Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG HSV DNA AMP PROBE - 90

Facility

$475.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060798
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 DNA AMP PROBE - 90

Facility

$475.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060798
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

HCHG HSV IGM 90

Facility

$188.00

Service Code	HCPCS 86694
Hospital Charge Code	H3020896
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 HSV IGM 90

Facility

$188.00

Service Code	HCPCS 86694
Hospital Charge Code	H3020896
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$14.39
Rate for Payer: AlohaCare Medicare	$14.39
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Devoted Health Medicare	$15.83
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$14.39
Rate for Payer: Kaiser Permanente Commercial	$118.44
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$14.39
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$15.83
Rate for Payer: Ohana Health Plan Medicare	$14.39
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$14.39
Rate for Payer: University Health Alliance Commercial	$37.20

HCHG HUMERUS, MIN 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73060
Hospital Charge Code	H3200456
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$61.20

HCHG HUMERUS, MIN 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73060
Hospital Charge Code	H3200456
Hospital Revenue Code	320
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 HUMERUS PORT, MIN 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73060
Hospital Charge Code	H3200458
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$61.20

HCHG HUMERUS PORT, MIN 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73060
Hospital Charge Code	H3200458
Hospital Revenue Code	320
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 I-131 DIAG PER 1MCI

Facility

$709.00

Service Code	HCPCS A9529
Hospital Charge Code	H3430214
Hospital Revenue Code	343
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$460.85
Rate for Payer: Cash Price	$460.85
Rate for Payer: Hawaii Western Management Group Commercial	$673.55
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Kaiser Permanente Commercial	$446.67
Rate for Payer: Kaiser Permanente Medicaid	$361.59
Rate for Payer: MDX Hawaii PPO	$687.73
Rate for Payer: UnitedHealthcare Medicaid	$20.00
Rate for Payer: University Health Alliance Commercial	$516.79

HCHG I-131 DIAG PER 1MCI

Facility

$709.00

Service Code	HCPCS A9529
Hospital Charge Code	H3430214
Hospital Revenue Code	343
Min. Negotiated Rate	$602.65
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$460.85
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: MDX Hawaii PPO	$687.73

HCHG I-131 DIAG (UPTAKE) PER 1UCI UP TO 100UCI

Facility

$7.00

Service Code	HCPCS A9531
Hospital Charge Code	H3440102
Hospital Revenue Code	343
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$11.50
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: UnitedHealthcare Medicaid	$11.50
Rate for Payer: University Health Alliance Commercial	$5.10

HCHG I-131 DIAG (UPTAKE) PER 1UCI UP TO 100UCI

Facility

$7.00

Service Code	HCPCS A9531
Hospital Charge Code	H3440102
Hospital Revenue Code	343
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.55
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

HCHG I-131 THERAPY PER 1MCI

Facility

$102.00

Service Code	HCPCS A9530
Hospital Charge Code	H3440147
Hospital Revenue Code	344
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$20.77
Rate for Payer: AlohaCare Medicare	$20.77
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Devoted Health Medicare	$22.85
Rate for Payer: Hawaii Medical Service Association Commercial	$25.96
Rate for Payer: Hawaii Medical Service Association Medicare	$20.77
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$20.77
Rate for Payer: Kaiser Permanente Commercial	$64.26
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$20.77
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$22.85
Rate for Payer: Ohana Health Plan Medicare	$20.77
Rate for Payer: UnitedHealthcare Medicaid	$20.00
Rate for Payer: UnitedHealthcare Medicare	$20.77
Rate for Payer: University Health Alliance Commercial	$74.35

HCHG I-131 THERAPY PER 1MCI

Facility

$102.00

Service Code	HCPCS A9530
Hospital Charge Code	H3440147
Hospital Revenue Code	344
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$66.30
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: MDX Hawaii PPO	$98.94

HCHG IADNA CYTOMEGALOVIRUS QUATIFICATION - 90

Facility

$593.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060786
Hospital Revenue Code	306
Min. Negotiated Rate	$504.05
Max. Negotiated Rate	$575.21
Rate for Payer: Cash Price	$385.45
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: MDX Hawaii PPO	$575.21

HCHG IADNA CYTOMEGALOVIRUS QUATIFICATION - 90

Facility

$593.00

Service Code	HCPCS 87491
Hospital Charge Code	H3060786
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$575.21
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$385.45
Rate for Payer: Cash Price	$385.45
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	$504.05
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$373.59
Rate for Payer: Kaiser Permanente Medicaid	$302.43
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$575.21
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 IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB - 90

Facility

$361.00

Service Code	HCPCS 87556
Hospital Charge Code	H3060791
Hospital Revenue Code	306
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$234.65
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: MDX Hawaii PPO	$350.17

HCHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB - 90

Facility

$361.00

Service Code	HCPCS 87556
Hospital Charge Code	H3060791
Hospital Revenue Code	306
Min. Negotiated Rate	$41.68
Max. Negotiated Rate	$350.17
Rate for Payer: AlohaCare Medicaid	$41.68
Rate for Payer: AlohaCare Medicare	$41.68
Rate for Payer: Cash Price	$234.65
Rate for Payer: Cash Price	$234.65
Rate for Payer: Devoted Health Medicare	$45.85
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$52.10
Rate for Payer: Hawaii Medical Service Association Medicare	$41.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Humana Medicare	$41.68
Rate for Payer: Kaiser Permanente Commercial	$227.43
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: Kaiser Permanente Medicare	$41.68
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: Ohana Health Plan Medicaid	$45.85
Rate for Payer: Ohana Health Plan Medicare	$41.68
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$41.68
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM - 90

Facility

$442.00

Service Code	HCPCS 87798
Hospital Charge Code	H3060792
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

HCHG IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM - 90

Facility

$442.00

Service Code	HCPCS 87798
Hospital Charge Code	H3060792
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 IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ

Facility

$450.00

Service Code	HCPCS 87641
Hospital Charge Code	H3060735
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$436.50
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$49.04
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	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$49.04
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ

Facility

$450.00

Service Code	HCPCS 87641
Hospital Charge Code	H3060735
Hospital Revenue Code	306
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$436.50

HCHG I&D ABSCESS COMPLICAT/MULT

Facility

$780.00

Service Code	HCPCS 10061
Hospital Charge Code	H4500464
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$507.00
Rate for Payer: Cash Price	$507.00
Rate for Payer: Cash Price	$507.00
Rate for Payer: Cash Price	$507.00
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$741.00
Rate for Payer: Health Management Network Commercial	$663.00
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$491.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$756.60
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG I&D ABSCESS COMPLICAT/MULT

Facility

$780.00

Service Code	HCPCS 10061
Hospital Charge Code	H4500464
Hospital Revenue Code	450
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$756.60
Rate for Payer: Cash Price	$507.00
Rate for Payer: Health Management Network Commercial	$663.00
Rate for Payer: MDX Hawaii PPO	$756.60

HCHG I&D ABSC PERITONSILLAR

Facility

$1,402.00

Service Code	HCPCS 42700
Hospital Charge Code	H4500466
Hospital Revenue Code	450
Min. Negotiated Rate	$1,191.70
Max. Negotiated Rate	$1,359.94
Rate for Payer: Cash Price	$911.30
Rate for Payer: Health Management Network Commercial	$1,191.70
Rate for Payer: MDX Hawaii PPO	$1,359.94

Know your out-of-pocket cost for care.

All Charges