Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG HEP B DNA QUANT 90

Facility

$526.00

Service Code	HCPCS 87517
Hospital Charge Code	H3060218
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 HEP B DNA QUANT 90

Facility

$526.00

Service Code	HCPCS 87517
Hospital Charge Code	H3060218
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 HEP BE AB

Facility

$144.00

Service Code	HCPCS 86707
Hospital Charge Code	H3020538
Hospital Revenue Code	302
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$11.57
Rate for Payer: AlohaCare Medicare	$11.57
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$12.73
Rate for Payer: Hawaii Medical Service Association ABD	$15.98
Rate for Payer: Hawaii Medical Service Association Commercial	$14.46
Rate for Payer: Hawaii Medical Service Association Medicare	$11.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.78
Rate for Payer: Hawaii Western Management Group Commercial	$11.57
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$11.57
Rate for Payer: Kaiser Permanente Commercial	$90.72
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$11.57
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$12.73
Rate for Payer: Ohana Health Plan Medicare	$11.57
Rate for Payer: UnitedHealthcare Medicaid	$15.98
Rate for Payer: UnitedHealthcare Medicare	$11.57
Rate for Payer: University Health Alliance Commercial	$29.90

HCHG HEP BE AB

Facility

$144.00

Service Code	HCPCS 86707
Hospital Charge Code	H3020538
Hospital Revenue Code	302
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 HEP BE AG

Facility

$142.00

Service Code	HCPCS 87350
Hospital Charge Code	H3060226
Hospital Revenue Code	306
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: MDX Hawaii PPO	$137.74

HCHG HEP BE AG

Facility

$142.00

Service Code	HCPCS 87350
Hospital Charge Code	H3060226
Hospital Revenue Code	306
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$11.53
Rate for Payer: AlohaCare Medicare	$11.53
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$12.68
Rate for Payer: Hawaii Medical Service Association ABD	$15.92
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$11.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.72
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$11.53
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$11.53
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$12.68
Rate for Payer: Ohana Health Plan Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicaid	$15.92
Rate for Payer: UnitedHealthcare Medicare	$11.53
Rate for Payer: University Health Alliance Commercial	$29.79

HCHG HEP B SURF AB

Facility

$146.00

Service Code	HCPCS 86706
Hospital Charge Code	H3020532
Hospital Revenue Code	302
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 HEP B SURF AB

Facility

$146.00

Service Code	HCPCS 86706
Hospital Charge Code	H3020532
Hospital Revenue Code	302
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$10.74
Rate for Payer: AlohaCare Medicare	$10.74
Rate for Payer: Cash Price	$94.90
Rate for Payer: Cash Price	$94.90
Rate for Payer: Devoted Health Medicare	$11.81
Rate for Payer: Hawaii Medical Service Association ABD	$14.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13.43
Rate for Payer: Hawaii Medical Service Association Medicare	$10.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.58
Rate for Payer: Hawaii Western Management Group Commercial	$10.74
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$10.74
Rate for Payer: Kaiser Permanente Commercial	$91.98
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$10.74
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$11.81
Rate for Payer: Ohana Health Plan Medicare	$10.74
Rate for Payer: UnitedHealthcare Medicaid	$14.84
Rate for Payer: UnitedHealthcare Medicare	$10.74
Rate for Payer: University Health Alliance Commercial	$27.77

HCHG HEP B SURF AG

Facility

$175.00

Service Code	HCPCS 87340
Hospital Charge Code	H3060222
Hospital Revenue Code	306
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HCHG HEP B SURF AG

Facility

$175.00

Service Code	HCPCS 87340
Hospital Charge Code	H3060222
Hospital Revenue Code	306
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$10.33
Rate for Payer: AlohaCare Medicare	$10.33
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$11.36
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.91
Rate for Payer: Hawaii Medical Service Association Medicare	$10.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.33
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$10.33
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$10.33
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$11.36
Rate for Payer: Ohana Health Plan Medicare	$10.33
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$10.33
Rate for Payer: University Health Alliance Commercial	$26.70

HCHG HEP B SURF AG CONF

Facility

$76.00

Service Code	HCPCS 87341
Hospital Charge Code	H3060224
Hospital Revenue Code	306
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$10.33
Rate for Payer: AlohaCare Medicare	$10.33
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$11.36
Rate for Payer: Hawaii Medical Service Association ABD	$14.43
Rate for Payer: Hawaii Medical Service Association Commercial	$12.91
Rate for Payer: Hawaii Medical Service Association Medicare	$10.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.15
Rate for Payer: Hawaii Western Management Group Commercial	$10.33
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$10.33
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$10.33
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$11.36
Rate for Payer: Ohana Health Plan Medicare	$10.33
Rate for Payer: UnitedHealthcare Medicaid	$14.43
Rate for Payer: UnitedHealthcare Medicare	$10.33
Rate for Payer: University Health Alliance Commercial	$26.70

HCHG HEP B SURF AG CONF

Facility

$76.00

Service Code	HCPCS 87341
Hospital Charge Code	H3060224
Hospital Revenue Code	306
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: MDX Hawaii PPO	$73.72

HCHG HEP C AB

Facility

$193.00

Service Code	HCPCS 86803
Hospital Charge Code	H3020540
Hospital Revenue Code	302
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: MDX Hawaii PPO	$187.21

HCHG HEP C AB

Facility

$193.00

Service Code	HCPCS 86803
Hospital Charge Code	H3020540
Hospital Revenue Code	302
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$14.27
Rate for Payer: AlohaCare Medicare	$14.27
Rate for Payer: Cash Price	$125.45
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$15.70
Rate for Payer: Hawaii Medical Service Association ABD	$19.73
Rate for Payer: Hawaii Medical Service Association Commercial	$17.84
Rate for Payer: Hawaii Medical Service Association Medicare	$14.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.72
Rate for Payer: Hawaii Western Management Group Commercial	$14.27
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$14.27
Rate for Payer: Kaiser Permanente Commercial	$121.59
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$14.27
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$15.70
Rate for Payer: Ohana Health Plan Medicare	$14.27
Rate for Payer: UnitedHealthcare Medicaid	$19.73
Rate for Payer: UnitedHealthcare Medicare	$14.27
Rate for Payer: University Health Alliance Commercial	$36.89

HCHG HEP C VIRAL RNA GEN 3

Facility

$3,322.00

Service Code	HCPCS 87902
Hospital Charge Code	H3060717
Hospital Revenue Code	306
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$3,222.34
Rate for Payer: AlohaCare Medicaid	$257.45
Rate for Payer: AlohaCare Medicare	$257.45
Rate for Payer: Cash Price	$2,159.30
Rate for Payer: Cash Price	$2,159.30
Rate for Payer: Devoted Health Medicare	$283.19
Rate for Payer: Hawaii Medical Service Association ABD	$256.16
Rate for Payer: Hawaii Medical Service Association Commercial	$321.81
Rate for Payer: Hawaii Medical Service Association Medicare	$257.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$355.58
Rate for Payer: Hawaii Western Management Group Commercial	$257.45
Rate for Payer: Health Management Network Commercial	$2,823.70
Rate for Payer: Humana Medicare	$257.45
Rate for Payer: Kaiser Permanente Commercial	$2,092.86
Rate for Payer: Kaiser Permanente Medicaid	$1,694.22
Rate for Payer: Kaiser Permanente Medicare	$257.45
Rate for Payer: MDX Hawaii PPO	$3,222.34
Rate for Payer: Ohana Health Plan Medicaid	$283.19
Rate for Payer: Ohana Health Plan Medicare	$257.45
Rate for Payer: UnitedHealthcare Medicaid	$256.16
Rate for Payer: UnitedHealthcare Medicare	$257.45
Rate for Payer: University Health Alliance Commercial	$665.43

HCHG HEP C VIRAL RNA GEN 3

Facility

$3,322.00

Service Code	HCPCS 87902
Hospital Charge Code	H3060717
Hospital Revenue Code	306
Min. Negotiated Rate	$2,823.70
Max. Negotiated Rate	$3,222.34
Rate for Payer: Cash Price	$2,159.30
Rate for Payer: Health Management Network Commercial	$2,823.70
Rate for Payer: MDX Hawaii PPO	$3,222.34

HCHG HEP E VIRUS IGG

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020546
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG HEP E VIRUS IGG

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020546
Hospital Revenue Code	302
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG HEP E VIRUS IGM

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020548
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG HEP E VIRUS IGM

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020548
Hospital Revenue Code	302
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG HER2 ISH MORPH MULTIPLEX

Facility

$1,118.00

Service Code	HCPCS 88374
Hospital Charge Code	H3120349
Hospital Revenue Code	312
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$1,084.46
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$726.70
Rate for Payer: Cash Price	$726.70
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$28.79
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	$160.01
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$950.30
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$704.34
Rate for Payer: Kaiser Permanente Medicaid	$570.18
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,084.46
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$195.04
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$736.61

HCHG HER2 ISH MORPH MULTIPLEX

Facility

$1,118.00

Service Code	HCPCS 88374
Hospital Charge Code	H3120349
Hospital Revenue Code	312
Min. Negotiated Rate	$950.30
Max. Negotiated Rate	$1,084.46
Rate for Payer: Cash Price	$726.70
Rate for Payer: Health Management Network Commercial	$950.30
Rate for Payer: MDX Hawaii PPO	$1,084.46

HCHG HERPES SIMPLEX TYPE 1 AB, IGG

Facility

$163.00

Service Code	HCPCS 86695
Hospital Charge Code	H3020919
Hospital Revenue Code	302
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: MDX Hawaii PPO	$158.11

HCHG HERPES SIMPLEX TYPE 1 AB, IGG

Facility

$163.00

Service Code	HCPCS 86695
Hospital Charge Code	H3020919
Hospital Revenue Code	302
Min. Negotiated Rate	$13.19
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$13.19
Rate for Payer: AlohaCare Medicare	$13.19
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$14.51
Rate for Payer: Hawaii Medical Service Association ABD	$18.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16.49
Rate for Payer: Hawaii Medical Service Association Medicare	$13.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.14
Rate for Payer: Hawaii Western Management Group Commercial	$13.19
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$13.19
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$13.19
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$14.51
Rate for Payer: Ohana Health Plan Medicare	$13.19
Rate for Payer: UnitedHealthcare Medicaid	$18.23
Rate for Payer: UnitedHealthcare Medicare	$13.19
Rate for Payer: University Health Alliance Commercial	$34.10

HCHG HERPES SIMPLEX TYPE 2 AB, IGG

Facility

$238.00

Service Code	HCPCS 86696
Hospital Charge Code	H3020920
Hospital Revenue Code	302
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

Know your out-of-pocket cost for care.

All Charges