Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG TC99M MAA, UP TO 10MCI

Facility

$714.00

Service Code	HCPCS A9540
Hospital Charge Code	H3430138
Hospital Revenue Code	343
Min. Negotiated Rate	$364.14
Max. Negotiated Rate	$692.58
Rate for Payer: Cash Price	$464.10
Rate for Payer: Hawaii Western Management Group Commercial	$678.30
Rate for Payer: Health Management Network Commercial	$606.90
Rate for Payer: Kaiser Permanente Commercial	$449.82
Rate for Payer: Kaiser Permanente Medicaid	$364.14
Rate for Payer: MDX Hawaii PPO	$692.58
Rate for Payer: University Health Alliance Commercial	$520.43

HCHG TC99M MAA, UP TO 10MCI

Facility

$714.00

Service Code	HCPCS A9540
Hospital Charge Code	H3430138
Hospital Revenue Code	343
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$692.58
Rate for Payer: Cash Price	$464.10
Rate for Payer: Health Management Network Commercial	$606.90
Rate for Payer: MDX Hawaii PPO	$692.58

HCHG TC99M MAG3, UP TO 15MCI

Facility

$2,012.00

Service Code	HCPCS A9562
Hospital Charge Code	H3430140
Hospital Revenue Code	343
Min. Negotiated Rate	$1,026.12
Max. Negotiated Rate	$1,951.64
Rate for Payer: Cash Price	$1,307.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.40
Rate for Payer: Health Management Network Commercial	$1,710.20
Rate for Payer: Kaiser Permanente Commercial	$1,267.56
Rate for Payer: Kaiser Permanente Medicaid	$1,026.12
Rate for Payer: MDX Hawaii PPO	$1,951.64
Rate for Payer: University Health Alliance Commercial	$1,466.55

HCHG TC99M MAG3, UP TO 15MCI

Facility

$2,012.00

Service Code	HCPCS A9562
Hospital Charge Code	H3430140
Hospital Revenue Code	343
Min. Negotiated Rate	$1,710.20
Max. Negotiated Rate	$1,951.64
Rate for Payer: Cash Price	$1,307.80
Rate for Payer: Health Management Network Commercial	$1,710.20
Rate for Payer: MDX Hawaii PPO	$1,951.64

HCHG TC99M MDP, UP TO 30MCI, PER STUDY DOSE

Facility

$53.00

Service Code	HCPCS A9503
Hospital Charge Code	H3430142
Hospital Revenue Code	343
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Hawaii Western Management Group Commercial	$50.35
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$33.39
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: UnitedHealthcare Medicaid	$31.20
Rate for Payer: University Health Alliance Commercial	$38.63

HCHG TC99M MDP, UP TO 30MCI, PER STUDY DOSE

Facility

$53.00

Service Code	HCPCS A9503
Hospital Charge Code	H3430142
Hospital Revenue Code	343
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: MDX Hawaii PPO	$51.41

HCHG TC99M MEBROFENIN

Facility

$150.00

Service Code	HCPCS A9537
Hospital Charge Code	H3430226
Hospital Revenue Code	343
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: University Health Alliance Commercial	$109.33

HCHG TC99M MEBROFENIN

Facility

$150.00

Service Code	HCPCS A9537
Hospital Charge Code	H3430226
Hospital Revenue Code	343
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

HCHG TC99M PERTECHNETATE, PER MCI

Facility

$71.00

Service Code	HCPCS A9512
Hospital Charge Code	H3430144
Hospital Revenue Code	343
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

HCHG TC99M PERTECHNETATE, PER MCI

Facility

$71.00

Service Code	HCPCS A9512
Hospital Charge Code	H3430144
Hospital Revenue Code	343
Min. Negotiated Rate	$36.21
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: University Health Alliance Commercial	$51.75

HCHG TC99M PYROPHOSPHATE, PER STUDY DOSE

Facility

$99.00

Service Code	HCPCS A9538
Hospital Charge Code	H3430146
Hospital Revenue Code	343
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

HCHG TC99M PYROPHOSPHATE, PER STUDY DOSE

Facility

$99.00

Service Code	HCPCS A9538
Hospital Charge Code	H3430146
Hospital Revenue Code	343
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$64.35
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: University Health Alliance Commercial	$72.16

HCHG TC99M SULFUR COLLOID UP TO 20MCI

Facility

$841.00

Service Code	HCPCS A9541
Hospital Charge Code	H3430150
Hospital Revenue Code	343
Min. Negotiated Rate	$714.85
Max. Negotiated Rate	$815.77
Rate for Payer: Cash Price	$546.65
Rate for Payer: Health Management Network Commercial	$714.85
Rate for Payer: MDX Hawaii PPO	$815.77

HCHG TC99M SULFUR COLLOID UP TO 20MCI

Facility

$841.00

Service Code	HCPCS A9541
Hospital Charge Code	H3430150
Hospital Revenue Code	343
Min. Negotiated Rate	$428.91
Max. Negotiated Rate	$815.77
Rate for Payer: Cash Price	$546.65
Rate for Payer: Hawaii Western Management Group Commercial	$798.95
Rate for Payer: Health Management Network Commercial	$714.85
Rate for Payer: Kaiser Permanente Commercial	$529.83
Rate for Payer: Kaiser Permanente Medicaid	$428.91
Rate for Payer: MDX Hawaii PPO	$815.77
Rate for Payer: University Health Alliance Commercial	$613.00

HCHG TC99M ULTRATAG, UP TO 30MCI

Facility

$177.00

Service Code	HCPCS A9560
Hospital Charge Code	H3430154
Hospital Revenue Code	343
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: MDX Hawaii PPO	$171.69

HCHG TC99M ULTRATAG, UP TO 30MCI

Facility

$177.00

Service Code	HCPCS A9560
Hospital Charge Code	H3430154
Hospital Revenue Code	343
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Cash Price	$115.05
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$111.51
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: UnitedHealthcare Medicaid	$55.00
Rate for Payer: University Health Alliance Commercial	$129.02

HCHG TC99 TILMANOCEPT DIAG 0.5MCI

Facility

$1,199.00

Service Code	HCPCS A9520
Hospital Charge Code	H3430215
Hospital Revenue Code	343
Min. Negotiated Rate	$1,019.15
Max. Negotiated Rate	$1,163.03
Rate for Payer: Cash Price	$779.35
Rate for Payer: Health Management Network Commercial	$1,019.15
Rate for Payer: MDX Hawaii PPO	$1,163.03

HCHG TC99 TILMANOCEPT DIAG 0.5MCI

Facility

$1,199.00

Service Code	HCPCS A9520
Hospital Charge Code	H3430215
Hospital Revenue Code	343
Min. Negotiated Rate	$611.49
Max. Negotiated Rate	$1,163.03
Rate for Payer: Cash Price	$779.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,139.05
Rate for Payer: Health Management Network Commercial	$1,019.15
Rate for Payer: Kaiser Permanente Commercial	$755.37
Rate for Payer: Kaiser Permanente Medicaid	$611.49
Rate for Payer: MDX Hawaii PPO	$1,163.03
Rate for Payer: University Health Alliance Commercial	$873.95

HCHG T CELL ABS CD4/CD8 COUNT

Facility

$484.00

Service Code	HCPCS 86360
Hospital Charge Code	H3020847
Hospital Revenue Code	302
Min. Negotiated Rate	$411.40
Max. Negotiated Rate	$469.48
Rate for Payer: Cash Price	$314.60
Rate for Payer: Health Management Network Commercial	$411.40
Rate for Payer: MDX Hawaii PPO	$469.48

HCHG T CELL ABS CD4/CD8 COUNT

Facility

$484.00

Service Code	HCPCS 86360
Hospital Charge Code	H3020847
Hospital Revenue Code	302
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$469.48
Rate for Payer: AlohaCare Medicaid	$46.98
Rate for Payer: AlohaCare Medicare	$46.98
Rate for Payer: Cash Price	$314.60
Rate for Payer: Cash Price	$314.60
Rate for Payer: Devoted Health Medicare	$51.68
Rate for Payer: Hawaii Medical Service Association ABD	$64.93
Rate for Payer: Hawaii Medical Service Association Commercial	$58.73
Rate for Payer: Hawaii Medical Service Association Medicare	$46.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$68.18
Rate for Payer: Hawaii Western Management Group Commercial	$46.98
Rate for Payer: Health Management Network Commercial	$411.40
Rate for Payer: Humana Medicare	$46.98
Rate for Payer: Kaiser Permanente Commercial	$304.92
Rate for Payer: Kaiser Permanente Medicaid	$246.84
Rate for Payer: Kaiser Permanente Medicare	$46.98
Rate for Payer: MDX Hawaii PPO	$469.48
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$46.98
Rate for Payer: UnitedHealthcare Medicaid	$64.93
Rate for Payer: UnitedHealthcare Medicare	$46.98
Rate for Payer: University Health Alliance Commercial	$121.45

HCHG T-CELL CLONAL (1)

Facility

$1,039.00

Service Code	HCPCS 81342
Hospital Charge Code	H3100222
Hospital Revenue Code	310
Min. Negotiated Rate	$88.87
Max. Negotiated Rate	$1,007.83
Rate for Payer: AlohaCare Medicaid	$201.50
Rate for Payer: AlohaCare Medicare	$201.50
Rate for Payer: Cash Price	$675.35
Rate for Payer: Cash Price	$675.35
Rate for Payer: Devoted Health Medicare	$221.65
Rate for Payer: Hawaii Medical Service Association Commercial	$251.88
Rate for Payer: Hawaii Medical Service Association Medicare	$201.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$269.73
Rate for Payer: Hawaii Western Management Group Commercial	$201.50
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: Humana Medicare	$201.50
Rate for Payer: Kaiser Permanente Commercial	$654.57
Rate for Payer: Kaiser Permanente Medicaid	$529.89
Rate for Payer: Kaiser Permanente Medicare	$201.50
Rate for Payer: MDX Hawaii PPO	$1,007.83
Rate for Payer: Ohana Health Plan Medicaid	$221.65
Rate for Payer: Ohana Health Plan Medicare	$201.50
Rate for Payer: UnitedHealthcare Medicaid	$88.87
Rate for Payer: UnitedHealthcare Medicare	$201.50
Rate for Payer: University Health Alliance Commercial	$757.33

HCHG T-CELL CLONAL (1)

Facility

$1,039.00

Service Code	HCPCS 81342
Hospital Charge Code	H3100222
Hospital Revenue Code	310
Min. Negotiated Rate	$883.15
Max. Negotiated Rate	$1,007.83
Rate for Payer: Cash Price	$675.35
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: MDX Hawaii PPO	$1,007.83

HCHG T-CELL CLONAL (2)

Facility

$1,128.00

Service Code	HCPCS 81340
Hospital Charge Code	H3100223
Hospital Revenue Code	310
Min. Negotiated Rate	$88.87
Max. Negotiated Rate	$1,094.16
Rate for Payer: AlohaCare Medicaid	$208.92
Rate for Payer: AlohaCare Medicare	$208.92
Rate for Payer: Cash Price	$733.20
Rate for Payer: Cash Price	$733.20
Rate for Payer: Devoted Health Medicare	$229.81
Rate for Payer: Hawaii Medical Service Association Commercial	$261.15
Rate for Payer: Hawaii Medical Service Association Medicare	$208.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$279.65
Rate for Payer: Hawaii Western Management Group Commercial	$208.92
Rate for Payer: Health Management Network Commercial	$958.80
Rate for Payer: Humana Medicare	$208.92
Rate for Payer: Kaiser Permanente Commercial	$710.64
Rate for Payer: Kaiser Permanente Medicaid	$575.28
Rate for Payer: Kaiser Permanente Medicare	$208.92
Rate for Payer: MDX Hawaii PPO	$1,094.16
Rate for Payer: Ohana Health Plan Medicaid	$229.81
Rate for Payer: Ohana Health Plan Medicare	$208.92
Rate for Payer: UnitedHealthcare Medicaid	$88.87
Rate for Payer: UnitedHealthcare Medicare	$208.92
Rate for Payer: University Health Alliance Commercial	$822.20

HCHG T-CELL CLONAL (2)

Facility

$1,128.00

Service Code	HCPCS 81340
Hospital Charge Code	H3100223
Hospital Revenue Code	310
Min. Negotiated Rate	$958.80
Max. Negotiated Rate	$1,094.16
Rate for Payer: Cash Price	$733.20
Rate for Payer: Health Management Network Commercial	$958.80
Rate for Payer: MDX Hawaii PPO	$1,094.16

HCHG T CELLS TOTAL COUNT

Facility

$389.00

Service Code	HCPCS 86359
Hospital Charge Code	H3110114
Hospital Revenue Code	302
Min. Negotiated Rate	$37.73
Max. Negotiated Rate	$377.33
Rate for Payer: AlohaCare Medicaid	$37.73
Rate for Payer: AlohaCare Medicare	$37.73
Rate for Payer: Cash Price	$252.85
Rate for Payer: Cash Price	$252.85
Rate for Payer: Devoted Health Medicare	$41.50
Rate for Payer: Hawaii Medical Service Association ABD	$52.13
Rate for Payer: Hawaii Medical Service Association Commercial	$47.16
Rate for Payer: Hawaii Medical Service Association Medicare	$37.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.74
Rate for Payer: Hawaii Western Management Group Commercial	$37.73
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Humana Medicare	$37.73
Rate for Payer: Kaiser Permanente Commercial	$245.07
Rate for Payer: Kaiser Permanente Medicaid	$198.39
Rate for Payer: Kaiser Permanente Medicare	$37.73
Rate for Payer: MDX Hawaii PPO	$377.33
Rate for Payer: Ohana Health Plan Medicaid	$41.50
Rate for Payer: Ohana Health Plan Medicare	$37.73
Rate for Payer: UnitedHealthcare Medicaid	$52.13
Rate for Payer: UnitedHealthcare Medicare	$37.73
Rate for Payer: University Health Alliance Commercial	$97.50

Know your out-of-pocket cost for care.

All Charges