Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SARSCOV2&INF A&B&RSV AMP PRB

Facility

$804.00

Service Code	HCPCS 87637
Hospital Charge Code	K3060053
Hospital Revenue Code	306
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG SARSCOV2&INF A&B&RSV AMP PRB

Facility

$850.00

Service Code	HCPCS 87637
Hospital Charge Code	H3060817
Hospital Revenue Code	306
Min. Negotiated Rate	$722.50
Max. Negotiated Rate	$824.50
Rate for Payer: Cash Price	$552.50
Rate for Payer: Health Management Network Commercial	$722.50
Rate for Payer: MDX Hawaii PPO	$824.50

HCHG SARSCOV2&INF A&B&RSV AMP PRB

Facility

$850.00

Service Code	HCPCS 87637
Hospital Charge Code	H3060817
Hospital Revenue Code	306
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$824.50
Rate for Payer: AlohaCare Medicaid	$142.63
Rate for Payer: AlohaCare Medicare	$142.63
Rate for Payer: Cash Price	$552.50
Rate for Payer: Cash Price	$552.50
Rate for Payer: Devoted Health Medicare	$156.89
Rate for Payer: Hawaii Medical Service Association ABD	$142.63
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$142.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$142.63
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$722.50
Rate for Payer: Humana Medicare	$142.63
Rate for Payer: Kaiser Permanente Commercial	$535.50
Rate for Payer: Kaiser Permanente Medicaid	$433.50
Rate for Payer: Kaiser Permanente Medicare	$142.63
Rate for Payer: MDX Hawaii PPO	$824.50
Rate for Payer: Ohana Health Plan Medicaid	$156.89
Rate for Payer: Ohana Health Plan Medicare	$142.63
Rate for Payer: UnitedHealthcare Medicaid	$142.63
Rate for Payer: UnitedHealthcare Medicare	$142.63
Rate for Payer: University Health Alliance Commercial	$619.57

HCHG SARS-COV-2 INFLU A/B RSV XP

Facility

$804.00

Service Code	HCPCS 0241U
Hospital Charge Code	K3060003
Hospital Revenue Code	306
Min. Negotiated Rate	$410.04
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Hawaii Western Management Group Commercial	$763.80
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Kaiser Permanente Commercial	$506.52
Rate for Payer: Kaiser Permanente Medicaid	$410.04
Rate for Payer: MDX Hawaii PPO	$779.88
Rate for Payer: University Health Alliance Commercial	$586.04

HCHG SARS-COV-2 INFLU A/B RSV XP

Facility

$804.00

Service Code	HCPCS 0241U
Hospital Charge Code	K3060003
Hospital Revenue Code	306
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG SARS-COV-2 INFLU A/B RSV XP 3 TRGT

Facility

$781.00

Service Code	HCPCS 0240U
Hospital Charge Code	H3001127
Hospital Revenue Code	300
Min. Negotiated Rate	$398.31
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Hawaii Western Management Group Commercial	$741.95
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Kaiser Permanente Commercial	$492.03
Rate for Payer: Kaiser Permanente Medicaid	$398.31
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: University Health Alliance Commercial	$569.27

HCHG SARS-COV-2 INFLU A/B RSV XP 3 TRGT

Facility

$781.00

Service Code	HCPCS 0240U
Hospital Charge Code	H3001127
Hospital Revenue Code	300
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: MDX Hawaii PPO	$757.57

HCHG SARS-COV-2 TOTAL AB, QUALITATIVE - 90

Facility

$131.00

Service Code	HCPCS 86769
Hospital Charge Code	H3021030
Hospital Revenue Code	302
Min. Negotiated Rate	$42.13
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$42.13
Rate for Payer: AlohaCare Medicare	$42.13
Rate for Payer: Cash Price	$85.15
Rate for Payer: Cash Price	$85.15
Rate for Payer: Devoted Health Medicare	$46.34
Rate for Payer: Hawaii Medical Service Association ABD	$42.13
Rate for Payer: Hawaii Medical Service Association Commercial	$52.66
Rate for Payer: Hawaii Medical Service Association Medicare	$42.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.13
Rate for Payer: Hawaii Western Management Group Commercial	$42.13
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$42.13
Rate for Payer: Kaiser Permanente Commercial	$82.53
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$42.13
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$46.34
Rate for Payer: Ohana Health Plan Medicare	$42.13
Rate for Payer: UnitedHealthcare Medicaid	$42.13
Rate for Payer: UnitedHealthcare Medicare	$42.13
Rate for Payer: University Health Alliance Commercial	$95.49

HCHG SARS-COV-2 TOTAL AB, QUALITATIVE - 90

Facility

$131.00

Service Code	HCPCS 86769
Hospital Charge Code	H3021030
Hospital Revenue Code	302
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$85.15
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: MDX Hawaii PPO	$127.07

HCHG SCABIES PREP

Facility

$66.00

Service Code	HCPCS 87220
Hospital Charge Code	K3060023
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
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	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG SCABIES PREP

Facility

$66.00

Service Code	HCPCS 87220
Hospital Charge Code	K3060023
Hospital Revenue Code	306
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

HCHG SCAPULA, COMPLETE

Facility

$570.00

Service Code	HCPCS 73010
Hospital Charge Code	H3200732
Hospital Revenue Code	320
Min. Negotiated Rate	$484.50
Max. Negotiated Rate	$552.90
Rate for Payer: Cash Price	$370.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: MDX Hawaii PPO	$552.90

HCHG SCAPULA, COMPLETE

Facility

$570.00

Service Code	HCPCS 73010
Hospital Charge Code	H3200732
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$552.90
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
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	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$290.70
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$552.90
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$58.59

HCHG SCLERODERMA AB SCL-70 90

Facility

$219.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020770
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$17.93
Rate for Payer: AlohaCare Medicare	$17.93
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Devoted Health Medicare	$19.72
Rate for Payer: Hawaii Medical Service Association ABD	$24.78
Rate for Payer: Hawaii Medical Service Association Commercial	$22.41
Rate for Payer: Hawaii Medical Service Association Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$17.93
Rate for Payer: Kaiser Permanente Commercial	$137.97
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$17.93
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$19.72
Rate for Payer: Ohana Health Plan Medicare	$17.93
Rate for Payer: UnitedHealthcare Medicaid	$24.78
Rate for Payer: UnitedHealthcare Medicare	$17.93
Rate for Payer: University Health Alliance Commercial	$46.36

HCHG SCLERODERMA AB SCL-70 90

Facility

$219.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020770
Hospital Revenue Code	302
Min. Negotiated Rate	$186.15
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$142.35
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: MDX Hawaii PPO	$212.43

HCHG SCR DIGI BRST TOMO BIL

Facility

$182.00

Service Code	HCPCS 77063
Hospital Charge Code	H4010129
Hospital Revenue Code	403
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: MDX Hawaii PPO	$176.54

HCHG SCR DIGI BRST TOMO BIL

Facility

$182.00

Service Code	HCPCS 77063
Hospital Charge Code	H4010129
Hospital Revenue Code	403
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Hawaii Medical Service Association ABD	$17.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.69
Rate for Payer: Hawaii Western Management Group Commercial	$172.90
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Kaiser Permanente Commercial	$114.66
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: UnitedHealthcare Medicaid	$33.66
Rate for Payer: University Health Alliance Commercial	$113.48

HCHG SEDIMENTATION RATE AUTO

Facility

$21.00

Service Code	HCPCS 85652
Hospital Charge Code	H3050285
Hospital Revenue Code	305
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$2.70
Rate for Payer: AlohaCare Medicare	$2.70
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Devoted Health Medicare	$2.97
Rate for Payer: Hawaii Medical Service Association ABD	$3.73
Rate for Payer: Hawaii Medical Service Association Commercial	$3.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.92
Rate for Payer: Hawaii Western Management Group Commercial	$2.70
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$2.70
Rate for Payer: Kaiser Permanente Commercial	$13.23
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$2.70
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$2.97
Rate for Payer: Ohana Health Plan Medicare	$2.70
Rate for Payer: UnitedHealthcare Medicaid	$3.73
Rate for Payer: UnitedHealthcare Medicare	$2.70
Rate for Payer: University Health Alliance Commercial	$6.97

HCHG SEDIMENTATION RATE AUTO

Facility

$21.00

Service Code	HCPCS 85652
Hospital Charge Code	H3050285
Hospital Revenue Code	305
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$13.65
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: MDX Hawaii PPO	$20.37

HCHG SEGMNT PRESSURE-SNGL LEV

Facility

$761.00

Service Code	HCPCS 93922
Hospital Charge Code	H9210132
Hospital Revenue Code	921
Min. Negotiated Rate	$68.30
Max. Negotiated Rate	$738.17
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$494.65
Rate for Payer: Cash Price	$494.65
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$68.30
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$81.54
Rate for Payer: Hawaii Western Management Group Commercial	$722.95
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$479.43
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$68.30
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$554.69

HCHG SEGMNT PRESSURE-SNGL LEV

Facility

$761.00

Service Code	HCPCS 93922
Hospital Charge Code	H9210132
Hospital Revenue Code	921
Min. Negotiated Rate	$646.85
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$494.65
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: MDX Hawaii PPO	$738.17

HCHG SENSITIVITY DISK

Facility

$93.00

Service Code	HCPCS 87184
Hospital Charge Code	K3060016
Hospital Revenue Code	306
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$7.48
Rate for Payer: AlohaCare Medicare	$7.48
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$8.23
Rate for Payer: Hawaii Medical Service Association ABD	$9.53
Rate for Payer: Hawaii Medical Service Association Commercial	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.01
Rate for Payer: Hawaii Western Management Group Commercial	$7.48
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$7.48
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$7.48
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$8.23
Rate for Payer: Ohana Health Plan Medicare	$7.48
Rate for Payer: UnitedHealthcare Medicaid	$9.53
Rate for Payer: UnitedHealthcare Medicare	$7.48
Rate for Payer: University Health Alliance Commercial	$17.82

HCHG SENSITIVITY DISK

Facility

$93.00

Service Code	HCPCS 87184
Hospital Charge Code	K3060016
Hospital Revenue Code	306
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: MDX Hawaii PPO	$90.21

HCHG SENSITIVITY ENZYME

Facility

$36.00

Service Code	HCPCS 87185
Hospital Charge Code	K3060017
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

HCHG SENSITIVITY ENZYME

Facility

$36.00

Service Code	HCPCS 87185
Hospital Charge Code	K3060017
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

Know your out-of-pocket cost for care.

All Charges