Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SENSITIVITY FUNGI EA

Facility

$194.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060434
Hospital Revenue Code	306
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$126.10
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: MDX Hawaii PPO	$188.18

HCHG SENSITIVITY FUNGI EA

Facility

$194.00

Service Code	HCPCS 87186
Hospital Charge Code	H3060434
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$122.22
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG SENSITIVITY MIC

Facility

$146.00

Service Code	HCPCS 87186
Hospital Charge Code	K3060020
Hospital Revenue Code	306
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$94.90
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: MDX Hawaii PPO	$141.62

HCHG SENSITIVITY MIC

Facility

$146.00

Service Code	HCPCS 87186
Hospital Charge Code	K3060020
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$8.65
Rate for Payer: Cash Price	$94.90
Rate for Payer: Cash Price	$94.90
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$8.65
Rate for Payer: Kaiser Permanente Commercial	$91.98
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$8.65
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$9.52
Rate for Payer: Ohana Health Plan Medicare	$8.65
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$8.65
Rate for Payer: University Health Alliance Commercial	$22.35

HCHG SEQUENCE ANALYSIS PANEL; HEME 5-50 GENES - 90

Facility

$3,010.00

Service Code	HCPCS 81450
Hospital Charge Code	H3100206
Hospital Revenue Code	310
Min. Negotiated Rate	$569.65
Max. Negotiated Rate	$2,919.70
Rate for Payer: AlohaCare Medicaid	$759.53
Rate for Payer: AlohaCare Medicare	$759.53
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Devoted Health Medicare	$835.48
Rate for Payer: Hawaii Medical Service Association ABD	$648.40
Rate for Payer: Hawaii Medical Service Association Commercial	$949.41
Rate for Payer: Hawaii Medical Service Association Medicare	$759.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$648.40
Rate for Payer: Hawaii Western Management Group Commercial	$759.53
Rate for Payer: Health Management Network Commercial	$2,558.50
Rate for Payer: Humana Medicare	$759.53
Rate for Payer: Kaiser Permanente Commercial	$1,896.30
Rate for Payer: Kaiser Permanente Medicaid	$1,535.10
Rate for Payer: Kaiser Permanente Medicare	$759.53
Rate for Payer: MDX Hawaii PPO	$2,919.70
Rate for Payer: Ohana Health Plan Medicaid	$835.48
Rate for Payer: Ohana Health Plan Medicare	$759.53
Rate for Payer: UnitedHealthcare Medicaid	$569.65
Rate for Payer: UnitedHealthcare Medicare	$759.53
Rate for Payer: University Health Alliance Commercial	$2,193.99

HCHG SEQUENCE ANALYSIS PANEL; HEME 5-50 GENES - 90

Facility

$3,010.00

Service Code	HCPCS 81450
Hospital Charge Code	H3100206
Hospital Revenue Code	310
Min. Negotiated Rate	$2,558.50
Max. Negotiated Rate	$2,919.70
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Health Management Network Commercial	$2,558.50
Rate for Payer: MDX Hawaii PPO	$2,919.70

HCHG SEROTONIN BLOOD 90

Facility

$380.00

Service Code	HCPCS 84260
Hospital Charge Code	H3011144
Hospital Revenue Code	301
Min. Negotiated Rate	$30.98
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$30.98
Rate for Payer: AlohaCare Medicare	$30.98
Rate for Payer: Cash Price	$247.00
Rate for Payer: Cash Price	$247.00
Rate for Payer: Devoted Health Medicare	$34.08
Rate for Payer: Hawaii Medical Service Association ABD	$42.81
Rate for Payer: Hawaii Medical Service Association Commercial	$38.73
Rate for Payer: Hawaii Medical Service Association Medicare	$30.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.95
Rate for Payer: Hawaii Western Management Group Commercial	$30.98
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$30.98
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$30.98
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$34.08
Rate for Payer: Ohana Health Plan Medicare	$30.98
Rate for Payer: UnitedHealthcare Medicaid	$42.81
Rate for Payer: UnitedHealthcare Medicare	$30.98
Rate for Payer: University Health Alliance Commercial	$80.07

HCHG SEROTONIN BLOOD 90

Facility

$380.00

Service Code	HCPCS 84260
Hospital Charge Code	H3011144
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 SEROTONIN RELEASE ASSAY, UFH

Facility

$226.00

Service Code	HCPCS 86022
Hospital Charge Code	H3020959
Hospital Revenue Code	302
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$18.37
Rate for Payer: AlohaCare Medicare	$18.37
Rate for Payer: Cash Price	$146.90
Rate for Payer: Cash Price	$146.90
Rate for Payer: Devoted Health Medicare	$20.21
Rate for Payer: Hawaii Medical Service Association ABD	$25.38
Rate for Payer: Hawaii Medical Service Association Commercial	$22.96
Rate for Payer: Hawaii Medical Service Association Medicare	$18.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.65
Rate for Payer: Hawaii Western Management Group Commercial	$18.37
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$18.37
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$18.37
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$20.21
Rate for Payer: Ohana Health Plan Medicare	$18.37
Rate for Payer: UnitedHealthcare Medicaid	$25.38
Rate for Payer: UnitedHealthcare Medicare	$18.37
Rate for Payer: University Health Alliance Commercial	$47.47

HCHG SEROTONIN RELEASE ASSAY, UFH

Facility

$226.00

Service Code	HCPCS 86022
Hospital Charge Code	H3020959
Hospital Revenue Code	302
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 SEROTONIN SERUM

Facility

$380.00

Service Code	HCPCS 84260
Hospital Charge Code	H3011146
Hospital Revenue Code	301
Min. Negotiated Rate	$30.98
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$30.98
Rate for Payer: AlohaCare Medicare	$30.98
Rate for Payer: Cash Price	$247.00
Rate for Payer: Cash Price	$247.00
Rate for Payer: Devoted Health Medicare	$34.08
Rate for Payer: Hawaii Medical Service Association ABD	$42.81
Rate for Payer: Hawaii Medical Service Association Commercial	$38.73
Rate for Payer: Hawaii Medical Service Association Medicare	$30.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.95
Rate for Payer: Hawaii Western Management Group Commercial	$30.98
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$30.98
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$30.98
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$34.08
Rate for Payer: Ohana Health Plan Medicare	$30.98
Rate for Payer: UnitedHealthcare Medicaid	$42.81
Rate for Payer: UnitedHealthcare Medicare	$30.98
Rate for Payer: University Health Alliance Commercial	$80.07

HCHG SEROTONIN SERUM

Facility

$380.00

Service Code	HCPCS 84260
Hospital Charge Code	H3011146
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 SGOT

Facility

$81.00

Service Code	HCPCS 84450
Hospital Charge Code	H3011150
Hospital Revenue Code	301
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$52.65
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

HCHG SGOT

Facility

$81.00

Service Code	HCPCS 84450
Hospital Charge Code	H3011150
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$78.57
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.14
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	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.14
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.36

HCHG SGPT

Facility

$81.00

Service Code	HCPCS 84460
Hospital Charge Code	H3011152
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$78.57
Rate for Payer: AlohaCare Medicaid	$5.30
Rate for Payer: AlohaCare Medicare	$5.30
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Devoted Health Medicare	$5.83
Rate for Payer: Hawaii Medical Service Association ABD	$7.32
Rate for Payer: Hawaii Medical Service Association Commercial	$6.62
Rate for Payer: Hawaii Medical Service Association Medicare	$5.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.69
Rate for Payer: Hawaii Western Management Group Commercial	$5.30
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Humana Medicare	$5.30
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: Kaiser Permanente Medicare	$5.30
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: Ohana Health Plan Medicaid	$5.83
Rate for Payer: Ohana Health Plan Medicare	$5.30
Rate for Payer: UnitedHealthcare Medicaid	$7.32
Rate for Payer: UnitedHealthcare Medicare	$5.30
Rate for Payer: University Health Alliance Commercial	$13.69

HCHG SGPT

Facility

$81.00

Service Code	HCPCS 84460
Hospital Charge Code	H3011152
Hospital Revenue Code	301
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$52.65
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

HCHG SHIGA-LIKE TOXIN

Facility

$91.00

Service Code	HCPCS 87427
Hospital Charge Code	H3060729
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 SHIGA-LIKE TOXIN

Facility

$91.00

Service Code	HCPCS 87427
Hospital Charge Code	H3060729
Hospital Revenue Code	306
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$10.06
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.57
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$10.06
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG SHIGA TOXIN 1

Facility

$132.00

Service Code	HCPCS 87899
Hospital Charge Code	K3060049
Hospital Revenue Code	306
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$16.07
Rate for Payer: AlohaCare Medicare	$16.07
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$17.68
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$16.07
Rate for Payer: Kaiser Permanente Commercial	$83.16
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$16.07
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$17.68
Rate for Payer: Ohana Health Plan Medicare	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.07
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG SHIGA TOXIN 1

Facility

$132.00

Service Code	HCPCS 87899
Hospital Charge Code	K3060049
Hospital Revenue Code	306
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: MDX Hawaii PPO	$128.04

HCHG SHIGA TOXIN 2

Facility

$132.00

Service Code	HCPCS 87899
Hospital Charge Code	K3060050
Hospital Revenue Code	306
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: MDX Hawaii PPO	$128.04

HCHG SHIGA TOXIN 2

Facility

$132.00

Service Code	HCPCS 87899
Hospital Charge Code	K3060050
Hospital Revenue Code	306
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$16.07
Rate for Payer: AlohaCare Medicare	$16.07
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$17.68
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.07
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$16.07
Rate for Payer: Kaiser Permanente Commercial	$83.16
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$16.07
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$17.68
Rate for Payer: Ohana Health Plan Medicare	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$16.07
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG SHOULDER 1 VIEW

Facility

$476.00

Service Code	HCPCS 73020
Hospital Charge Code	H3200742
Hospital Revenue Code	320
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$15.78
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	$16.87
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$15.78
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$49.15

HCHG SHOULDER 1 VIEW

Facility

$476.00

Service Code	HCPCS 73020
Hospital Charge Code	H3200742
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG SHOULDER ARTHROGRAM *

Facility

$2,034.00

Service Code	HCPCS 73040
Hospital Charge Code	H3200744
Hospital Revenue Code	320
Min. Negotiated Rate	$1,728.90
Max. Negotiated Rate	$1,972.98
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Health Management Network Commercial	$1,728.90
Rate for Payer: MDX Hawaii PPO	$1,972.98

Know your out-of-pocket cost for care.

All Charges