Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG IFE URINE

Facility

$385.00

Service Code	HCPCS 86335
Hospital Charge Code	H3020606
Hospital Revenue Code	302
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$373.45
Rate for Payer: Cash Price	$250.25
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: MDX Hawaii PPO	$373.45

HCHG IGA CELIAC DX CASCADE SO

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	K3010028
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$59.85
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HCHG IGA CELIAC DX CASCADE SO

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	K3010028
Hospital Revenue Code	301
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: MDX Hawaii PPO	$92.15

HCHG IGF-1 (SOMATOMEDIN)

Facility

$274.00

Service Code	HCPCS 84305
Hospital Charge Code	H3011174
Hospital Revenue Code	301
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$265.78
Rate for Payer: AlohaCare Medicaid	$21.26
Rate for Payer: AlohaCare Medicare	$21.26
Rate for Payer: Cash Price	$178.10
Rate for Payer: Cash Price	$178.10
Rate for Payer: Devoted Health Medicare	$23.39
Rate for Payer: Hawaii Medical Service Association ABD	$29.38
Rate for Payer: Hawaii Medical Service Association Commercial	$26.57
Rate for Payer: Hawaii Medical Service Association Medicare	$21.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.85
Rate for Payer: Hawaii Western Management Group Commercial	$21.26
Rate for Payer: Health Management Network Commercial	$232.90
Rate for Payer: Humana Medicare	$21.26
Rate for Payer: Kaiser Permanente Commercial	$172.62
Rate for Payer: Kaiser Permanente Medicaid	$139.74
Rate for Payer: Kaiser Permanente Medicare	$21.26
Rate for Payer: MDX Hawaii PPO	$265.78
Rate for Payer: Ohana Health Plan Medicaid	$23.39
Rate for Payer: Ohana Health Plan Medicare	$21.26
Rate for Payer: UnitedHealthcare Medicaid	$29.38
Rate for Payer: UnitedHealthcare Medicare	$21.26
Rate for Payer: University Health Alliance Commercial	$54.95

HCHG IGF-1 (SOMATOMEDIN)

Facility

$274.00

Service Code	HCPCS 84305
Hospital Charge Code	H3011174
Hospital Revenue Code	301
Min. Negotiated Rate	$232.90
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$178.10
Rate for Payer: Health Management Network Commercial	$232.90
Rate for Payer: MDX Hawaii PPO	$265.78

HCHG IGG-CSF 90

Facility

$68.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010752
Hospital Revenue Code	301
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: MDX Hawaii PPO	$65.96

HCHG IGG-CSF 90

Facility

$68.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010752
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HCHG IGG SYNTH INDEX CF SER SO

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	K3010027
Hospital Revenue Code	301
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: MDX Hawaii PPO	$92.15

HCHG IGG SYNTH INDEX CF SER SO

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	K3010027
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$11.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.30
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$59.85
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$19.74

HCHG IGK GENE REARRANGEMENT SO

Facility

$1,213.00

Service Code	HCPCS 81264
Hospital Charge Code	K3090001
Hospital Revenue Code	309
Min. Negotiated Rate	$67.19
Max. Negotiated Rate	$1,176.61
Rate for Payer: AlohaCare Medicaid	$172.73
Rate for Payer: AlohaCare Medicare	$172.73
Rate for Payer: Cash Price	$788.45
Rate for Payer: Cash Price	$788.45
Rate for Payer: Devoted Health Medicare	$190.00
Rate for Payer: Hawaii Medical Service Association Commercial	$215.91
Rate for Payer: Hawaii Medical Service Association Medicare	$172.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$199.89
Rate for Payer: Hawaii Western Management Group Commercial	$172.73
Rate for Payer: Health Management Network Commercial	$1,031.05
Rate for Payer: Humana Medicare	$172.73
Rate for Payer: Kaiser Permanente Commercial	$764.19
Rate for Payer: Kaiser Permanente Medicaid	$618.63
Rate for Payer: Kaiser Permanente Medicare	$172.73
Rate for Payer: MDX Hawaii PPO	$1,176.61
Rate for Payer: Ohana Health Plan Medicaid	$190.00
Rate for Payer: Ohana Health Plan Medicare	$172.73
Rate for Payer: UnitedHealthcare Medicaid	$67.19
Rate for Payer: UnitedHealthcare Medicare	$172.73
Rate for Payer: University Health Alliance Commercial	$884.16

HCHG IGK GENE REARRANGEMENT SO

Facility

$1,213.00

Service Code	HCPCS 81264
Hospital Charge Code	K3090001
Hospital Revenue Code	309
Min. Negotiated Rate	$1,031.05
Max. Negotiated Rate	$1,176.61
Rate for Payer: Cash Price	$788.45
Rate for Payer: Health Management Network Commercial	$1,031.05
Rate for Payer: MDX Hawaii PPO	$1,176.61

HCHG IHC EA AB PER BLOCK 1ST AB PER SLIDE

Facility

$656.00

Service Code	HCPCS 88342
Hospital Charge Code	H3120318
Hospital Revenue Code	312
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$636.32
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
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	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$413.28
Rate for Payer: Kaiser Permanente Medicaid	$334.56
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$636.32
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$28.15
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$193.25

HCHG IHC EA AB PER BLOCK 1ST AB PER SLIDE

Facility

$656.00

Service Code	HCPCS 88342
Hospital Charge Code	H3120318
Hospital Revenue Code	312
Min. Negotiated Rate	$557.60
Max. Negotiated Rate	$636.32
Rate for Payer: Cash Price	$426.40
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: MDX Hawaii PPO	$636.32

HCHG IHC MORPHOMETRY

Facility

$814.00

Service Code	HCPCS 88361
Hospital Charge Code	H3120146
Hospital Revenue Code	312
Min. Negotiated Rate	$67.41
Max. Negotiated Rate	$789.58
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$529.10
Rate for Payer: Cash Price	$529.10
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$67.41
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83.58
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$512.82
Rate for Payer: Kaiser Permanente Medicaid	$415.14
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$67.41
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$315.18

HCHG IHC MORPHOMETRY

Facility

$814.00

Service Code	HCPCS 88361
Hospital Charge Code	H3120146
Hospital Revenue Code	312
Min. Negotiated Rate	$691.90
Max. Negotiated Rate	$789.58
Rate for Payer: Cash Price	$529.10
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: MDX Hawaii PPO	$789.58

HCHG IHC MORPHOMETRY MANUAL

Facility

$693.00

Service Code	HCPCS 88360
Hospital Charge Code	H3120300
Hospital Revenue Code	312
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$672.21
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$450.45
Rate for Payer: Cash Price	$450.45
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$38.87
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	$42.44
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$589.05
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$436.59
Rate for Payer: Kaiser Permanente Medicaid	$353.43
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$672.21
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$38.87
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$231.14

HCHG IHC MORPHOMETRY MANUAL

Facility

$693.00

Service Code	HCPCS 88360
Hospital Charge Code	H3120300
Hospital Revenue Code	312
Min. Negotiated Rate	$589.05
Max. Negotiated Rate	$672.21
Rate for Payer: Cash Price	$450.45
Rate for Payer: Health Management Network Commercial	$589.05
Rate for Payer: MDX Hawaii PPO	$672.21

HCHG IMAGE CATH FLUID COLXN PERQ

Facility

$6,278.00

Service Code	HCPCS 49406
Hospital Charge Code	H3610604
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$6,089.66
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$4,080.70
Rate for Payer: Cash Price	$4,080.70
Rate for Payer: Cash Price	$4,080.70
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$5,336.30
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$3,955.14
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,089.66
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,576.03

HCHG IMAGE CATH FLUID COLXN PERQ

Facility

$6,278.00

Service Code	HCPCS 49406
Hospital Charge Code	H3610604
Hospital Revenue Code	361
Min. Negotiated Rate	$5,336.30
Max. Negotiated Rate	$6,089.66
Rate for Payer: Cash Price	$4,080.70
Rate for Payer: Health Management Network Commercial	$5,336.30
Rate for Payer: MDX Hawaii PPO	$6,089.66

HCHG IMAGE CATH FLUID COLXN PERQ TRNS/VGNL

Facility

$3,813.00

Service Code	HCPCS 49407
Hospital Charge Code	H3610605
Hospital Revenue Code	361
Min. Negotiated Rate	$3,241.05
Max. Negotiated Rate	$3,698.61
Rate for Payer: Cash Price	$2,478.45
Rate for Payer: Health Management Network Commercial	$3,241.05
Rate for Payer: MDX Hawaii PPO	$3,698.61

HCHG IMAGE CATH FLUID COLXN PERQ TRNS/VGNL

Facility

$3,813.00

Service Code	HCPCS 49407
Hospital Charge Code	H3610605
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$3,698.61
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$2,478.45
Rate for Payer: Cash Price	$2,478.45
Rate for Payer: Cash Price	$2,478.45
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Health Management Network Commercial	$3,241.05
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$2,402.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$3,698.61
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$2,779.30

HCHG IMMUNIZATION ADMIN EA ADDL

Facility

$114.00

Service Code	HCPCS 90472
Hospital Charge Code	H7710103
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Cash Price	$74.10
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.28
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$71.82
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: University Health Alliance Commercial	$83.09

HCHG IMMUNIZATION ADMIN EA ADDL

Facility

$114.00

Service Code	HCPCS 90472
Hospital Charge Code	H7710103
Hospital Revenue Code	771
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

HCHG IMMUNIZATION ADMINISTRATION, ONE VACCINE

Facility

$205.00

Service Code	HCPCS 90471
Hospital Charge Code	H7710102
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.56
Rate for Payer: Hawaii Western Management Group Commercial	$194.75
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$129.15
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$149.42

HCHG IMMUNIZATION ADMINISTRATION, ONE VACCINE

Facility

$205.00

Service Code	HCPCS 90471
Hospital Charge Code	H7710102
Hospital Revenue Code	771
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$133.25
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: MDX Hawaii PPO	$198.85

Know your out-of-pocket cost for care.

All Charges