Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ANESTHESIA EACH 15 MIN

Facility

$155.00

Hospital Charge Code	K3700001
Hospital Revenue Code	370
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 ANESTHESIA EACH 15 MIN

Facility

$155.00

Hospital Charge Code	K3700001
Hospital Revenue Code	370
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$97.65
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: University Health Alliance Commercial	$112.98

HCHG ANESTHESIA EACH ADDITIONAL 15 MIN

Facility

$197.00

Hospital Charge Code	K3700003
Hospital Revenue Code	370
Min. Negotiated Rate	$100.47
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$128.05
Rate for Payer: Hawaii Western Management Group Commercial	$187.15
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$124.11
Rate for Payer: Kaiser Permanente Medicaid	$100.47
Rate for Payer: MDX Hawaii PPO	$191.09
Rate for Payer: University Health Alliance Commercial	$143.59

HCHG ANESTHESIA EACH ADDITIONAL 15 MIN

Facility

$197.00

Hospital Charge Code	K3700003
Hospital Revenue Code	370
Min. Negotiated Rate	$167.45
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$128.05
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: MDX Hawaii PPO	$191.09

HCHG ANESTHESIA FIRST 15 MIN

Facility

$232.00

Hospital Charge Code	K3700002
Hospital Revenue Code	370
Min. Negotiated Rate	$118.32
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$150.80
Rate for Payer: Hawaii Western Management Group Commercial	$220.40
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$146.16
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: University Health Alliance Commercial	$169.10

HCHG ANESTHESIA FIRST 15 MIN

Facility

$232.00

Hospital Charge Code	K3700002
Hospital Revenue Code	370
Min. Negotiated Rate	$197.20
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$150.80
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: MDX Hawaii PPO	$225.04

HCHG ANGIOTENSIN CONVERTING ENZ 90

Facility

$180.00

Service Code	HCPCS 82164
Hospital Charge Code	H3010228
Hospital Revenue Code	301
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$14.60
Rate for Payer: AlohaCare Medicare	$14.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$16.06
Rate for Payer: Hawaii Medical Service Association ABD	$20.17
Rate for Payer: Hawaii Medical Service Association Commercial	$18.25
Rate for Payer: Hawaii Medical Service Association Medicare	$14.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.18
Rate for Payer: Hawaii Western Management Group Commercial	$14.60
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$14.60
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$14.60
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$16.06
Rate for Payer: Ohana Health Plan Medicare	$14.60
Rate for Payer: UnitedHealthcare Medicaid	$20.17
Rate for Payer: UnitedHealthcare Medicare	$14.60
Rate for Payer: University Health Alliance Commercial	$37.72

HCHG ANGIOTENSIN CONVERTING ENZ 90

Facility

$180.00

Service Code	HCPCS 82164
Hospital Charge Code	H3010228
Hospital Revenue Code	301
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

HCHG ANKLE (2 VIEWS)

Facility

$476.00

Service Code	HCPCS 73600
Hospital Charge Code	H3200148
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$55.46

HCHG ANKLE (2 VIEWS)

Facility

$476.00

Service Code	HCPCS 73600
Hospital Charge Code	H3200148
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG ANKLE MIN 3 VIEWS

Facility

$533.00

Service Code	HCPCS 73610
Hospital Charge Code	H3200152
Hospital Revenue Code	320
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: MDX Hawaii PPO	$517.01

HCHG ANKLE MIN 3 VIEWS

Facility

$533.00

Service Code	HCPCS 73610
Hospital Charge Code	H3200152
Hospital Revenue Code	320
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$517.01
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.34
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.95
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$335.79
Rate for Payer: Kaiser Permanente Medicaid	$271.83
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$517.01
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$62.59

HCHG ANTIBODY SCRN

Facility

$256.00

Service Code	HCPCS 86850
Hospital Charge Code	H3020240
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

HCHG ANTIBODY SCRN

Facility

$256.00

Service Code	HCPCS 86850
Hospital Charge Code	H3020240
Hospital Revenue Code	302
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$248.32
Rate for Payer: AlohaCare Medicaid	$9.77
Rate for Payer: AlohaCare Medicare	$9.77
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Devoted Health Medicare	$10.75
Rate for Payer: Hawaii Medical Service Association ABD	$19.65
Rate for Payer: Hawaii Medical Service Association Commercial	$12.21
Rate for Payer: Hawaii Medical Service Association Medicare	$9.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.51
Rate for Payer: Hawaii Western Management Group Commercial	$9.77
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: Humana Medicare	$9.77
Rate for Payer: Kaiser Permanente Commercial	$161.28
Rate for Payer: Kaiser Permanente Medicaid	$130.56
Rate for Payer: Kaiser Permanente Medicare	$9.77
Rate for Payer: MDX Hawaii PPO	$248.32
Rate for Payer: Ohana Health Plan Medicaid	$10.75
Rate for Payer: Ohana Health Plan Medicare	$9.77
Rate for Payer: UnitedHealthcare Medicaid	$19.65
Rate for Payer: UnitedHealthcare Medicare	$9.77
Rate for Payer: University Health Alliance Commercial	$50.88

HCHG ANTI-CENTROMERE AB 90

Facility

$238.00

Service Code	HCPCS 86255
Hospital Charge Code	H3020242
Hospital Revenue Code	302
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

HCHG ANTI-CENTROMERE AB 90

Facility

$238.00

Service Code	HCPCS 86255
Hospital Charge Code	H3020242
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$16.66
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$31.15

HCHG ANTI-DNA DBLE STRAND

Facility

$169.00

Service Code	HCPCS 86225
Hospital Charge Code	H3020246
Hospital Revenue Code	302
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$13.74
Rate for Payer: AlohaCare Medicare	$13.74
Rate for Payer: Cash Price	$109.85
Rate for Payer: Cash Price	$109.85
Rate for Payer: Devoted Health Medicare	$15.11
Rate for Payer: Hawaii Medical Service Association ABD	$18.99
Rate for Payer: Hawaii Medical Service Association Commercial	$17.18
Rate for Payer: Hawaii Medical Service Association Medicare	$13.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.94
Rate for Payer: Hawaii Western Management Group Commercial	$13.74
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$13.74
Rate for Payer: Kaiser Permanente Commercial	$106.47
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$13.74
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$15.11
Rate for Payer: Ohana Health Plan Medicare	$13.74
Rate for Payer: UnitedHealthcare Medicaid	$18.99
Rate for Payer: UnitedHealthcare Medicare	$13.74
Rate for Payer: University Health Alliance Commercial	$35.52

HCHG ANTI-DNA DBLE STRAND

Facility

$169.00

Service Code	HCPCS 86225
Hospital Charge Code	H3020246
Hospital Revenue Code	302
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$109.85
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: MDX Hawaii PPO	$163.93

HCHG ANTI-ENA AB

Facility

$219.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020248
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.93
Rate for Payer: AlohaCare Medicare	$17.93
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.72
Rate for Payer: Hawaii Medical Service Association ABD	$24.78
Rate for Payer: Hawaii Medical Service Association Commercial	$22.41
Rate for Payer: Hawaii Medical Service Association Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.93
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.93
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.72
Rate for Payer: Ohana Health Plan Medicare	$17.93
Rate for Payer: UnitedHealthcare Medicaid	$24.78
Rate for Payer: UnitedHealthcare Medicare	$17.93
Rate for Payer: University Health Alliance Commercial	$46.36

HCHG ANTI-ENA AB

Facility

$219.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020248
Hospital Revenue Code	302
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 ANTI-GLIADIN AB IGG

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3010234
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$33.47

HCHG ANTI-GLIADIN AB IGG

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3010234
Hospital Revenue Code	301
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

HCHG ANTI GLOB TEST DIR COOMBS

Facility

$145.00

Service Code	HCPCS 86880
Hospital Charge Code	H3020234
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 ANTI GLOB TEST DIR COOMBS

Facility

$145.00

Service Code	HCPCS 86880
Hospital Charge Code	H3020234
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 ANTI-GLOM BASEMT MEM AB 90

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3010236
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$33.47

Know your out-of-pocket cost for care.

All Charges