Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ACUTE HEPATITIS PANEL

Facility

$804.00

Service Code	HCPCS 80074
Hospital Charge Code	H3010132
Hospital Revenue Code	301
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG ACYLCARNITINE PROFILE, QUANT

Facility

$208.00

Service Code	HCPCS 82017
Hospital Charge Code	H3010134
Hospital Revenue Code	301
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

HCHG ACYLCARNITINE PROFILE, QUANT

Facility

$208.00

Service Code	HCPCS 82017
Hospital Charge Code	H3010134
Hospital Revenue Code	301
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$16.87
Rate for Payer: AlohaCare Medicare	$16.87
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Devoted Health Medicare	$18.56
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	$16.87
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	$176.80
Rate for Payer: Humana Medicare	$16.87
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$16.87
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$18.56
Rate for Payer: Ohana Health Plan Medicare	$16.87
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: UnitedHealthcare Medicare	$16.87
Rate for Payer: University Health Alliance Commercial	$43.60

HCHG ADAMTS-13 ACTIVITY SO

Facility

$318.00

Service Code	HCPCS 85397
Hospital Charge Code	K3050005
Hospital Revenue Code	305
Min. Negotiated Rate	$270.30
Max. Negotiated Rate	$308.46
Rate for Payer: Cash Price	$206.70
Rate for Payer: Health Management Network Commercial	$270.30
Rate for Payer: MDX Hawaii PPO	$308.46

HCHG ADAMTS-13 ACTIVITY SO

Facility

$318.00

Service Code	HCPCS 85397
Hospital Charge Code	K3050005
Hospital Revenue Code	305
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$308.46
Rate for Payer: AlohaCare Medicaid	$30.86
Rate for Payer: AlohaCare Medicare	$30.86
Rate for Payer: Cash Price	$206.70
Rate for Payer: Cash Price	$206.70
Rate for Payer: Devoted Health Medicare	$33.95
Rate for Payer: Hawaii Medical Service Association Commercial	$38.58
Rate for Payer: Hawaii Medical Service Association Medicare	$30.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.31
Rate for Payer: Hawaii Western Management Group Commercial	$30.86
Rate for Payer: Health Management Network Commercial	$270.30
Rate for Payer: Humana Medicare	$30.86
Rate for Payer: Kaiser Permanente Commercial	$200.34
Rate for Payer: Kaiser Permanente Medicaid	$162.18
Rate for Payer: Kaiser Permanente Medicare	$30.86
Rate for Payer: MDX Hawaii PPO	$308.46
Rate for Payer: Ohana Health Plan Medicaid	$33.95
Rate for Payer: Ohana Health Plan Medicare	$30.86
Rate for Payer: UnitedHealthcare Medicaid	$23.15
Rate for Payer: UnitedHealthcare Medicare	$30.86
Rate for Payer: University Health Alliance Commercial	$231.79

HCHG ADENOSINE DEAMINASE, PERITONEAL - 90

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011651
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$8.10
Rate for Payer: AlohaCare Medicare	$8.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$8.91
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	$8.10
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	$73.10
Rate for Payer: Humana Medicare	$8.10
Rate for Payer: Kaiser Permanente Commercial	$54.18
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$8.10
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$8.91
Rate for Payer: Ohana Health Plan Medicare	$8.10
Rate for Payer: UnitedHealthcare Medicaid	$9.66
Rate for Payer: UnitedHealthcare Medicare	$8.10
Rate for Payer: University Health Alliance Commercial	$18.07

HCHG ADENOSINE DEAMINASE, PERITONEAL - 90

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011651
Hospital Revenue Code	301
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: MDX Hawaii PPO	$83.42

HCHG ADENOSINE DEAMINASE, PLEURAL FLUID

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011553
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$8.10
Rate for Payer: AlohaCare Medicare	$8.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$8.91
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	$8.10
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	$73.10
Rate for Payer: Humana Medicare	$8.10
Rate for Payer: Kaiser Permanente Commercial	$54.18
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$8.10
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$8.91
Rate for Payer: Ohana Health Plan Medicare	$8.10
Rate for Payer: UnitedHealthcare Medicaid	$9.66
Rate for Payer: UnitedHealthcare Medicare	$8.10
Rate for Payer: University Health Alliance Commercial	$18.07

HCHG ADENOSINE DEAMINASE, PLEURAL FLUID

Facility

$86.00

Service Code	HCPCS 84311
Hospital Charge Code	H3011553
Hospital Revenue Code	301
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: MDX Hawaii PPO	$83.42

HCHG ADMIN BEBTELOVIMAB INJ

Facility

$1,939.00

Service Code	HCPCS M0222
Hospital Charge Code	H7710136
Hospital Revenue Code	771
Min. Negotiated Rate	$1,648.15
Max. Negotiated Rate	$1,880.83
Rate for Payer: Cash Price	$1,260.35
Rate for Payer: Health Management Network Commercial	$1,648.15
Rate for Payer: MDX Hawaii PPO	$1,880.83

HCHG ADMIN BEBTELOVIMAB INJ

Facility

$1,939.00

Service Code	HCPCS M0222
Hospital Charge Code	H7710136
Hospital Revenue Code	771
Min. Negotiated Rate	$988.89
Max. Negotiated Rate	$1,880.83
Rate for Payer: Cash Price	$1,260.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,842.05
Rate for Payer: Health Management Network Commercial	$1,648.15
Rate for Payer: Kaiser Permanente Commercial	$1,221.57
Rate for Payer: Kaiser Permanente Medicaid	$988.89
Rate for Payer: MDX Hawaii PPO	$1,880.83
Rate for Payer: University Health Alliance Commercial	$1,413.34

HCHG ADMIN OF HEP B VACCINE

Facility

$93.00

Service Code	HCPCS G0010
Hospital Charge Code	H7710105
Hospital Revenue Code	771
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: MDX Hawaii PPO	$90.21

HCHG ADMIN OF HEP B VACCINE

Facility

$93.00

Service Code	HCPCS G0010
Hospital Charge Code	H7710105
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$67.79

HCHG ADMIN OF INFLUENZA VACCINE

Facility

$176.00

Service Code	HCPCS G0008
Hospital Charge Code	H7710106
Hospital Revenue Code	771
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: MDX Hawaii PPO	$170.72

HCHG ADMIN OF INFLUENZA VACCINE

Facility

$176.00

Service Code	HCPCS G0008
Hospital Charge Code	H7710106
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$170.72
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$167.20
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$110.88
Rate for Payer: Kaiser Permanente Medicaid	$89.76
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$170.72
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$128.29

HCHG ADMIN PNEUMOVAX

Facility

$141.00

Service Code	HCPCS G0009
Hospital Charge Code	H7710109
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$102.77

HCHG ADMIN PNEUMOVAX

Facility

$141.00

Service Code	HCPCS G0009
Hospital Charge Code	H7710109
Hospital Revenue Code	771
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: MDX Hawaii PPO	$136.77

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	$32.13
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$39.69
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: MDX Hawaii PPO	$61.11
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: 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	$54.06
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$68.90
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: University Health Alliance Commercial	$77.26

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: 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 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: 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	$91.29
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$112.77
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: University Health Alliance Commercial	$130.47

HCHG ADMN RSV MONOC ANTB IM CNSL

Facility

$161.00

Service Code	HCPCS 96380
Hospital Charge Code	H7710160
Hospital Revenue Code	771
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Hawaii Western Management Group Commercial	$152.95
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: UnitedHealthcare Medicaid	$14.77
Rate for Payer: University Health Alliance Commercial	$117.35

HCHG ADMN RSV MONOC ANTB IM CNSL

Facility

$161.00

Service Code	HCPCS 96380
Hospital Charge Code	H7710160
Hospital Revenue Code	771
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

Know your out-of-pocket cost for care.

All Charges