Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CULTURE TISSUE AEROBIC

Facility

$146.00

Service Code	HCPCS 87070
Hospital Charge Code	H3060705
Hospital Revenue Code	306
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$94.90
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: MDX Hawaii PPO	$141.62

HCHG CULT URINE

Facility

$112.00

Service Code	HCPCS 87086
Hospital Charge Code	H3060180
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$8.07
Rate for Payer: AlohaCare Medicare	$8.07
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Devoted Health Medicare	$8.88
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$8.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$8.07
Rate for Payer: Kaiser Permanente Commercial	$70.56
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$8.07
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$8.88
Rate for Payer: Ohana Health Plan Medicare	$8.07
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$8.07
Rate for Payer: University Health Alliance Commercial	$20.87

HCHG CULT URINE

Facility

$112.00

Service Code	HCPCS 87086
Hospital Charge Code	H3060180
Hospital Revenue Code	306
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$72.80
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: MDX Hawaii PPO	$108.64

HCHG CYCLOSPORINE

Facility

$223.00

Service Code	HCPCS 80158
Hospital Charge Code	H3010458
Hospital Revenue Code	301
Min. Negotiated Rate	$18.05
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$18.05
Rate for Payer: AlohaCare Medicare	$18.05
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$19.86
Rate for Payer: Hawaii Medical Service Association ABD	$24.95
Rate for Payer: Hawaii Medical Service Association Commercial	$22.56
Rate for Payer: Hawaii Medical Service Association Medicare	$18.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.20
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$18.05
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$18.05
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$19.86
Rate for Payer: Ohana Health Plan Medicare	$18.05
Rate for Payer: UnitedHealthcare Medicaid	$24.95
Rate for Payer: UnitedHealthcare Medicare	$18.05
Rate for Payer: University Health Alliance Commercial	$46.68

HCHG CYCLOSPORINE

Facility

$223.00

Service Code	HCPCS 80158
Hospital Charge Code	H3010458
Hospital Revenue Code	301
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 CYSTOGRAPHY MIN 3 VWS

Facility

$1,214.00

Service Code	HCPCS 74430
Hospital Charge Code	H3200298
Hospital Revenue Code	320
Min. Negotiated Rate	$34.94
Max. Negotiated Rate	$1,177.58
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$789.10
Rate for Payer: Cash Price	$789.10
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$34.94
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.51
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,031.90
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$764.82
Rate for Payer: Kaiser Permanente Medicaid	$619.14
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,177.58
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$34.94
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$148.81

HCHG CYSTOGRAPHY MIN 3 VWS

Facility

$1,214.00

Service Code	HCPCS 74430
Hospital Charge Code	H3200298
Hospital Revenue Code	320
Min. Negotiated Rate	$1,031.90
Max. Negotiated Rate	$1,177.58
Rate for Payer: Cash Price	$789.10
Rate for Payer: Health Management Network Commercial	$1,031.90
Rate for Payer: MDX Hawaii PPO	$1,177.58

HCHG CYSTOURETHRO W URETER CATH

Facility

$5,680.00

Service Code	HCPCS 52005
Hospital Charge Code	H4500360
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,509.60
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$3,692.00
Rate for Payer: Cash Price	$3,692.00
Rate for Payer: Cash Price	$3,692.00
Rate for Payer: Devoted Health Medicare	$2,716.41
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	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,396.00
Rate for Payer: Health Management Network Commercial	$4,828.00
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$3,578.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$5,509.60
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG CYSTOURETHRO W URETER CATH

Facility

$5,680.00

Service Code	HCPCS 52005
Hospital Charge Code	H4500360
Hospital Revenue Code	450
Min. Negotiated Rate	$4,828.00
Max. Negotiated Rate	$5,509.60
Rate for Payer: Cash Price	$3,692.00
Rate for Payer: Health Management Network Commercial	$4,828.00
Rate for Payer: MDX Hawaii PPO	$5,509.60

HCHG CYTOGENETICS AND MOLECULAR CYTOGENETICS INTERPRETATION - 90

Facility

$152.00

Service Code	HCPCS 88291
Hospital Charge Code	H3100205
Hospital Revenue Code	310
Min. Negotiated Rate	$16.54
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Hawaii Medical Service Association ABD	$16.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.81
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$95.76
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: UnitedHealthcare Medicaid	$16.54
Rate for Payer: University Health Alliance Commercial	$51.10

HCHG CYTOGENETICS AND MOLECULAR CYTOGENETICS INTERPRETATION - 90

Facility

$152.00

Service Code	HCPCS 88291
Hospital Charge Code	H3100205
Hospital Revenue Code	310
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

HCHG CYTOLOGIC EXAM EA ADDL SITE

Facility

$2,097.00

Service Code	HCPCS 88334
Hospital Charge Code	H3100134
Hospital Revenue Code	311
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$2,034.09
Rate for Payer: Cash Price	$1,363.05
Rate for Payer: Cash Price	$1,363.05
Rate for Payer: Hawaii Medical Service Association ABD	$9.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,992.15
Rate for Payer: Health Management Network Commercial	$1,782.45
Rate for Payer: Kaiser Permanente Commercial	$1,321.11
Rate for Payer: Kaiser Permanente Medicaid	$1,069.47
Rate for Payer: MDX Hawaii PPO	$2,034.09
Rate for Payer: UnitedHealthcare Medicaid	$9.97
Rate for Payer: University Health Alliance Commercial	$102.47

HCHG CYTOLOGIC EXAM EA ADDL SITE

Facility

$2,097.00

Service Code	HCPCS 88334
Hospital Charge Code	H3100134
Hospital Revenue Code	311
Min. Negotiated Rate	$1,782.45
Max. Negotiated Rate	$2,034.09
Rate for Payer: Cash Price	$1,363.05
Rate for Payer: Health Management Network Commercial	$1,782.45
Rate for Payer: MDX Hawaii PPO	$2,034.09

HCHG CYTOLOGIC EXAM INIT SITE

Facility

$4,193.00

Service Code	HCPCS 88333
Hospital Charge Code	H3100133
Hospital Revenue Code	311
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$4,067.21
Rate for Payer: AlohaCare Medicaid	$951.79
Rate for Payer: AlohaCare Medicare	$951.79
Rate for Payer: Cash Price	$2,725.45
Rate for Payer: Cash Price	$2,725.45
Rate for Payer: Devoted Health Medicare	$1,046.97
Rate for Payer: Hawaii Medical Service Association ABD	$16.28
Rate for Payer: Hawaii Medical Service Association Commercial	$1,189.74
Rate for Payer: Hawaii Medical Service Association Medicare	$951.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.67
Rate for Payer: Hawaii Western Management Group Commercial	$951.79
Rate for Payer: Health Management Network Commercial	$3,564.05
Rate for Payer: Humana Medicare	$951.79
Rate for Payer: Kaiser Permanente Commercial	$2,641.59
Rate for Payer: Kaiser Permanente Medicaid	$2,138.43
Rate for Payer: Kaiser Permanente Medicare	$951.79
Rate for Payer: MDX Hawaii PPO	$4,067.21
Rate for Payer: Ohana Health Plan Medicaid	$1,046.97
Rate for Payer: Ohana Health Plan Medicare	$951.79
Rate for Payer: UnitedHealthcare Medicaid	$16.28
Rate for Payer: UnitedHealthcare Medicare	$951.79
Rate for Payer: University Health Alliance Commercial	$174.99

HCHG CYTOLOGIC EXAM INIT SITE

Facility

$4,193.00

Service Code	HCPCS 88333
Hospital Charge Code	H3100133
Hospital Revenue Code	311
Min. Negotiated Rate	$3,564.05
Max. Negotiated Rate	$4,067.21
Rate for Payer: Cash Price	$2,725.45
Rate for Payer: Health Management Network Commercial	$3,564.05
Rate for Payer: MDX Hawaii PPO	$4,067.21

HCHG CYTOLOGY ADEQUACY/SMR EXAM

Facility

$491.00

Service Code	HCPCS 88172
Hospital Charge Code	H3110158
Hospital Revenue Code	311
Min. Negotiated Rate	$417.35
Max. Negotiated Rate	$476.27
Rate for Payer: Cash Price	$319.15
Rate for Payer: Health Management Network Commercial	$417.35
Rate for Payer: MDX Hawaii PPO	$476.27

HCHG CYTOLOGY ADEQUACY/SMR EXAM

Facility

$491.00

Service Code	HCPCS 88172
Hospital Charge Code	H3110158
Hospital Revenue Code	311
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$476.27
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$319.15
Rate for Payer: Cash Price	$319.15
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$39.40
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.64
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$417.35
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$309.33
Rate for Payer: Kaiser Permanente Medicaid	$250.41
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$476.27
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$39.40
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$101.12

HCHG CYTOMEGALOVIRUS DNA QUAL PCR

Facility

$431.00

Service Code	HCPCS 87496
Hospital Charge Code	H3060182
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
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	$366.35
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$418.07
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 CYTOMEGALOVIRUS DNA QUAL PCR

Facility

$431.00

Service Code	HCPCS 87496
Hospital Charge Code	H3060182
Hospital Revenue Code	306
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

HCHG CYTOMEGALOVIRUS DNA QUANT PCR

Facility

$526.00

Service Code	HCPCS 87497
Hospital Charge Code	H3060601
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$510.22
Rate for Payer: AlohaCare Medicaid	$42.84
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$341.90
Rate for Payer: Cash Price	$341.90
Rate for Payer: Devoted Health Medicare	$47.12
Rate for Payer: Hawaii Medical Service Association ABD	$59.20
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$62.16
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$447.10
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$331.38
Rate for Payer: Kaiser Permanente Medicaid	$268.26
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$510.22
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$59.20
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$110.72

HCHG CYTOMEGALOVIRUS DNA QUANT PCR

Facility

$526.00

Service Code	HCPCS 87497
Hospital Charge Code	H3060601
Hospital Revenue Code	306
Min. Negotiated Rate	$447.10
Max. Negotiated Rate	$510.22
Rate for Payer: Cash Price	$341.90
Rate for Payer: Health Management Network Commercial	$447.10
Rate for Payer: MDX Hawaii PPO	$510.22

HCHG CYTOMEG DNA AMP PROBE - 90

Facility

$431.00

Service Code	HCPCS 87496
Hospital Charge Code	H3060794
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
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	$366.35
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$418.07
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 CYTOMEG DNA AMP PROBE - 90

Facility

$431.00

Service Code	HCPCS 87496
Hospital Charge Code	H3060794
Hospital Revenue Code	306
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

HCHG CYTOPATH CONC SM & INTERP

Facility

$296.00

Service Code	HCPCS 88108
Hospital Charge Code	H3110160
Hospital Revenue Code	311
Min. Negotiated Rate	$31.77
Max. Negotiated Rate	$287.12
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$44.12
Rate for Payer: Cash Price	$192.40
Rate for Payer: Cash Price	$192.40
Rate for Payer: Devoted Health Medicare	$48.53
Rate for Payer: Hawaii Medical Service Association ABD	$44.09
Rate for Payer: Hawaii Medical Service Association Commercial	$55.15
Rate for Payer: Hawaii Medical Service Association Medicare	$44.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.77
Rate for Payer: Hawaii Western Management Group Commercial	$44.12
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Humana Medicare	$44.12
Rate for Payer: Kaiser Permanente Commercial	$186.48
Rate for Payer: Kaiser Permanente Medicaid	$150.96
Rate for Payer: Kaiser Permanente Medicare	$44.12
Rate for Payer: MDX Hawaii PPO	$287.12
Rate for Payer: Ohana Health Plan Medicaid	$48.53
Rate for Payer: Ohana Health Plan Medicare	$44.12
Rate for Payer: UnitedHealthcare Medicaid	$44.09
Rate for Payer: UnitedHealthcare Medicare	$44.12
Rate for Payer: University Health Alliance Commercial	$143.97

HCHG CYTOPATH CONC SM & INTERP

Facility

$296.00

Service Code	HCPCS 88108
Hospital Charge Code	H3110160
Hospital Revenue Code	311
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

Know your out-of-pocket cost for care.

All Charges