Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG BETA-2 TRANSFERRIN

Facility

$85.00

Service Code	HCPCS 86335
Hospital Charge Code	K3020021
Hospital Revenue Code	302
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$29.35
Rate for Payer: AlohaCare Medicare	$29.35
Rate for Payer: Cash Price	$55.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Devoted Health Medicare	$32.28
Rate for Payer: Hawaii Medical Service Association ABD	$16.26
Rate for Payer: Hawaii Medical Service Association Commercial	$36.69
Rate for Payer: Hawaii Medical Service Association Medicare	$29.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.53
Rate for Payer: Hawaii Western Management Group Commercial	$29.35
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$29.35
Rate for Payer: Kaiser Permanente Commercial	$53.55
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$29.35
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$32.28
Rate for Payer: Ohana Health Plan Medicare	$29.35
Rate for Payer: UnitedHealthcare Medicaid	$16.26
Rate for Payer: UnitedHealthcare Medicare	$29.35
Rate for Payer: University Health Alliance Commercial	$75.85

HCHG BETA-2 TRANSFERRIN

Facility

$85.00

Service Code	HCPCS 86335
Hospital Charge Code	K3020021
Hospital Revenue Code	302
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$55.25
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: MDX Hawaii PPO	$82.45

HCHG BETA-HYDROXYBUTYRATE

Facility

$141.00

Service Code	HCPCS 82010
Hospital Charge Code	H3011599
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$8.17
Rate for Payer: AlohaCare Medicare	$8.17
Rate for Payer: Cash Price	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$8.99
Rate for Payer: Hawaii Medical Service Association ABD	$11.29
Rate for Payer: Hawaii Medical Service Association Commercial	$10.21
Rate for Payer: Hawaii Medical Service Association Medicare	$8.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.85
Rate for Payer: Hawaii Western Management Group Commercial	$8.17
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$8.17
Rate for Payer: Kaiser Permanente Commercial	$88.83
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$8.17
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$8.99
Rate for Payer: Ohana Health Plan Medicare	$8.17
Rate for Payer: UnitedHealthcare Medicaid	$11.29
Rate for Payer: UnitedHealthcare Medicare	$8.17
Rate for Payer: University Health Alliance Commercial	$21.13

HCHG BETA-HYDROXYBUTYRATE

Facility

$141.00

Service Code	HCPCS 82010
Hospital Charge Code	H3011599
Hospital Revenue Code	301
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 BILAT VEIN MAP PRE HEMO ACCESS

Facility

$1,450.00

Service Code	HCPCS 93985
Hospital Charge Code	H3230109
Hospital Revenue Code	323
Min. Negotiated Rate	$277.08
Max. Negotiated Rate	$1,406.50
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$942.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Western Management Group Commercial	$1,377.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$739.50
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,406.50
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$277.08
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$1,056.90

HCHG BILAT VEIN MAP PRE HEMO ACCESS

Facility

$1,450.00

Service Code	HCPCS 93985
Hospital Charge Code	H3230109
Hospital Revenue Code	323
Min. Negotiated Rate	$1,232.50
Max. Negotiated Rate	$1,406.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: MDX Hawaii PPO	$1,406.50

HCHG BILE ACIDS TOTAL SO

Facility

$280.00

Service Code	HCPCS 82239
Hospital Charge Code	K3010024
Hospital Revenue Code	301
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$271.60
Rate for Payer: AlohaCare Medicaid	$17.12
Rate for Payer: AlohaCare Medicare	$17.12
Rate for Payer: Cash Price	$182.00
Rate for Payer: Cash Price	$182.00
Rate for Payer: Devoted Health Medicare	$18.83
Rate for Payer: Hawaii Medical Service Association ABD	$23.67
Rate for Payer: Hawaii Medical Service Association Commercial	$21.40
Rate for Payer: Hawaii Medical Service Association Medicare	$17.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.85
Rate for Payer: Hawaii Western Management Group Commercial	$17.12
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Humana Medicare	$17.12
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: Kaiser Permanente Medicaid	$142.80
Rate for Payer: Kaiser Permanente Medicare	$17.12
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: Ohana Health Plan Medicaid	$18.83
Rate for Payer: Ohana Health Plan Medicare	$17.12
Rate for Payer: UnitedHealthcare Medicaid	$23.67
Rate for Payer: UnitedHealthcare Medicare	$17.12
Rate for Payer: University Health Alliance Commercial	$44.29

HCHG BILE ACIDS TOTAL SO

Facility

$280.00

Service Code	HCPCS 82239
Hospital Charge Code	K3010024
Hospital Revenue Code	301
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$182.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: MDX Hawaii PPO	$271.60

HCHG BILIRUBIN-BODY FLD TOTAL

Facility

$68.00

Service Code	HCPCS 82247
Hospital Charge Code	H3010282
Hospital Revenue Code	301
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HCHG BILIRUBIN-BODY FLD TOTAL

Facility

$68.00

Service Code	HCPCS 82247
Hospital Charge Code	H3010282
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$5.02
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$5.52
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$5.02
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$5.02
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$5.52
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$5.02
Rate for Payer: University Health Alliance Commercial	$12.99

HCHG BILIRUBIN DIR

Facility

$68.00

Service Code	HCPCS 82248
Hospital Charge Code	H3010274
Hospital Revenue Code	301
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HCHG BILIRUBIN DIR

Facility

$68.00

Service Code	HCPCS 82248
Hospital Charge Code	H3010274
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$5.02
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$5.52
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$5.02
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$5.02
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$5.52
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$5.02
Rate for Payer: University Health Alliance Commercial	$12.99

HCHG BILIRUBIN TOT

Facility

$68.00

Service Code	HCPCS 82247
Hospital Charge Code	H3010278
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$5.02
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$5.52
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$5.02
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$5.02
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$5.52
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$5.02
Rate for Payer: University Health Alliance Commercial	$12.99

HCHG BILIRUBIN TOT

Facility

$68.00

Service Code	HCPCS 82247
Hospital Charge Code	H3010278
Hospital Revenue Code	301
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HCHG BILIRUBIN TOTAL TRANSCUT

Facility

$56.00

Service Code	HCPCS 88720
Hospital Charge Code	H3011714
Hospital Revenue Code	301
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: MDX Hawaii PPO	$54.32

HCHG BILIRUBIN TOTAL TRANSCUT

Facility

$56.00

Service Code	HCPCS 88720
Hospital Charge Code	H3011714
Hospital Revenue Code	301
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$5.02
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Devoted Health Medicare	$5.52
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.19
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$5.02
Rate for Payer: Kaiser Permanente Commercial	$35.28
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$5.02
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$5.52
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$3.77
Rate for Payer: UnitedHealthcare Medicare	$5.02
Rate for Payer: University Health Alliance Commercial	$40.82

HCHG BIPAP/CPAP, DAILY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100280
Hospital Revenue Code	410
Min. Negotiated Rate	$799.85
Max. Negotiated Rate	$912.77
Rate for Payer: Cash Price	$611.65
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: MDX Hawaii PPO	$912.77

HCHG BIPAP/CPAP, DAILY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100280
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$912.77
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$611.65
Rate for Payer: Cash Price	$611.65
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Hawaii Western Management Group Commercial	$893.95
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$592.83
Rate for Payer: Kaiser Permanente Medicaid	$479.91
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$912.77
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$685.89

HCHG BLADDER IRRIG SIMPL LAV/INSTIL

Facility

$1,458.00

Service Code	HCPCS 51700
Hospital Charge Code	H4500144
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$947.70
Rate for Payer: Cash Price	$947.70
Rate for Payer: Cash Price	$947.70
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,385.10
Rate for Payer: Health Management Network Commercial	$1,239.30
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$918.54
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$1,414.26
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$1,062.74

HCHG BLADDER IRRIG SIMPL LAV/INSTIL

Facility

$1,458.00

Service Code	HCPCS 51700
Hospital Charge Code	H4500144
Hospital Revenue Code	450
Min. Negotiated Rate	$1,239.30
Max. Negotiated Rate	$1,414.26
Rate for Payer: Cash Price	$947.70
Rate for Payer: Health Management Network Commercial	$1,239.30
Rate for Payer: MDX Hawaii PPO	$1,414.26

HCHG BLASTOMYCES ANTIBODY - 90

Facility

$90.00

Service Code	HCPCS 86612
Hospital Charge Code	H3021101
Hospital Revenue Code	302
Min. Negotiated Rate	$10.82
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$12.90
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Hawaii Medical Service Association ABD	$10.82
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Medicare	$12.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.83
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$12.90
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$12.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$14.19
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicaid	$10.82
Rate for Payer: UnitedHealthcare Medicare	$12.90
Rate for Payer: University Health Alliance Commercial	$33.36

HCHG BLASTOMYCES ANTIBODY - 90

Facility

$90.00

Service Code	HCPCS 86612
Hospital Charge Code	H3021101
Hospital Revenue Code	302
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$87.30

HCHG BLEPHAROTOMY DRAIN ABSC EYELID

Facility

$1,736.00

Service Code	HCPCS 67700
Hospital Charge Code	H4501097
Hospital Revenue Code	450
Min. Negotiated Rate	$374.96
Max. Negotiated Rate	$1,683.92
Rate for Payer: AlohaCare Medicaid	$374.96
Rate for Payer: AlohaCare Medicare	$374.96
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Devoted Health Medicare	$412.46
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$374.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,649.20
Rate for Payer: Health Management Network Commercial	$1,475.60
Rate for Payer: Humana Medicare	$374.96
Rate for Payer: Kaiser Permanente Commercial	$1,093.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$374.96
Rate for Payer: MDX Hawaii PPO	$1,683.92
Rate for Payer: Ohana Health Plan Medicaid	$412.46
Rate for Payer: Ohana Health Plan Medicare	$374.96
Rate for Payer: UnitedHealthcare Medicare	$374.96
Rate for Payer: University Health Alliance Commercial	$1,265.37

HCHG BLEPHAROTOMY DRAIN ABSC EYELID

Facility

$1,736.00

Service Code	HCPCS 67700
Hospital Charge Code	H4501097
Hospital Revenue Code	450
Min. Negotiated Rate	$1,475.60
Max. Negotiated Rate	$1,683.92
Rate for Payer: Cash Price	$1,128.40
Rate for Payer: Health Management Network Commercial	$1,475.60
Rate for Payer: MDX Hawaii PPO	$1,683.92

HCHG BLOOD COUNT AUTO DIFF

Facility

$88.00

Service Code	HCPCS 85004
Hospital Charge Code	K3050001
Hospital Revenue Code	305
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: MDX Hawaii PPO	$85.36

Know your out-of-pocket cost for care.

All Charges