Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CALCIUM IONIZED

Facility

$185.00

Service Code	HCPCS 82330
Hospital Charge Code	H3010310
Hospital Revenue Code	301
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$120.25
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

HCHG CALCIUM IONIZED

Facility

$185.00

Service Code	HCPCS 82330
Hospital Charge Code	H3010310
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$13.68
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$120.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Devoted Health Medicare	$15.05
Rate for Payer: Hawaii Medical Service Association ABD	$18.88
Rate for Payer: Hawaii Medical Service Association Commercial	$17.10
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.82
Rate for Payer: Hawaii Western Management Group Commercial	$13.68
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$13.68
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$13.68
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$15.05
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicaid	$18.88
Rate for Payer: UnitedHealthcare Medicare	$13.68
Rate for Payer: University Health Alliance Commercial	$35.32

HCHG CALCIUM TOTAL

Facility

$88.00

Service Code	HCPCS 82310
Hospital Charge Code	H3010306
Hospital Revenue Code	301
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

HCHG CALCIUM TOTAL

Facility

$88.00

Service Code	HCPCS 82310
Hospital Charge Code	H3010306
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$5.16
Rate for Payer: AlohaCare Medicare	$5.16
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Devoted Health Medicare	$5.68
Rate for Payer: Hawaii Medical Service Association ABD	$7.12
Rate for Payer: Hawaii Medical Service Association Commercial	$6.45
Rate for Payer: Hawaii Medical Service Association Medicare	$5.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.48
Rate for Payer: Hawaii Western Management Group Commercial	$5.16
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$5.16
Rate for Payer: Kaiser Permanente Commercial	$55.44
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$5.16
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$5.68
Rate for Payer: Ohana Health Plan Medicare	$5.16
Rate for Payer: UnitedHealthcare Medicaid	$7.12
Rate for Payer: UnitedHealthcare Medicare	$5.16
Rate for Payer: University Health Alliance Commercial	$13.32

HCHG CALCULUS SPECTROSCOPY

Facility

$142.00

Service Code	HCPCS 82365
Hospital Charge Code	H3011675
Hospital Revenue Code	301
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 CALCULUS SPECTROSCOPY

Facility

$142.00

Service Code	HCPCS 82365
Hospital Charge Code	H3011675
Hospital Revenue Code	301
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$12.90
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Hawaii Medical Service Association ABD	$11.44
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	$12.01
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$12.90
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$12.90
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$14.19
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicaid	$11.44
Rate for Payer: UnitedHealthcare Medicare	$12.90
Rate for Payer: University Health Alliance Commercial	$21.40

HCHG CALPROTECTIN, STOOL-90

Facility

$133.00

Service Code	HCPCS 83993
Hospital Charge Code	H3011635
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$19.63
Rate for Payer: AlohaCare Medicare	$19.63
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$21.59
Rate for Payer: Hawaii Medical Service Association ABD	$27.42
Rate for Payer: Hawaii Medical Service Association Commercial	$24.54
Rate for Payer: Hawaii Medical Service Association Medicare	$19.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.11
Rate for Payer: Hawaii Western Management Group Commercial	$19.63
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$19.63
Rate for Payer: Kaiser Permanente Commercial	$83.79
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$19.63
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$21.59
Rate for Payer: Ohana Health Plan Medicare	$19.63
Rate for Payer: UnitedHealthcare Medicaid	$27.42
Rate for Payer: UnitedHealthcare Medicare	$19.63
Rate for Payer: University Health Alliance Commercial	$50.73

HCHG CALPROTECTIN, STOOL-90

Facility

$133.00

Service Code	HCPCS 83993
Hospital Charge Code	H3011635
Hospital Revenue Code	301
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: MDX Hawaii PPO	$129.01

HCHG CALR EXON 9 ANALYSIS SO

Facility

$518.00

Service Code	HCPCS 81219
Hospital Charge Code	K3100001
Hospital Revenue Code	310
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$502.46
Rate for Payer: AlohaCare Medicaid	$121.63
Rate for Payer: AlohaCare Medicare	$121.63
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Devoted Health Medicare	$133.79
Rate for Payer: Hawaii Medical Service Association ABD	$122.60
Rate for Payer: Hawaii Medical Service Association Commercial	$152.04
Rate for Payer: Hawaii Medical Service Association Medicare	$121.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$122.60
Rate for Payer: Hawaii Western Management Group Commercial	$121.63
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$121.63
Rate for Payer: Kaiser Permanente Commercial	$326.34
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$121.63
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$133.79
Rate for Payer: Ohana Health Plan Medicare	$121.63
Rate for Payer: UnitedHealthcare Medicaid	$99.41
Rate for Payer: UnitedHealthcare Medicare	$121.63
Rate for Payer: University Health Alliance Commercial	$377.57

HCHG CALR EXON 9 ANALYSIS SO

Facility

$518.00

Service Code	HCPCS 81219
Hospital Charge Code	K3100001
Hospital Revenue Code	310
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$336.70
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: MDX Hawaii PPO	$502.46

HCHG CAMPY ANTIGEN DIRECT

Facility

$129.00

Service Code	HCPCS 87899
Hospital Charge Code	K3060048
Hospital Revenue Code	306
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: MDX Hawaii PPO	$125.13

HCHG CAMPY ANTIGEN DIRECT

Facility

$129.00

Service Code	HCPCS 87899
Hospital Charge Code	K3060048
Hospital Revenue Code	306
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$16.07
Rate for Payer: AlohaCare Medicare	$16.07
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Devoted Health Medicare	$17.68
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$16.07
Rate for Payer: Kaiser Permanente Commercial	$81.27
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$16.07
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$17.68
Rate for Payer: Ohana Health Plan Medicare	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.07
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG CANALITH REPOSITIONING PROCEDURE

Facility

$206.00

Service Code	HCPCS 95992
Hospital Charge Code	H4501139
Hospital Revenue Code	450
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$133.90
Rate for Payer: Cash Price	$133.90
Rate for Payer: Cash Price	$133.90
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$195.70
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Kaiser Permanente Commercial	$129.78
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: University Health Alliance Commercial	$150.15

HCHG CANALITH REPOSITIONING PROCEDURE

Facility

$206.00

Service Code	HCPCS 95992
Hospital Charge Code	H4501139
Hospital Revenue Code	450
Min. Negotiated Rate	$175.10
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$133.90
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: MDX Hawaii PPO	$199.82

HCHG CANDIDA AB ID

Facility

$156.00

Service Code	HCPCS 86628
Hospital Charge Code	H3020366
Hospital Revenue Code	302
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$12.01
Rate for Payer: AlohaCare Medicare	$12.01
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$13.21
Rate for Payer: Hawaii Medical Service Association ABD	$16.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.01
Rate for Payer: Hawaii Medical Service Association Medicare	$12.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.43
Rate for Payer: Hawaii Western Management Group Commercial	$12.01
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$12.01
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$12.01
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$13.21
Rate for Payer: Ohana Health Plan Medicare	$12.01
Rate for Payer: UnitedHealthcare Medicaid	$16.60
Rate for Payer: UnitedHealthcare Medicare	$12.01
Rate for Payer: University Health Alliance Commercial	$31.04

HCHG CANDIDA AB ID

Facility

$156.00

Service Code	HCPCS 86628
Hospital Charge Code	H3020366
Hospital Revenue Code	302
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HCHG CANDIDA SPECIES, DIRECT PROBE

Facility

$248.00

Service Code	HCPCS 87480
Hospital Charge Code	H3060676
Hospital Revenue Code	306
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$161.20
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: MDX Hawaii PPO	$240.56

HCHG CANDIDA SPECIES, DIRECT PROBE

Facility

$248.00

Service Code	HCPCS 87480
Hospital Charge Code	H3060676
Hospital Revenue Code	306
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$20.05
Rate for Payer: AlohaCare Medicare	$20.05
Rate for Payer: Cash Price	$161.20
Rate for Payer: Cash Price	$161.20
Rate for Payer: Devoted Health Medicare	$22.05
Rate for Payer: Hawaii Medical Service Association ABD	$27.71
Rate for Payer: Hawaii Medical Service Association Commercial	$25.06
Rate for Payer: Hawaii Medical Service Association Medicare	$20.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.10
Rate for Payer: Hawaii Western Management Group Commercial	$20.05
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$20.05
Rate for Payer: Kaiser Permanente Commercial	$156.24
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$20.05
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$22.05
Rate for Payer: Ohana Health Plan Medicare	$20.05
Rate for Payer: UnitedHealthcare Medicaid	$27.71
Rate for Payer: UnitedHealthcare Medicare	$20.05
Rate for Payer: University Health Alliance Commercial	$51.84

HCHG CANTHOTOMY

Facility

$6,935.00

Service Code	HCPCS 67715
Hospital Charge Code	H4500882
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$6,726.95
Rate for Payer: AlohaCare Medicaid	$2,808.63
Rate for Payer: AlohaCare Medicare	$2,808.63
Rate for Payer: Cash Price	$4,507.75
Rate for Payer: Cash Price	$4,507.75
Rate for Payer: Cash Price	$4,507.75
Rate for Payer: Devoted Health Medicare	$3,089.49
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	$2,808.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,588.25
Rate for Payer: Health Management Network Commercial	$5,894.75
Rate for Payer: Humana Medicare	$2,808.63
Rate for Payer: Kaiser Permanente Commercial	$4,369.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,808.63
Rate for Payer: MDX Hawaii PPO	$6,726.95
Rate for Payer: Ohana Health Plan Medicaid	$3,089.49
Rate for Payer: Ohana Health Plan Medicare	$2,808.63
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,808.63
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG CANTHOTOMY

Facility

$6,935.00

Service Code	HCPCS 67715
Hospital Charge Code	H4500882
Hospital Revenue Code	450
Min. Negotiated Rate	$5,894.75
Max. Negotiated Rate	$6,726.95
Rate for Payer: Cash Price	$4,507.75
Rate for Payer: Health Management Network Commercial	$5,894.75
Rate for Payer: MDX Hawaii PPO	$6,726.95

HCHG CARBAMAZEPINE (TEGRETOL) TOTAL

Facility

$180.00

Service Code	HCPCS 80156
Hospital Charge Code	H3010316
Hospital Revenue Code	301
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$14.57
Rate for Payer: AlohaCare Medicare	$14.57
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$16.03
Rate for Payer: Hawaii Medical Service Association ABD	$20.12
Rate for Payer: Hawaii Medical Service Association Commercial	$18.21
Rate for Payer: Hawaii Medical Service Association Medicare	$14.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.13
Rate for Payer: Hawaii Western Management Group Commercial	$14.57
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$14.57
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$14.57
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$16.03
Rate for Payer: Ohana Health Plan Medicare	$14.57
Rate for Payer: UnitedHealthcare Medicaid	$20.12
Rate for Payer: UnitedHealthcare Medicare	$14.57
Rate for Payer: University Health Alliance Commercial	$37.63

HCHG CARBAMAZEPINE (TEGRETOL) TOTAL

Facility

$180.00

Service Code	HCPCS 80156
Hospital Charge Code	H3010316
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 CARBOXYHEMOGLOBIN QUANT

Facility

$208.00

Service Code	HCPCS 82375
Hospital Charge Code	H3010318
Hospital Revenue Code	301
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$12.32
Rate for Payer: AlohaCare Medicare	$12.32
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Devoted Health Medicare	$13.55
Rate for Payer: Hawaii Medical Service Association Commercial	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$12.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.32
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$12.32
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$12.32
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$13.55
Rate for Payer: Ohana Health Plan Medicare	$12.32
Rate for Payer: UnitedHealthcare Medicaid	$17.03
Rate for Payer: UnitedHealthcare Medicare	$12.32
Rate for Payer: University Health Alliance Commercial	$31.86

HCHG CARBOXYHEMOGLOBIN QUANT

Facility

$208.00

Service Code	HCPCS 82375
Hospital Charge Code	H3010318
Hospital Revenue Code	301
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

HCHG CARCINOEMBRYONIC AG, BODY FLUID

Facility

$192.00

Service Code	HCPCS 82378
Hospital Charge Code	H3011554
Hospital Revenue Code	301
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: MDX Hawaii PPO	$186.24

Know your out-of-pocket cost for care.

All Charges