Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CARS/BD TST INFT-12MO 60 MIN

Facility

$301.00

Service Code	HCPCS 94780
Hospital Charge Code	H4120103
Hospital Revenue Code	410
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$44.12
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Devoted Health Medicare	$48.53
Rate for Payer: Hawaii Medical Service Association Commercial	$55.15
Rate for Payer: Hawaii Medical Service Association Medicare	$44.12
Rate for Payer: Hawaii Western Management Group Commercial	$285.95
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$44.12
Rate for Payer: Kaiser Permanente Commercial	$189.63
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$44.12
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$48.53
Rate for Payer: Ohana Health Plan Medicare	$44.12
Rate for Payer: UnitedHealthcare Medicaid	$14.47
Rate for Payer: UnitedHealthcare Medicare	$44.12
Rate for Payer: University Health Alliance Commercial	$219.40

HCHG CARS/BD TST INFT-12MO 60 MIN

Facility

$301.00

Service Code	HCPCS 94780
Hospital Charge Code	H4120103
Hospital Revenue Code	410
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: MDX Hawaii PPO	$291.97

HCHG CATECHOLAMINE-PLASMA FRACTIONATED

Facility

$311.00

Service Code	HCPCS 82384
Hospital Charge Code	H3010326
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$301.67
Rate for Payer: AlohaCare Medicaid	$25.25
Rate for Payer: AlohaCare Medicare	$25.25
Rate for Payer: Cash Price	$202.15
Rate for Payer: Cash Price	$202.15
Rate for Payer: Devoted Health Medicare	$27.77
Rate for Payer: Hawaii Medical Service Association ABD	$34.90
Rate for Payer: Hawaii Medical Service Association Commercial	$31.56
Rate for Payer: Hawaii Medical Service Association Medicare	$25.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.25
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: Humana Medicare	$25.25
Rate for Payer: Kaiser Permanente Commercial	$195.93
Rate for Payer: Kaiser Permanente Medicaid	$158.61
Rate for Payer: Kaiser Permanente Medicare	$25.25
Rate for Payer: MDX Hawaii PPO	$301.67
Rate for Payer: Ohana Health Plan Medicaid	$27.77
Rate for Payer: Ohana Health Plan Medicare	$25.25
Rate for Payer: UnitedHealthcare Medicaid	$34.90
Rate for Payer: UnitedHealthcare Medicare	$25.25
Rate for Payer: University Health Alliance Commercial	$65.27

HCHG CATECHOLAMINE-PLASMA FRACTIONATED

Facility

$311.00

Service Code	HCPCS 82384
Hospital Charge Code	H3010326
Hospital Revenue Code	301
Min. Negotiated Rate	$264.35
Max. Negotiated Rate	$301.67
Rate for Payer: Cash Price	$202.15
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: MDX Hawaii PPO	$301.67

HCHG CATECHOLAMINES 24 HR URINE FRACTIONATED

Facility

$311.00

Service Code	HCPCS 82384
Hospital Charge Code	H3010328
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$301.67
Rate for Payer: AlohaCare Medicaid	$25.25
Rate for Payer: AlohaCare Medicare	$25.25
Rate for Payer: Cash Price	$202.15
Rate for Payer: Cash Price	$202.15
Rate for Payer: Devoted Health Medicare	$27.77
Rate for Payer: Hawaii Medical Service Association ABD	$34.90
Rate for Payer: Hawaii Medical Service Association Commercial	$31.56
Rate for Payer: Hawaii Medical Service Association Medicare	$25.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.25
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: Humana Medicare	$25.25
Rate for Payer: Kaiser Permanente Commercial	$195.93
Rate for Payer: Kaiser Permanente Medicaid	$158.61
Rate for Payer: Kaiser Permanente Medicare	$25.25
Rate for Payer: MDX Hawaii PPO	$301.67
Rate for Payer: Ohana Health Plan Medicaid	$27.77
Rate for Payer: Ohana Health Plan Medicare	$25.25
Rate for Payer: UnitedHealthcare Medicaid	$34.90
Rate for Payer: UnitedHealthcare Medicare	$25.25
Rate for Payer: University Health Alliance Commercial	$65.27

HCHG CATECHOLAMINES 24 HR URINE FRACTIONATED

Facility

$311.00

Service Code	HCPCS 82384
Hospital Charge Code	H3010328
Hospital Revenue Code	301
Min. Negotiated Rate	$264.35
Max. Negotiated Rate	$301.67
Rate for Payer: Cash Price	$202.15
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: MDX Hawaii PPO	$301.67

HCHG CATHETERIZE FOR URINE SPEC

Facility

$61.00

Service Code	HCPCS P9612
Hospital Charge Code	H3001112
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$9.34
Rate for Payer: AlohaCare Medicare	$9.34
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$10.27
Rate for Payer: Hawaii Medical Service Association ABD	$3.00
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$9.34
Rate for Payer: Hawaii Western Management Group Commercial	$57.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$9.34
Rate for Payer: Kaiser Permanente Commercial	$38.43
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$9.34
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$10.27
Rate for Payer: Ohana Health Plan Medicare	$9.34
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$9.34
Rate for Payer: University Health Alliance Commercial	$44.46

HCHG CATHETERIZE FOR URINE SPEC

Facility

$61.00

Service Code	HCPCS P9612
Hospital Charge Code	H3001112
Hospital Revenue Code	300
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 CATH & INTRO HYSTEROSONOGRAM

Facility

$508.00

Service Code	HCPCS 58340
Hospital Charge Code	H4020108
Hospital Revenue Code	361
Min. Negotiated Rate	$431.80
Max. Negotiated Rate	$492.76
Rate for Payer: Cash Price	$330.20
Rate for Payer: Health Management Network Commercial	$431.80
Rate for Payer: MDX Hawaii PPO	$492.76

HCHG CATH & INTRO HYSTEROSONOGRAM

Facility

$508.00

Service Code	HCPCS 58340
Hospital Charge Code	H4020108
Hospital Revenue Code	361
Min. Negotiated Rate	$38.69
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$330.20
Rate for Payer: Cash Price	$330.20
Rate for Payer: Cash Price	$330.20
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 Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$431.80
Rate for Payer: Kaiser Permanente Commercial	$320.04
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$492.76
Rate for Payer: UnitedHealthcare Medicaid	$38.69
Rate for Payer: University Health Alliance Commercial	$370.28

HCHG CATH TIP CULT

Facility

$163.00

Service Code	HCPCS 87071
Hospital Charge Code	H3060120
Hospital Revenue Code	306
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$9.89
Rate for Payer: AlohaCare Medicare	$9.89
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$10.88
Rate for Payer: Hawaii Medical Service Association ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$12.36
Rate for Payer: Hawaii Medical Service Association Medicare	$9.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.65
Rate for Payer: Hawaii Western Management Group Commercial	$9.89
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$9.89
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$9.89
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$10.88
Rate for Payer: Ohana Health Plan Medicare	$9.89
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$9.89
Rate for Payer: University Health Alliance Commercial	$24.38

HCHG CATH TIP CULT

Facility

$163.00

Service Code	HCPCS 87071
Hospital Charge Code	H3060120
Hospital Revenue Code	306
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: MDX Hawaii PPO	$158.11

HCHG CBC W DIFF

Facility

$132.00

Service Code	HCPCS 85025
Hospital Charge Code	H3000186
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$7.77
Rate for Payer: AlohaCare Medicare	$7.77
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$8.55
Rate for Payer: Hawaii Medical Service Association ABD	$10.74
Rate for Payer: Hawaii Medical Service Association Commercial	$9.71
Rate for Payer: Hawaii Medical Service Association Medicare	$7.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.28
Rate for Payer: Hawaii Western Management Group Commercial	$7.77
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$7.77
Rate for Payer: Kaiser Permanente Commercial	$83.16
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$7.77
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$8.55
Rate for Payer: Ohana Health Plan Medicare	$7.77
Rate for Payer: UnitedHealthcare Medicaid	$10.74
Rate for Payer: UnitedHealthcare Medicare	$7.77
Rate for Payer: University Health Alliance Commercial	$20.09

HCHG CBC W DIFF

Facility

$132.00

Service Code	HCPCS 85025
Hospital Charge Code	H3000186
Hospital Revenue Code	305
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: MDX Hawaii PPO	$128.04

HCHG CBC WO DIFF

Facility

$101.00

Service Code	HCPCS 85027
Hospital Charge Code	H3050124
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$16.72

HCHG CBC WO DIFF

Facility

$101.00

Service Code	HCPCS 85027
Hospital Charge Code	H3050124
Hospital Revenue Code	305
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 CBT 1ST HOUR

Facility

$591.00

Service Code	HCPCS 94644
Hospital Charge Code	H4100307
Hospital Revenue Code	410
Min. Negotiated Rate	$27.58
Max. Negotiated Rate	$573.27
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$384.15
Rate for Payer: Cash Price	$384.15
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$561.45
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$372.33
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$27.58
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$430.78

HCHG CBT 1ST HOUR

Facility

$591.00

Service Code	HCPCS 94644
Hospital Charge Code	H4100307
Hospital Revenue Code	410
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$384.15
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: MDX Hawaii PPO	$573.27

HCHG CBT EACH ADDL HOUR

Facility

$360.00

Service Code	HCPCS 94645
Hospital Charge Code	H4100308
Hospital Revenue Code	410
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$234.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$349.20

HCHG CBT EACH ADDL HOUR

Facility

$360.00

Service Code	HCPCS 94645
Hospital Charge Code	H4100308
Hospital Revenue Code	410
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: UnitedHealthcare Medicaid	$10.46
Rate for Payer: University Health Alliance Commercial	$262.40

HCHG C-CITRULLINATED PEPTIDE 90

Facility

$160.00

Service Code	HCPCS 86200
Hospital Charge Code	H3010334
Hospital Revenue Code	302
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 C-CITRULLINATED PEPTIDE 90

Facility

$160.00

Service Code	HCPCS 86200
Hospital Charge Code	H3010334
Hospital Revenue Code	302
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$12.95
Rate for Payer: AlohaCare Medicare	$12.95
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$14.24
Rate for Payer: Hawaii Medical Service Association ABD	$12.66
Rate for Payer: Hawaii Medical Service Association Commercial	$16.19
Rate for Payer: Hawaii Medical Service Association Medicare	$12.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.95
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$12.95
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$12.95
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$14.24
Rate for Payer: Ohana Health Plan Medicare	$12.95
Rate for Payer: UnitedHealthcare Medicaid	$12.66
Rate for Payer: UnitedHealthcare Medicare	$12.95
Rate for Payer: University Health Alliance Commercial	$33.47

HCHG C. DIFFICILE NUCLEIC ACID AMPLIFY

Facility

$484.00

Service Code	HCPCS 87493
Hospital Charge Code	H3060682
Hospital Revenue Code	306
Min. Negotiated Rate	$411.40
Max. Negotiated Rate	$469.48
Rate for Payer: Cash Price	$314.60
Rate for Payer: Health Management Network Commercial	$411.40
Rate for Payer: MDX Hawaii PPO	$469.48

HCHG C. DIFFICILE NUCLEIC ACID AMPLIFY

Facility

$484.00

Service Code	HCPCS 87493
Hospital Charge Code	H3060682
Hospital Revenue Code	306
Min. Negotiated Rate	$37.27
Max. Negotiated Rate	$469.48
Rate for Payer: AlohaCare Medicaid	$37.27
Rate for Payer: AlohaCare Medicare	$37.27
Rate for Payer: Cash Price	$314.60
Rate for Payer: Cash Price	$314.60
Rate for Payer: Devoted Health Medicare	$41.00
Rate for Payer: Hawaii Medical Service Association ABD	$50.27
Rate for Payer: Hawaii Medical Service Association Commercial	$46.59
Rate for Payer: Hawaii Medical Service Association Medicare	$37.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$37.27
Rate for Payer: Health Management Network Commercial	$411.40
Rate for Payer: Humana Medicare	$37.27
Rate for Payer: Kaiser Permanente Commercial	$304.92
Rate for Payer: Kaiser Permanente Medicaid	$246.84
Rate for Payer: Kaiser Permanente Medicare	$37.27
Rate for Payer: MDX Hawaii PPO	$469.48
Rate for Payer: Ohana Health Plan Medicaid	$41.00
Rate for Payer: Ohana Health Plan Medicare	$37.27
Rate for Payer: UnitedHealthcare Medicaid	$50.27
Rate for Payer: UnitedHealthcare Medicare	$37.27
Rate for Payer: University Health Alliance Commercial	$93.00

HCHG CEA LEVEL RIA

Facility

$192.00

Service Code	HCPCS 82378
Hospital Charge Code	H3010336
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