Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG COTININE SCREEN U CORD SO

Facility

$296.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010011
Hospital Revenue Code	301
Min. Negotiated Rate	$251.60
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$192.40
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: MDX Hawaii PPO	$287.12

HCHG COTININE SCREEN U CORD SO

Facility

$296.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010011
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$287.12
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$192.40
Rate for Payer: Cash Price	$192.40
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$186.48
Rate for Payer: Kaiser Permanente Medicaid	$150.96
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$287.12
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG COV-19 AMP PRB HGH THRUPUT

Facility

$300.00

Service Code	HCPCS U0003
Hospital Charge Code	H3060750
Hospital Revenue Code	306
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: University Health Alliance Commercial	$218.67

HCHG COV-19 AMP PRB HGH THRUPUT

Facility

$300.00

Service Code	HCPCS U0003
Hospital Charge Code	H3060750
Hospital Revenue Code	306
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: MDX Hawaii PPO	$291.00

HCHG COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT

Facility

$219.00

Service Code	HCPCS U0005
Hospital Charge Code	H3060753
Hospital Revenue Code	306
Min. Negotiated Rate	$111.69
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$142.35
Rate for Payer: Hawaii Western Management Group Commercial	$208.05
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: University Health Alliance Commercial	$159.63

HCHG COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT

Facility

$219.00

Service Code	HCPCS U0005
Hospital Charge Code	H3060753
Hospital Revenue Code	306
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 COVID, FLU AB BY PCR (CEPHIED)

Facility

$781.00

Service Code	HCPCS 87636
Hospital Charge Code	H3060815
Hospital Revenue Code	306
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: MDX Hawaii PPO	$757.57

HCHG COVID, FLU AB BY PCR (CEPHIED)

Facility

$781.00

Service Code	HCPCS 87636
Hospital Charge Code	H3060815
Hospital Revenue Code	306
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$757.57
Rate for Payer: AlohaCare Medicaid	$142.63
Rate for Payer: AlohaCare Medicare	$142.63
Rate for Payer: Cash Price	$507.65
Rate for Payer: Cash Price	$507.65
Rate for Payer: Devoted Health Medicare	$156.89
Rate for Payer: Hawaii Medical Service Association ABD	$142.63
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$142.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$142.63
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Humana Medicare	$142.63
Rate for Payer: Kaiser Permanente Commercial	$492.03
Rate for Payer: Kaiser Permanente Medicaid	$398.31
Rate for Payer: Kaiser Permanente Medicare	$142.63
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: Ohana Health Plan Medicaid	$156.89
Rate for Payer: Ohana Health Plan Medicare	$142.63
Rate for Payer: UnitedHealthcare Medicaid	$142.63
Rate for Payer: UnitedHealthcare Medicare	$142.63
Rate for Payer: University Health Alliance Commercial	$569.27

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020458
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020456
Hospital Revenue Code	302
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.92
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.99
Rate for Payer: Hawaii Western Management Group Commercial	$13.03
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.33
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$10.92
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$33.67

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020456
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020454
Hospital Revenue Code	302
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.92
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.99
Rate for Payer: Hawaii Western Management Group Commercial	$13.03
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.33
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$10.92
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$33.67

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020454
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020460
Hospital Revenue Code	302
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.92
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.99
Rate for Payer: Hawaii Western Management Group Commercial	$13.03
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.33
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$10.92
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$33.67

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020460
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG COXSACKIE A AB 7 90

Facility

$161.00

Service Code	HCPCS 86658
Hospital Charge Code	H3020458
Hospital Revenue Code	302
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.92
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.99
Rate for Payer: Hawaii Western Management Group Commercial	$13.03
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.33
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$10.92
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$33.67

HCHG C-PEPTIDE 90

Facility

$256.00

Service Code	HCPCS 84681
Hospital Charge Code	H3010422
Hospital Revenue Code	301
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	$28.75
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	$30.19
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	$28.75
Rate for Payer: UnitedHealthcare Medicare	$20.81
Rate for Payer: University Health Alliance Commercial	$53.78

HCHG C-PEPTIDE 90

Facility

$256.00

Service Code	HCPCS 84681
Hospital Charge Code	H3010422
Hospital Revenue Code	301
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 CPK ISOENZYMES - 90

Facility

$165.00

Service Code	HCPCS 82552
Hospital Charge Code	H3011669
Hospital Revenue Code	301
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$13.39
Rate for Payer: AlohaCare Medicare	$13.39
Rate for Payer: Cash Price	$107.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Devoted Health Medicare	$14.73
Rate for Payer: Hawaii Medical Service Association ABD	$18.51
Rate for Payer: Hawaii Medical Service Association Commercial	$16.74
Rate for Payer: Hawaii Medical Service Association Medicare	$13.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.44
Rate for Payer: Hawaii Western Management Group Commercial	$13.39
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$13.39
Rate for Payer: Kaiser Permanente Commercial	$103.95
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$13.39
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$14.73
Rate for Payer: Ohana Health Plan Medicare	$13.39
Rate for Payer: UnitedHealthcare Medicaid	$18.51
Rate for Payer: UnitedHealthcare Medicare	$13.39
Rate for Payer: University Health Alliance Commercial	$34.61

HCHG CPK ISOENZYMES - 90

Facility

$165.00

Service Code	HCPCS 82552
Hospital Charge Code	H3011669
Hospital Revenue Code	301
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$107.25
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: MDX Hawaii PPO	$160.05

HCHG CPK TOTAL

Facility

$110.00

Service Code	HCPCS 82550
Hospital Charge Code	H3010424
Hospital Revenue Code	301
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$6.51
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$71.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Devoted Health Medicare	$7.16
Rate for Payer: Hawaii Medical Service Association ABD	$9.01
Rate for Payer: Hawaii Medical Service Association Commercial	$8.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.46
Rate for Payer: Hawaii Western Management Group Commercial	$6.51
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$7.16
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicaid	$9.01
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$16.84

HCHG CPK TOTAL

Facility

$110.00

Service Code	HCPCS 82550
Hospital Charge Code	H3010424
Hospital Revenue Code	301
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$71.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: MDX Hawaii PPO	$106.70

HCHG CPK TOTAL - 90

Facility

$110.00

Service Code	HCPCS 82550
Hospital Charge Code	H3011668
Hospital Revenue Code	301
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$6.51
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$71.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Devoted Health Medicare	$7.16
Rate for Payer: Hawaii Medical Service Association ABD	$9.01
Rate for Payer: Hawaii Medical Service Association Commercial	$8.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.46
Rate for Payer: Hawaii Western Management Group Commercial	$6.51
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$7.16
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicaid	$9.01
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$16.84

HCHG CPK TOTAL - 90

Facility

$110.00

Service Code	HCPCS 82550
Hospital Charge Code	H3011668
Hospital Revenue Code	301
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$71.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: MDX Hawaii PPO	$106.70

HCHG CPR

Facility

$1,800.00

Service Code	HCPCS 92950
Hospital Charge Code	H4500352
Hospital Revenue Code	450
Min. Negotiated Rate	$1,530.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: MDX Hawaii PPO	$1,746.00

Know your out-of-pocket cost for care.

All Charges