Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ADMN RSV MONOC ANTB IM NJX

Facility

$100.00

Service Code	HCPCS 96381
Hospital Charge Code	H7710161
Hospital Revenue Code	771
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: MDX Hawaii PPO	$97.00

HCHG ADMN RSV MONOC ANTB IM NJX

Facility

$100.00

Service Code	HCPCS 96381
Hospital Charge Code	H7710161
Hospital Revenue Code	771
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: UnitedHealthcare Medicaid	$12.92
Rate for Payer: University Health Alliance Commercial	$72.89

HCHG ADM SARSCV2 BVL 30MCG/.3ML B

Facility

$142.00

Service Code	HCPCS 0124A
Hospital Charge Code	H7710146
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: MDX Hawaii PPO	$137.74

HCHG ADM SARSCV2 BVL 30MCG/.3ML B

Facility

$142.00

Service Code	HCPCS 0124A
Hospital Charge Code	H7710146
Hospital Revenue Code	771
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: MDX Hawaii PPO	$137.74
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: MDX Hawaii PPO	$137.74

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	$72.42
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: University Health Alliance Commercial	$103.50

HCHG AEP SCR AUDITORY POTENTIAL

Facility

$539.00

Service Code	HCPCS 92650
Hospital Charge Code	H4710171
Hospital Revenue Code	471
Min. Negotiated Rate	$19.16
Max. Negotiated Rate	$522.83
Rate for Payer: Cash Price	$350.35
Rate for Payer: Cash Price	$350.35
Rate for Payer: Hawaii Western Management Group Commercial	$512.05
Rate for Payer: Health Management Network Commercial	$458.15
Rate for Payer: Kaiser Permanente Commercial	$339.57
Rate for Payer: Kaiser Permanente Medicaid	$274.89
Rate for Payer: MDX Hawaii PPO	$522.83
Rate for Payer: UnitedHealthcare Medicaid	$19.16
Rate for Payer: University Health Alliance Commercial	$392.88

HCHG AEP SCR AUDITORY POTENTIAL

Facility

$539.00

Service Code	HCPCS 92650
Hospital Charge Code	H4710171
Hospital Revenue Code	471
Min. Negotiated Rate	$458.15
Max. Negotiated Rate	$522.83
Rate for Payer: Cash Price	$350.35
Rate for Payer: Health Management Network Commercial	$458.15
Rate for Payer: MDX Hawaii PPO	$522.83

HCHG AERONEB TX, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100296
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG AERONEB TX, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100296
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG AFB ID EACH ISOLATE

Facility

$111.00

Service Code	HCPCS 87118
Hospital Charge Code	K3060013
Hospital Revenue Code	306
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$14.61
Rate for Payer: AlohaCare Medicare	$14.61
Rate for Payer: Cash Price	$72.15
Rate for Payer: Cash Price	$72.15
Rate for Payer: Devoted Health Medicare	$16.07
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	$14.61
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	$94.35
Rate for Payer: Humana Medicare	$14.61
Rate for Payer: Kaiser Permanente Commercial	$69.93
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$14.61
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$16.07
Rate for Payer: Ohana Health Plan Medicare	$14.61
Rate for Payer: UnitedHealthcare Medicaid	$15.13
Rate for Payer: UnitedHealthcare Medicare	$14.61
Rate for Payer: University Health Alliance Commercial	$28.29

HCHG AFB ID EACH ISOLATE

Facility

$111.00

Service Code	HCPCS 87118
Hospital Charge Code	K3060013
Hospital Revenue Code	306
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$72.15
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: MDX Hawaii PPO	$107.67

HCHG AFB MALDI ID - 90

Facility

$134.00

Service Code	HCPCS 87118
Hospital Charge Code	H3060719
Hospital Revenue Code	306
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: MDX Hawaii PPO	$129.98

HCHG AFB MALDI ID - 90

Facility

$134.00

Service Code	HCPCS 87118
Hospital Charge Code	H3060719
Hospital Revenue Code	306
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$14.61
Rate for Payer: AlohaCare Medicare	$14.61
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$16.07
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	$14.61
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	$113.90
Rate for Payer: Humana Medicare	$14.61
Rate for Payer: Kaiser Permanente Commercial	$84.42
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$14.61
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$16.07
Rate for Payer: Ohana Health Plan Medicare	$14.61
Rate for Payer: UnitedHealthcare Medicaid	$15.13
Rate for Payer: UnitedHealthcare Medicare	$14.61
Rate for Payer: University Health Alliance Commercial	$28.29

HCHG AFB RAPID GROWER MIC

Facility

$312.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060603
Hospital Revenue Code	306
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$202.80
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: MDX Hawaii PPO	$302.64

HCHG AFB RAPID GROWER MIC

Facility

$312.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060603
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$302.64
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$202.80
Rate for Payer: Cash Price	$202.80
Rate for Payer: Devoted Health Medicare	$9.52
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	$8.65
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	$265.20
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$196.56
Rate for Payer: Kaiser Permanente Medicaid	$159.12
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$302.64
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG AFB SUSC MIC SO

Facility

$219.00

Service Code	HCPCS 87186
Hospital Charge Code	K3060019
Hospital Revenue Code	306
Min. Negotiated Rate	$186.15
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$142.35
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: MDX Hawaii PPO	$212.43

HCHG AFB SUSC MIC SO

Facility

$219.00

Service Code	HCPCS 87186
Hospital Charge Code	K3060019
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$9.52
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	$8.65
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	$186.15
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG AFP MATERNAL SERUM

Facility

$207.00

Service Code	HCPCS 82105
Hospital Charge Code	H3010138
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$16.77
Rate for Payer: AlohaCare Medicare	$16.77
Rate for Payer: Cash Price	$134.55
Rate for Payer: Cash Price	$134.55
Rate for Payer: Devoted Health Medicare	$18.45
Rate for Payer: Hawaii Medical Service Association ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$16.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.34
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$16.77
Rate for Payer: Kaiser Permanente Commercial	$130.41
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$16.77
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$18.45
Rate for Payer: Ohana Health Plan Medicare	$16.77
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$16.77
Rate for Payer: University Health Alliance Commercial	$43.36

HCHG AFP MATERNAL SERUM

Facility

$207.00

Service Code	HCPCS 82105
Hospital Charge Code	H3010138
Hospital Revenue Code	301
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: MDX Hawaii PPO	$200.79

HCHG AFP NON-MATERNAL

Facility

$207.00

Service Code	HCPCS 82105
Hospital Charge Code	H3010140
Hospital Revenue Code	301
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: MDX Hawaii PPO	$200.79

HCHG AFP NON-MATERNAL

Facility

$207.00

Service Code	HCPCS 82105
Hospital Charge Code	H3010140
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$16.77
Rate for Payer: AlohaCare Medicare	$16.77
Rate for Payer: Cash Price	$134.55
Rate for Payer: Cash Price	$134.55
Rate for Payer: Devoted Health Medicare	$18.45
Rate for Payer: Hawaii Medical Service Association ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$16.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.34
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$16.77
Rate for Payer: Kaiser Permanente Commercial	$130.41
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$16.77
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$18.45
Rate for Payer: Ohana Health Plan Medicare	$16.77
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$16.77
Rate for Payer: University Health Alliance Commercial	$43.36

HCHG AG TEST DONOR BLD USING RGT SERUM, EA AG TEST

Facility

$703.00

Service Code	HCPCS 86902
Hospital Charge Code	H3020132
Hospital Revenue Code	302
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$681.91
Rate for Payer: AlohaCare Medicaid	$6.35
Rate for Payer: AlohaCare Medicare	$6.35
Rate for Payer: Cash Price	$456.95
Rate for Payer: Cash Price	$456.95
Rate for Payer: Devoted Health Medicare	$6.99
Rate for Payer: Hawaii Medical Service Association ABD	$5.38
Rate for Payer: Hawaii Medical Service Association Commercial	$7.94
Rate for Payer: Hawaii Medical Service Association Medicare	$6.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$6.35
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: Humana Medicare	$6.35
Rate for Payer: Kaiser Permanente Commercial	$442.89
Rate for Payer: Kaiser Permanente Medicaid	$358.53
Rate for Payer: Kaiser Permanente Medicare	$6.35
Rate for Payer: MDX Hawaii PPO	$681.91
Rate for Payer: Ohana Health Plan Medicaid	$6.99
Rate for Payer: Ohana Health Plan Medicare	$6.35
Rate for Payer: UnitedHealthcare Medicaid	$5.38
Rate for Payer: UnitedHealthcare Medicare	$6.35
Rate for Payer: University Health Alliance Commercial	$9.95

HCHG AG TEST DONOR BLD USING RGT SERUM, EA AG TEST

Facility

$703.00

Service Code	HCPCS 86902
Hospital Charge Code	H3020132
Hospital Revenue Code	302
Min. Negotiated Rate	$597.55
Max. Negotiated Rate	$681.91
Rate for Payer: Cash Price	$456.95
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: MDX Hawaii PPO	$681.91

HCHG AHG TEST (C3) DIRECT

Facility

$145.00

Service Code	HCPCS 86880
Hospital Charge Code	H3020172
Hospital Revenue Code	302
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$5.39
Rate for Payer: AlohaCare Medicare	$5.39
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$5.93
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$5.39
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$5.39
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.39
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$5.39
Rate for Payer: University Health Alliance Commercial	$13.88

Know your out-of-pocket cost for care.

All Charges