. Negotiated Rate	$151.70
Max. Negotiated Rate	$151.70
Rate for Payer: Cash Price	$116.01
Rate for Payer: Health Management Network Commercial	$151.70

SYNCHRONOUS AUDIO-ONLY VISIT EST SF MDM 10 MIN

Professional

Both

$70.59

Service Code	HCPCS 98012
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Cash Price	$45.88
Rate for Payer: Health Management Network Commercial	$60.00

SYNCHRONOUS AUDIO-VIDEO VISIT EST LOW MDM 20 MIN

Professional

Both

$134.36

Service Code	HCPCS 98005
Min. Negotiated Rate	$114.21
Max. Negotiated Rate	$114.21
Rate for Payer: Cash Price	$87.33
Rate for Payer: Health Management Network Commercial	$114.21

SYNCHRONOUS AUDIO-VIDEO VISIT EST MOD MDM 30 MIN

Professional

Both

$197.31

Service Code	HCPCS 98006
Min. Negotiated Rate	$167.71
Max. Negotiated Rate	$167.71
Rate for Payer: Cash Price	$128.25
Rate for Payer: Health Management Network Commercial	$167.71

SYNCHRONOUS AUDIO-VIDEO VISIT EST SF MDM 10 MIN

Professional

Both

$77.28

Service Code	HCPCS 98004
Min. Negotiated Rate	$65.69
Max. Negotiated Rate	$65.69
Rate for Payer: Cash Price	$50.23
Rate for Payer: Health Management Network Commercial	$65.69

SYNCHRONOUS AUDIO-VIDEO VISIT NEW LOW MDM 30 MIN

Professional

Both

$163.41

Service Code	HCPCS 98001
Min. Negotiated Rate	$138.90
Max. Negotiated Rate	$138.90
Rate for Payer: Cash Price	$106.22
Rate for Payer: Health Management Network Commercial	$138.90

SYNCHRONOUS AUDIO-VIDEO VISIT NEW MOD MDM 45 MIN

Professional

Both

$260.06

Service Code	HCPCS 98002
Min. Negotiated Rate	$221.05
Max. Negotiated Rate	$221.05
Rate for Payer: Cash Price	$169.04
Rate for Payer: Health Management Network Commercial	$221.05

SYNCHRONOUS AUDIO-VIDEO VISIT NEW SF MDM 15 MIN

Professional

Both

$99.86

Service Code	HCPCS 98000
Min. Negotiated Rate	$84.88
Max. Negotiated Rate	$84.88
Rate for Payer: Cash Price	$64.91
Rate for Payer: Health Management Network Commercial	$84.88

SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN

Professional

Both

$261.51

Service Code	HCPCS 98007
Min. Negotiated Rate	$222.28
Max. Negotiated Rate	$222.28
Rate for Payer: Cash Price	$169.98
Rate for Payer: Health Management Network Commercial	$222.28

SYNCHRONOUS AUDIO-VIDEO VST NEW HIGH MDM 60 MIN

Professional

Both

$344.40

Service Code	HCPCS 98003
Min. Negotiated Rate	$292.74
Max. Negotiated Rate	$292.74
Rate for Payer: Cash Price	$223.86
Rate for Payer: Health Management Network Commercial	$292.74

SYNCOPE AND COLLAPSE

Facility

$15,035.10

Service Code	MSDRG 312
Min. Negotiated Rate	$11,463.93
Max. Negotiated Rate	$15,035.10
Rate for Payer: AlohaCare Medicare	$11,463.93
Rate for Payer: Devoted Health Medicare	$12,610.32
Rate for Payer: Hawaii Medical Service Association Commercial	$14,247.24
Rate for Payer: Hawaii Medical Service Association Medicare	$11,463.93
Rate for Payer: Humana Medicare	$11,463.93
Rate for Payer: Kaiser Permanente Commercial	$15,035.10
Rate for Payer: Kaiser Permanente Medicare	$11,463.93
Rate for Payer: Ohana Health Plan Medicare	$11,463.93
Rate for Payer: UnitedHealthcare Medicare	$11,463.93

SYNCOPE & COLLAPSE

Facility

$6,585.18

Service Code	APR-DRG 2044
Min. Negotiated Rate	$6,585.18
Max. Negotiated Rate	$6,585.18
Rate for Payer: AlohaCare Medicaid	$6,585.18
Rate for Payer: Hawaii Medical Service Association ABD	$6,585.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,585.18
Rate for Payer: Kaiser Permanente Medicaid	$6,585.18
Rate for Payer: Ohana Health Plan Medicaid	$6,585.18
Rate for Payer: UnitedHealthcare Medicaid	$6,585.18

SYNCOPE & COLLAPSE

Facility

$3,292.91

Service Code	APR-DRG 2042
Min. Negotiated Rate	$3,292.91
Max. Negotiated Rate	$3,292.91
Rate for Payer: AlohaCare Medicaid	$3,292.91
Rate for Payer: Hawaii Medical Service Association ABD	$3,292.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,292.91
Rate for Payer: Kaiser Permanente Medicaid	$3,292.91
Rate for Payer: Ohana Health Plan Medicaid	$3,292.91
Rate for Payer: UnitedHealthcare Medicaid	$3,292.91

SYNCOPE & COLLAPSE

Facility

$4,183.80

Service Code	APR-DRG 2043
Min. Negotiated Rate	$4,183.80
Max. Negotiated Rate	$4,183.80
Rate for Payer: AlohaCare Medicaid	$4,183.80
Rate for Payer: Hawaii Medical Service Association ABD	$4,183.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,183.80
Rate for Payer: Kaiser Permanente Medicaid	$4,183.80
Rate for Payer: Ohana Health Plan Medicaid	$4,183.80
Rate for Payer: UnitedHealthcare Medicaid	$4,183.80

SYNCOPE & COLLAPSE

Facility

$2,857.34

Service Code	APR-DRG 2041
Min. Negotiated Rate	$2,857.34
Max. Negotiated Rate	$2,857.34
Rate for Payer: AlohaCare Medicaid	$2,857.34
Rate for Payer: Hawaii Medical Service Association ABD	$2,857.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,857.34
Rate for Payer: Kaiser Permanente Medicaid	$2,857.34
Rate for Payer: Ohana Health Plan Medicaid	$2,857.34
Rate for Payer: UnitedHealthcare Medicaid	$2,857.34

Synovasure Alpha Defensin Lateral Flow Test 00888812501 [3642670]

Facility

$2,496.25

Hospital Charge Code	3642670
Hospital Revenue Code	272
Min. Negotiated Rate	$2,121.81
Max. Negotiated Rate	$2,421.36
Rate for Payer: Cash Price	$1,622.56
Rate for Payer: Health Management Network Commercial	$2,121.81
Rate for Payer: MDX Hawaii PPO	$2,421.36

Synovasure Alpha Defensin Lateral Flow Test 00888812501 [3642670]

Facility

$2,496.25

Hospital Charge Code	3642670
Hospital Revenue Code	272
Min. Negotiated Rate	$1,273.09
Max. Negotiated Rate	$2,421.36
Rate for Payer: Cash Price	$1,622.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,371.44
Rate for Payer: Health Management Network Commercial	$2,121.81
Rate for Payer: Kaiser Permanente Commercial	$1,572.64
Rate for Payer: Kaiser Permanente Medicaid	$1,273.09
Rate for Payer: MDX Hawaii PPO	$2,421.36
Rate for Payer: University Health Alliance Commercial	$1,819.52

T15 Hexalobe Driver Ar-8941DH [3644449]

Facility

$1,223.44

Hospital Charge Code	3644449
Hospital Revenue Code	272
Min. Negotiated Rate	$623.95
Max. Negotiated Rate	$1,186.74
Rate for Payer: Cash Price	$795.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.27
Rate for Payer: Health Management Network Commercial	$1,039.92
Rate for Payer: Kaiser Permanente Commercial	$770.77
Rate for Payer: Kaiser Permanente Medicaid	$623.95
Rate for Payer: MDX Hawaii PPO	$1,186.74
Rate for Payer: University Health Alliance Commercial	$891.77

T15 Hexalobe Driver Ar-8941DH [3644449]

Facility

$1,223.44

Hospital Charge Code	3644449
Hospital Revenue Code	272
Min. Negotiated Rate	$1,039.92
Max. Negotiated Rate	$1,186.74
Rate for Payer: Cash Price	$795.24
Rate for Payer: Health Management Network Commercial	$1,039.92
Rate for Payer: MDX Hawaii PPO	$1,186.74

TACROLIMUS 1 MG PO CAP

Facility

$7.55

Service Code	HCPCS J7507
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$7.32
Rate for Payer: Cash Price	$4.91
Rate for Payer: Cash Price	$16.00
Rate for Payer: Health Management Network Commercial	$20.93
Rate for Payer: Health Management Network Commercial	$6.42
Rate for Payer: MDX Hawaii PPO	$23.88
Rate for Payer: MDX Hawaii PPO	$7.32

TACROLIMUS 1 MG PO CAP

Facility

$24.62

Service Code	HCPCS J7507
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$23.88
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$4.91
Rate for Payer: Cash Price	$4.91
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.15
Rate for Payer: Hawaii Western Management Group Commercial	$23.39
Rate for Payer: Hawaii Western Management Group Commercial	$7.17
Rate for Payer: Health Management Network Commercial	$6.42
Rate for Payer: Health Management Network Commercial	$20.93
Rate for Payer: Kaiser Permanente Commercial	$4.76
Rate for Payer: Kaiser Permanente Commercial	$15.51
Rate for Payer: Kaiser Permanente Medicaid	$12.56
Rate for Payer: Kaiser Permanente Medicaid	$3.85
Rate for Payer: MDX Hawaii PPO	$7.32
Rate for Payer: MDX Hawaii PPO	$23.88
Rate for Payer: UnitedHealthcare Medicaid	$14.77
Rate for Payer: UnitedHealthcare Medicaid	$4.53
Rate for Payer: University Health Alliance Commercial	$5.50
Rate for Payer: University Health Alliance Commercial	$17.95

TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML INJ SUSP

Facility

$341.08

Service Code	HCPCS J9325
Hospital Revenue Code	636
Min. Negotiated Rate	$73.55
Max. Negotiated Rate	$330.85
Rate for Payer: AlohaCare Medicaid	$73.94
Rate for Payer: AlohaCare Medicare	$73.94
Rate for Payer: Cash Price	$221.70
Rate for Payer: Cash Price	$221.70
Rate for Payer: Devoted Health Medicare	$81.33
Rate for Payer: Hawaii Medical Service Association ABD	$73.55
Rate for Payer: Hawaii Medical Service Association Commercial	$92.42
Rate for Payer: Hawaii Medical Service Association Medicare	$73.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$73.55
Rate for Payer: Hawaii Western Management Group Commercial	$324.03
Rate for Payer: Health Management Network Commercial	$289.92
Rate for Payer: Humana Medicare	$73.94
Rate for Payer: Kaiser Permanente Commercial	$214.88
Rate for Payer: Kaiser Permanente Medicaid	$173.95
Rate for Payer: Kaiser Permanente Medicare	$73.94
Rate for Payer: MDX Hawaii PPO	$330.85
Rate for Payer: Ohana Health Plan Medicaid	$81.33
Rate for Payer: Ohana Health Plan Medicare	$73.94
Rate for Payer: UnitedHealthcare Medicaid	$204.65
Rate for Payer: UnitedHealthcare Medicare	$73.94
Rate for Payer: University Health Alliance Commercial	$248.61

TALIMOGENE LAHERPAREPVEC 10EXP6 (1 MILLION) PFU/ML INJ SUSP

Facility

$341.08

Service Code	HCPCS J9325
Hospital Revenue Code	250
Min. Negotiated Rate	$289.92
Max. Negotiated Rate	$330.85
Rate for Payer: Cash Price	$221.70
Rate for Payer: Health Management Network Commercial	$289.92
Rate for Payer: MDX Hawaii PPO	$330.85

Know your out-of-pocket cost for care.

All Charges