Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CHEST PA ONLY 1 VIEW

Facility

$485.00

Service Code	HCPCS 71045
Hospital Charge Code	H3240116
Hospital Revenue Code	324
Min. Negotiated Rate	$412.25
Max. Negotiated Rate	$470.45
Rate for Payer: Cash Price	$315.25
Rate for Payer: Health Management Network Commercial	$412.25
Rate for Payer: MDX Hawaii PPO	$470.45

HCHG CHEST SPEC 1 VIEW

Facility

$485.00

Service Code	HCPCS 71045
Hospital Charge Code	H3200258
Hospital Revenue Code	324
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$470.45
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$315.25
Rate for Payer: Cash Price	$315.25
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$15.78
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	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$412.25
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$305.55
Rate for Payer: Kaiser Permanente Medicaid	$247.35
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$470.45
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$16.90
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$40.29

HCHG CHEST SPEC 1 VIEW

Facility

$485.00

Service Code	HCPCS 71045
Hospital Charge Code	H3200258
Hospital Revenue Code	324
Min. Negotiated Rate	$412.25
Max. Negotiated Rate	$470.45
Rate for Payer: Cash Price	$315.25
Rate for Payer: Health Management Network Commercial	$412.25
Rate for Payer: MDX Hawaii PPO	$470.45

HCHG CHLAMYDIA PCR

Facility

$231.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060124
Hospital Revenue Code	306
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: MDX Hawaii PPO	$224.07

HCHG CHLAMYDIA PCR

Facility

$231.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060124
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$145.53
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG CHLAMYDIA TRACHOMATIS PCR

Facility

$231.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060126
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$145.53
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG CHLAMYDIA TRACHOMATIS PCR

Facility

$231.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060126
Hospital Revenue Code	306
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: MDX Hawaii PPO	$224.07

HCHG CHLMY TRCH&NEISRA GONOR MULT - 90

Facility

$403.00

Service Code	HCPCS 87494
Hospital Charge Code	H3060820
Hospital Revenue Code	306
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$390.91
Rate for Payer: AlohaCare Medicaid	$70.18
Rate for Payer: AlohaCare Medicare	$70.18
Rate for Payer: Cash Price	$261.95
Rate for Payer: Cash Price	$261.95
Rate for Payer: Devoted Health Medicare	$77.20
Rate for Payer: Hawaii Medical Service Association Commercial	$87.72
Rate for Payer: Hawaii Medical Service Association Medicare	$70.18
Rate for Payer: Hawaii Western Management Group Commercial	$70.18
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Humana Medicare	$70.18
Rate for Payer: Kaiser Permanente Commercial	$253.89
Rate for Payer: Kaiser Permanente Medicaid	$205.53
Rate for Payer: Kaiser Permanente Medicare	$70.18
Rate for Payer: MDX Hawaii PPO	$390.91
Rate for Payer: Ohana Health Plan Medicaid	$77.20
Rate for Payer: Ohana Health Plan Medicare	$70.18
Rate for Payer: UnitedHealthcare Medicare	$70.18
Rate for Payer: University Health Alliance Commercial	$293.75

HCHG CHLMY TRCH&NEISRA GONOR MULT - 90

Facility

$403.00

Service Code	HCPCS 87494
Hospital Charge Code	H3060820
Hospital Revenue Code	306
Min. Negotiated Rate	$342.55
Max. Negotiated Rate	$390.91
Rate for Payer: Cash Price	$261.95
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: MDX Hawaii PPO	$390.91

HCHG CHLORIDE BLOOD

Facility

$32.00

Service Code	HCPCS 82435
Hospital Charge Code	H3010342
Hospital Revenue Code	301
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: MDX Hawaii PPO	$31.04

HCHG CHLORIDE BLOOD

Facility

$32.00

Service Code	HCPCS 82435
Hospital Charge Code	H3010342
Hospital Revenue Code	301
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$4.60
Rate for Payer: AlohaCare Medicare	$4.60
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Devoted Health Medicare	$5.06
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.75
Rate for Payer: Hawaii Medical Service Association Medicare	$4.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.60
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$4.60
Rate for Payer: Kaiser Permanente Commercial	$20.16
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$4.60
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$5.06
Rate for Payer: Ohana Health Plan Medicare	$4.60
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$4.60
Rate for Payer: University Health Alliance Commercial	$11.88

HCHG CHLORIDE FECES

Facility

$60.00

Service Code	HCPCS 82438
Hospital Charge Code	H3010346
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$5.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$5.50
Rate for Payer: Hawaii Medical Service Association ABD	$6.76
Rate for Payer: Hawaii Medical Service Association Commercial	$6.25
Rate for Payer: Hawaii Medical Service Association Medicare	$5.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$5.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$5.00
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$5.00
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$5.50
Rate for Payer: Ohana Health Plan Medicare	$5.00
Rate for Payer: UnitedHealthcare Medicaid	$6.76
Rate for Payer: UnitedHealthcare Medicare	$5.00
Rate for Payer: University Health Alliance Commercial	$12.64

HCHG CHLORIDE FECES

Facility

$60.00

Service Code	HCPCS 82438
Hospital Charge Code	H3010346
Hospital Revenue Code	301
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$58.20

HCHG CHLORIDE-URINE

Facility

$62.00

Service Code	HCPCS 82436
Hospital Charge Code	H3010352
Hospital Revenue Code	301
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$40.30
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: MDX Hawaii PPO	$60.14

HCHG CHLORIDE-URINE

Facility

$62.00

Service Code	HCPCS 82436
Hospital Charge Code	H3010352
Hospital Revenue Code	301
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$5.75
Rate for Payer: AlohaCare Medicare	$5.75
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Devoted Health Medicare	$6.33
Rate for Payer: Hawaii Medical Service Association ABD	$6.95
Rate for Payer: Hawaii Medical Service Association Commercial	$7.19
Rate for Payer: Hawaii Medical Service Association Medicare	$5.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.30
Rate for Payer: Hawaii Western Management Group Commercial	$5.75
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$5.75
Rate for Payer: Kaiser Permanente Commercial	$39.06
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$5.75
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$6.33
Rate for Payer: Ohana Health Plan Medicare	$5.75
Rate for Payer: UnitedHealthcare Medicaid	$6.95
Rate for Payer: UnitedHealthcare Medicare	$5.75
Rate for Payer: University Health Alliance Commercial	$12.99

HCHG CHOLESTEROL DIR LDL

Facility

$124.00

Service Code	HCPCS 83721
Hospital Charge Code	H3010362
Hospital Revenue Code	301
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$80.60
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: MDX Hawaii PPO	$120.28

HCHG CHOLESTEROL DIR LDL

Facility

$124.00

Service Code	HCPCS 83721
Hospital Charge Code	H3010362
Hospital Revenue Code	301
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Devoted Health Medicare	$11.55
Rate for Payer: Hawaii Medical Service Association ABD	$13.18
Rate for Payer: Hawaii Medical Service Association Commercial	$13.12
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.84
Rate for Payer: Hawaii Western Management Group Commercial	$10.50
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$11.55
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicaid	$13.18
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$24.66

HCHG CHOLESTEROL TOTAL

Facility

$57.00

Service Code	HCPCS 82465
Hospital Charge Code	H3010356
Hospital Revenue Code	301
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$37.05
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: MDX Hawaii PPO	$55.29

HCHG CHOLESTEROL TOTAL

Facility

$57.00

Service Code	HCPCS 82465
Hospital Charge Code	H3010356
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$4.35
Rate for Payer: AlohaCare Medicare	$4.35
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Devoted Health Medicare	$4.79
Rate for Payer: Hawaii Medical Service Association ABD	$6.02
Rate for Payer: Hawaii Medical Service Association Commercial	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.32
Rate for Payer: Hawaii Western Management Group Commercial	$4.35
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$4.35
Rate for Payer: Kaiser Permanente Commercial	$35.91
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$4.35
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$4.79
Rate for Payer: Ohana Health Plan Medicare	$4.35
Rate for Payer: UnitedHealthcare Medicaid	$6.02
Rate for Payer: UnitedHealthcare Medicare	$4.35
Rate for Payer: University Health Alliance Commercial	$11.25

HCHG CHROM ANALY 20-25 CELLS

Facility

$814.00

Service Code	HCPCS 88264
Hospital Charge Code	H3110288
Hospital Revenue Code	311
Min. Negotiated Rate	$104.48
Max. Negotiated Rate	$789.58
Rate for Payer: AlohaCare Medicaid	$144.61
Rate for Payer: AlohaCare Medicare	$144.61
Rate for Payer: Cash Price	$529.10
Rate for Payer: Cash Price	$529.10
Rate for Payer: Devoted Health Medicare	$159.07
Rate for Payer: Hawaii Medical Service Association ABD	$104.48
Rate for Payer: Hawaii Medical Service Association Commercial	$180.76
Rate for Payer: Hawaii Medical Service Association Medicare	$144.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$172.14
Rate for Payer: Hawaii Western Management Group Commercial	$144.61
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Humana Medicare	$144.61
Rate for Payer: Kaiser Permanente Commercial	$512.82
Rate for Payer: Kaiser Permanente Medicaid	$415.14
Rate for Payer: Kaiser Permanente Medicare	$144.61
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: Ohana Health Plan Medicaid	$159.07
Rate for Payer: Ohana Health Plan Medicare	$144.61
Rate for Payer: UnitedHealthcare Medicaid	$104.48
Rate for Payer: UnitedHealthcare Medicare	$144.61
Rate for Payer: University Health Alliance Commercial	$322.16

HCHG CHROM ANALY 20-25 CELLS

Facility

$814.00

Service Code	HCPCS 88264
Hospital Charge Code	H3110288
Hospital Revenue Code	311
Min. Negotiated Rate	$691.90
Max. Negotiated Rate	$789.58
Rate for Payer: Cash Price	$529.10
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: MDX Hawaii PPO	$789.58

HCHG CHROM ANALY ADD KARYO EA

Facility

$223.00

Service Code	HCPCS 88280
Hospital Charge Code	H3110289
Hospital Revenue Code	311
Min. Negotiated Rate	$33.47
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$33.47
Rate for Payer: AlohaCare Medicare	$33.47
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$36.82
Rate for Payer: Hawaii Medical Service Association ABD	$34.68
Rate for Payer: Hawaii Medical Service Association Commercial	$41.84
Rate for Payer: Hawaii Medical Service Association Medicare	$33.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.41
Rate for Payer: Hawaii Western Management Group Commercial	$33.47
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$33.47
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$33.47
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$36.82
Rate for Payer: Ohana Health Plan Medicare	$33.47
Rate for Payer: UnitedHealthcare Medicaid	$34.68
Rate for Payer: UnitedHealthcare Medicare	$33.47
Rate for Payer: University Health Alliance Commercial	$64.88

HCHG CHROM ANALY ADD KARYO EA

Facility

$223.00

Service Code	HCPCS 88280
Hospital Charge Code	H3110289
Hospital Revenue Code	311
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$144.95
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: MDX Hawaii PPO	$216.31

HCHG CHROMOGRANIN A

Facility

$256.00

Service Code	HCPCS 86316
Hospital Charge Code	H3020908
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 CHROMOGRANIN A

Facility

$256.00

Service Code	HCPCS 86316
Hospital Charge Code	H3020908
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$248.32
Rate for Payer: AlohaCare Medicaid	$20.81
Rate for Payer: AlohaCare Medicare	$20.81
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Devoted Health Medicare	$22.89
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$20.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: Humana Medicare	$20.81
Rate for Payer: Kaiser Permanente Commercial	$161.28
Rate for Payer: Kaiser Permanente Medicaid	$130.56
Rate for Payer: Kaiser Permanente Medicare	$20.81
Rate for Payer: MDX Hawaii PPO	$248.32
Rate for Payer: Ohana Health Plan Medicaid	$22.89
Rate for Payer: Ohana Health Plan Medicare	$20.81
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$20.81
Rate for Payer: University Health Alliance Commercial	$53.78

Know your out-of-pocket cost for care.

All Charges