Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG LUTETIUM LU 177 VIPIVOTIDE TETRAXETAN, THERAPEUTIC, 1 MILLICURIE

Facility

$1,251.00

Service Code	HCPCS A9607
Hospital Charge Code	H3440151
Hospital Revenue Code	344
Min. Negotiated Rate	$1,063.35
Max. Negotiated Rate	$1,213.47
Rate for Payer: Cash Price	$813.15
Rate for Payer: Health Management Network Commercial	$1,063.35
Rate for Payer: MDX Hawaii PPO	$1,213.47

HCHG LYME DISEASE ABS IMMUNOBLOT

Facility

$191.00

Service Code	HCPCS 86617
Hospital Charge Code	H3020994
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$185.27
Rate for Payer: AlohaCare Medicaid	$15.49
Rate for Payer: AlohaCare Medicare	$15.49
Rate for Payer: Cash Price	$124.15
Rate for Payer: Cash Price	$124.15
Rate for Payer: Devoted Health Medicare	$17.04
Rate for Payer: Hawaii Medical Service Association ABD	$21.40
Rate for Payer: Hawaii Medical Service Association Commercial	$19.36
Rate for Payer: Hawaii Medical Service Association Medicare	$15.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.47
Rate for Payer: Hawaii Western Management Group Commercial	$15.49
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$15.49
Rate for Payer: Kaiser Permanente Commercial	$120.33
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$15.49
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$17.04
Rate for Payer: Ohana Health Plan Medicare	$15.49
Rate for Payer: UnitedHealthcare Medicaid	$21.40
Rate for Payer: UnitedHealthcare Medicare	$15.49
Rate for Payer: University Health Alliance Commercial	$40.03

HCHG LYME DISEASE ABS IMMUNOBLOT

Facility

$191.00

Service Code	HCPCS 86617
Hospital Charge Code	H3020994
Hospital Revenue Code	302
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: MDX Hawaii PPO	$185.27

HCHG LYME DISEASE ABS, REFLX TO BLOT

Facility

$263.00

Service Code	HCPCS 86618
Hospital Charge Code	H3020634
Hospital Revenue Code	302
Min. Negotiated Rate	$223.55
Max. Negotiated Rate	$255.11
Rate for Payer: Cash Price	$170.95
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: MDX Hawaii PPO	$255.11

HCHG LYME DISEASE ABS, REFLX TO BLOT

Facility

$263.00

Service Code	HCPCS 86618
Hospital Charge Code	H3020634
Hospital Revenue Code	302
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$255.11
Rate for Payer: AlohaCare Medicaid	$17.03
Rate for Payer: AlohaCare Medicare	$17.03
Rate for Payer: Cash Price	$170.95
Rate for Payer: Cash Price	$170.95
Rate for Payer: Devoted Health Medicare	$18.73
Rate for Payer: Hawaii Medical Service Association ABD	$23.54
Rate for Payer: Hawaii Medical Service Association Commercial	$21.29
Rate for Payer: Hawaii Medical Service Association Medicare	$17.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.72
Rate for Payer: Hawaii Western Management Group Commercial	$17.03
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: Humana Medicare	$17.03
Rate for Payer: Kaiser Permanente Commercial	$165.69
Rate for Payer: Kaiser Permanente Medicaid	$134.13
Rate for Payer: Kaiser Permanente Medicare	$17.03
Rate for Payer: MDX Hawaii PPO	$255.11
Rate for Payer: Ohana Health Plan Medicaid	$18.73
Rate for Payer: Ohana Health Plan Medicare	$17.03
Rate for Payer: UnitedHealthcare Medicaid	$23.54
Rate for Payer: UnitedHealthcare Medicare	$17.03
Rate for Payer: University Health Alliance Commercial	$44.03

HCHG LYMPH GLAND SCAN

Facility

$2,314.00

Service Code	HCPCS 78195
Hospital Charge Code	H3410220
Hospital Revenue Code	341
Min. Negotiated Rate	$1,966.90
Max. Negotiated Rate	$2,244.58
Rate for Payer: Cash Price	$1,504.10
Rate for Payer: Health Management Network Commercial	$1,966.90
Rate for Payer: MDX Hawaii PPO	$2,244.58

HCHG LYMPH GLAND SCAN

Facility

$2,314.00

Service Code	HCPCS 78195
Hospital Charge Code	H3410220
Hospital Revenue Code	341
Min. Negotiated Rate	$157.85
Max. Negotiated Rate	$2,244.58
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$1,504.10
Rate for Payer: Cash Price	$1,504.10
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$162.90
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$157.85
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$1,966.90
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$1,457.82
Rate for Payer: Kaiser Permanente Medicaid	$1,180.14
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$2,244.58
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$162.90
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$616.24

HCHG MACROSCOPIC EXAM ARTHROPOD

Facility

$30.00

Service Code	HCPCS 87168
Hospital Charge Code	K3060814
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.40
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG MACROSCOPIC EXAM ARTHROPOD

Facility

$30.00

Service Code	HCPCS 87168
Hospital Charge Code	K3060814
Hospital Revenue Code	306
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10

HCHG MAGNESIUM

Facility

$116.00

Service Code	HCPCS 83735
Hospital Charge Code	H3010846
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$112.52
Rate for Payer: AlohaCare Medicaid	$6.70
Rate for Payer: AlohaCare Medicare	$6.70
Rate for Payer: Cash Price	$75.40
Rate for Payer: Cash Price	$75.40
Rate for Payer: Devoted Health Medicare	$7.37
Rate for Payer: Hawaii Medical Service Association ABD	$9.26
Rate for Payer: Hawaii Medical Service Association Commercial	$8.38
Rate for Payer: Hawaii Medical Service Association Medicare	$6.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.70
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Humana Medicare	$6.70
Rate for Payer: Kaiser Permanente Commercial	$73.08
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicare	$6.70
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: Ohana Health Plan Medicaid	$7.37
Rate for Payer: Ohana Health Plan Medicare	$6.70
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: UnitedHealthcare Medicare	$6.70
Rate for Payer: University Health Alliance Commercial	$17.32

HCHG MAGNESIUM

Facility

$116.00

Service Code	HCPCS 83735
Hospital Charge Code	H3010846
Hospital Revenue Code	301
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$75.40
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: MDX Hawaii PPO	$112.52

HCHG MAGNESIUM FECES

Facility

$116.00

Service Code	HCPCS 83735
Hospital Charge Code	H3010850
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$112.52
Rate for Payer: AlohaCare Medicaid	$6.70
Rate for Payer: AlohaCare Medicare	$6.70
Rate for Payer: Cash Price	$75.40
Rate for Payer: Cash Price	$75.40
Rate for Payer: Devoted Health Medicare	$7.37
Rate for Payer: Hawaii Medical Service Association ABD	$9.26
Rate for Payer: Hawaii Medical Service Association Commercial	$8.38
Rate for Payer: Hawaii Medical Service Association Medicare	$6.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.70
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Humana Medicare	$6.70
Rate for Payer: Kaiser Permanente Commercial	$73.08
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicare	$6.70
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: Ohana Health Plan Medicaid	$7.37
Rate for Payer: Ohana Health Plan Medicare	$6.70
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: UnitedHealthcare Medicare	$6.70
Rate for Payer: University Health Alliance Commercial	$17.32

HCHG MAGNESIUM FECES

Facility

$116.00

Service Code	HCPCS 83735
Hospital Charge Code	H3010850
Hospital Revenue Code	301
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$75.40
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: MDX Hawaii PPO	$112.52

HCHG MAMMO BILAT POST BX

Facility

$565.00

Service Code	HCPCS 77066
Hospital Charge Code	H4010132
Hospital Revenue Code	401
Min. Negotiated Rate	$77.83
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$367.25
Rate for Payer: Cash Price	$367.25
Rate for Payer: Hawaii Medical Service Association ABD	$77.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$104.42
Rate for Payer: Hawaii Western Management Group Commercial	$536.75
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: Kaiser Permanente Commercial	$355.95
Rate for Payer: Kaiser Permanente Medicaid	$288.15
Rate for Payer: MDX Hawaii PPO	$548.05
Rate for Payer: UnitedHealthcare Medicaid	$105.44
Rate for Payer: University Health Alliance Commercial	$352.89

HCHG MAMMO BILAT POST BX

Facility

$565.00

Service Code	HCPCS 77066
Hospital Charge Code	H4010132
Hospital Revenue Code	401
Min. Negotiated Rate	$480.25
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$367.25
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: MDX Hawaii PPO	$548.05

HCHG MAMMOGRAPHY DIAG INC CAD BILAT

Facility

$565.00

Service Code	HCPCS 77066
Hospital Charge Code	H4020295
Hospital Revenue Code	401
Min. Negotiated Rate	$480.25
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$367.25
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: MDX Hawaii PPO	$548.05

HCHG MAMMOGRAPHY DIAG INC CAD BILAT

Facility

$565.00

Service Code	HCPCS 77066
Hospital Charge Code	H4020295
Hospital Revenue Code	401
Min. Negotiated Rate	$77.83
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$367.25
Rate for Payer: Cash Price	$367.25
Rate for Payer: Hawaii Medical Service Association ABD	$77.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$104.42
Rate for Payer: Hawaii Western Management Group Commercial	$536.75
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: Kaiser Permanente Commercial	$355.95
Rate for Payer: Kaiser Permanente Medicaid	$288.15
Rate for Payer: MDX Hawaii PPO	$548.05
Rate for Payer: UnitedHealthcare Medicaid	$105.44
Rate for Payer: University Health Alliance Commercial	$352.89

HCHG MAMMOGRAPHY DIAG INC CAD UNILAT

Facility

$411.00

Service Code	HCPCS 77065
Hospital Charge Code	H4020294
Hospital Revenue Code	401
Min. Negotiated Rate	$64.13
Max. Negotiated Rate	$398.67
Rate for Payer: Cash Price	$267.15
Rate for Payer: Cash Price	$267.15
Rate for Payer: Hawaii Medical Service Association ABD	$64.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$85.82
Rate for Payer: Hawaii Western Management Group Commercial	$390.45
Rate for Payer: Health Management Network Commercial	$349.35
Rate for Payer: Kaiser Permanente Commercial	$258.93
Rate for Payer: Kaiser Permanente Medicaid	$209.61
Rate for Payer: MDX Hawaii PPO	$398.67
Rate for Payer: UnitedHealthcare Medicaid	$83.29
Rate for Payer: University Health Alliance Commercial	$277.78

HCHG MAMMOGRAPHY DIAG INC CAD UNILAT

Facility

$411.00

Service Code	HCPCS 77065
Hospital Charge Code	H4020294
Hospital Revenue Code	401
Min. Negotiated Rate	$349.35
Max. Negotiated Rate	$398.67
Rate for Payer: Cash Price	$267.15
Rate for Payer: Health Management Network Commercial	$349.35
Rate for Payer: MDX Hawaii PPO	$398.67

HCHG MAMMO UNILAT POST BX

Facility

$411.00

Service Code	HCPCS 77065
Hospital Charge Code	H4010131
Hospital Revenue Code	401
Min. Negotiated Rate	$64.13
Max. Negotiated Rate	$398.67
Rate for Payer: Cash Price	$267.15
Rate for Payer: Cash Price	$267.15
Rate for Payer: Hawaii Medical Service Association ABD	$64.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$85.82
Rate for Payer: Hawaii Western Management Group Commercial	$390.45
Rate for Payer: Health Management Network Commercial	$349.35
Rate for Payer: Kaiser Permanente Commercial	$258.93
Rate for Payer: Kaiser Permanente Medicaid	$209.61
Rate for Payer: MDX Hawaii PPO	$398.67
Rate for Payer: UnitedHealthcare Medicaid	$83.29
Rate for Payer: University Health Alliance Commercial	$277.78

HCHG MAMMO UNILAT POST BX

Facility

$411.00

Service Code	HCPCS 77065
Hospital Charge Code	H4010131
Hospital Revenue Code	401
Min. Negotiated Rate	$349.35
Max. Negotiated Rate	$398.67
Rate for Payer: Cash Price	$267.15
Rate for Payer: Health Management Network Commercial	$349.35
Rate for Payer: MDX Hawaii PPO	$398.67

HCHG MAMOGRAPHY SCREENING BILAT INC CAD

Facility

$335.00

Service Code	HCPCS 77067
Hospital Charge Code	H4020296
Hospital Revenue Code	403
Min. Negotiated Rate	$284.75
Max. Negotiated Rate	$324.95
Rate for Payer: Cash Price	$217.75
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: MDX Hawaii PPO	$324.95

HCHG MAMOGRAPHY SCREENING BILAT INC CAD

Facility

$335.00

Service Code	HCPCS 77067
Hospital Charge Code	H4020296
Hospital Revenue Code	403
Min. Negotiated Rate	$80.77
Max. Negotiated Rate	$324.95
Rate for Payer: Cash Price	$217.75
Rate for Payer: Cash Price	$217.75
Rate for Payer: Hawaii Medical Service Association ABD	$80.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$106.74
Rate for Payer: Hawaii Western Management Group Commercial	$318.25
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Kaiser Permanente Commercial	$211.05
Rate for Payer: Kaiser Permanente Medicaid	$170.85
Rate for Payer: MDX Hawaii PPO	$324.95
Rate for Payer: UnitedHealthcare Medicaid	$85.27
Rate for Payer: University Health Alliance Commercial	$285.53

HCHG MANDIBLE < 4 VIEWS

Facility

$568.00

Service Code	HCPCS 70100
Hospital Charge Code	H3200558
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$550.96
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$369.20
Rate for Payer: Cash Price	$369.20
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
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	$18.57
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$357.84
Rate for Payer: Kaiser Permanente Medicaid	$289.68
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$550.96
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$61.70

HCHG MANDIBLE < 4 VIEWS

Facility

$568.00

Service Code	HCPCS 70100
Hospital Charge Code	H3200558
Hospital Revenue Code	320
Min. Negotiated Rate	$482.80
Max. Negotiated Rate	$550.96
Rate for Payer: Cash Price	$369.20
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: MDX Hawaii PPO	$550.96

Know your out-of-pocket cost for care.

All Charges