Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG IV INFUSION THERAPY UP TO 1 HR

Facility

$1,060.00

Service Code	HCPCS 96365
Hospital Charge Code	H4500500
Hospital Revenue Code	450
Min. Negotiated Rate	$251.28
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$689.00
Rate for Payer: Cash Price	$689.00
Rate for Payer: Cash Price	$689.00
Rate for Payer: Cash Price	$689.00
Rate for Payer: Devoted Health Medicare	$276.41
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	$251.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,007.00
Rate for Payer: Health Management Network Commercial	$901.00
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$667.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$1,028.20
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$772.63

HCHG IV INFUSION THERAPY UP TO 1 HR

Facility

$1,060.00

Service Code	HCPCS 96365
Hospital Charge Code	H2600000
Hospital Revenue Code	260
Min. Negotiated Rate	$46.51
Max. Negotiated Rate	$1,028.20
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$689.00
Rate for Payer: Cash Price	$689.00
Rate for Payer: Devoted Health Medicare	$276.41
Rate for Payer: Hawaii Medical Service Association Commercial	$314.10
Rate for Payer: Hawaii Medical Service Association Medicare	$251.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,007.00
Rate for Payer: Health Management Network Commercial	$901.00
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$667.80
Rate for Payer: Kaiser Permanente Medicaid	$540.60
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$1,028.20
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicaid	$46.51
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$772.63

HCHG IV INFUSION THERAPY UP TO 1 HR

Facility

$1,060.00

Service Code	HCPCS 96365
Hospital Charge Code	H2600000
Hospital Revenue Code	260
Min. Negotiated Rate	$901.00
Max. Negotiated Rate	$1,028.20
Rate for Payer: Cash Price	$689.00
Rate for Payer: Health Management Network Commercial	$901.00
Rate for Payer: MDX Hawaii PPO	$1,028.20

HCHG IV INFUSION TX EA ADDL HR

Facility

$268.00

Service Code	HCPCS 96366
Hospital Charge Code	H3310116
Hospital Revenue Code	260
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$254.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$168.84
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$195.35

HCHG IV INFUSION TX EA ADDL HR

Facility

$268.00

Service Code	HCPCS 96366
Hospital Charge Code	H3310116
Hospital Revenue Code	260
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$174.20
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: MDX Hawaii PPO	$259.96

HCHG IV INFUSION TX UP TO 1 HR

Facility

$1,060.00

Service Code	HCPCS 96365
Hospital Charge Code	H3310114
Hospital Revenue Code	260
Min. Negotiated Rate	$901.00
Max. Negotiated Rate	$1,028.20
Rate for Payer: Cash Price	$689.00
Rate for Payer: Health Management Network Commercial	$901.00
Rate for Payer: MDX Hawaii PPO	$1,028.20

HCHG IV INFUSION TX UP TO 1 HR

Facility

$1,060.00

Service Code	HCPCS 96365
Hospital Charge Code	H3310114
Hospital Revenue Code	260
Min. Negotiated Rate	$46.51
Max. Negotiated Rate	$1,028.20
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$689.00
Rate for Payer: Cash Price	$689.00
Rate for Payer: Devoted Health Medicare	$276.41
Rate for Payer: Hawaii Medical Service Association Commercial	$314.10
Rate for Payer: Hawaii Medical Service Association Medicare	$251.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,007.00
Rate for Payer: Health Management Network Commercial	$901.00
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$667.80
Rate for Payer: Kaiser Permanente Medicaid	$540.60
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$1,028.20
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicaid	$46.51
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$772.63

HCHG IV INFUS SEQ INFUS UP TO 1HR

Facility

$270.00

Service Code	HCPCS 96367
Hospital Charge Code	H9400139
Hospital Revenue Code	940
Min. Negotiated Rate	$23.03
Max. Negotiated Rate	$261.90
Rate for Payer: AlohaCare Medicaid	$85.06
Rate for Payer: AlohaCare Medicare	$85.06
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Devoted Health Medicare	$93.57
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Medicare	$85.06
Rate for Payer: Hawaii Western Management Group Commercial	$256.50
Rate for Payer: Health Management Network Commercial	$229.50
Rate for Payer: Humana Medicare	$85.06
Rate for Payer: Kaiser Permanente Commercial	$170.10
Rate for Payer: Kaiser Permanente Medicaid	$137.70
Rate for Payer: Kaiser Permanente Medicare	$85.06
Rate for Payer: MDX Hawaii PPO	$261.90
Rate for Payer: Ohana Health Plan Medicaid	$93.57
Rate for Payer: Ohana Health Plan Medicare	$85.06
Rate for Payer: UnitedHealthcare Medicaid	$23.03
Rate for Payer: UnitedHealthcare Medicare	$85.06
Rate for Payer: University Health Alliance Commercial	$196.80

HCHG IV INFUS SEQ INFUS UP TO 1HR

Facility

$270.00

Service Code	HCPCS 96367
Hospital Charge Code	H9400139
Hospital Revenue Code	940
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$261.90
Rate for Payer: Cash Price	$175.50
Rate for Payer: Health Management Network Commercial	$229.50
Rate for Payer: MDX Hawaii PPO	$261.90

HCHG IV INJECTION EA ADDL SAME DRUG

Facility

$282.00

Service Code	HCPCS 96376
Hospital Charge Code	H2600128
Hospital Revenue Code	260
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

HCHG IV INJECTION EA ADDL SAME DRUG

Facility

$282.00

Service Code	HCPCS 96376
Hospital Charge Code	H2600128
Hospital Revenue Code	260
Min. Negotiated Rate	$143.82
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: University Health Alliance Commercial	$205.55

HCHG IV INJ/PUSH EA ADDL

Facility

$355.00

Service Code	HCPCS 96375
Hospital Charge Code	H4500867
Hospital Revenue Code	450
Min. Negotiated Rate	$301.75
Max. Negotiated Rate	$344.35
Rate for Payer: Cash Price	$230.75
Rate for Payer: Health Management Network Commercial	$301.75
Rate for Payer: MDX Hawaii PPO	$344.35

HCHG IV INJ/PUSH EA ADDL

Facility

$355.00

Service Code	HCPCS 96375
Hospital Charge Code	H4500867
Hospital Revenue Code	450
Min. Negotiated Rate	$55.32
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Devoted Health Medicare	$60.85
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	$55.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$337.25
Rate for Payer: Health Management Network Commercial	$301.75
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$223.65
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$344.35
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$258.76

HCHG IV INJ/PUSH EA ADD SAME SUB

Facility

$282.00

Service Code	HCPCS 96376
Hospital Charge Code	H4500907
Hospital Revenue Code	450
Min. Negotiated Rate	$177.66
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$183.30
Rate for Payer: Cash Price	$183.30
Rate for Payer: Cash Price	$183.30
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: University Health Alliance Commercial	$205.55

HCHG IV INJ/PUSH EA ADD SAME SUB

Facility

$282.00

Service Code	HCPCS 96376
Hospital Charge Code	H4500907
Hospital Revenue Code	450
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

HCHG IV INJ/PUSH INITIAL

Facility

$423.00

Service Code	HCPCS 96374
Hospital Charge Code	H4500512
Hospital Revenue Code	450
Min. Negotiated Rate	$359.55
Max. Negotiated Rate	$410.31
Rate for Payer: Cash Price	$274.95
Rate for Payer: Health Management Network Commercial	$359.55
Rate for Payer: MDX Hawaii PPO	$410.31

HCHG IV INJ/PUSH INITIAL

Facility

$423.00

Service Code	HCPCS 96374
Hospital Charge Code	H4500512
Hospital Revenue Code	450
Min. Negotiated Rate	$251.28
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$274.95
Rate for Payer: Cash Price	$274.95
Rate for Payer: Cash Price	$274.95
Rate for Payer: Cash Price	$274.95
Rate for Payer: Devoted Health Medicare	$276.41
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	$251.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$401.85
Rate for Payer: Health Management Network Commercial	$359.55
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$266.49
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$410.31
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$308.32

HCHG JAK2 EXON 12 ANALYSIS SOO

Facility

$1,190.00

Service Code	HCPCS 81279
Hospital Charge Code	K3100004
Hospital Revenue Code	310
Min. Negotiated Rate	$111.12
Max. Negotiated Rate	$1,154.30
Rate for Payer: AlohaCare Medicaid	$185.20
Rate for Payer: AlohaCare Medicare	$185.20
Rate for Payer: Cash Price	$773.50
Rate for Payer: Cash Price	$773.50
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	$1,011.50
Rate for Payer: Humana Medicare	$185.20
Rate for Payer: Kaiser Permanente Commercial	$749.70
Rate for Payer: Kaiser Permanente Medicaid	$606.90
Rate for Payer: Kaiser Permanente Medicare	$185.20
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: Ohana Health Plan Medicaid	$203.72
Rate for Payer: Ohana Health Plan Medicare	$185.20
Rate for Payer: UnitedHealthcare Medicaid	$111.12
Rate for Payer: UnitedHealthcare Medicare	$185.20
Rate for Payer: University Health Alliance Commercial	$867.39

HCHG JAK2 EXON 12 ANALYSIS SOO

Facility

$1,190.00

Service Code	HCPCS 81279
Hospital Charge Code	K3100004
Hospital Revenue Code	310
Min. Negotiated Rate	$1,011.50
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$773.50
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: MDX Hawaii PPO	$1,154.30

HCHG JAK2 EXON 12 MUTATION ANALYSIS

Facility

$1,190.00

Service Code	HCPCS 81279
Hospital Charge Code	H3100241
Hospital Revenue Code	310
Min. Negotiated Rate	$111.12
Max. Negotiated Rate	$1,154.30
Rate for Payer: AlohaCare Medicaid	$185.20
Rate for Payer: AlohaCare Medicare	$185.20
Rate for Payer: Cash Price	$773.50
Rate for Payer: Cash Price	$773.50
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	$1,011.50
Rate for Payer: Humana Medicare	$185.20
Rate for Payer: Kaiser Permanente Commercial	$749.70
Rate for Payer: Kaiser Permanente Medicaid	$606.90
Rate for Payer: Kaiser Permanente Medicare	$185.20
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: Ohana Health Plan Medicaid	$203.72
Rate for Payer: Ohana Health Plan Medicare	$185.20
Rate for Payer: UnitedHealthcare Medicaid	$111.12
Rate for Payer: UnitedHealthcare Medicare	$185.20
Rate for Payer: University Health Alliance Commercial	$867.39

HCHG JAK2 EXON 12 MUTATION ANALYSIS

Facility

$1,190.00

Service Code	HCPCS 81279
Hospital Charge Code	H3100241
Hospital Revenue Code	310
Min. Negotiated Rate	$1,011.50
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$773.50
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: MDX Hawaii PPO	$1,154.30

HCHG JAK2 GENE ANALYSIS - 90

Facility

$546.00

Service Code	HCPCS 81270
Hospital Charge Code	H3100209
Hospital Revenue Code	310
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$529.62
Rate for Payer: AlohaCare Medicaid	$91.66
Rate for Payer: AlohaCare Medicare	$91.66
Rate for Payer: Cash Price	$354.90
Rate for Payer: Cash Price	$354.90
Rate for Payer: Devoted Health Medicare	$100.83
Rate for Payer: Hawaii Medical Service Association ABD	$122.70
Rate for Payer: Hawaii Medical Service Association Commercial	$114.58
Rate for Payer: Hawaii Medical Service Association Medicare	$91.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$122.70
Rate for Payer: Hawaii Western Management Group Commercial	$91.66
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: Humana Medicare	$91.66
Rate for Payer: Kaiser Permanente Commercial	$343.98
Rate for Payer: Kaiser Permanente Medicaid	$278.46
Rate for Payer: Kaiser Permanente Medicare	$91.66
Rate for Payer: MDX Hawaii PPO	$529.62
Rate for Payer: Ohana Health Plan Medicaid	$100.83
Rate for Payer: Ohana Health Plan Medicare	$91.66
Rate for Payer: UnitedHealthcare Medicaid	$49.73
Rate for Payer: UnitedHealthcare Medicare	$91.66
Rate for Payer: University Health Alliance Commercial	$230.79

HCHG JAK2 GENE ANALYSIS - 90

Facility

$546.00

Service Code	HCPCS 81270
Hospital Charge Code	H3100209
Hospital Revenue Code	310
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$529.62
Rate for Payer: Cash Price	$354.90
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: MDX Hawaii PPO	$529.62

HCHG JAK2V617F MUTATION ANALYSIS

Facility

$546.00

Service Code	HCPCS 81270
Hospital Charge Code	H3100156
Hospital Revenue Code	310
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$529.62
Rate for Payer: Cash Price	$354.90
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: MDX Hawaii PPO	$529.62

HCHG JAK2V617F MUTATION ANALYSIS

Facility

$546.00

Service Code	HCPCS 81270
Hospital Charge Code	H3100156
Hospital Revenue Code	310
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$529.62
Rate for Payer: AlohaCare Medicaid	$91.66
Rate for Payer: AlohaCare Medicare	$91.66
Rate for Payer: Cash Price	$354.90
Rate for Payer: Cash Price	$354.90
Rate for Payer: Devoted Health Medicare	$100.83
Rate for Payer: Hawaii Medical Service Association ABD	$122.70
Rate for Payer: Hawaii Medical Service Association Commercial	$114.58
Rate for Payer: Hawaii Medical Service Association Medicare	$91.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$122.70
Rate for Payer: Hawaii Western Management Group Commercial	$91.66
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: Humana Medicare	$91.66
Rate for Payer: Kaiser Permanente Commercial	$343.98
Rate for Payer: Kaiser Permanente Medicaid	$278.46
Rate for Payer: Kaiser Permanente Medicare	$91.66
Rate for Payer: MDX Hawaii PPO	$529.62
Rate for Payer: Ohana Health Plan Medicaid	$100.83
Rate for Payer: Ohana Health Plan Medicare	$91.66
Rate for Payer: UnitedHealthcare Medicaid	$49.73
Rate for Payer: UnitedHealthcare Medicare	$91.66
Rate for Payer: University Health Alliance Commercial	$230.79

Know your out-of-pocket cost for care.

All Charges