Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG HIV-1 AG W/ HIV-1 & HIV-2 AB WITH REFLEX

Facility

$342.00

Service Code	HCPCS 87389
Hospital Charge Code	H3100176
Hospital Revenue Code	306
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$222.30
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: MDX Hawaii PPO	$331.74

HCHG HIV-1 ANTIBODY

Facility

$109.00

Service Code	HCPCS 86701
Hospital Charge Code	H3021001
Hospital Revenue Code	302
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$8.89
Rate for Payer: AlohaCare Medicare	$8.89
Rate for Payer: Cash Price	$70.85
Rate for Payer: Cash Price	$70.85
Rate for Payer: Devoted Health Medicare	$9.78
Rate for Payer: Hawaii Medical Service Association ABD	$12.28
Rate for Payer: Hawaii Medical Service Association Commercial	$11.11
Rate for Payer: Hawaii Medical Service Association Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.89
Rate for Payer: Hawaii Western Management Group Commercial	$8.89
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$8.89
Rate for Payer: Kaiser Permanente Commercial	$68.67
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$8.89
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$9.78
Rate for Payer: Ohana Health Plan Medicare	$8.89
Rate for Payer: UnitedHealthcare Medicaid	$12.28
Rate for Payer: UnitedHealthcare Medicare	$8.89
Rate for Payer: University Health Alliance Commercial	$22.96

HCHG HIV-1 ANTIBODY

Facility

$109.00

Service Code	HCPCS 86701
Hospital Charge Code	H3021001
Hospital Revenue Code	302
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$70.85
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: MDX Hawaii PPO	$105.73

HCHG HIV-1 RNA QUANT BY PCR 90

Facility

$1,098.00

Service Code	HCPCS 87536
Hospital Charge Code	H3060234
Hospital Revenue Code	306
Min. Negotiated Rate	$85.10
Max. Negotiated Rate	$1,065.06
Rate for Payer: AlohaCare Medicaid	$85.10
Rate for Payer: AlohaCare Medicare	$85.10
Rate for Payer: Cash Price	$713.70
Rate for Payer: Cash Price	$713.70
Rate for Payer: Devoted Health Medicare	$93.61
Rate for Payer: Hawaii Medical Service Association ABD	$117.59
Rate for Payer: Hawaii Medical Service Association Commercial	$106.38
Rate for Payer: Hawaii Medical Service Association Medicare	$85.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$123.47
Rate for Payer: Hawaii Western Management Group Commercial	$85.10
Rate for Payer: Health Management Network Commercial	$933.30
Rate for Payer: Humana Medicare	$85.10
Rate for Payer: Kaiser Permanente Commercial	$691.74
Rate for Payer: Kaiser Permanente Medicaid	$559.98
Rate for Payer: Kaiser Permanente Medicare	$85.10
Rate for Payer: MDX Hawaii PPO	$1,065.06
Rate for Payer: Ohana Health Plan Medicaid	$93.61
Rate for Payer: Ohana Health Plan Medicare	$85.10
Rate for Payer: UnitedHealthcare Medicaid	$117.59
Rate for Payer: UnitedHealthcare Medicare	$85.10
Rate for Payer: University Health Alliance Commercial	$219.95

HCHG HIV-1 RNA QUANT BY PCR 90

Facility

$1,098.00

Service Code	HCPCS 87536
Hospital Charge Code	H3060234
Hospital Revenue Code	306
Min. Negotiated Rate	$933.30
Max. Negotiated Rate	$1,065.06
Rate for Payer: Cash Price	$713.70
Rate for Payer: Health Management Network Commercial	$933.30
Rate for Payer: MDX Hawaii PPO	$1,065.06

HCHG HIV-2 ANTIBODY

Facility

$166.00

Service Code	HCPCS 86702
Hospital Charge Code	H3021002
Hospital Revenue Code	302
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$13.52
Rate for Payer: AlohaCare Medicare	$13.52
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Devoted Health Medicare	$14.87
Rate for Payer: Hawaii Medical Service Association ABD	$18.69
Rate for Payer: Hawaii Medical Service Association Commercial	$16.90
Rate for Payer: Hawaii Medical Service Association Medicare	$13.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.62
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$13.52
Rate for Payer: Kaiser Permanente Commercial	$104.58
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$13.52
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$14.87
Rate for Payer: Ohana Health Plan Medicare	$13.52
Rate for Payer: UnitedHealthcare Medicaid	$18.69
Rate for Payer: UnitedHealthcare Medicare	$13.52
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG HIV-2 ANTIBODY

Facility

$166.00

Service Code	HCPCS 86702
Hospital Charge Code	H3021002
Hospital Revenue Code	302
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: MDX Hawaii PPO	$161.02

HCHG HIV AG WITH HIV 1&2 ABS

Facility

$251.00

Service Code	HCPCS 87806
Hospital Charge Code	K3060047
Hospital Revenue Code	306
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$163.15
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: MDX Hawaii PPO	$243.47

HCHG HIV AG WITH HIV 1&2 ABS

Facility

$251.00

Service Code	HCPCS 87806
Hospital Charge Code	K3060047
Hospital Revenue Code	306
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$243.47
Rate for Payer: AlohaCare Medicaid	$32.77
Rate for Payer: AlohaCare Medicare	$32.77
Rate for Payer: Cash Price	$163.15
Rate for Payer: Cash Price	$163.15
Rate for Payer: Devoted Health Medicare	$36.05
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$40.96
Rate for Payer: Hawaii Medical Service Association Medicare	$32.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$32.77
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Humana Medicare	$32.77
Rate for Payer: Kaiser Permanente Commercial	$158.13
Rate for Payer: Kaiser Permanente Medicaid	$128.01
Rate for Payer: Kaiser Permanente Medicare	$32.77
Rate for Payer: MDX Hawaii PPO	$243.47
Rate for Payer: Ohana Health Plan Medicaid	$36.05
Rate for Payer: Ohana Health Plan Medicare	$32.77
Rate for Payer: UnitedHealthcare Medicaid	$24.58
Rate for Payer: UnitedHealthcare Medicare	$32.77
Rate for Payer: University Health Alliance Commercial	$182.95

HCHG HLA-B27

Facility

$334.00

Service Code	HCPCS 86812
Hospital Charge Code	H3020582
Hospital Revenue Code	302
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$323.98
Rate for Payer: AlohaCare Medicaid	$25.81
Rate for Payer: AlohaCare Medicare	$25.81
Rate for Payer: Cash Price	$217.10
Rate for Payer: Cash Price	$217.10
Rate for Payer: Devoted Health Medicare	$28.39
Rate for Payer: Hawaii Medical Service Association ABD	$35.66
Rate for Payer: Hawaii Medical Service Association Commercial	$32.26
Rate for Payer: Hawaii Medical Service Association Medicare	$25.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.44
Rate for Payer: Hawaii Western Management Group Commercial	$25.81
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$25.81
Rate for Payer: Kaiser Permanente Commercial	$210.42
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$25.81
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$28.39
Rate for Payer: Ohana Health Plan Medicare	$25.81
Rate for Payer: UnitedHealthcare Medicaid	$35.66
Rate for Payer: UnitedHealthcare Medicare	$25.81
Rate for Payer: University Health Alliance Commercial	$66.71

HCHG HLA-B27

Facility

$334.00

Service Code	HCPCS 86812
Hospital Charge Code	H3020582
Hospital Revenue Code	302
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$217.10
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: MDX Hawaii PPO	$323.98

HCHG HOMOCYSTEINE TOT

Facility

$208.00

Service Code	HCPCS 83090
Hospital Charge Code	H3010730
Hospital Revenue Code	301
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$17.92
Rate for Payer: AlohaCare Medicare	$17.92
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Devoted Health Medicare	$19.71
Rate for Payer: Hawaii Medical Service Association ABD	$23.31
Rate for Payer: Hawaii Medical Service Association Commercial	$22.40
Rate for Payer: Hawaii Medical Service Association Medicare	$17.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.48
Rate for Payer: Hawaii Western Management Group Commercial	$17.92
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$17.92
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$17.92
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$19.71
Rate for Payer: Ohana Health Plan Medicare	$17.92
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: UnitedHealthcare Medicare	$17.92
Rate for Payer: University Health Alliance Commercial	$43.60

HCHG HOMOCYSTEINE TOT

Facility

$208.00

Service Code	HCPCS 83090
Hospital Charge Code	H3010730
Hospital Revenue Code	301
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

HCHG HOMOGENIZATION TISSUE F/CULTURE - 90

Facility

$41.00

Service Code	HCPCS 87176
Hospital Charge Code	H3011638
Hospital Revenue Code	300
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: MDX Hawaii PPO	$39.77

HCHG HOMOGENIZATION TISSUE F/CULTURE - 90

Facility

$41.00

Service Code	HCPCS 87176
Hospital Charge Code	H3011638
Hospital Revenue Code	300
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$5.88
Rate for Payer: AlohaCare Medicare	$5.88
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association ABD	$4.93
Rate for Payer: Hawaii Medical Service Association Commercial	$7.35
Rate for Payer: Hawaii Medical Service Association Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.12
Rate for Payer: Hawaii Western Management Group Commercial	$5.88
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$5.88
Rate for Payer: Kaiser Permanente Commercial	$25.83
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$5.88
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$6.47
Rate for Payer: Ohana Health Plan Medicare	$5.88
Rate for Payer: UnitedHealthcare Medicaid	$4.93
Rate for Payer: UnitedHealthcare Medicare	$5.88
Rate for Payer: University Health Alliance Commercial	$15.21

HCHG H PYLORI AG EIA STOOL

Facility

$163.00

Service Code	HCPCS 87338
Hospital Charge Code	H3060204
Hospital Revenue Code	306
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$14.38
Rate for Payer: AlohaCare Medicare	$14.38
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$15.82
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$17.98
Rate for Payer: Hawaii Medical Service Association Medicare	$14.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.70
Rate for Payer: Hawaii Western Management Group Commercial	$14.38
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$14.38
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$14.38
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$15.82
Rate for Payer: Ohana Health Plan Medicare	$14.38
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$14.38
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG H PYLORI AG EIA STOOL

Facility

$163.00

Service Code	HCPCS 87338
Hospital Charge Code	H3060204
Hospital Revenue Code	306
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 H PYLORI BREATH DRUG ADMIN

Facility

$97.00

Service Code	HCPCS 83014
Hospital Charge Code	H3010688
Hospital Revenue Code	301
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: MDX Hawaii PPO	$94.09

HCHG H PYLORI BREATH DRUG ADMIN

Facility

$97.00

Service Code	HCPCS 83014
Hospital Charge Code	H3010688
Hospital Revenue Code	301
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$7.86
Rate for Payer: AlohaCare Medicare	$7.86
Rate for Payer: Cash Price	$63.05
Rate for Payer: Cash Price	$63.05
Rate for Payer: Devoted Health Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association ABD	$10.86
Rate for Payer: Hawaii Medical Service Association Commercial	$9.82
Rate for Payer: Hawaii Medical Service Association Medicare	$7.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$7.86
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$7.86
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$7.86
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$8.65
Rate for Payer: Ohana Health Plan Medicare	$7.86
Rate for Payer: UnitedHealthcare Medicaid	$10.86
Rate for Payer: UnitedHealthcare Medicare	$7.86
Rate for Payer: University Health Alliance Commercial	$20.31

HCHG H PYLORI BREATH TEST

Facility

$689.00

Service Code	HCPCS 83013
Hospital Charge Code	H3010690
Hospital Revenue Code	301
Min. Negotiated Rate	$67.36
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$67.36
Rate for Payer: AlohaCare Medicare	$67.36
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Devoted Health Medicare	$74.10
Rate for Payer: Hawaii Medical Service Association ABD	$93.09
Rate for Payer: Hawaii Medical Service Association Commercial	$84.20
Rate for Payer: Hawaii Medical Service Association Medicare	$67.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$97.74
Rate for Payer: Hawaii Western Management Group Commercial	$67.36
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$67.36
Rate for Payer: Kaiser Permanente Commercial	$434.07
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$67.36
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$74.10
Rate for Payer: Ohana Health Plan Medicare	$67.36
Rate for Payer: UnitedHealthcare Medicaid	$93.09
Rate for Payer: UnitedHealthcare Medicare	$67.36
Rate for Payer: University Health Alliance Commercial	$174.10

HCHG H PYLORI BREATH TEST

Facility

$689.00

Service Code	HCPCS 83013
Hospital Charge Code	H3010690
Hospital Revenue Code	301
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: MDX Hawaii PPO	$668.33

HCHG HRAS EXON 2 SO

Facility

$476.00

Service Code	HCPCS 81403
Hospital Charge Code	K3090002
Hospital Revenue Code	309
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$185.20
Rate for Payer: AlohaCare Medicare	$185.20
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$203.72
Rate for Payer: Hawaii Medical Service Association ABD	$185.20
Rate for Payer: Hawaii Medical Service Association Commercial	$231.50
Rate for Payer: Hawaii Medical Service Association Medicare	$185.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$185.20
Rate for Payer: Hawaii Western Management Group Commercial	$185.20
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$185.20
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$185.20
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$203.72
Rate for Payer: Ohana Health Plan Medicare	$185.20
Rate for Payer: UnitedHealthcare Medicaid	$141.00
Rate for Payer: UnitedHealthcare Medicare	$185.20
Rate for Payer: University Health Alliance Commercial	$346.96

HCHG HRAS EXON 2 SO

Facility

$476.00

Service Code	HCPCS 81403
Hospital Charge Code	K3090002
Hospital Revenue Code	309
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG HSV, AMP PROBE

Facility

$475.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060645
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$460.75
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$308.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
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	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$299.25
Rate for Payer: Kaiser Permanente Medicaid	$242.25
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$460.75
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG HSV, AMP PROBE

Facility

$475.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060645
Hospital Revenue Code	306
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$460.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: MDX Hawaii PPO	$460.75

Know your out-of-pocket cost for care.

All Charges