Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG WHITE BLOOD COUNT AUTOMATED

Facility

$20.00

Service Code	HCPCS 85048
Hospital Charge Code	H3050264
Hospital Revenue Code	305
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

HCHG WORM ID

Facility

$65.00

Service Code	HCPCS 87169
Hospital Charge Code	H3060548
Hospital Revenue Code	306
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

HCHG WORM ID

Facility

$65.00

Service Code	HCPCS 87169
Hospital Charge Code	H3060548
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$64.35
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$58.50
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$64.35
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.39
Rate for Payer: Hawaii Medical Service Association Medicare	$58.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.31
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$58.50
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$58.50
Rate for Payer: Ohana Health Plan Medicare	$58.50
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$58.50
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG WRIST (2 VIEWS)

Facility

$564.00

Service Code	HCPCS 73100
Hospital Charge Code	H3200896
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$558.36
Rate for Payer: AlohaCare Medicaid	$282.00
Rate for Payer: AlohaCare Medicare	$507.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Devoted Health Medicare	$558.36
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$507.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Humana Medicare	$507.60
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: Kaiser Permanente Medicaid	$287.64
Rate for Payer: Kaiser Permanente Medicare	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08
Rate for Payer: Ohana Health Plan Medicaid	$507.60
Rate for Payer: Ohana Health Plan Medicare	$507.60
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$507.60
Rate for Payer: University Health Alliance Commercial	$57.07

HCHG WRIST (2 VIEWS)

Facility

$564.00

Service Code	HCPCS 73100
Hospital Charge Code	H3200896
Hospital Revenue Code	320
Min. Negotiated Rate	$479.40
Max. Negotiated Rate	$547.08
Rate for Payer: Cash Price	$366.60
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08

HCHG WRIST 2 VIEWS PORT

Facility

$564.00

Service Code	HCPCS 73100
Hospital Charge Code	H3200902
Hospital Revenue Code	320
Min. Negotiated Rate	$479.40
Max. Negotiated Rate	$547.08
Rate for Payer: Cash Price	$366.60
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08

HCHG WRIST 2 VIEWS PORT

Facility

$564.00

Service Code	HCPCS 73100
Hospital Charge Code	H3200902
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$558.36
Rate for Payer: AlohaCare Medicaid	$282.00
Rate for Payer: AlohaCare Medicare	$507.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Devoted Health Medicare	$558.36
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$507.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Humana Medicare	$507.60
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: Kaiser Permanente Medicaid	$287.64
Rate for Payer: Kaiser Permanente Medicare	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08
Rate for Payer: Ohana Health Plan Medicaid	$507.60
Rate for Payer: Ohana Health Plan Medicare	$507.60
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$507.60
Rate for Payer: University Health Alliance Commercial	$57.07

HCHG WRIST MIN 3 VIEWS

Facility

$604.00

Service Code	HCPCS 73110
Hospital Charge Code	H3200900
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: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG WRIST MIN 3 VIEWS

Facility

$604.00

Service Code	HCPCS 73110
Hospital Charge Code	H3200900
Hospital Revenue Code	320
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$597.96
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$543.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$597.96
Rate for Payer: Hawaii Medical Service Association ABD	$17.34
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$543.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.95
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$543.60
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$543.60
Rate for Payer: Ohana Health Plan Medicare	$543.60
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$543.60
Rate for Payer: University Health Alliance Commercial	$66.60

HCHG WRIST W NAVICULAR, MIN 3 VIEWS

Facility

$604.00

Service Code	HCPCS 73110
Hospital Charge Code	H3200904
Hospital Revenue Code	320
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$597.96
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$543.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$597.96
Rate for Payer: Hawaii Medical Service Association ABD	$17.34
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$543.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.95
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$543.60
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$543.60
Rate for Payer: Ohana Health Plan Medicare	$543.60
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$543.60
Rate for Payer: University Health Alliance Commercial	$66.60

HCHG WRIST W NAVICULAR, MIN 3 VIEWS

Facility

$604.00

Service Code	HCPCS 73110
Hospital Charge Code	H3200904
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: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG X-RAY COMPL ABD SERIES W/S/E/D VIEWS 1 VIEW CHEST

Facility

$758.00

Service Code	HCPCS 74022
Hospital Charge Code	H3200964
Hospital Revenue Code	320
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: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

HCHG X-RAY COMPL ABD SERIES W/S/E/D VIEWS 1 VIEW CHEST

Facility

$758.00

Service Code	HCPCS 74022
Hospital Charge Code	H3200964
Hospital Revenue Code	320
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$750.42
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$682.20
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$750.42
Rate for Payer: Hawaii Medical Service Association ABD	$24.39
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$682.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.81
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$682.20
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$682.20
Rate for Payer: Ohana Health Plan Medicare	$682.20
Rate for Payer: UnitedHealthcare Medicaid	$24.39
Rate for Payer: UnitedHealthcare Medicare	$682.20
Rate for Payer: University Health Alliance Commercial	$95.72

HCHG X-RAY EXAM OF FEMUR 2/>

Facility

$563.00

Service Code	HCPCS 73552
Hospital Charge Code	H3200368
Hospital Revenue Code	320
Min. Negotiated Rate	$478.55
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$365.95
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11

HCHG X-RAY EXAM OF FEMUR 2/>

Facility

$563.00

Service Code	HCPCS 73552
Hospital Charge Code	H3200368
Hospital Revenue Code	320
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$557.37
Rate for Payer: AlohaCare Medicaid	$281.50
Rate for Payer: AlohaCare Medicare	$506.70
Rate for Payer: Cash Price	$365.95
Rate for Payer: Cash Price	$365.95
Rate for Payer: Devoted Health Medicare	$557.37
Rate for Payer: Hawaii Medical Service Association ABD	$15.87
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$506.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.67
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Humana Medicare	$506.70
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: Kaiser Permanente Medicare	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: Ohana Health Plan Medicaid	$506.70
Rate for Payer: Ohana Health Plan Medicare	$506.70
Rate for Payer: UnitedHealthcare Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicare	$506.70
Rate for Payer: University Health Alliance Commercial	$67.43

HCHG YEAST IDENTIFICATION

Facility

$191.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060737
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$189.09
Rate for Payer: AlohaCare Medicaid	$95.50
Rate for Payer: AlohaCare Medicare	$171.90
Rate for Payer: Cash Price	$124.15
Rate for Payer: Cash Price	$124.15
Rate for Payer: Devoted Health Medicare	$189.09
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$171.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$171.90
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$171.90
Rate for Payer: Ohana Health Plan Medicare	$171.90
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$171.90
Rate for Payer: University Health Alliance Commercial	$26.68

HCHG YEAST IDENTIFICATION

Facility

$191.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060737
Hospital Revenue Code	306
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27

HCHG YERSINIA STOOL CULT

Facility

$156.00

Service Code	HCPCS 87046
Hospital Charge Code	H3060550
Hospital Revenue Code	306
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: MDX Hawaii PPO	$151.32

HCHG YERSINIA STOOL CULT

Facility

$156.00

Service Code	HCPCS 87046
Hospital Charge Code	H3060550
Hospital Revenue Code	306
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$154.44
Rate for Payer: AlohaCare Medicaid	$78.00
Rate for Payer: AlohaCare Medicare	$140.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$154.44
Rate for Payer: Hawaii Medical Service Association ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$140.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.65
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$140.40
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$140.40
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$140.40
Rate for Payer: Ohana Health Plan Medicare	$140.40
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$140.40
Rate for Payer: University Health Alliance Commercial	$24.38

HCHG ZINC PLASMA 90

Facility

$87.00

Service Code	HCPCS 84630
Hospital Charge Code	H3011302
Hospital Revenue Code	301
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$86.13
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$78.30
Rate for Payer: Cash Price	$56.55
Rate for Payer: Cash Price	$56.55
Rate for Payer: Devoted Health Medicare	$86.13
Rate for Payer: Hawaii Medical Service Association ABD	$15.74
Rate for Payer: Hawaii Medical Service Association Commercial	$14.24
Rate for Payer: Hawaii Medical Service Association Medicare	$78.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.53
Rate for Payer: Hawaii Western Management Group Commercial	$11.39
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$78.30
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$78.30
Rate for Payer: Ohana Health Plan Medicare	$78.30
Rate for Payer: UnitedHealthcare Medicaid	$15.74
Rate for Payer: UnitedHealthcare Medicare	$78.30
Rate for Payer: University Health Alliance Commercial	$29.43

HCHG ZINC PLASMA 90

Facility

$87.00

Service Code	HCPCS 84630
Hospital Charge Code	H3011302
Hospital Revenue Code	301
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$56.55
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

HEADACHES WITH MCC

Facility

$15,667.02

Service Code	MSDRG 102
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEADACHES WITHOUT MCC

Facility

$15,667.02

Service Code	MSDRG 103
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEART FAILURE AND SHOCK WITH CC

Facility

$28,513.51

Service Code	MSDRG 292
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITH MCC

Facility

$28,513.51

Service Code	MSDRG 291
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

Know your out-of-pocket cost for care.

All Charges