Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG FACTOR V

Facility

$250.00

Service Code	HCPCS 81241
Hospital Charge Code	H3100155
Hospital Revenue Code	310
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: MDX Hawaii PPO	$242.50

HCHG FACTOR V ACTIVITY CLOTTING

Facility

$217.00

Service Code	HCPCS 85220
Hospital Charge Code	H3000210
Hospital Revenue Code	300
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$17.65
Rate for Payer: AlohaCare Medicare	$17.65
Rate for Payer: Cash Price	$141.05
Rate for Payer: Cash Price	$141.05
Rate for Payer: Devoted Health Medicare	$19.41
Rate for Payer: Hawaii Medical Service Association ABD	$24.39
Rate for Payer: Hawaii Medical Service Association Commercial	$22.06
Rate for Payer: Hawaii Medical Service Association Medicare	$17.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.61
Rate for Payer: Hawaii Western Management Group Commercial	$17.65
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Humana Medicare	$17.65
Rate for Payer: Kaiser Permanente Commercial	$136.71
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: Kaiser Permanente Medicare	$17.65
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: Ohana Health Plan Medicaid	$19.41
Rate for Payer: Ohana Health Plan Medicare	$17.65
Rate for Payer: UnitedHealthcare Medicaid	$24.39
Rate for Payer: UnitedHealthcare Medicare	$17.65
Rate for Payer: University Health Alliance Commercial	$45.62

HCHG FACTOR V ACTIVITY CLOTTING

Facility

$217.00

Service Code	HCPCS 85220
Hospital Charge Code	H3000210
Hospital Revenue Code	300
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$141.05
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: MDX Hawaii PPO	$210.49

HCHG FACTOR VII ACTIVITY CLOTTING

Facility

$219.00

Service Code	HCPCS 85230
Hospital Charge Code	H3000212
Hospital Revenue Code	305
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.90
Rate for Payer: AlohaCare Medicare	$17.90
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.69
Rate for Payer: Hawaii Medical Service Association ABD	$24.75
Rate for Payer: Hawaii Medical Service Association Commercial	$22.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.99
Rate for Payer: Hawaii Western Management Group Commercial	$17.90
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.90
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.90
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.69
Rate for Payer: Ohana Health Plan Medicare	$17.90
Rate for Payer: UnitedHealthcare Medicaid	$24.75
Rate for Payer: UnitedHealthcare Medicare	$17.90
Rate for Payer: University Health Alliance Commercial	$46.29

HCHG FACTOR VII ACTIVITY CLOTTING

Facility

$219.00

Service Code	HCPCS 85230
Hospital Charge Code	H3000212
Hospital Revenue Code	305
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 FACTOR VIII ACTIVITY

Facility

$219.00

Service Code	HCPCS 85240
Hospital Charge Code	H3050138
Hospital Revenue Code	305
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 FACTOR VIII ACTIVITY

Facility

$219.00

Service Code	HCPCS 85240
Hospital Charge Code	H3050138
Hospital Revenue Code	305
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.90
Rate for Payer: AlohaCare Medicare	$17.90
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.69
Rate for Payer: Hawaii Medical Service Association ABD	$24.75
Rate for Payer: Hawaii Medical Service Association Commercial	$22.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.99
Rate for Payer: Hawaii Western Management Group Commercial	$17.90
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.90
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.90
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.69
Rate for Payer: Ohana Health Plan Medicare	$17.90
Rate for Payer: UnitedHealthcare Medicaid	$24.75
Rate for Payer: UnitedHealthcare Medicare	$17.90
Rate for Payer: University Health Alliance Commercial	$46.29

HCHG FACTOR VIII RISTOCET COFACT 90

Facility

$282.00

Service Code	HCPCS 85245
Hospital Charge Code	H3050148
Hospital Revenue Code	305
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$273.54
Rate for Payer: AlohaCare Medicaid	$22.94
Rate for Payer: AlohaCare Medicare	$22.94
Rate for Payer: Cash Price	$183.30
Rate for Payer: Cash Price	$183.30
Rate for Payer: Devoted Health Medicare	$25.23
Rate for Payer: Hawaii Medical Service Association ABD	$31.72
Rate for Payer: Hawaii Medical Service Association Commercial	$28.68
Rate for Payer: Hawaii Medical Service Association Medicare	$22.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.31
Rate for Payer: Hawaii Western Management Group Commercial	$22.94
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Humana Medicare	$22.94
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: Kaiser Permanente Medicare	$22.94
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: Ohana Health Plan Medicaid	$25.23
Rate for Payer: Ohana Health Plan Medicare	$22.94
Rate for Payer: UnitedHealthcare Medicaid	$31.72
Rate for Payer: UnitedHealthcare Medicare	$22.94
Rate for Payer: University Health Alliance Commercial	$59.31

HCHG FACTOR VIII RISTOCET COFACT 90

Facility

$282.00

Service Code	HCPCS 85245
Hospital Charge Code	H3050148
Hospital Revenue Code	305
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

HCHG FACTOR VIII VON WILL AG

Facility

$282.00

Service Code	HCPCS 85246
Hospital Charge Code	H3050150
Hospital Revenue Code	305
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$273.54
Rate for Payer: AlohaCare Medicaid	$22.94
Rate for Payer: AlohaCare Medicare	$22.94
Rate for Payer: Cash Price	$183.30
Rate for Payer: Cash Price	$183.30
Rate for Payer: Devoted Health Medicare	$25.23
Rate for Payer: Hawaii Medical Service Association ABD	$31.72
Rate for Payer: Hawaii Medical Service Association Commercial	$28.68
Rate for Payer: Hawaii Medical Service Association Medicare	$22.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.31
Rate for Payer: Hawaii Western Management Group Commercial	$22.94
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Humana Medicare	$22.94
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: Kaiser Permanente Medicare	$22.94
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: Ohana Health Plan Medicaid	$25.23
Rate for Payer: Ohana Health Plan Medicare	$22.94
Rate for Payer: UnitedHealthcare Medicaid	$31.72
Rate for Payer: UnitedHealthcare Medicare	$22.94
Rate for Payer: University Health Alliance Commercial	$59.31

HCHG FACTOR VIII VON WILL AG

Facility

$282.00

Service Code	HCPCS 85246
Hospital Charge Code	H3050150
Hospital Revenue Code	305
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

HCHG FACTOR X ACTIVITY CLOTTING

Facility

$219.00

Service Code	HCPCS 85260
Hospital Charge Code	H3000214
Hospital Revenue Code	305
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.90
Rate for Payer: AlohaCare Medicare	$17.90
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.69
Rate for Payer: Hawaii Medical Service Association ABD	$24.75
Rate for Payer: Hawaii Medical Service Association Commercial	$22.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.99
Rate for Payer: Hawaii Western Management Group Commercial	$17.90
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.90
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.90
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.69
Rate for Payer: Ohana Health Plan Medicare	$17.90
Rate for Payer: UnitedHealthcare Medicaid	$24.75
Rate for Payer: UnitedHealthcare Medicare	$17.90
Rate for Payer: University Health Alliance Commercial	$46.29

HCHG FACTOR X ACTIVITY CLOTTING

Facility

$219.00

Service Code	HCPCS 85260
Hospital Charge Code	H3000214
Hospital Revenue Code	305
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 FACTOR XI ACTIVITY CLOTTING

Facility

$219.00

Service Code	HCPCS 85270
Hospital Charge Code	H3000216
Hospital Revenue Code	305
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 FACTOR XI ACTIVITY CLOTTING

Facility

$219.00

Service Code	HCPCS 85270
Hospital Charge Code	H3000216
Hospital Revenue Code	305
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.90
Rate for Payer: AlohaCare Medicare	$17.90
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.69
Rate for Payer: Hawaii Medical Service Association ABD	$24.75
Rate for Payer: Hawaii Medical Service Association Commercial	$22.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.99
Rate for Payer: Hawaii Western Management Group Commercial	$17.90
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.90
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.90
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.69
Rate for Payer: Ohana Health Plan Medicare	$17.90
Rate for Payer: UnitedHealthcare Medicaid	$24.75
Rate for Payer: UnitedHealthcare Medicare	$17.90
Rate for Payer: University Health Alliance Commercial	$46.29

HCHG FACTOR XII ACTIVITY CLOTTING

Facility

$238.00

Service Code	HCPCS 85280
Hospital Charge Code	H3000218
Hospital Revenue Code	305
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$19.35
Rate for Payer: AlohaCare Medicare	$19.35
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$21.29
Rate for Payer: Hawaii Medical Service Association ABD	$22.58
Rate for Payer: Hawaii Medical Service Association Commercial	$24.19
Rate for Payer: Hawaii Medical Service Association Medicare	$19.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.74
Rate for Payer: Hawaii Western Management Group Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$19.35
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$19.35
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$21.29
Rate for Payer: Ohana Health Plan Medicare	$19.35
Rate for Payer: UnitedHealthcare Medicaid	$22.58
Rate for Payer: UnitedHealthcare Medicare	$19.35
Rate for Payer: University Health Alliance Commercial	$50.02

HCHG FACTOR XII ACTIVITY CLOTTING

Facility

$238.00

Service Code	HCPCS 85280
Hospital Charge Code	H3000218
Hospital Revenue Code	305
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

HCHG FAT FECAL QNT 90

Facility

$122.00

Service Code	HCPCS 82710
Hospital Charge Code	H3010594
Hospital Revenue Code	301
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: MDX Hawaii PPO	$118.34

HCHG FAT FECAL QNT 90

Facility

$122.00

Service Code	HCPCS 82710
Hospital Charge Code	H3010594
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$16.80
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.37
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$16.80
Rate for Payer: Kaiser Permanente Commercial	$76.86
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$16.80
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$18.48
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$16.80
Rate for Payer: University Health Alliance Commercial	$43.42

HCHG FAXITRON X-RAY EXAM BREAST SPECIMEN

Facility

$2,905.00

Service Code	HCPCS 76098
Hospital Charge Code	H3200364
Hospital Revenue Code	320
Min. Negotiated Rate	$2,469.25
Max. Negotiated Rate	$2,817.85
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Health Management Network Commercial	$2,469.25
Rate for Payer: MDX Hawaii PPO	$2,817.85

HCHG FAXITRON X-RAY EXAM BREAST SPECIMEN

Facility

$2,905.00

Service Code	HCPCS 76098
Hospital Charge Code	H3200364
Hospital Revenue Code	320
Min. Negotiated Rate	$16.29
Max. Negotiated Rate	$2,817.85
Rate for Payer: AlohaCare Medicaid	$645.50
Rate for Payer: AlohaCare Medicare	$645.50
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Cash Price	$1,888.25
Rate for Payer: Devoted Health Medicare	$710.05
Rate for Payer: Hawaii Medical Service Association ABD	$16.47
Rate for Payer: Hawaii Medical Service Association Commercial	$806.88
Rate for Payer: Hawaii Medical Service Association Medicare	$645.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.29
Rate for Payer: Hawaii Western Management Group Commercial	$645.50
Rate for Payer: Health Management Network Commercial	$2,469.25
Rate for Payer: Humana Medicare	$645.50
Rate for Payer: Kaiser Permanente Commercial	$1,830.15
Rate for Payer: Kaiser Permanente Medicaid	$1,481.55
Rate for Payer: Kaiser Permanente Medicare	$645.50
Rate for Payer: MDX Hawaii PPO	$2,817.85
Rate for Payer: Ohana Health Plan Medicaid	$710.05
Rate for Payer: Ohana Health Plan Medicare	$645.50
Rate for Payer: UnitedHealthcare Medicaid	$16.47
Rate for Payer: UnitedHealthcare Medicare	$645.50
Rate for Payer: University Health Alliance Commercial	$42.66

HCHG FECAL FAT, QUALITATIVE

Facility

$66.00

Service Code	HCPCS 82705
Hospital Charge Code	H3011552
Hospital Revenue Code	301
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

HCHG FECAL FAT, QUALITATIVE

Facility

$66.00

Service Code	HCPCS 82705
Hospital Charge Code	H3011552
Hospital Revenue Code	301
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$5.10
Rate for Payer: AlohaCare Medicare	$5.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Devoted Health Medicare	$5.61
Rate for Payer: Hawaii Medical Service Association ABD	$7.04
Rate for Payer: Hawaii Medical Service Association Commercial	$6.38
Rate for Payer: Hawaii Medical Service Association Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.39
Rate for Payer: Hawaii Western Management Group Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$5.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$5.10
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$5.61
Rate for Payer: Ohana Health Plan Medicare	$5.10
Rate for Payer: UnitedHealthcare Medicaid	$7.04
Rate for Payer: UnitedHealthcare Medicare	$5.10
Rate for Payer: University Health Alliance Commercial	$13.15

HCHG FECES CULTURE AEROBIC BACT

Facility

$144.00

Service Code	HCPCS 87045
Hospital Charge Code	H3000200
Hospital Revenue Code	306
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$139.68

HCHG FECES CULTURE AEROBIC BACT

Facility

$144.00

Service Code	HCPCS 87045
Hospital Charge Code	H3000200
Hospital Revenue Code	306
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$9.44
Rate for Payer: AlohaCare Medicare	$9.44
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$10.38
Rate for Payer: Hawaii Medical Service Association ABD	$13.04
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.69
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$9.44
Rate for Payer: Kaiser Permanente Commercial	$90.72
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$9.44
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicare	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$13.04
Rate for Payer: UnitedHealthcare Medicare	$9.44
Rate for Payer: University Health Alliance Commercial	$24.38

Know your out-of-pocket cost for care.

All Charges