Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ALDOSTERONE 24 HR URINE

Facility

$502.00

Service Code	HCPCS 82088
Hospital Charge Code	H3010154
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

HCHG ALDOSTERONE 24 HR URINE

Facility

$502.00

Service Code	HCPCS 82088
Hospital Charge Code	H3010154
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-SERUM 90

Facility

$502.00

Service Code	HCPCS 82088
Hospital Charge Code	H3010156
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-SERUM 90

Facility

$502.00

Service Code	HCPCS 82088
Hospital Charge Code	H3010156
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

HCHG ALKALINE PHOS BONE SP

Facility

$81.00

Service Code	HCPCS 84075
Hospital Charge Code	H3010160
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$78.57
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG ALKALINE PHOS BONE SP

Facility

$81.00

Service Code	HCPCS 84075
Hospital Charge Code	H3010160
Hospital Revenue Code	301
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$52.65
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

HCHG ALKALINE PHOS ISOENZYMES 90

Facility

$254.00

Service Code	HCPCS 84080
Hospital Charge Code	H3010162
Hospital Revenue Code	301
Min. Negotiated Rate	$215.90
Max. Negotiated Rate	$246.38
Rate for Payer: Cash Price	$165.10
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: MDX Hawaii PPO	$246.38

HCHG ALKALINE PHOS ISOENZYMES 90

Facility

$254.00

Service Code	HCPCS 84080
Hospital Charge Code	H3010162
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$246.38
Rate for Payer: AlohaCare Medicaid	$14.78
Rate for Payer: AlohaCare Medicare	$14.78
Rate for Payer: Cash Price	$165.10
Rate for Payer: Cash Price	$165.10
Rate for Payer: Devoted Health Medicare	$16.26
Rate for Payer: Hawaii Medical Service Association ABD	$20.44
Rate for Payer: Hawaii Medical Service Association Commercial	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$14.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.46
Rate for Payer: Hawaii Western Management Group Commercial	$14.78
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Humana Medicare	$14.78
Rate for Payer: Kaiser Permanente Commercial	$160.02
Rate for Payer: Kaiser Permanente Medicaid	$129.54
Rate for Payer: Kaiser Permanente Medicare	$14.78
Rate for Payer: MDX Hawaii PPO	$246.38
Rate for Payer: Ohana Health Plan Medicaid	$16.26
Rate for Payer: Ohana Health Plan Medicare	$14.78
Rate for Payer: UnitedHealthcare Medicaid	$20.44
Rate for Payer: UnitedHealthcare Medicare	$14.78
Rate for Payer: University Health Alliance Commercial	$38.22

HCHG ALK MUTATION ANALYSIS

Facility

$1,064.00

Service Code	HCPCS 81479
Hospital Charge Code	K3100007
Hospital Revenue Code	310
Min. Negotiated Rate	$904.40
Max. Negotiated Rate	$1,032.08
Rate for Payer: Cash Price	$691.60
Rate for Payer: Health Management Network Commercial	$904.40
Rate for Payer: MDX Hawaii PPO	$1,032.08

HCHG ALK MUTATION ANALYSIS

Facility

$1,064.00

Service Code	HCPCS 81479
Hospital Charge Code	K3100007
Hospital Revenue Code	310
Min. Negotiated Rate	$542.64
Max. Negotiated Rate	$1,032.08
Rate for Payer: Cash Price	$691.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,010.80
Rate for Payer: Health Management Network Commercial	$904.40
Rate for Payer: Kaiser Permanente Commercial	$670.32
Rate for Payer: Kaiser Permanente Medicaid	$542.64
Rate for Payer: MDX Hawaii PPO	$1,032.08
Rate for Payer: University Health Alliance Commercial	$775.55

HCHG ALK PHOS ISOENZYMES SO

Facility

$254.00

Service Code	HCPCS 84080
Hospital Charge Code	K3010042
Hospital Revenue Code	301
Min. Negotiated Rate	$215.90
Max. Negotiated Rate	$246.38
Rate for Payer: Cash Price	$165.10
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: MDX Hawaii PPO	$246.38

HCHG ALK PHOS ISOENZYMES SO

Facility

$254.00

Service Code	HCPCS 84080
Hospital Charge Code	K3010042
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$246.38
Rate for Payer: AlohaCare Medicaid	$14.78
Rate for Payer: AlohaCare Medicare	$14.78
Rate for Payer: Cash Price	$165.10
Rate for Payer: Cash Price	$165.10
Rate for Payer: Devoted Health Medicare	$16.26
Rate for Payer: Hawaii Medical Service Association ABD	$20.44
Rate for Payer: Hawaii Medical Service Association Commercial	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$14.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.46
Rate for Payer: Hawaii Western Management Group Commercial	$14.78
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Humana Medicare	$14.78
Rate for Payer: Kaiser Permanente Commercial	$160.02
Rate for Payer: Kaiser Permanente Medicaid	$129.54
Rate for Payer: Kaiser Permanente Medicare	$14.78
Rate for Payer: MDX Hawaii PPO	$246.38
Rate for Payer: Ohana Health Plan Medicaid	$16.26
Rate for Payer: Ohana Health Plan Medicare	$14.78
Rate for Payer: UnitedHealthcare Medicaid	$20.44
Rate for Payer: UnitedHealthcare Medicare	$14.78
Rate for Payer: University Health Alliance Commercial	$38.22

HCHG ALK PHTASE

Facility

$81.00

Service Code	HCPCS 84075
Hospital Charge Code	H3010158
Hospital Revenue Code	301
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$52.65
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

HCHG ALK PHTASE

Facility

$81.00

Service Code	HCPCS 84075
Hospital Charge Code	H3010158
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$78.57
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG ALLERGEN

Facility

$37.00

Service Code	HCPCS 86003
Hospital Charge Code	H3020176
Hospital Revenue Code	302
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

HCHG ALLERGEN

Facility

$37.00

Service Code	HCPCS 86003
Hospital Charge Code	H3020176
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$5.22
Rate for Payer: AlohaCare Medicare	$5.22
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Devoted Health Medicare	$5.74
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$5.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.58
Rate for Payer: Hawaii Western Management Group Commercial	$5.22
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$5.22
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$5.22
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$5.74
Rate for Payer: Ohana Health Plan Medicare	$5.22
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$5.22
Rate for Payer: University Health Alliance Commercial	$13.51

HCHG ALPHA-1 ANTITRYPSIN GENOTYPE - 90

Facility

$268.00

Service Code	HCPCS 81332
Hospital Charge Code	H3100246
Hospital Revenue Code	310
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$43.65
Rate for Payer: AlohaCare Medicare	$43.65
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Devoted Health Medicare	$48.02
Rate for Payer: Hawaii Medical Service Association Commercial	$54.56
Rate for Payer: Hawaii Medical Service Association Medicare	$43.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.43
Rate for Payer: Hawaii Western Management Group Commercial	$43.65
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$43.65
Rate for Payer: Kaiser Permanente Commercial	$168.84
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$43.65
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$48.02
Rate for Payer: Ohana Health Plan Medicare	$43.65
Rate for Payer: UnitedHealthcare Medicaid	$42.12
Rate for Payer: UnitedHealthcare Medicare	$43.65
Rate for Payer: University Health Alliance Commercial	$195.35

HCHG ALPHA-1 ANTITRYPSIN GENOTYPE - 90

Facility

$268.00

Service Code	HCPCS 81332
Hospital Charge Code	H3100246
Hospital Revenue Code	310
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$174.20
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: MDX Hawaii PPO	$259.96

HCHG ALPHA-1-ANTITRYPSIN PHENOTYPE

Facility

$101.00

Service Code	HCPCS 82104
Hospital Charge Code	H3011372
Hospital Revenue Code	301
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$65.65
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

HCHG ALPHA-1-ANTITRYPSIN PHENOTYPE

Facility

$101.00

Service Code	HCPCS 82104
Hospital Charge Code	H3011372
Hospital Revenue Code	301
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$14.46
Rate for Payer: AlohaCare Medicare	$14.46
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Devoted Health Medicare	$15.91
Rate for Payer: Hawaii Medical Service Association ABD	$19.98
Rate for Payer: Hawaii Medical Service Association Commercial	$18.07
Rate for Payer: Hawaii Medical Service Association Medicare	$14.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.98
Rate for Payer: Hawaii Western Management Group Commercial	$14.46
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$14.46
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$14.46
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$15.91
Rate for Payer: Ohana Health Plan Medicare	$14.46
Rate for Payer: UnitedHealthcare Medicaid	$19.98
Rate for Payer: UnitedHealthcare Medicare	$14.46
Rate for Payer: University Health Alliance Commercial	$37.37

HCHG ALPHA 1 ANTITRYPSIN STL SO

Facility

$165.00

Service Code	HCPCS 82103
Hospital Charge Code	K3010021
Hospital Revenue Code	301
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$107.25
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: MDX Hawaii PPO	$160.05

HCHG ALPHA 1 ANTITRYPSIN STL SO

Facility

$165.00

Service Code	HCPCS 82103
Hospital Charge Code	K3010021
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$13.44
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$107.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Devoted Health Medicare	$14.78
Rate for Payer: Hawaii Medical Service Association ABD	$18.56
Rate for Payer: Hawaii Medical Service Association Commercial	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.49
Rate for Payer: Hawaii Western Management Group Commercial	$13.44
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$103.95
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$14.78
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicaid	$18.56
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$34.72

HCHG ALPHA-1 ANTITRYPSIN TOTAL

Facility

$165.00

Service Code	HCPCS 82103
Hospital Charge Code	H3010166
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$13.44
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$107.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Devoted Health Medicare	$14.78
Rate for Payer: Hawaii Medical Service Association ABD	$18.56
Rate for Payer: Hawaii Medical Service Association Commercial	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.49
Rate for Payer: Hawaii Western Management Group Commercial	$13.44
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$103.95
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$14.78
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicaid	$18.56
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$34.72

HCHG ALPHA-1 ANTITRYPSIN TOTAL

Facility

$165.00

Service Code	HCPCS 82103
Hospital Charge Code	H3010166
Hospital Revenue Code	301
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$107.25
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: MDX Hawaii PPO	$160.05

HCHG ALPHA FETOPROTEIN CSF SO

Facility

$256.00

Service Code	HCPCS 86316
Hospital Charge Code	K3020005
Hospital Revenue Code	302
Min. Negotiated Rate	$217.60
Max. Negotiated Rate	$248.32
Rate for Payer: Cash Price	$166.40
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: MDX Hawaii PPO	$248.32

Know your out-of-pocket cost for care.

All Charges