Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG ACUTE HEPATITIS PANEL

Facility

$1,072.00

Service Code	HCPCS 80074
Hospital Charge Code	H3010132
Hospital Revenue Code	301
Min. Negotiated Rate	$911.20
Max. Negotiated Rate	$1,039.84
Rate for Payer: Cash Price	$696.80
Rate for Payer: Health Management Network Commercial	$911.20
Rate for Payer: Kaiser Permanente Commercial	$964.80
Rate for Payer: MDX Hawaii PPO	$1,039.84

HCHG ACUTE HEPATITIS PANEL

Facility

$1,072.00

Service Code	HCPCS 80074
Hospital Charge Code	H3010132
Hospital Revenue Code	301
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$1,061.28
Rate for Payer: AlohaCare Medicaid	$536.00
Rate for Payer: AlohaCare Medicare	$964.80
Rate for Payer: Cash Price	$696.80
Rate for Payer: Cash Price	$696.80
Rate for Payer: Devoted Health Medicare	$1,061.28
Rate for Payer: Hawaii Medical Service Association ABD	$65.82
Rate for Payer: Hawaii Medical Service Association Commercial	$59.54
Rate for Payer: Hawaii Medical Service Association Medicare	$964.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$69.11
Rate for Payer: Hawaii Western Management Group Commercial	$47.63
Rate for Payer: Health Management Network Commercial	$911.20
Rate for Payer: Humana Medicare	$964.80
Rate for Payer: Kaiser Permanente Commercial	$964.80
Rate for Payer: Kaiser Permanente Medicaid	$546.72
Rate for Payer: Kaiser Permanente Medicare	$964.80
Rate for Payer: MDX Hawaii PPO	$1,039.84
Rate for Payer: Ohana Health Plan Medicaid	$964.80
Rate for Payer: Ohana Health Plan Medicare	$964.80
Rate for Payer: UnitedHealthcare Medicaid	$65.82
Rate for Payer: UnitedHealthcare Medicare	$964.80
Rate for Payer: University Health Alliance Commercial	$123.10

HCHG ACYLCARNITINE PROFILE, QUANT

Facility

$126.00

Service Code	HCPCS 82017
Hospital Charge Code	H3010134
Hospital Revenue Code	301
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$124.74
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$113.40
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Devoted Health Medicare	$124.74
Rate for Payer: Hawaii Medical Service Association ABD	$23.31
Rate for Payer: Hawaii Medical Service Association Commercial	$21.09
Rate for Payer: Hawaii Medical Service Association Medicare	$113.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.48
Rate for Payer: Hawaii Western Management Group Commercial	$16.87
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$113.40
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$113.40
Rate for Payer: Ohana Health Plan Medicare	$113.40
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: UnitedHealthcare Medicare	$113.40
Rate for Payer: University Health Alliance Commercial	$43.60

HCHG ACYLCARNITINE PROFILE, QUANT

Facility

$126.00

Service Code	HCPCS 82017
Hospital Charge Code	H3010134
Hospital Revenue Code	301
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$81.90
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

HCHG ADENOSINE DEAMINASE, PERITONEAL - 90

Facility

$62.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011651
Hospital Revenue Code	301
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$40.30
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

HCHG ADENOSINE DEAMINASE, PERITONEAL - 90

Facility

$62.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011651
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$61.38
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$55.80
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Devoted Health Medicare	$61.38
Rate for Payer: Hawaii Medical Service Association ABD	$9.66
Rate for Payer: Hawaii Medical Service Association Commercial	$10.12
Rate for Payer: Hawaii Medical Service Association Medicare	$55.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.14
Rate for Payer: Hawaii Western Management Group Commercial	$8.10
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$55.80
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$55.80
Rate for Payer: Ohana Health Plan Medicare	$55.80
Rate for Payer: UnitedHealthcare Medicaid	$9.66
Rate for Payer: UnitedHealthcare Medicare	$55.80
Rate for Payer: University Health Alliance Commercial	$18.07

HCHG ADENOSINE DEAMINASE, PLEURAL FLUID

Facility

$62.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011553
Hospital Revenue Code	301
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$40.30
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

HCHG ADENOSINE DEAMINASE, PLEURAL FLUID

Facility

$62.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011553
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$61.38
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$55.80
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Devoted Health Medicare	$61.38
Rate for Payer: Hawaii Medical Service Association ABD	$9.66
Rate for Payer: Hawaii Medical Service Association Commercial	$10.12
Rate for Payer: Hawaii Medical Service Association Medicare	$55.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.14
Rate for Payer: Hawaii Western Management Group Commercial	$8.10
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$55.80
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$55.80
Rate for Payer: Ohana Health Plan Medicare	$55.80
Rate for Payer: UnitedHealthcare Medicaid	$9.66
Rate for Payer: UnitedHealthcare Medicare	$55.80
Rate for Payer: University Health Alliance Commercial	$18.07

HCHG ADMIN OF INFLUENZA VACCINE

Facility

$224.00

Service Code	HCPCS G0008
Hospital Charge Code	H7710106
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$221.76
Rate for Payer: AlohaCare Medicaid	$112.00
Rate for Payer: AlohaCare Medicare	$201.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Devoted Health Medicare	$221.76
Rate for Payer: Hawaii Medical Service Association Commercial	$59.80
Rate for Payer: Hawaii Medical Service Association Medicare	$201.60
Rate for Payer: Hawaii Western Management Group Commercial	$212.80
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Humana Medicare	$201.60
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$114.24
Rate for Payer: Kaiser Permanente Medicare	$201.60
Rate for Payer: MDX Hawaii PPO	$217.28
Rate for Payer: Ohana Health Plan Medicaid	$201.60
Rate for Payer: Ohana Health Plan Medicare	$201.60
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: UnitedHealthcare Medicare	$201.60
Rate for Payer: University Health Alliance Commercial	$163.27

HCHG ADMIN OF INFLUENZA VACCINE

Facility

$224.00

Service Code	HCPCS G0008
Hospital Charge Code	H7710106
Hospital Revenue Code	771
Min. Negotiated Rate	$190.40
Max. Negotiated Rate	$217.28
Rate for Payer: Cash Price	$145.60
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: MDX Hawaii PPO	$217.28

HCHG ADMIN SARSCOV2 100MCG/0.5ML 1ST

Facility

$63.00

Service Code	HCPCS 0011A
Hospital Charge Code	H7710112
Hospital Revenue Code	771
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$62.37
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$56.70
Rate for Payer: Cash Price	$40.95
Rate for Payer: Devoted Health Medicare	$62.37
Rate for Payer: Hawaii Medical Service Association Medicare	$56.70
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$56.70
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$56.70
Rate for Payer: Ohana Health Plan Medicare	$56.70
Rate for Payer: UnitedHealthcare Medicare	$56.70
Rate for Payer: University Health Alliance Commercial	$45.92

HCHG ADMIN SARSCOV2 100MCG/0.5ML 1ST

Facility

$63.00

Service Code	HCPCS 0011A
Hospital Charge Code	H7710112
Hospital Revenue Code	771
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

HCHG ADMIN SARSCOV2 100MCG/0.5ML 2ND

Facility

$106.00

Service Code	HCPCS 0012A
Hospital Charge Code	H7710113
Hospital Revenue Code	771
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Cash Price	$68.90
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: MDX Hawaii PPO	$102.82

HCHG ADMIN SARSCOV2 100MCG/0.5ML 2ND

Facility

$106.00

Service Code	HCPCS 0012A
Hospital Charge Code	H7710113
Hospital Revenue Code	771
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$104.94
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: AlohaCare Medicare	$95.40
Rate for Payer: Cash Price	$68.90
Rate for Payer: Devoted Health Medicare	$104.94
Rate for Payer: Hawaii Medical Service Association Medicare	$95.40
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$95.40
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$95.40
Rate for Payer: Ohana Health Plan Medicare	$95.40
Rate for Payer: UnitedHealthcare Medicare	$95.40
Rate for Payer: University Health Alliance Commercial	$77.26

HCHG ADMIN SARSCOV2 100MCG/0.5ML 3RD

Facility

$179.00

Service Code	HCPCS 0013A
Hospital Charge Code	H7710120
Hospital Revenue Code	771
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

HCHG ADMIN SARSCOV2 100MCG/0.5ML 3RD

Facility

$179.00

Service Code	HCPCS 0013A
Hospital Charge Code	H7710120
Hospital Revenue Code	771
Min. Negotiated Rate	$89.50
Max. Negotiated Rate	$177.21
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$161.10
Rate for Payer: Cash Price	$116.35
Rate for Payer: Devoted Health Medicare	$177.21
Rate for Payer: Hawaii Medical Service Association Medicare	$161.10
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$161.10
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$161.10
Rate for Payer: Ohana Health Plan Medicare	$161.10
Rate for Payer: UnitedHealthcare Medicare	$161.10
Rate for Payer: University Health Alliance Commercial	$130.47

HCHG ADM SARSCV2 BVL 50MCG/.5ML B

Facility

$142.00

Service Code	HCPCS 0134A
Hospital Charge Code	H7710147
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$140.58
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$127.80
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$140.58
Rate for Payer: Hawaii Medical Service Association Medicare	$127.80
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$127.80
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$127.80
Rate for Payer: Ohana Health Plan Medicare	$127.80
Rate for Payer: UnitedHealthcare Medicare	$127.80
Rate for Payer: University Health Alliance Commercial	$103.50

HCHG ADM SARSCV2 BVL 50MCG/.5ML B

Facility

$142.00

Service Code	HCPCS 0134A
Hospital Charge Code	H7710147
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

HCHG AERONEB TX, DAILY

Facility

$1,256.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100296
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$1,243.44
Rate for Payer: AlohaCare Medicaid	$628.00
Rate for Payer: AlohaCare Medicare	$1,130.40
Rate for Payer: Cash Price	$816.40
Rate for Payer: Cash Price	$816.40
Rate for Payer: Devoted Health Medicare	$1,243.44
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1,130.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,193.20
Rate for Payer: Health Management Network Commercial	$1,067.60
Rate for Payer: Humana Medicare	$1,130.40
Rate for Payer: Kaiser Permanente Commercial	$1,130.40
Rate for Payer: Kaiser Permanente Medicaid	$640.56
Rate for Payer: Kaiser Permanente Medicare	$1,130.40
Rate for Payer: MDX Hawaii PPO	$1,218.32
Rate for Payer: Ohana Health Plan Medicaid	$1,130.40
Rate for Payer: Ohana Health Plan Medicare	$1,130.40
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$1,130.40
Rate for Payer: University Health Alliance Commercial	$915.50

HCHG AERONEB TX, DAILY

Facility

$1,256.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100296
Hospital Revenue Code	410
Min. Negotiated Rate	$1,067.60
Max. Negotiated Rate	$1,218.32
Rate for Payer: Cash Price	$816.40
Rate for Payer: Health Management Network Commercial	$1,067.60
Rate for Payer: Kaiser Permanente Commercial	$1,130.40
Rate for Payer: MDX Hawaii PPO	$1,218.32

HCHG AFB MALDI ID - 90

Facility

$215.00

Service Code	HCPCS 87118
Hospital Charge Code	H3060719
Hospital Revenue Code	306
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$139.75
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

HCHG AFB MALDI ID - 90

Facility

$215.00

Service Code	HCPCS 87118
Hospital Charge Code	H3060719
Hospital Revenue Code	306
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$212.85
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$193.50
Rate for Payer: Cash Price	$139.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Devoted Health Medicare	$212.85
Rate for Payer: Hawaii Medical Service Association ABD	$15.13
Rate for Payer: Hawaii Medical Service Association Commercial	$18.26
Rate for Payer: Hawaii Medical Service Association Medicare	$193.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.89
Rate for Payer: Hawaii Western Management Group Commercial	$14.61
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$193.50
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$193.50
Rate for Payer: Ohana Health Plan Medicare	$193.50
Rate for Payer: UnitedHealthcare Medicaid	$15.13
Rate for Payer: UnitedHealthcare Medicare	$193.50
Rate for Payer: University Health Alliance Commercial	$28.29

HCHG AFB RAPID GROWER MIC

Facility

$319.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060603
Hospital Revenue Code	306
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43

HCHG AFB RAPID GROWER MIC

Facility

$319.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060603
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$315.81
Rate for Payer: AlohaCare Medicaid	$159.50
Rate for Payer: AlohaCare Medicare	$287.10
Rate for Payer: Cash Price	$207.35
Rate for Payer: Cash Price	$207.35
Rate for Payer: Devoted Health Medicare	$315.81
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	$287.10
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	$271.15
Rate for Payer: Humana Medicare	$287.10
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: Kaiser Permanente Medicaid	$162.69
Rate for Payer: Kaiser Permanente Medicare	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43
Rate for Payer: Ohana Health Plan Medicaid	$287.10
Rate for Payer: Ohana Health Plan Medicare	$287.10
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$287.10
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG AFP MATERNAL SERUM

Facility

$237.00

Service Code	HCPCS 82105
Hospital Charge Code	H3010138
Hospital Revenue Code	301
Min. Negotiated Rate	$201.45
Max. Negotiated Rate	$229.89
Rate for Payer: Cash Price	$154.05
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89

Know your out-of-pocket cost for care.

All Charges