Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG NUTRITION CLASS, NON-PHYS PER SESSION

Facility

$226.00

Service Code	HCPCS S9452
Hospital Charge Code	K9420005
Hospital Revenue Code	942
Min. Negotiated Rate	$115.26
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: University Health Alliance Commercial	$164.73

HCHG NUTRITION CLASS, NON-PHYS PER SESSION

Facility

$226.00

Service Code	HCPCS S9452
Hospital Charge Code	K9420005
Hospital Revenue Code	942
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 OBSTETRIC PANEL

Facility

$299.00

Service Code	HCPCS 80055
Hospital Charge Code	H3010986
Hospital Revenue Code	301
Min. Negotiated Rate	$254.15
Max. Negotiated Rate	$290.03
Rate for Payer: Cash Price	$194.35
Rate for Payer: Health Management Network Commercial	$254.15
Rate for Payer: MDX Hawaii PPO	$290.03

HCHG OBSTETRIC PANEL

Facility

$299.00

Service Code	HCPCS 80055
Hospital Charge Code	H3010986
Hospital Revenue Code	301
Min. Negotiated Rate	$21.14
Max. Negotiated Rate	$290.03
Rate for Payer: AlohaCare Medicaid	$47.81
Rate for Payer: AlohaCare Medicare	$47.81
Rate for Payer: Cash Price	$194.35
Rate for Payer: Cash Price	$194.35
Rate for Payer: Devoted Health Medicare	$52.59
Rate for Payer: Hawaii Medical Service Association ABD	$21.14
Rate for Payer: Hawaii Medical Service Association Commercial	$59.76
Rate for Payer: Hawaii Medical Service Association Medicare	$47.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$82.74
Rate for Payer: Hawaii Western Management Group Commercial	$47.81
Rate for Payer: Health Management Network Commercial	$254.15
Rate for Payer: Humana Medicare	$47.81
Rate for Payer: Kaiser Permanente Commercial	$188.37
Rate for Payer: Kaiser Permanente Medicaid	$152.49
Rate for Payer: Kaiser Permanente Medicare	$47.81
Rate for Payer: MDX Hawaii PPO	$290.03
Rate for Payer: Ohana Health Plan Medicaid	$52.59
Rate for Payer: Ohana Health Plan Medicare	$47.81
Rate for Payer: UnitedHealthcare Medicaid	$21.14
Rate for Payer: UnitedHealthcare Medicare	$47.81
Rate for Payer: University Health Alliance Commercial	$217.94

HCHG OB US NUCHAL MEAS, 1 GEST

Facility

$603.00

Service Code	HCPCS 76813
Hospital Charge Code	H4020278
Hospital Revenue Code	402
Min. Negotiated Rate	$512.55
Max. Negotiated Rate	$584.91
Rate for Payer: Cash Price	$391.95
Rate for Payer: Health Management Network Commercial	$512.55
Rate for Payer: MDX Hawaii PPO	$584.91

HCHG OB US NUCHAL MEAS, 1 GEST

Facility

$603.00

Service Code	HCPCS 76813
Hospital Charge Code	H4020278
Hospital Revenue Code	402
Min. Negotiated Rate	$54.01
Max. Negotiated Rate	$584.91
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$391.95
Rate for Payer: Cash Price	$391.95
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$54.01
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$64.95
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$512.55
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$379.89
Rate for Payer: Kaiser Permanente Medicaid	$307.53
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$584.91
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$54.01
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$260.13

HCHG OB US NUCHAL MEAS, EA ADDL

Facility

$312.00

Service Code	HCPCS 76814
Hospital Charge Code	H4020279
Hospital Revenue Code	402
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$202.80
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: MDX Hawaii PPO	$302.64

HCHG OB US NUCHAL MEAS, EA ADDL

Facility

$312.00

Service Code	HCPCS 76814
Hospital Charge Code	H4020279
Hospital Revenue Code	402
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$202.80
Rate for Payer: Cash Price	$202.80
Rate for Payer: Hawaii Medical Service Association ABD	$27.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.32
Rate for Payer: Hawaii Western Management Group Commercial	$296.40
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Kaiser Permanente Commercial	$196.56
Rate for Payer: Kaiser Permanente Medicaid	$159.12
Rate for Payer: MDX Hawaii PPO	$302.64
Rate for Payer: UnitedHealthcare Medicaid	$27.73
Rate for Payer: University Health Alliance Commercial	$163.21

HCHG OCCULT BLOOD FECES

Facility

$45.00

Service Code	HCPCS 82272
Hospital Charge Code	H3000328
Hospital Revenue Code	300
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$4.23
Rate for Payer: AlohaCare Medicare	$4.23
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Devoted Health Medicare	$4.65
Rate for Payer: Hawaii Medical Service Association ABD	$4.54
Rate for Payer: Hawaii Medical Service Association Commercial	$5.29
Rate for Payer: Hawaii Medical Service Association Medicare	$4.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.77
Rate for Payer: Hawaii Western Management Group Commercial	$4.23
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$4.23
Rate for Payer: Kaiser Permanente Commercial	$28.35
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$4.23
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.23
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: UnitedHealthcare Medicare	$4.23
Rate for Payer: University Health Alliance Commercial	$8.40

HCHG OCCULT BLOOD FECES

Facility

$45.00

Service Code	HCPCS 82272
Hospital Charge Code	H3000328
Hospital Revenue Code	300
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: MDX Hawaii PPO	$43.65

HCHG OCCULT BLOOD FECES

Facility

$60.00

Service Code	HCPCS 82270
Hospital Charge Code	H3011713
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 OCCULT BLOOD FECES

Facility

$60.00

Service Code	HCPCS 82270
Hospital Charge Code	H3011713
Hospital Revenue Code	301
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$4.38
Rate for Payer: AlohaCare Medicare	$4.38
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$4.82
Rate for Payer: Hawaii Medical Service Association ABD	$4.49
Rate for Payer: Hawaii Medical Service Association Commercial	$5.47
Rate for Payer: Hawaii Medical Service Association Medicare	$4.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.71
Rate for Payer: Hawaii Western Management Group Commercial	$4.38
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$4.38
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$4.38
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$4.82
Rate for Payer: Ohana Health Plan Medicare	$4.38
Rate for Payer: UnitedHealthcare Medicaid	$4.49
Rate for Payer: UnitedHealthcare Medicare	$4.38
Rate for Payer: University Health Alliance Commercial	$8.40

HCHG OCCULT BLOOD GASTRIC - 90

Facility

$40.00

Service Code	HCPCS 82271
Hospital Charge Code	H3011667
Hospital Revenue Code	301
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

HCHG OCCULT BLOOD GASTRIC - 90

Facility

$40.00

Service Code	HCPCS 82271
Hospital Charge Code	H3011667
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$5.32
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$26.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Devoted Health Medicare	$5.85
Rate for Payer: Hawaii Medical Service Association ABD	$4.54
Rate for Payer: Hawaii Medical Service Association Commercial	$6.65
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.77
Rate for Payer: Hawaii Western Management Group Commercial	$5.32
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$5.85
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$8.40

HCHG OCTREOSCAN (6MCI)

Facility

$7,308.00

Service Code	HCPCS A9572
Hospital Charge Code	H3430120
Hospital Revenue Code	343
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$7,088.76
Rate for Payer: AlohaCare Medicaid	$2,000.94
Rate for Payer: AlohaCare Medicare	$2,000.94
Rate for Payer: Cash Price	$4,750.20
Rate for Payer: Cash Price	$4,750.20
Rate for Payer: Devoted Health Medicare	$2,201.03
Rate for Payer: Hawaii Medical Service Association Commercial	$2,501.18
Rate for Payer: Hawaii Medical Service Association Medicare	$2,000.94
Rate for Payer: Hawaii Western Management Group Commercial	$6,942.60
Rate for Payer: Health Management Network Commercial	$6,211.80
Rate for Payer: Humana Medicare	$2,000.94
Rate for Payer: Kaiser Permanente Commercial	$4,604.04
Rate for Payer: Kaiser Permanente Medicaid	$3,727.08
Rate for Payer: Kaiser Permanente Medicare	$2,000.94
Rate for Payer: MDX Hawaii PPO	$7,088.76
Rate for Payer: Ohana Health Plan Medicaid	$2,201.03
Rate for Payer: Ohana Health Plan Medicare	$2,000.94
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: UnitedHealthcare Medicare	$2,000.94
Rate for Payer: University Health Alliance Commercial	$5,326.80

HCHG OCTREOSCAN (6MCI)

Facility

$7,308.00

Service Code	HCPCS A9572
Hospital Charge Code	H3430120
Hospital Revenue Code	343
Min. Negotiated Rate	$6,211.80
Max. Negotiated Rate	$7,088.76
Rate for Payer: Cash Price	$4,750.20
Rate for Payer: Health Management Network Commercial	$6,211.80
Rate for Payer: MDX Hawaii PPO	$7,088.76

HCHG OLIGOCLONAL BANDS

Facility

$248.00

Service Code	HCPCS 83916
Hospital Charge Code	H3010990
Hospital Revenue Code	301
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$27.39
Rate for Payer: AlohaCare Medicare	$27.39
Rate for Payer: Cash Price	$161.20
Rate for Payer: Cash Price	$161.20
Rate for Payer: Devoted Health Medicare	$30.13
Rate for Payer: Hawaii Medical Service Association ABD	$27.79
Rate for Payer: Hawaii Medical Service Association Commercial	$34.24
Rate for Payer: Hawaii Medical Service Association Medicare	$27.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.18
Rate for Payer: Hawaii Western Management Group Commercial	$27.39
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$27.39
Rate for Payer: Kaiser Permanente Commercial	$156.24
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$27.39
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$30.13
Rate for Payer: Ohana Health Plan Medicare	$27.39
Rate for Payer: UnitedHealthcare Medicaid	$27.79
Rate for Payer: UnitedHealthcare Medicare	$27.39
Rate for Payer: University Health Alliance Commercial	$51.97

HCHG OLIGOCLONAL BANDS

Facility

$248.00

Service Code	HCPCS 83916
Hospital Charge Code	H3010990
Hospital Revenue Code	301
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$161.20
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: MDX Hawaii PPO	$240.56

HCHG ONCO MRNA GENE EXPRESS SO

Facility

$5,719.00

Service Code	HCPCS 81540
Hospital Charge Code	K3090004
Hospital Revenue Code	309
Min. Negotiated Rate	$861.58
Max. Negotiated Rate	$5,547.43
Rate for Payer: AlohaCare Medicaid	$3,750.00
Rate for Payer: AlohaCare Medicare	$3,750.00
Rate for Payer: Cash Price	$3,717.35
Rate for Payer: Cash Price	$3,717.35
Rate for Payer: Devoted Health Medicare	$4,125.00
Rate for Payer: Hawaii Medical Service Association ABD	$2,920.30
Rate for Payer: Hawaii Medical Service Association Commercial	$4,687.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,750.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,920.30
Rate for Payer: Hawaii Western Management Group Commercial	$3,750.00
Rate for Payer: Health Management Network Commercial	$4,861.15
Rate for Payer: Humana Medicare	$3,750.00
Rate for Payer: Kaiser Permanente Commercial	$3,602.97
Rate for Payer: Kaiser Permanente Medicaid	$2,916.69
Rate for Payer: Kaiser Permanente Medicare	$3,750.00
Rate for Payer: MDX Hawaii PPO	$5,547.43
Rate for Payer: Ohana Health Plan Medicaid	$4,125.00
Rate for Payer: Ohana Health Plan Medicare	$3,750.00
Rate for Payer: UnitedHealthcare Medicaid	$861.58
Rate for Payer: UnitedHealthcare Medicare	$3,750.00
Rate for Payer: University Health Alliance Commercial	$4,168.58

HCHG ONCO MRNA GENE EXPRESS SO

Facility

$5,719.00

Service Code	HCPCS 81540
Hospital Charge Code	K3090004
Hospital Revenue Code	309
Min. Negotiated Rate	$4,861.15
Max. Negotiated Rate	$5,547.43
Rate for Payer: Cash Price	$3,717.35
Rate for Payer: Health Management Network Commercial	$4,861.15
Rate for Payer: MDX Hawaii PPO	$5,547.43

HCHG OPIATES 1+ DRUG CONFIRM 90

Facility

$134.00

Service Code	HCPCS 80361
Hospital Charge Code	H3011582
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Hawaii Medical Service Association ABD	$26.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.23
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$84.42
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: University Health Alliance Commercial	$97.67

HCHG OPIATES 1+ DRUG CONFIRM 90

Facility

$134.00

Service Code	HCPCS 80361
Hospital Charge Code	H3011582
Hospital Revenue Code	301
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: MDX Hawaii PPO	$129.98

HCHG OPIATES UR QUANT

Facility

$380.00

Service Code	HCPCS G0480
Hospital Charge Code	K3010056
Hospital Revenue Code	301
Min. Negotiated Rate	$47.96
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$114.43
Rate for Payer: AlohaCare Medicare	$114.43
Rate for Payer: Cash Price	$247.00
Rate for Payer: Cash Price	$247.00
Rate for Payer: Devoted Health Medicare	$125.87
Rate for Payer: Hawaii Medical Service Association Commercial	$143.04
Rate for Payer: Hawaii Medical Service Association Medicare	$114.43
Rate for Payer: Hawaii Western Management Group Commercial	$361.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$114.43
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$114.43
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$125.87
Rate for Payer: Ohana Health Plan Medicare	$114.43
Rate for Payer: UnitedHealthcare Medicaid	$47.96
Rate for Payer: UnitedHealthcare Medicare	$114.43
Rate for Payer: University Health Alliance Commercial	$276.98

HCHG OPIATES UR QUANT

Facility

$380.00

Service Code	HCPCS G0480
Hospital Charge Code	K3010056
Hospital Revenue Code	301
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$247.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: MDX Hawaii PPO	$368.60

HCHG OP INTRAOP CHOLANGIO PORT

Facility

$680.00

Service Code	HCPCS 74300
Hospital Charge Code	H3200600
Hospital Revenue Code	320
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$659.60
Rate for Payer: Cash Price	$442.00
Rate for Payer: Health Management Network Commercial	$578.00
Rate for Payer: MDX Hawaii PPO	$659.60

Know your out-of-pocket cost for care.

All Charges