Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG RP THERAPY IV ADMIN

Facility

$1,547.00

Service Code	HCPCS 79101
Hospital Charge Code	H3420132
Hospital Revenue Code	342
Min. Negotiated Rate	$1,314.95
Max. Negotiated Rate	$1,500.59
Rate for Payer: Cash Price	$1,005.55
Rate for Payer: Health Management Network Commercial	$1,314.95
Rate for Payer: MDX Hawaii PPO	$1,500.59

HCHG RSV AG EIA

Facility

$91.00

Service Code	HCPCS 87206
Hospital Charge Code	H3060458
Hospital Revenue Code	306
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 RSV AG EIA

Facility

$197.00

Service Code	HCPCS 87420
Hospital Charge Code	K3060033
Hospital Revenue Code	306
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$191.09
Rate for Payer: AlohaCare Medicaid	$13.91
Rate for Payer: AlohaCare Medicare	$13.91
Rate for Payer: Cash Price	$128.05
Rate for Payer: Cash Price	$128.05
Rate for Payer: Devoted Health Medicare	$15.30
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$17.39
Rate for Payer: Hawaii Medical Service Association Medicare	$13.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$13.91
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Humana Medicare	$13.91
Rate for Payer: Kaiser Permanente Commercial	$124.11
Rate for Payer: Kaiser Permanente Medicaid	$100.47
Rate for Payer: Kaiser Permanente Medicare	$13.91
Rate for Payer: MDX Hawaii PPO	$191.09
Rate for Payer: Ohana Health Plan Medicaid	$15.30
Rate for Payer: Ohana Health Plan Medicare	$13.91
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$13.91
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG RSV AG EIA

Facility

$197.00

Service Code	HCPCS 87420
Hospital Charge Code	K3060033
Hospital Revenue Code	306
Min. Negotiated Rate	$167.45
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$128.05
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: MDX Hawaii PPO	$191.09

HCHG RSV AG EIA

Facility

$91.00

Service Code	HCPCS 87206
Hospital Charge Code	H3060458
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$5.39
Rate for Payer: AlohaCare Medicare	$5.39
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$5.93
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$5.39
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$5.39
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.39
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$5.39
Rate for Payer: University Health Alliance Commercial	$13.88

HCHG RSVP AM PROBE

Facility

$867.00

Service Code	HCPCS 87634
Hospital Charge Code	K3060036
Hospital Revenue Code	306
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$840.99
Rate for Payer: AlohaCare Medicaid	$70.20
Rate for Payer: AlohaCare Medicare	$70.20
Rate for Payer: Cash Price	$563.55
Rate for Payer: Cash Price	$563.55
Rate for Payer: Devoted Health Medicare	$77.22
Rate for Payer: Hawaii Medical Service Association ABD	$58.84
Rate for Payer: Hawaii Medical Service Association Commercial	$87.75
Rate for Payer: Hawaii Medical Service Association Medicare	$70.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$96.95
Rate for Payer: Hawaii Western Management Group Commercial	$70.20
Rate for Payer: Health Management Network Commercial	$736.95
Rate for Payer: Humana Medicare	$70.20
Rate for Payer: Kaiser Permanente Commercial	$546.21
Rate for Payer: Kaiser Permanente Medicaid	$442.17
Rate for Payer: Kaiser Permanente Medicare	$70.20
Rate for Payer: MDX Hawaii PPO	$840.99
Rate for Payer: Ohana Health Plan Medicaid	$77.22
Rate for Payer: Ohana Health Plan Medicare	$70.20
Rate for Payer: UnitedHealthcare Medicaid	$52.00
Rate for Payer: UnitedHealthcare Medicare	$70.20
Rate for Payer: University Health Alliance Commercial	$160.32

HCHG RSVP AM PROBE

Facility

$867.00

Service Code	HCPCS 87634
Hospital Charge Code	K3060036
Hospital Revenue Code	306
Min. Negotiated Rate	$736.95
Max. Negotiated Rate	$840.99
Rate for Payer: Cash Price	$563.55
Rate for Payer: Health Management Network Commercial	$736.95
Rate for Payer: MDX Hawaii PPO	$840.99

HCHG RSV, RNA, REAL-TIME PCR

Facility

$442.00

Service Code	HCPCS 87798
Hospital Charge Code	H3060663
Hospital Revenue Code	306
Min. Negotiated Rate	$375.70
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$287.30
Rate for Payer: Health Management Network Commercial	$375.70
Rate for Payer: MDX Hawaii PPO	$428.74

HCHG RSV, RNA, REAL-TIME PCR

Facility

$442.00

Service Code	HCPCS 87798
Hospital Charge Code	H3060663
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$428.74
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$287.30
Rate for Payer: Cash Price	$287.30
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
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	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$375.70
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$278.46
Rate for Payer: Kaiser Permanente Medicaid	$225.42
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$428.74
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG RT-QUIC FOR PRION DETECTION - 90

Facility

$2,371.00

Service Code	HCPCS 0035U
Hospital Charge Code	H3001114
Hospital Revenue Code	300
Min. Negotiated Rate	$2,015.35
Max. Negotiated Rate	$2,299.87
Rate for Payer: Cash Price	$1,541.15
Rate for Payer: Health Management Network Commercial	$2,015.35
Rate for Payer: MDX Hawaii PPO	$2,299.87

HCHG RT-QUIC FOR PRION DETECTION - 90

Facility

$2,371.00

Service Code	HCPCS 0035U
Hospital Charge Code	H3001114
Hospital Revenue Code	300
Min. Negotiated Rate	$405.74
Max. Negotiated Rate	$2,299.87
Rate for Payer: AlohaCare Medicaid	$540.99
Rate for Payer: AlohaCare Medicare	$540.99
Rate for Payer: Cash Price	$1,541.15
Rate for Payer: Cash Price	$1,541.15
Rate for Payer: Devoted Health Medicare	$595.09
Rate for Payer: Hawaii Medical Service Association Commercial	$676.24
Rate for Payer: Hawaii Medical Service Association Medicare	$540.99
Rate for Payer: Hawaii Western Management Group Commercial	$2,252.45
Rate for Payer: Health Management Network Commercial	$2,015.35
Rate for Payer: Humana Medicare	$540.99
Rate for Payer: Kaiser Permanente Commercial	$1,493.73
Rate for Payer: Kaiser Permanente Medicaid	$1,209.21
Rate for Payer: Kaiser Permanente Medicare	$540.99
Rate for Payer: MDX Hawaii PPO	$2,299.87
Rate for Payer: Ohana Health Plan Medicaid	$595.09
Rate for Payer: Ohana Health Plan Medicare	$540.99
Rate for Payer: UnitedHealthcare Medicaid	$405.74
Rate for Payer: UnitedHealthcare Medicare	$540.99
Rate for Payer: University Health Alliance Commercial	$1,728.22

HCHG RUBELLA AB

Facility

$246.00

Service Code	HCPCS 86762
Hospital Charge Code	K3020013
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$14.39
Rate for Payer: AlohaCare Medicare	$14.39
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Devoted Health Medicare	$15.83
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$14.39
Rate for Payer: Kaiser Permanente Commercial	$154.98
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$14.39
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$15.83
Rate for Payer: Ohana Health Plan Medicare	$14.39
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$14.39
Rate for Payer: University Health Alliance Commercial	$37.20

HCHG RUBELLA AB

Facility

$246.00

Service Code	HCPCS 86762
Hospital Charge Code	K3020013
Hospital Revenue Code	302
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: MDX Hawaii PPO	$238.62

HCHG RUBELLA AB IGG

Facility

$246.00

Service Code	HCPCS 86762
Hospital Charge Code	H3020760
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$14.39
Rate for Payer: AlohaCare Medicare	$14.39
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Devoted Health Medicare	$15.83
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$14.39
Rate for Payer: Kaiser Permanente Commercial	$154.98
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$14.39
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$15.83
Rate for Payer: Ohana Health Plan Medicare	$14.39
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$14.39
Rate for Payer: University Health Alliance Commercial	$37.20

HCHG RUBELLA AB IGG

Facility

$246.00

Service Code	HCPCS 86762
Hospital Charge Code	H3020760
Hospital Revenue Code	302
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: MDX Hawaii PPO	$238.62

HCHG RUBELLA AB IGM 90

Facility

$246.00

Service Code	HCPCS 86762
Hospital Charge Code	H3020762
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$14.39
Rate for Payer: AlohaCare Medicare	$14.39
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Devoted Health Medicare	$15.83
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$14.39
Rate for Payer: Kaiser Permanente Commercial	$154.98
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$14.39
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$15.83
Rate for Payer: Ohana Health Plan Medicare	$14.39
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$14.39
Rate for Payer: University Health Alliance Commercial	$37.20

HCHG RUBELLA AB IGM 90

Facility

$246.00

Service Code	HCPCS 86762
Hospital Charge Code	H3020762
Hospital Revenue Code	302
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: MDX Hawaii PPO	$238.62

HCHG RUBEOLA AB IGG

Facility

$167.00

Service Code	HCPCS 86765
Hospital Charge Code	H3020764
Hospital Revenue Code	302
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$108.55
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: MDX Hawaii PPO	$161.99

HCHG RUBEOLA AB IGG

Facility

$167.00

Service Code	HCPCS 86765
Hospital Charge Code	H3020764
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$105.21
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG RUBEOLA AB IGM 90

Facility

$167.00

Service Code	HCPCS 86765
Hospital Charge Code	H3020766
Hospital Revenue Code	302
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$108.55
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: MDX Hawaii PPO	$161.99

HCHG RUBEOLA AB IGM 90

Facility

$167.00

Service Code	HCPCS 86765
Hospital Charge Code	H3020766
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$105.21
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG SACROCOC SPINE, MIN 2 VIEWS

Facility

$573.00

Service Code	HCPCS 72220
Hospital Charge Code	H3200728
Hospital Revenue Code	320
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: MDX Hawaii PPO	$555.81

HCHG SACROCOC SPINE, MIN 2 VIEWS

Facility

$573.00

Service Code	HCPCS 72220
Hospital Charge Code	H3200728
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
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	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$360.99
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$62.01

HCHG SACROILIACS, 3 OR MORE VIEWS

Facility

$518.00

Service Code	HCPCS 72202
Hospital Charge Code	H3200730
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$502.46
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
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	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$326.34
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$71.43

HCHG SACROILIACS, 3 OR MORE VIEWS

Facility

$518.00

Service Code	HCPCS 72202
Hospital Charge Code	H3200730
Hospital Revenue Code	320
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$336.70
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: MDX Hawaii PPO	$502.46

Know your out-of-pocket cost for care.

All Charges