Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG MOLECULAR CYTOGEN, DNA PROBE EA

Facility

$260.00

Service Code	HCPCS 88271
Hospital Charge Code	H3110291
Hospital Revenue Code	311
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$169.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: MDX Hawaii PPO	$252.20

HCHG MOLECULAR CYTOGENETICS, DNA PROBE 90

Facility

$260.00

Service Code	HCPCS 88271
Hospital Charge Code	H3110286
Hospital Revenue Code	311
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$169.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: MDX Hawaii PPO	$252.20

HCHG MOLECULAR CYTOGENETICS, DNA PROBE 90

Facility

$260.00

Service Code	HCPCS 88271
Hospital Charge Code	H3110286
Hospital Revenue Code	311
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$21.42
Rate for Payer: AlohaCare Medicare	$21.42
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Devoted Health Medicare	$23.56
Rate for Payer: Hawaii Medical Service Association ABD	$29.60
Rate for Payer: Hawaii Medical Service Association Commercial	$26.77
Rate for Payer: Hawaii Medical Service Association Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.08
Rate for Payer: Hawaii Western Management Group Commercial	$21.42
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$21.42
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$21.42
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$23.56
Rate for Payer: Ohana Health Plan Medicare	$21.42
Rate for Payer: UnitedHealthcare Medicaid	$29.60
Rate for Payer: UnitedHealthcare Medicare	$21.42
Rate for Payer: University Health Alliance Commercial	$55.37

HCHG MOLECULAR CYTOGEN,INTERPHASE INSITU 100-300 CELLS

Facility

$488.00

Service Code	HCPCS 88275
Hospital Charge Code	H3110282
Hospital Revenue Code	311
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$473.36
Rate for Payer: AlohaCare Medicaid	$51.19
Rate for Payer: AlohaCare Medicare	$51.19
Rate for Payer: Cash Price	$317.20
Rate for Payer: Cash Price	$317.20
Rate for Payer: Devoted Health Medicare	$56.31
Rate for Payer: Hawaii Medical Service Association ABD	$55.50
Rate for Payer: Hawaii Medical Service Association Commercial	$63.99
Rate for Payer: Hawaii Medical Service Association Medicare	$51.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.28
Rate for Payer: Hawaii Western Management Group Commercial	$51.19
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Humana Medicare	$51.19
Rate for Payer: Kaiser Permanente Commercial	$307.44
Rate for Payer: Kaiser Permanente Medicaid	$248.88
Rate for Payer: Kaiser Permanente Medicare	$51.19
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: Ohana Health Plan Medicaid	$56.31
Rate for Payer: Ohana Health Plan Medicare	$51.19
Rate for Payer: UnitedHealthcare Medicaid	$55.50
Rate for Payer: UnitedHealthcare Medicare	$51.19
Rate for Payer: University Health Alliance Commercial	$103.80

HCHG MOLECULAR CYTOGEN,INTERPHASE INSITU 100-300 CELLS

Facility

$488.00

Service Code	HCPCS 88275
Hospital Charge Code	H3110282
Hospital Revenue Code	311
Min. Negotiated Rate	$414.80
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$317.20
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: MDX Hawaii PPO	$473.36

HCHG MONKEYPOX, DNA, PCR – LABCORP-90

Facility

$589.00

Service Code	HCPCS 87593
Hospital Charge Code	H3060766
Hospital Revenue Code	306
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$51.31
Rate for Payer: AlohaCare Medicare	$51.31
Rate for Payer: Cash Price	$382.85
Rate for Payer: Cash Price	$382.85
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$51.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.07
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Humana Medicare	$51.31
Rate for Payer: Kaiser Permanente Commercial	$371.07
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$51.31
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: Ohana Health Plan Medicaid	$56.44
Rate for Payer: Ohana Health Plan Medicare	$51.31
Rate for Payer: UnitedHealthcare Medicaid	$38.48
Rate for Payer: UnitedHealthcare Medicare	$51.31
Rate for Payer: University Health Alliance Commercial	$429.32

HCHG MONKEYPOX, DNA, PCR – LABCORP-90

Facility

$589.00

Service Code	HCPCS 87593
Hospital Charge Code	H3060766
Hospital Revenue Code	306
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$382.85
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: MDX Hawaii PPO	$571.33

HCHG MONO SCRN SPECIFIC

Facility

$89.00

Service Code	HCPCS 86308
Hospital Charge Code	H3020636
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$56.07
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG MONO SCRN SPECIFIC

Facility

$89.00

Service Code	HCPCS 86308
Hospital Charge Code	H3020636
Hospital Revenue Code	302
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: MDX Hawaii PPO	$86.33

HCHG MORPH INSITU HYBRID ADDED EA MULTIPLEX

Facility

$1,118.00

Service Code	HCPCS 88374
Hospital Charge Code	H3120333
Hospital Revenue Code	312
Min. Negotiated Rate	$950.30
Max. Negotiated Rate	$1,084.46
Rate for Payer: Cash Price	$726.70
Rate for Payer: Health Management Network Commercial	$950.30
Rate for Payer: MDX Hawaii PPO	$1,084.46

HCHG MORPH INSITU HYBRID ADDED EA MULTIPLEX

Facility

$1,118.00

Service Code	HCPCS 88374
Hospital Charge Code	H3120333
Hospital Revenue Code	312
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$1,084.46
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$726.70
Rate for Payer: Cash Price	$726.70
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$28.79
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	$160.01
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$950.30
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$704.34
Rate for Payer: Kaiser Permanente Medicaid	$570.18
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,084.46
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$195.04
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$736.61

HCHG MORPH INSITU HYBRID ADDED EA MULTIPLEX 90

Facility

$1,065.00

Service Code	HCPCS 88374
Hospital Charge Code	H3120336
Hospital Revenue Code	312
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$1,033.05
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$692.25
Rate for Payer: Cash Price	$692.25
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$28.79
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	$160.01
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$905.25
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$670.95
Rate for Payer: Kaiser Permanente Medicaid	$543.15
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,033.05
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$195.04
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$736.61

HCHG MORPH INSITU HYBRID ADDED EA MULTIPLEX 90

Facility

$1,065.00

Service Code	HCPCS 88374
Hospital Charge Code	H3120336
Hospital Revenue Code	312
Min. Negotiated Rate	$905.25
Max. Negotiated Rate	$1,033.05
Rate for Payer: Cash Price	$692.25
Rate for Payer: Health Management Network Commercial	$905.25
Rate for Payer: MDX Hawaii PPO	$1,033.05

HCHG MORPH INSITU HYBRID MANUAL EA ADDL SNGL

Facility

$210.00

Service Code	HCPCS 88369
Hospital Charge Code	H3120331
Hospital Revenue Code	312
Min. Negotiated Rate	$48.59
Max. Negotiated Rate	$243.52
Rate for Payer: Cash Price	$136.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.59
Rate for Payer: Hawaii Western Management Group Commercial	$199.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$107.10
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: UnitedHealthcare Medicaid	$86.03
Rate for Payer: University Health Alliance Commercial	$243.52

HCHG MORPH INSITU HYBRID MANUAL EA ADDL SNGL

Facility

$210.00

Service Code	HCPCS 88369
Hospital Charge Code	H3120331
Hospital Revenue Code	312
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$136.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: MDX Hawaii PPO	$203.70

HCHG MORPH INSITU HYBRID MANUAL EA MULTIPLEX

Facility

$1,041.00

Service Code	HCPCS 88377
Hospital Charge Code	H3120334
Hospital Revenue Code	312
Min. Negotiated Rate	$884.85
Max. Negotiated Rate	$1,009.77
Rate for Payer: Cash Price	$676.65
Rate for Payer: Health Management Network Commercial	$884.85
Rate for Payer: MDX Hawaii PPO	$1,009.77

HCHG MORPH INSITU HYBRID MANUAL EA MULTIPLEX

Facility

$1,041.00

Service Code	HCPCS 88377
Hospital Charge Code	H3120334
Hospital Revenue Code	312
Min. Negotiated Rate	$148.91
Max. Negotiated Rate	$1,009.77
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$676.65
Rate for Payer: Cash Price	$676.65
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$475.14
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	$148.91
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$884.85
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$655.83
Rate for Payer: Kaiser Permanente Medicaid	$530.91
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,009.77
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$267.53
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$884.71

HCHG MORPH INSITU HYBRID MANUAL EA MULTIPLEX 90

Facility

$1,093.00

Service Code	HCPCS 88377
Hospital Charge Code	H3120346
Hospital Revenue Code	312
Min. Negotiated Rate	$148.91
Max. Negotiated Rate	$1,060.21
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$710.45
Rate for Payer: Cash Price	$710.45
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$475.14
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	$148.91
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$929.05
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$688.59
Rate for Payer: Kaiser Permanente Medicaid	$557.43
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,060.21
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$267.53
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$884.71

HCHG MORPH INSITU HYBRID MANUAL EA MULTIPLEX 90

Facility

$1,093.00

Service Code	HCPCS 88377
Hospital Charge Code	H3120346
Hospital Revenue Code	312
Min. Negotiated Rate	$929.05
Max. Negotiated Rate	$1,060.21
Rate for Payer: Cash Price	$710.45
Rate for Payer: Health Management Network Commercial	$929.05
Rate for Payer: MDX Hawaii PPO	$1,060.21

HCHG MPL CODON ANALYSIS SO

Facility

$510.00

Service Code	HCPCS 81338
Hospital Charge Code	K3100005
Hospital Revenue Code	310
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$494.70
Rate for Payer: AlohaCare Medicaid	$150.33
Rate for Payer: AlohaCare Medicare	$150.33
Rate for Payer: Cash Price	$331.50
Rate for Payer: Cash Price	$331.50
Rate for Payer: Devoted Health Medicare	$165.36
Rate for Payer: Hawaii Medical Service Association ABD	$150.33
Rate for Payer: Hawaii Medical Service Association Commercial	$187.91
Rate for Payer: Hawaii Medical Service Association Medicare	$150.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$150.33
Rate for Payer: Hawaii Western Management Group Commercial	$150.33
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: Humana Medicare	$150.33
Rate for Payer: Kaiser Permanente Commercial	$321.30
Rate for Payer: Kaiser Permanente Medicaid	$260.10
Rate for Payer: Kaiser Permanente Medicare	$150.33
Rate for Payer: MDX Hawaii PPO	$494.70
Rate for Payer: Ohana Health Plan Medicaid	$165.36
Rate for Payer: Ohana Health Plan Medicare	$150.33
Rate for Payer: UnitedHealthcare Medicaid	$90.20
Rate for Payer: UnitedHealthcare Medicare	$150.33
Rate for Payer: University Health Alliance Commercial	$371.74

HCHG MPL CODON ANALYSIS SO

Facility

$510.00

Service Code	HCPCS 81338
Hospital Charge Code	K3100005
Hospital Revenue Code	310
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$494.70
Rate for Payer: Cash Price	$331.50
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: MDX Hawaii PPO	$494.70

HCHG M.PNEUMONIAE DNA AMP PROBE - 90

Facility

$431.00

Service Code	HCPCS 87581
Hospital Charge Code	H3060803
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
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	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG M.PNEUMONIAE DNA AMP PROBE - 90

Facility

$431.00

Service Code	HCPCS 87581
Hospital Charge Code	H3060803
Hospital Revenue Code	306
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

HCHG MRA ABDOMEN W/ CONTR

Facility

$2,115.00

Service Code	HCPCS 74185
Hospital Charge Code	H6100126
Hospital Revenue Code	610
Min. Negotiated Rate	$1,797.75
Max. Negotiated Rate	$2,051.55
Rate for Payer: Cash Price	$1,374.75
Rate for Payer: Health Management Network Commercial	$1,797.75
Rate for Payer: MDX Hawaii PPO	$2,051.55

HCHG MRA ABDOMEN W/ CONTR

Facility

$2,115.00

Service Code	HCPCS 74185
Hospital Charge Code	H6100126
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$2,051.55
Rate for Payer: Cash Price	$1,374.75
Rate for Payer: Cash Price	$1,374.75
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,009.25
Rate for Payer: Health Management Network Commercial	$1,797.75
Rate for Payer: Kaiser Permanente Commercial	$1,332.45
Rate for Payer: Kaiser Permanente Medicaid	$1,078.65
Rate for Payer: MDX Hawaii PPO	$2,051.55
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$987.38

Know your out-of-pocket cost for care.

All Charges