Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG DRUG SCRN UCRD 17 ETG SO

Facility

$874.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010013
Hospital Revenue Code	301
Min. Negotiated Rate	$742.90
Max. Negotiated Rate	$847.78
Rate for Payer: Cash Price	$568.10
Rate for Payer: Health Management Network Commercial	$742.90
Rate for Payer: MDX Hawaii PPO	$847.78

HCHG DRUG TEST PRSMV DIR OPT OBS

Facility

$119.00

Service Code	HCPCS 80305
Hospital Charge Code	H3011824
Hospital Revenue Code	301
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$12.60
Rate for Payer: AlohaCare Medicare	$12.60
Rate for Payer: Cash Price	$77.35
Rate for Payer: Cash Price	$77.35
Rate for Payer: Devoted Health Medicare	$13.86
Rate for Payer: Hawaii Medical Service Association ABD	$19.03
Rate for Payer: Hawaii Medical Service Association Commercial	$15.75
Rate for Payer: Hawaii Medical Service Association Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.11
Rate for Payer: Hawaii Western Management Group Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$12.60
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$12.60
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$13.86
Rate for Payer: Ohana Health Plan Medicare	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$8.98
Rate for Payer: UnitedHealthcare Medicare	$12.60
Rate for Payer: University Health Alliance Commercial	$27.68

HCHG DRUG TEST PRSMV DIR OPT OBS

Facility

$119.00

Service Code	HCPCS 80305
Hospital Charge Code	H3011824
Hospital Revenue Code	301
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HCHG DRUG TEST(S) PRESUMPTIVE BY INSTRUMENT - 90

Facility

$370.00

Service Code	HCPCS 80307
Hospital Charge Code	H3011648
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$358.90
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$240.50
Rate for Payer: Cash Price	$240.50
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	$314.50
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$188.70
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$358.90
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 DRUG TEST(S) PRESUMPTIVE BY INSTRUMENT - 90

Facility

$370.00

Service Code	HCPCS 80307
Hospital Charge Code	H3011648
Hospital Revenue Code	301
Min. Negotiated Rate	$314.50
Max. Negotiated Rate	$358.90
Rate for Payer: Cash Price	$240.50
Rate for Payer: Health Management Network Commercial	$314.50
Rate for Payer: MDX Hawaii PPO	$358.90

HCHG DRVV CONFIRM

Facility

$129.00

Service Code	HCPCS 85597
Hospital Charge Code	H3050282
Hospital Revenue Code	305
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$17.98
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Devoted Health Medicare	$19.78
Rate for Payer: Hawaii Medical Service Association ABD	$24.84
Rate for Payer: Hawaii Medical Service Association Commercial	$22.48
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.08
Rate for Payer: Hawaii Western Management Group Commercial	$17.98
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$81.27
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$19.78
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicaid	$24.84
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$46.47

HCHG DRVV CONFIRM

Facility

$129.00

Service Code	HCPCS 85597
Hospital Charge Code	H3050282
Hospital Revenue Code	305
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 DRVV MIX

Facility

$70.00

Service Code	HCPCS 85613
Hospital Charge Code	H3050283
Hospital Revenue Code	305
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$9.58
Rate for Payer: AlohaCare Medicare	$9.58
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association ABD	$13.22
Rate for Payer: Hawaii Medical Service Association Commercial	$11.97
Rate for Payer: Hawaii Medical Service Association Medicare	$9.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.88
Rate for Payer: Hawaii Western Management Group Commercial	$9.58
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$9.58
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$9.58
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$10.54
Rate for Payer: Ohana Health Plan Medicare	$9.58
Rate for Payer: UnitedHealthcare Medicaid	$13.22
Rate for Payer: UnitedHealthcare Medicare	$9.58
Rate for Payer: University Health Alliance Commercial	$24.73

HCHG DRVV MIX

Facility

$70.00

Service Code	HCPCS 85613
Hospital Charge Code	H3050283
Hospital Revenue Code	305
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$45.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: MDX Hawaii PPO	$67.90

HCHG DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Facility

$482.00

Service Code	HCPCS 93971
Hospital Charge Code	H3200976
Hospital Revenue Code	320
Min. Negotiated Rate	$409.70
Max. Negotiated Rate	$467.54
Rate for Payer: Cash Price	$313.30
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: MDX Hawaii PPO	$467.54

HCHG DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Facility

$482.00

Service Code	HCPCS 93971
Hospital Charge Code	H3200976
Hospital Revenue Code	320
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$467.54
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$313.30
Rate for Payer: Cash Price	$313.30
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$93.10
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$109.94
Rate for Payer: Hawaii Western Management Group Commercial	$457.90
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$303.66
Rate for Payer: Kaiser Permanente Medicaid	$245.82
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$467.54
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$93.10
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$351.33

HCHG DX BRONCHOSCOPE WASH

Facility

$5,230.00

Service Code	HCPCS 31622
Hospital Charge Code	H7610179
Hospital Revenue Code	761
Min. Negotiated Rate	$4,445.50
Max. Negotiated Rate	$5,073.10
Rate for Payer: Cash Price	$3,399.50
Rate for Payer: Health Management Network Commercial	$4,445.50
Rate for Payer: MDX Hawaii PPO	$5,073.10

HCHG DX BRONCHOSCOPE WASH

Facility

$5,230.00

Service Code	HCPCS 31622
Hospital Charge Code	H7610179
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Cash Price	$3,399.50
Rate for Payer: Cash Price	$3,399.50
Rate for Payer: Cash Price	$3,399.50
Rate for Payer: Devoted Health Medicare	$2,312.94
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$4,968.50
Rate for Payer: Health Management Network Commercial	$4,445.50
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Commercial	$3,294.90
Rate for Payer: Kaiser Permanente Medicaid	$2,667.30
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: MDX Hawaii PPO	$5,073.10
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG DX DIGI BRST TOMO

Facility

$249.00

Service Code	HCPCS 77061
Hospital Charge Code	H4010130
Hospital Revenue Code	401
Min. Negotiated Rate	$126.99
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$161.85
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$156.87
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: MDX Hawaii PPO	$241.53

HCHG DX DIGI BRST TOMO

Facility

$249.00

Service Code	HCPCS 77061
Hospital Charge Code	H4010130
Hospital Revenue Code	401
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$161.85
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: MDX Hawaii PPO	$241.53

HCHG EBV AB EARLY AG IGG

Facility

$162.00

Service Code	HCPCS 86663
Hospital Charge Code	H3020490
Hospital Revenue Code	302
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$105.30
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$157.14

HCHG EBV AB EARLY AG IGG

Facility

$162.00

Service Code	HCPCS 86663
Hospital Charge Code	H3020490
Hospital Revenue Code	302
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$13.12
Rate for Payer: AlohaCare Medicare	$13.12
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Devoted Health Medicare	$14.43
Rate for Payer: Hawaii Medical Service Association ABD	$18.13
Rate for Payer: Hawaii Medical Service Association Commercial	$16.40
Rate for Payer: Hawaii Medical Service Association Medicare	$13.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.04
Rate for Payer: Hawaii Western Management Group Commercial	$13.12
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$13.12
Rate for Payer: Kaiser Permanente Commercial	$102.06
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$13.12
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$14.43
Rate for Payer: Ohana Health Plan Medicare	$13.12
Rate for Payer: UnitedHealthcare Medicaid	$18.13
Rate for Payer: UnitedHealthcare Medicare	$13.12
Rate for Payer: University Health Alliance Commercial	$33.91

HCHG E-B VIRUS AB IGG 90

Facility

$223.00

Service Code	HCPCS 86665
Hospital Charge Code	H3020484
Hospital Revenue Code	302
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 E-B VIRUS AB IGG 90

Facility

$223.00

Service Code	HCPCS 86665
Hospital Charge Code	H3020484
Hospital Revenue Code	302
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$18.14
Rate for Payer: AlohaCare Medicare	$18.14
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$19.95
Rate for Payer: Hawaii Medical Service Association ABD	$25.07
Rate for Payer: Hawaii Medical Service Association Commercial	$22.68
Rate for Payer: Hawaii Medical Service Association Medicare	$18.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.32
Rate for Payer: Hawaii Western Management Group Commercial	$18.14
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$18.14
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$18.14
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$19.95
Rate for Payer: Ohana Health Plan Medicare	$18.14
Rate for Payer: UnitedHealthcare Medicaid	$25.07
Rate for Payer: UnitedHealthcare Medicare	$18.14
Rate for Payer: University Health Alliance Commercial	$46.90

HCHG E-B VIRUS AB IGM 90

Facility

$223.00

Service Code	HCPCS 86665
Hospital Charge Code	H3020486
Hospital Revenue Code	302
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 E-B VIRUS AB IGM 90

Facility

$223.00

Service Code	HCPCS 86665
Hospital Charge Code	H3020486
Hospital Revenue Code	302
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$18.14
Rate for Payer: AlohaCare Medicare	$18.14
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$19.95
Rate for Payer: Hawaii Medical Service Association ABD	$25.07
Rate for Payer: Hawaii Medical Service Association Commercial	$22.68
Rate for Payer: Hawaii Medical Service Association Medicare	$18.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.32
Rate for Payer: Hawaii Western Management Group Commercial	$18.14
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$18.14
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$18.14
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$19.95
Rate for Payer: Ohana Health Plan Medicare	$18.14
Rate for Payer: UnitedHealthcare Medicaid	$25.07
Rate for Payer: UnitedHealthcare Medicare	$18.14
Rate for Payer: University Health Alliance Commercial	$46.90

HCHG E-B VIRUS AB NUC AG 90

Facility

$188.00

Service Code	HCPCS 86664
Hospital Charge Code	H3020488
Hospital Revenue Code	302
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$15.29
Rate for Payer: AlohaCare Medicare	$15.29
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Devoted Health Medicare	$16.82
Rate for Payer: Hawaii Medical Service Association ABD	$21.14
Rate for Payer: Hawaii Medical Service Association Commercial	$19.11
Rate for Payer: Hawaii Medical Service Association Medicare	$15.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$15.29
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$15.29
Rate for Payer: Kaiser Permanente Commercial	$118.44
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$15.29
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$16.82
Rate for Payer: Ohana Health Plan Medicare	$15.29
Rate for Payer: UnitedHealthcare Medicaid	$21.14
Rate for Payer: UnitedHealthcare Medicare	$15.29
Rate for Payer: University Health Alliance Commercial	$39.55

HCHG E-B VIRUS AB NUC AG 90

Facility

$188.00

Service Code	HCPCS 86664
Hospital Charge Code	H3020488
Hospital Revenue Code	302
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$122.20
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: MDX Hawaii PPO	$182.36

HCHG EBV PCR SO

Facility

$442.00

Service Code	HCPCS 87798
Hospital Charge Code	K3060043
Hospital Revenue Code	306
Min. Negotiated Rate	$375.70
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$287.30
Rate for Payer: Health Management Network Commercial	$375.70
Rate for Payer: MDX Hawaii PPO	$428.74

HCHG EBV PCR SO

Facility

$442.00

Service Code	HCPCS 87798
Hospital Charge Code	K3060043
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$428.74
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$287.30
Rate for Payer: Cash Price	$287.30
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	$375.70
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$278.46
Rate for Payer: Kaiser Permanente Medicaid	$225.42
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$428.74
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

Know your out-of-pocket cost for care.

All Charges