Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI

Facility

$135.00

Service Code	HCPCS 97802
Hospital Charge Code	K9420001
Hospital Revenue Code	942
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$87.75
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

HCHG MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M

Facility

$128.00

Service Code	HCPCS 97803
Hospital Charge Code	K9420002
Hospital Revenue Code	942
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Hawaii Western Management Group Commercial	$121.60
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$80.64
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: UnitedHealthcare Medicaid	$13.40
Rate for Payer: University Health Alliance Commercial	$93.30

HCHG MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M

Facility

$128.00

Service Code	HCPCS 97803
Hospital Charge Code	K9420002
Hospital Revenue Code	942
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: MDX Hawaii PPO	$124.16

HCHG MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI

Facility

$91.00

Service Code	HCPCS 97804
Hospital Charge Code	K9420003
Hospital Revenue Code	942
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

HCHG MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI

Facility

$91.00

Service Code	HCPCS 97804
Hospital Charge Code	K9420003
Hospital Revenue Code	942
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: UnitedHealthcare Medicaid	$5.20
Rate for Payer: University Health Alliance Commercial	$66.33

HCHG MERCURY URINE

Facility

$201.00

Service Code	HCPCS 83825
Hospital Charge Code	H3010874
Hospital Revenue Code	301
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$16.26
Rate for Payer: AlohaCare Medicare	$16.26
Rate for Payer: Cash Price	$130.65
Rate for Payer: Cash Price	$130.65
Rate for Payer: Devoted Health Medicare	$17.89
Rate for Payer: Hawaii Medical Service Association ABD	$22.47
Rate for Payer: Hawaii Medical Service Association Commercial	$20.32
Rate for Payer: Hawaii Medical Service Association Medicare	$16.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.59
Rate for Payer: Hawaii Western Management Group Commercial	$16.26
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$16.26
Rate for Payer: Kaiser Permanente Commercial	$126.63
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$16.26
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$17.89
Rate for Payer: Ohana Health Plan Medicare	$16.26
Rate for Payer: UnitedHealthcare Medicaid	$22.47
Rate for Payer: UnitedHealthcare Medicare	$16.26
Rate for Payer: University Health Alliance Commercial	$42.03

HCHG MERCURY URINE

Facility

$201.00

Service Code	HCPCS 83825
Hospital Charge Code	H3010874
Hospital Revenue Code	301
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$130.65
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: MDX Hawaii PPO	$194.97

HCHG META NEB COMBO TX, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100294
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG META NEB COMBO TX, DAILY

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100294
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
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	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG META NEB COMBO TX, SUBSEQUENT

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100295
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Cash Price	$884.65
Rate for Payer: Devoted Health Medicare	$284.56
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	$258.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,292.95
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$857.43
Rate for Payer: Kaiser Permanente Medicaid	$694.11
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$1,320.17
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$992.03

HCHG META NEB COMBO TX, SUBSEQUENT

Facility

$1,361.00

Service Code	HCPCS 94640
Hospital Charge Code	H4100295
Hospital Revenue Code	410
Min. Negotiated Rate	$1,156.85
Max. Negotiated Rate	$1,320.17
Rate for Payer: Cash Price	$884.65
Rate for Payer: Health Management Network Commercial	$1,156.85
Rate for Payer: MDX Hawaii PPO	$1,320.17

HCHG METANEPHRINE 24 HR URINE

Facility

$209.00

Service Code	HCPCS 83835
Hospital Charge Code	H3010878
Hospital Revenue Code	301
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: MDX Hawaii PPO	$202.73

HCHG METANEPHRINE 24 HR URINE

Facility

$209.00

Service Code	HCPCS 83835
Hospital Charge Code	H3010878
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$16.94
Rate for Payer: AlohaCare Medicare	$16.94
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Devoted Health Medicare	$18.63
Rate for Payer: Hawaii Medical Service Association ABD	$23.41
Rate for Payer: Hawaii Medical Service Association Commercial	$21.18
Rate for Payer: Hawaii Medical Service Association Medicare	$16.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.58
Rate for Payer: Hawaii Western Management Group Commercial	$16.94
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$16.94
Rate for Payer: Kaiser Permanente Commercial	$131.67
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$16.94
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$18.63
Rate for Payer: Ohana Health Plan Medicare	$16.94
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$16.94
Rate for Payer: University Health Alliance Commercial	$43.79

HCHG METANEPHRINE PLASMA

Facility

$209.00

Service Code	HCPCS 83835
Hospital Charge Code	H3010880
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$16.94
Rate for Payer: AlohaCare Medicare	$16.94
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Devoted Health Medicare	$18.63
Rate for Payer: Hawaii Medical Service Association ABD	$23.41
Rate for Payer: Hawaii Medical Service Association Commercial	$21.18
Rate for Payer: Hawaii Medical Service Association Medicare	$16.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.58
Rate for Payer: Hawaii Western Management Group Commercial	$16.94
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$16.94
Rate for Payer: Kaiser Permanente Commercial	$131.67
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$16.94
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$18.63
Rate for Payer: Ohana Health Plan Medicare	$16.94
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$16.94
Rate for Payer: University Health Alliance Commercial	$43.79

HCHG METANEPHRINE PLASMA

Facility

$209.00

Service Code	HCPCS 83835
Hospital Charge Code	H3010880
Hospital Revenue Code	301
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: MDX Hawaii PPO	$202.73

HCHG METANEPHRINE RANDOM UR 90

Facility

$209.00

Service Code	HCPCS 83835
Hospital Charge Code	H3000302
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$16.94
Rate for Payer: AlohaCare Medicare	$16.94
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Devoted Health Medicare	$18.63
Rate for Payer: Hawaii Medical Service Association ABD	$23.41
Rate for Payer: Hawaii Medical Service Association Commercial	$21.18
Rate for Payer: Hawaii Medical Service Association Medicare	$16.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.58
Rate for Payer: Hawaii Western Management Group Commercial	$16.94
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$16.94
Rate for Payer: Kaiser Permanente Commercial	$131.67
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$16.94
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$18.63
Rate for Payer: Ohana Health Plan Medicare	$16.94
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$16.94
Rate for Payer: University Health Alliance Commercial	$43.79

HCHG METANEPHRINE RANDOM UR 90

Facility

$209.00

Service Code	HCPCS 83835
Hospital Charge Code	H3000302
Hospital Revenue Code	301
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: MDX Hawaii PPO	$202.73

HCHG METHEMOGLOBIN

Facility

$60.00

Service Code	HCPCS 83050
Hospital Charge Code	H3010894
Hospital Revenue Code	301
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$58.20

HCHG METHEMOGLOBIN

Facility

$60.00

Service Code	HCPCS 83050
Hospital Charge Code	H3010894
Hospital Revenue Code	301
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$8.20
Rate for Payer: AlohaCare Medicare	$8.20
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$9.02
Rate for Payer: Hawaii Medical Service Association ABD	$10.12
Rate for Payer: Hawaii Medical Service Association Commercial	$10.25
Rate for Payer: Hawaii Medical Service Association Medicare	$8.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.63
Rate for Payer: Hawaii Western Management Group Commercial	$8.20
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$8.20
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$8.20
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$9.02
Rate for Payer: Ohana Health Plan Medicare	$8.20
Rate for Payer: UnitedHealthcare Medicaid	$10.12
Rate for Payer: UnitedHealthcare Medicare	$8.20
Rate for Payer: University Health Alliance Commercial	$18.93

HCHG METHYLMALONIC ACID SERUM QUANT

Facility

$202.00

Service Code	HCPCS 83921
Hospital Charge Code	H3010900
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$21.21
Rate for Payer: AlohaCare Medicare	$21.21
Rate for Payer: Cash Price	$131.30
Rate for Payer: Cash Price	$131.30
Rate for Payer: Devoted Health Medicare	$23.33
Rate for Payer: Hawaii Medical Service Association ABD	$22.75
Rate for Payer: Hawaii Medical Service Association Commercial	$26.51
Rate for Payer: Hawaii Medical Service Association Medicare	$21.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.89
Rate for Payer: Hawaii Western Management Group Commercial	$21.21
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$21.21
Rate for Payer: Kaiser Permanente Commercial	$127.26
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$21.21
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$23.33
Rate for Payer: Ohana Health Plan Medicare	$21.21
Rate for Payer: UnitedHealthcare Medicaid	$22.75
Rate for Payer: UnitedHealthcare Medicare	$21.21
Rate for Payer: University Health Alliance Commercial	$42.55

HCHG METHYLMALONIC ACID SERUM QUANT

Facility

$202.00

Service Code	HCPCS 83921
Hospital Charge Code	H3010900
Hospital Revenue Code	301
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$131.30
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: MDX Hawaii PPO	$195.94

HCHG M GENTIALIUM AMP PROBE

Facility

$324.00

Service Code	HCPCS 87563
Hospital Charge Code	K3060051
Hospital Revenue Code	306
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$314.28
Rate for Payer: Cash Price	$210.60
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: MDX Hawaii PPO	$314.28

HCHG M GENTIALIUM AMP PROBE

Facility

$324.00

Service Code	HCPCS 87563
Hospital Charge Code	K3060051
Hospital Revenue Code	306
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$314.28
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$33.68
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.68
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$204.12
Rate for Payer: Kaiser Permanente Medicaid	$165.24
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$314.28
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$236.16

HCHG MIC (E-TEST)

Facility

$36.00

Service Code	HCPCS 87181
Hospital Charge Code	H3060312
Hospital Revenue Code	306
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$4.75
Rate for Payer: AlohaCare Medicare	$4.75
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$5.22
Rate for Payer: Hawaii Medical Service Association ABD	$2.57
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$4.75
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$4.75
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$5.22
Rate for Payer: Ohana Health Plan Medicare	$4.75
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$4.75
Rate for Payer: University Health Alliance Commercial	$4.81

HCHG MIC (E-TEST)

Facility

$36.00

Service Code	HCPCS 87181
Hospital Charge Code	H3060312
Hospital Revenue Code	306
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

Know your out-of-pocket cost for care.

All Charges