Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG KOH SKIN HAIR NAILS

Facility

$88.00

Service Code	HCPCS 87220
Hospital Charge Code	K3060002
Hospital Revenue Code	306
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: MDX Hawaii PPO	$85.36

HCHG KRAS GENE ANALYSIS

Facility

$1,001.00

Service Code	HCPCS 81275
Hospital Charge Code	H3100228
Hospital Revenue Code	310
Min. Negotiated Rate	$139.39
Max. Negotiated Rate	$970.97
Rate for Payer: AlohaCare Medicaid	$193.25
Rate for Payer: AlohaCare Medicare	$193.25
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Devoted Health Medicare	$212.57
Rate for Payer: Hawaii Medical Service Association ABD	$174.51
Rate for Payer: Hawaii Medical Service Association Commercial	$241.56
Rate for Payer: Hawaii Medical Service Association Medicare	$193.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$174.51
Rate for Payer: Hawaii Western Management Group Commercial	$193.25
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Humana Medicare	$193.25
Rate for Payer: Kaiser Permanente Commercial	$630.63
Rate for Payer: Kaiser Permanente Medicaid	$510.51
Rate for Payer: Kaiser Permanente Medicare	$193.25
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: Ohana Health Plan Medicaid	$212.57
Rate for Payer: Ohana Health Plan Medicare	$193.25
Rate for Payer: UnitedHealthcare Medicaid	$139.39
Rate for Payer: UnitedHealthcare Medicare	$193.25
Rate for Payer: University Health Alliance Commercial	$729.63

HCHG KRAS GENE ANALYSIS

Facility

$1,001.00

Service Code	HCPCS 81275
Hospital Charge Code	H3100228
Hospital Revenue Code	310
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: MDX Hawaii PPO	$970.97

HCHG KUB AP 1 VW

Facility

$426.00

Service Code	HCPCS 74018
Hospital Charge Code	H3200528
Hospital Revenue Code	320
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$413.22
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$276.90
Rate for Payer: Cash Price	$276.90
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.74
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	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$268.38
Rate for Payer: Kaiser Permanente Medicaid	$217.26
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$413.22
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$20.11
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$56.31

HCHG KUB AP 1 VW

Facility

$426.00

Service Code	HCPCS 74018
Hospital Charge Code	H3200528
Hospital Revenue Code	320
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$413.22
Rate for Payer: Cash Price	$276.90
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: MDX Hawaii PPO	$413.22

HCHG KUB PORT AP 1 VW

Facility

$426.00

Service Code	HCPCS 74018
Hospital Charge Code	H3200532
Hospital Revenue Code	320
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$413.22
Rate for Payer: Cash Price	$276.90
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: MDX Hawaii PPO	$413.22

HCHG KUB PORT AP 1 VW

Facility

$426.00

Service Code	HCPCS 74018
Hospital Charge Code	H3200532
Hospital Revenue Code	320
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$413.22
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$276.90
Rate for Payer: Cash Price	$276.90
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.74
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	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$268.38
Rate for Payer: Kaiser Permanente Medicaid	$217.26
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$413.22
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$20.11
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$56.31

HCHG LABOR CARE LEVEL 1 PER HR

Facility

$213.00

Hospital Charge Code	K7210000
Hospital Revenue Code	721
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$138.45
Rate for Payer: Hawaii Western Management Group Commercial	$202.35
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$134.19
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: University Health Alliance Commercial	$155.26

HCHG LABOR CARE LEVEL 1 PER HR

Facility

$213.00

Hospital Charge Code	K7210000
Hospital Revenue Code	721
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$138.45
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: MDX Hawaii PPO	$206.61

HCHG LABOR CARE LEVEL 2 PER HR

Facility

$319.00

Hospital Charge Code	K7210001
Hospital Revenue Code	721
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: MDX Hawaii PPO	$309.43

HCHG LABOR CARE LEVEL 2 PER HR

Facility

$319.00

Hospital Charge Code	K7210001
Hospital Revenue Code	721
Min. Negotiated Rate	$162.69
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Hawaii Western Management Group Commercial	$303.05
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$200.97
Rate for Payer: Kaiser Permanente Medicaid	$162.69
Rate for Payer: MDX Hawaii PPO	$309.43
Rate for Payer: University Health Alliance Commercial	$232.52

HCHG LABOR INDUCTION AUG ADDL HR

Facility

$406.00

Hospital Charge Code	K7210002
Hospital Revenue Code	721
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$393.82
Rate for Payer: Cash Price	$263.90
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: MDX Hawaii PPO	$393.82

HCHG LABOR INDUCTION AUG ADDL HR

Facility

$406.00

Hospital Charge Code	K7210002
Hospital Revenue Code	721
Min. Negotiated Rate	$207.06
Max. Negotiated Rate	$393.82
Rate for Payer: Cash Price	$263.90
Rate for Payer: Hawaii Western Management Group Commercial	$385.70
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: Kaiser Permanente Commercial	$255.78
Rate for Payer: Kaiser Permanente Medicaid	$207.06
Rate for Payer: MDX Hawaii PPO	$393.82
Rate for Payer: University Health Alliance Commercial	$295.93

HCHG LABOR INDUCTION AUG INITIAL HR

Facility

$946.00

Hospital Charge Code	K7210003
Hospital Revenue Code	721
Min. Negotiated Rate	$804.10
Max. Negotiated Rate	$917.62
Rate for Payer: Cash Price	$614.90
Rate for Payer: Health Management Network Commercial	$804.10
Rate for Payer: MDX Hawaii PPO	$917.62

HCHG LABOR INDUCTION AUG INITIAL HR

Facility

$946.00

Hospital Charge Code	K7210003
Hospital Revenue Code	721
Min. Negotiated Rate	$482.46
Max. Negotiated Rate	$917.62
Rate for Payer: Cash Price	$614.90
Rate for Payer: Hawaii Western Management Group Commercial	$898.70
Rate for Payer: Health Management Network Commercial	$804.10
Rate for Payer: Kaiser Permanente Commercial	$595.98
Rate for Payer: Kaiser Permanente Medicaid	$482.46
Rate for Payer: MDX Hawaii PPO	$917.62
Rate for Payer: University Health Alliance Commercial	$689.54

HCHG LACOSAMIDE

Facility

$226.00

Service Code	HCPCS 80235
Hospital Charge Code	H3011663
Hospital Revenue Code	301
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$27.11
Rate for Payer: AlohaCare Medicare	$27.11
Rate for Payer: Cash Price	$146.90
Rate for Payer: Cash Price	$146.90
Rate for Payer: Devoted Health Medicare	$29.82
Rate for Payer: Hawaii Medical Service Association ABD	$26.21
Rate for Payer: Hawaii Medical Service Association Commercial	$33.89
Rate for Payer: Hawaii Medical Service Association Medicare	$27.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$27.11
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$27.11
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$27.11
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$29.82
Rate for Payer: Ohana Health Plan Medicare	$27.11
Rate for Payer: UnitedHealthcare Medicaid	$16.27
Rate for Payer: UnitedHealthcare Medicare	$27.11
Rate for Payer: University Health Alliance Commercial	$164.73

HCHG LACOSAMIDE

Facility

$226.00

Service Code	HCPCS 80235
Hospital Charge Code	H3011663
Hospital Revenue Code	301
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: MDX Hawaii PPO	$219.22

HCHG LACTATION CLASS

Facility

$211.00

Service Code	HCPCS S9443
Hospital Charge Code	H9420120
Hospital Revenue Code	942
Min. Negotiated Rate	$107.61
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: University Health Alliance Commercial	$153.80

HCHG LACTATION CLASS

Facility

$211.00

Service Code	HCPCS S9443
Hospital Charge Code	H9420120
Hospital Revenue Code	942
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG LACTIC ACID

Facility

$145.00

Service Code	HCPCS 83605
Hospital Charge Code	H3010808
Hospital Revenue Code	301
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HCHG LACTIC ACID

Facility

$145.00

Service Code	HCPCS 83605
Hospital Charge Code	H3010808
Hospital Revenue Code	301
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$11.57
Rate for Payer: AlohaCare Medicare	$11.57
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$12.73
Rate for Payer: Hawaii Medical Service Association ABD	$14.76
Rate for Payer: Hawaii Medical Service Association Commercial	$14.46
Rate for Payer: Hawaii Medical Service Association Medicare	$11.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.50
Rate for Payer: Hawaii Western Management Group Commercial	$11.57
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$11.57
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$11.57
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$12.73
Rate for Payer: Ohana Health Plan Medicare	$11.57
Rate for Payer: UnitedHealthcare Medicaid	$14.76
Rate for Payer: UnitedHealthcare Medicare	$11.57
Rate for Payer: University Health Alliance Commercial	$27.60

HCHG LACTOFERRIN FECAL (QUAL) - 90

Facility

$251.00

Service Code	HCPCS 83630
Hospital Charge Code	H3011672
Hospital Revenue Code	301
Min. Negotiated Rate	$16.45
Max. Negotiated Rate	$243.47
Rate for Payer: AlohaCare Medicaid	$19.70
Rate for Payer: AlohaCare Medicare	$19.70
Rate for Payer: Cash Price	$163.15
Rate for Payer: Cash Price	$163.15
Rate for Payer: Devoted Health Medicare	$21.67
Rate for Payer: Hawaii Medical Service Association ABD	$16.45
Rate for Payer: Hawaii Medical Service Association Commercial	$24.62
Rate for Payer: Hawaii Medical Service Association Medicare	$19.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$19.70
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Humana Medicare	$19.70
Rate for Payer: Kaiser Permanente Commercial	$158.13
Rate for Payer: Kaiser Permanente Medicaid	$128.01
Rate for Payer: Kaiser Permanente Medicare	$19.70
Rate for Payer: MDX Hawaii PPO	$243.47
Rate for Payer: Ohana Health Plan Medicaid	$21.67
Rate for Payer: Ohana Health Plan Medicare	$19.70
Rate for Payer: UnitedHealthcare Medicaid	$16.45
Rate for Payer: UnitedHealthcare Medicare	$19.70
Rate for Payer: University Health Alliance Commercial	$50.73

HCHG LACTOFERRIN FECAL (QUAL) - 90

Facility

$251.00

Service Code	HCPCS 83630
Hospital Charge Code	H3011672
Hospital Revenue Code	301
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 LAMBDA LT CHAINS QUANT SERUM

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011548
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$13.60
Rate for Payer: AlohaCare Medicare	$13.60
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$14.96
Rate for Payer: Hawaii Medical Service Association ABD	$18.79
Rate for Payer: Hawaii Medical Service Association Commercial	$17.00
Rate for Payer: Hawaii Medical Service Association Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.73
Rate for Payer: Hawaii Western Management Group Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$13.60
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$14.96
Rate for Payer: Ohana Health Plan Medicare	$13.60
Rate for Payer: UnitedHealthcare Medicaid	$18.79
Rate for Payer: UnitedHealthcare Medicare	$13.60
Rate for Payer: University Health Alliance Commercial	$35.15

HCHG LAMBDA LT CHAINS QUANT SERUM

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011548
Hospital Revenue Code	301
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

Know your out-of-pocket cost for care.

All Charges