Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG IMMUNOASSAY ANAL MULT SO

Facility

$156.00

Service Code	HCPCS 83516
Hospital Charge Code	K3010033
Hospital Revenue Code	301
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HCHG IMMUNOASSAY ANAL MULT SO

Facility

$156.00

Service Code	HCPCS 83516
Hospital Charge Code	K3010033
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$11.53
Rate for Payer: AlohaCare Medicare	$11.53
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$12.68
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
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	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$11.53
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$11.53
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$12.68
Rate for Payer: Ohana Health Plan Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$11.53
Rate for Payer: University Health Alliance Commercial	$29.82

HCHG IMMUNOASSAY ANALY RIA SO

Facility

$243.00

Service Code	HCPCS 83519
Hospital Charge Code	K3010038
Hospital Revenue Code	301
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$157.95
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

HCHG IMMUNOASSAY ANALY RIA SO

Facility

$243.00

Service Code	HCPCS 83519
Hospital Charge Code	K3010038
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$157.95
Rate for Payer: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association ABD	$18.67
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.60
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$18.67
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG IMMUNOASSAY QUANT NOS NONAB - 90

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3010758
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$33.47

HCHG IMMUNOASSAY QUANT NOS NONAB - 90

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3010758
Hospital Revenue Code	301
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

HCHG IMMUNOCYTOCHEM INITIAL

Facility

$600.00

Service Code	HCPCS 88342
Hospital Charge Code	K3100010
Hospital Revenue Code	310
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: MDX Hawaii PPO	$582.00

HCHG IMMUNOCYTOCHEM INITIAL

Facility

$600.00

Service Code	HCPCS 88342
Hospital Charge Code	K3100010
Hospital Revenue Code	310
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$582.00
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cash Price	$390.00
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	$510.00
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$378.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$582.00
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 IMMUNODIFFUSION,GEL,QUAL,AB/AG

Facility

$156.00

Service Code	HCPCS 86331
Hospital Charge Code	H3020913
Hospital Revenue Code	302
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$10.05
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.56
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$10.05
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$30.99

HCHG IMMUNODIFFUSION,GEL,QUAL,AB/AG

Facility

$156.00

Service Code	HCPCS 86331
Hospital Charge Code	H3020913
Hospital Revenue Code	302
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HCHG IMMUNO EA ADDL SNGL

Facility

$437.00

Service Code	HCPCS 88341
Hospital Charge Code	H3120327
Hospital Revenue Code	312
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$423.89
Rate for Payer: Cash Price	$284.05
Rate for Payer: Cash Price	$284.05
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$415.15
Rate for Payer: Health Management Network Commercial	$371.45
Rate for Payer: Kaiser Permanente Commercial	$275.31
Rate for Payer: Kaiser Permanente Medicaid	$222.87
Rate for Payer: MDX Hawaii PPO	$423.89
Rate for Payer: UnitedHealthcare Medicaid	$60.64
Rate for Payer: University Health Alliance Commercial	$139.55

HCHG IMMUNO EA ADDL SNGL

Facility

$437.00

Service Code	HCPCS 88341
Hospital Charge Code	H3120327
Hospital Revenue Code	312
Min. Negotiated Rate	$371.45
Max. Negotiated Rate	$423.89
Rate for Payer: Cash Price	$284.05
Rate for Payer: Health Management Network Commercial	$371.45
Rate for Payer: MDX Hawaii PPO	$423.89

HCHG IMMUNO EA MULTIPLEX

Facility

$1,183.00

Service Code	HCPCS 88344
Hospital Charge Code	H3120328
Hospital Revenue Code	312
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$1,147.51
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$768.95
Rate for Payer: Cash Price	$768.95
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
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	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$745.29
Rate for Payer: Kaiser Permanente Medicaid	$603.33
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$1,147.51
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$116.58
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$242.83

HCHG IMMUNO EA MULTIPLEX

Facility

$1,183.00

Service Code	HCPCS 88344
Hospital Charge Code	H3120328
Hospital Revenue Code	312
Min. Negotiated Rate	$1,005.55
Max. Negotiated Rate	$1,147.51
Rate for Payer: Cash Price	$768.95
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: MDX Hawaii PPO	$1,147.51

HCHG IMMUNOGLOBULIN A

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010778
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 IMMUNOGLOBULIN A

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010778
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 IMMUNOGLOBULIN E

Facility

$120.00

Service Code	HCPCS 82785
Hospital Charge Code	H3010782
Hospital Revenue Code	301
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: MDX Hawaii PPO	$116.40

HCHG IMMUNOGLOBULIN E

Facility

$120.00

Service Code	HCPCS 82785
Hospital Charge Code	H3010782
Hospital Revenue Code	301
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$16.46
Rate for Payer: AlohaCare Medicare	$16.46
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$18.11
Rate for Payer: Hawaii Medical Service Association ABD	$22.76
Rate for Payer: Hawaii Medical Service Association Commercial	$20.57
Rate for Payer: Hawaii Medical Service Association Medicare	$16.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.90
Rate for Payer: Hawaii Western Management Group Commercial	$16.46
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$16.46
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$16.46
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$18.11
Rate for Payer: Ohana Health Plan Medicare	$16.46
Rate for Payer: UnitedHealthcare Medicaid	$22.76
Rate for Payer: UnitedHealthcare Medicare	$16.46
Rate for Payer: University Health Alliance Commercial	$42.57

HCHG IMMUNOGLOBULIN G

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010784
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 IMMUNOGLOBULIN G

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010784
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 IMMUNOGLOBULIN M

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010786
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 IMMUNOGLOBULIN M

Facility

$95.00

Service Code	HCPCS 82784
Hospital Charge Code	H3010786
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 IMMUNOGLOBULIN SUBCLASS

Facility

$103.00

Service Code	HCPCS 82787
Hospital Charge Code	H3011398
Hospital Revenue Code	301
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: MDX Hawaii PPO	$99.91

HCHG IMMUNOGLOBULIN SUBCLASS

Facility

$103.00

Service Code	HCPCS 82787
Hospital Charge Code	H3011398
Hospital Revenue Code	301
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$8.02
Rate for Payer: AlohaCare Medicare	$8.02
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Devoted Health Medicare	$8.82
Rate for Payer: Hawaii Medical Service Association ABD	$11.20
Rate for Payer: Hawaii Medical Service Association Commercial	$10.03
Rate for Payer: Hawaii Medical Service Association Medicare	$8.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.85
Rate for Payer: Hawaii Western Management Group Commercial	$8.02
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$8.02
Rate for Payer: Kaiser Permanente Commercial	$64.89
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$8.02
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$8.82
Rate for Payer: Ohana Health Plan Medicare	$8.02
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: UnitedHealthcare Medicare	$8.02
Rate for Payer: University Health Alliance Commercial	$20.72

HCHG IMRT DELIVERY CMPLX

Facility

$3,210.00

Service Code	HCPCS 77386
Hospital Charge Code	H3330232
Hospital Revenue Code	333
Min. Negotiated Rate	$433.85
Max. Negotiated Rate	$3,113.70
Rate for Payer: Cash Price	$2,086.50
Rate for Payer: Cash Price	$2,086.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,049.50
Rate for Payer: Health Management Network Commercial	$2,728.50
Rate for Payer: Kaiser Permanente Commercial	$2,022.30
Rate for Payer: Kaiser Permanente Medicaid	$1,637.10
Rate for Payer: MDX Hawaii PPO	$3,113.70
Rate for Payer: UnitedHealthcare Medicaid	$433.85
Rate for Payer: University Health Alliance Commercial	$860.08

Know your out-of-pocket cost for care.

All Charges