Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG AHG TEST (C3) DIRECT

Facility

$145.00

Service Code	HCPCS 86880
Hospital Charge Code	H3020172
Hospital Revenue Code	302
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HCHG AHG TEST (IGG) DIRECT

Facility

$145.00

Service Code	HCPCS 86880
Hospital Charge Code	H3020174
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

HCHG AHG TEST (IGG) DIRECT

Facility

$145.00

Service Code	HCPCS 86880
Hospital Charge Code	H3020174
Hospital Revenue Code	302
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HCHG AIRWAY INHALATION TREATMENT

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4500996
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 AIRWAY INHALATION TREATMENT

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4500996
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 AIRWAY INHALATION TREATMENT, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100306
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 AIRWAY INHALATION TREATMENT, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100306
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 ALBUMIN BODY FLUID

Facility

$71.00

Service Code	HCPCS 82042
Hospital Charge Code	H3010144
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$7.78
Rate for Payer: AlohaCare Medicare	$7.78
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$8.56
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$9.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$7.78
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$7.78
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$7.78
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$8.56
Rate for Payer: Ohana Health Plan Medicare	$7.78
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$7.78
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG ALBUMIN BODY FLUID

Facility

$71.00

Service Code	HCPCS 82042
Hospital Charge Code	H3010144
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

HCHG ALBUMIN CSF X 90

Facility

$91.00

Service Code	HCPCS 82042
Hospital Charge Code	H3010146
Hospital Revenue Code	301
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

HCHG ALBUMIN CSF X 90

Facility

$91.00

Service Code	HCPCS 82042
Hospital Charge Code	H3010146
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$7.78
Rate for Payer: AlohaCare Medicare	$7.78
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$8.56
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$9.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$7.78
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$7.78
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$7.78
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$8.56
Rate for Payer: Ohana Health Plan Medicare	$7.78
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$7.78
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG ALBUMIN, RANDOM URINE - 90

Facility

$71.00

Service Code	HCPCS 82043
Hospital Charge Code	H3011828
Hospital Revenue Code	301
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$5.78
Rate for Payer: AlohaCare Medicare	$5.78
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$6.36
Rate for Payer: Hawaii Medical Service Association ABD	$8.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7.22
Rate for Payer: Hawaii Medical Service Association Medicare	$5.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$5.78
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$5.78
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$5.78
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$6.36
Rate for Payer: Ohana Health Plan Medicare	$5.78
Rate for Payer: UnitedHealthcare Medicaid	$8.00
Rate for Payer: UnitedHealthcare Medicare	$5.78
Rate for Payer: University Health Alliance Commercial	$14.97

HCHG ALBUMIN, RANDOM URINE - 90

Facility

$71.00

Service Code	HCPCS 82043
Hospital Charge Code	H3011828
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

HCHG ALBUMIN SERUM/PLASMA/WHOLE BLOOD

Facility

$61.00

Service Code	HCPCS 82040
Hospital Charge Code	H3010142
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: MDX Hawaii PPO	$59.17

HCHG ALBUMIN SERUM/PLASMA/WHOLE BLOOD

Facility

$61.00

Service Code	HCPCS 82040
Hospital Charge Code	H3010142
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$4.95
Rate for Payer: AlohaCare Medicare	$4.95
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$5.45
Rate for Payer: Hawaii Medical Service Association ABD	$6.85
Rate for Payer: Hawaii Medical Service Association Commercial	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$4.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.19
Rate for Payer: Hawaii Western Management Group Commercial	$4.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$4.95
Rate for Payer: Kaiser Permanente Commercial	$38.43
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$4.95
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$5.45
Rate for Payer: Ohana Health Plan Medicare	$4.95
Rate for Payer: UnitedHealthcare Medicaid	$6.85
Rate for Payer: UnitedHealthcare Medicare	$4.95
Rate for Payer: University Health Alliance Commercial	$12.80

HCHG ALCOHOL BLOOD

Facility

$298.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010020
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$289.06
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$193.70
Rate for Payer: Cash Price	$193.70
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$253.30
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$187.74
Rate for Payer: Kaiser Permanente Medicaid	$151.98
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$289.06
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG ALCOHOL BLOOD

Facility

$298.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010020
Hospital Revenue Code	301
Min. Negotiated Rate	$253.30
Max. Negotiated Rate	$289.06
Rate for Payer: Cash Price	$193.70
Rate for Payer: Health Management Network Commercial	$253.30
Rate for Payer: MDX Hawaii PPO	$289.06

HCHG ALCOHOL (ETHANOL) ANY SPECIMEN EXPECT BREATH 90

Facility

$189.00

Service Code	HCPCS 80320
Hospital Charge Code	H3011562
Hospital Revenue Code	301
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$122.85
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: MDX Hawaii PPO	$183.33

HCHG ALCOHOL (ETHANOL) ANY SPECIMEN EXPECT BREATH 90

Facility

$189.00

Service Code	HCPCS 80320
Hospital Charge Code	H3011562
Hospital Revenue Code	301
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$122.85
Rate for Payer: Cash Price	$122.85
Rate for Payer: Hawaii Medical Service Association ABD	$14.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.68
Rate for Payer: Hawaii Western Management Group Commercial	$179.55
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: Kaiser Permanente Commercial	$119.07
Rate for Payer: Kaiser Permanente Medicaid	$96.39
Rate for Payer: MDX Hawaii PPO	$183.33
Rate for Payer: University Health Alliance Commercial	$137.76

HCHG ALCOHOL METABOLITE CON SO

Facility

$155.00

Service Code	HCPCS G0480
Hospital Charge Code	K3010052
Hospital Revenue Code	301
Min. Negotiated Rate	$47.96
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$114.43
Rate for Payer: AlohaCare Medicare	$114.43
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$125.87
Rate for Payer: Hawaii Medical Service Association Commercial	$143.04
Rate for Payer: Hawaii Medical Service Association Medicare	$114.43
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$114.43
Rate for Payer: Kaiser Permanente Commercial	$97.65
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$114.43
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$125.87
Rate for Payer: Ohana Health Plan Medicare	$114.43
Rate for Payer: UnitedHealthcare Medicaid	$47.96
Rate for Payer: UnitedHealthcare Medicare	$114.43
Rate for Payer: University Health Alliance Commercial	$112.98

HCHG ALCOHOL METABOLITE CON SO

Facility

$155.00

Service Code	HCPCS G0480
Hospital Charge Code	K3010052
Hospital Revenue Code	301
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: MDX Hawaii PPO	$150.35

HCHG ALDOLASE 90

Facility

$120.00

Service Code	HCPCS 82085
Hospital Charge Code	H3010152
Hospital Revenue Code	301
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: MDX Hawaii PPO	$116.40

HCHG ALDOLASE 90

Facility

$120.00

Service Code	HCPCS 82085
Hospital Charge Code	H3010152
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$9.71
Rate for Payer: AlohaCare Medicare	$9.71
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$10.68
Rate for Payer: Hawaii Medical Service Association ABD	$13.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.14
Rate for Payer: Hawaii Medical Service Association Medicare	$9.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.09
Rate for Payer: Hawaii Western Management Group Commercial	$9.71
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$9.71
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$9.71
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$10.68
Rate for Payer: Ohana Health Plan Medicare	$9.71
Rate for Payer: UnitedHealthcare Medicaid	$13.42
Rate for Payer: UnitedHealthcare Medicare	$9.71
Rate for Payer: University Health Alliance Commercial	$25.09

HCHG ALDOSTERONE

Facility

$502.00

Service Code	HCPCS 82088
Hospital Charge Code	H3011734
Hospital Revenue Code	301
Min. Negotiated Rate	$426.70
Max. Negotiated Rate	$486.94
Rate for Payer: Cash Price	$326.30
Rate for Payer: Health Management Network Commercial	$426.70
Rate for Payer: MDX Hawaii PPO	$486.94

HCHG ALDOSTERONE

Facility

$502.00

Service Code	HCPCS 82088
Hospital Charge Code	H3011734
Hospital Revenue Code	301
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$486.94
Rate for Payer: AlohaCare Medicaid	$40.75
Rate for Payer: AlohaCare Medicare	$40.75
Rate for Payer: Cash Price	$326.30
Rate for Payer: Cash Price	$326.30
Rate for Payer: Devoted Health Medicare	$44.83
Rate for Payer: Hawaii Medical Service Association ABD	$56.32
Rate for Payer: Hawaii Medical Service Association Commercial	$50.94
Rate for Payer: Hawaii Medical Service Association Medicare	$40.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.14
Rate for Payer: Hawaii Western Management Group Commercial	$40.75
Rate for Payer: Health Management Network Commercial	$426.70
Rate for Payer: Humana Medicare	$40.75
Rate for Payer: Kaiser Permanente Commercial	$316.26
Rate for Payer: Kaiser Permanente Medicaid	$256.02
Rate for Payer: Kaiser Permanente Medicare	$40.75
Rate for Payer: MDX Hawaii PPO	$486.94
Rate for Payer: Ohana Health Plan Medicaid	$44.83
Rate for Payer: Ohana Health Plan Medicare	$40.75
Rate for Payer: UnitedHealthcare Medicaid	$56.32
Rate for Payer: UnitedHealthcare Medicare	$40.75
Rate for Payer: University Health Alliance Commercial	$105.34

Know your out-of-pocket cost for care.

All Charges