Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ASSAY OF FREE THYROXINE

Professional

Both

$18.00

Service Code	HCPCS 84439
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$15.30
Rate for Payer: AlohaCare Medicaid	$12.46
Rate for Payer: AlohaCare Medicare	$9.02
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cash Price	$11.70
Rate for Payer: Devoted Health Medicare	$9.92
Rate for Payer: Hawaii Medical Service Association Medicare	$9.02
Rate for Payer: Hawaii Western Management Group Commercial	$12.45
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$10.82
Rate for Payer: Kaiser Permanente Medicaid	$10.82
Rate for Payer: Kaiser Permanente Medicare	$10.82
Rate for Payer: Ohana Health Plan Medicaid	$12.46
Rate for Payer: Ohana Health Plan Medicare	$9.02
Rate for Payer: UnitedHealthcare Medicaid	$12.46
Rate for Payer: UnitedHealthcare Medicare	$9.02

ASSAY OF IRON

Professional

Both

$12.00

Service Code	HCPCS 83540
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$10.20
Rate for Payer: AlohaCare Medicaid	$8.95
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Western Management Group Commercial	$8.95
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.76
Rate for Payer: Kaiser Permanente Medicaid	$7.76
Rate for Payer: Kaiser Permanente Medicare	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$8.95
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$6.47

ASSAY OF L7383TRANSFERRIN

Professional

Both

$25.00

Service Code	HCPCS 84466
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$21.25
Rate for Payer: AlohaCare Medicaid	$17.65
Rate for Payer: AlohaCare Medicare	$12.76
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Hawaii Medical Service Association Medicare	$12.76
Rate for Payer: Hawaii Western Management Group Commercial	$17.65
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$15.31
Rate for Payer: Kaiser Permanente Medicaid	$15.31
Rate for Payer: Kaiser Permanente Medicare	$15.31
Rate for Payer: Ohana Health Plan Medicaid	$17.65
Rate for Payer: Ohana Health Plan Medicare	$12.76
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: UnitedHealthcare Medicare	$12.76

ASSAY OF MAGNESIUM

Professional

Both

$13.00

Service Code	HCPCS 83735
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$11.05
Rate for Payer: AlohaCare Medicaid	$9.26
Rate for Payer: AlohaCare Medicare	$6.70
Rate for Payer: Cash Price	$8.45
Rate for Payer: Cash Price	$8.45
Rate for Payer: Devoted Health Medicare	$7.37
Rate for Payer: Hawaii Medical Service Association Medicare	$6.70
Rate for Payer: Hawaii Western Management Group Commercial	$9.25
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$8.04
Rate for Payer: Kaiser Permanente Medicaid	$8.04
Rate for Payer: Kaiser Permanente Medicare	$8.04
Rate for Payer: Ohana Health Plan Medicaid	$9.26
Rate for Payer: Ohana Health Plan Medicare	$6.70
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: UnitedHealthcare Medicare	$6.70

ASSAY OF PHOSPHATASE ALKALINE

Professional

Both

$10.00

Service Code	HCPCS 84075
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicaid	$7.15
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Western Management Group Commercial	$7.15
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.22
Rate for Payer: Kaiser Permanente Medicaid	$6.22
Rate for Payer: Kaiser Permanente Medicare	$6.22
Rate for Payer: Ohana Health Plan Medicaid	$7.15
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18

ASSAY OF PHOSPHORUS INORGANIC

Professional

Both

$9.00

Service Code	HCPCS 84100
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$7.65
Rate for Payer: AlohaCare Medicaid	$6.56
Rate for Payer: AlohaCare Medicare	$4.74
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$5.21
Rate for Payer: Hawaii Medical Service Association Medicare	$4.74
Rate for Payer: Hawaii Western Management Group Commercial	$6.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.69
Rate for Payer: Kaiser Permanente Medicaid	$5.69
Rate for Payer: Kaiser Permanente Medicare	$5.69
Rate for Payer: Ohana Health Plan Medicaid	$6.56
Rate for Payer: Ohana Health Plan Medicare	$4.74
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$4.74

ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL

Professional

Both

$36.00

Service Code	HCPCS 84153
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$30.60
Rate for Payer: AlohaCare Medicaid	$25.42
Rate for Payer: AlohaCare Medicare	$18.39
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$20.23
Rate for Payer: Hawaii Medical Service Association Medicare	$18.39
Rate for Payer: Hawaii Western Management Group Commercial	$25.43
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$22.07
Rate for Payer: Kaiser Permanente Medicaid	$22.07
Rate for Payer: Kaiser Permanente Medicare	$22.07
Rate for Payer: Ohana Health Plan Medicaid	$25.42
Rate for Payer: Ohana Health Plan Medicare	$18.39
Rate for Payer: UnitedHealthcare Medicaid	$25.42
Rate for Payer: UnitedHealthcare Medicare	$18.39

ASSAY OF TESTOSTERONE TOTAL

Professional

Both

$52.00

Service Code	HCPCS 84403
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$44.20
Rate for Payer: AlohaCare Medicaid	$35.68
Rate for Payer: AlohaCare Medicare	$25.81
Rate for Payer: Cash Price	$33.80
Rate for Payer: Cash Price	$33.80
Rate for Payer: Devoted Health Medicare	$28.39
Rate for Payer: Hawaii Medical Service Association Medicare	$25.81
Rate for Payer: Hawaii Western Management Group Commercial	$35.68
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$30.97
Rate for Payer: Kaiser Permanente Medicaid	$30.97
Rate for Payer: Kaiser Permanente Medicare	$30.97
Rate for Payer: Ohana Health Plan Medicaid	$35.68
Rate for Payer: Ohana Health Plan Medicare	$25.81
Rate for Payer: UnitedHealthcare Medicaid	$35.68
Rate for Payer: UnitedHealthcare Medicare	$25.81

ASSAY OF THYROID STIMULATING HORMONE TSH

Professional

Both

$34.00

Service Code	HCPCS 84443
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$28.90
Rate for Payer: AlohaCare Medicaid	$23.21
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Western Management Group Commercial	$23.20
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$20.16
Rate for Payer: Kaiser Permanente Medicaid	$20.16
Rate for Payer: Kaiser Permanente Medicare	$20.16
Rate for Payer: Ohana Health Plan Medicaid	$23.21
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$16.80

ASSAY OF THYROXINE TOTAL

Professional

Both

$14.00

Service Code	HCPCS 84436
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$11.90
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$6.87
Rate for Payer: Cash Price	$9.10
Rate for Payer: Cash Price	$9.10
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.87
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$8.24
Rate for Payer: Kaiser Permanente Medicaid	$8.24
Rate for Payer: Kaiser Permanente Medicare	$8.24
Rate for Payer: Ohana Health Plan Medicaid	$9.50
Rate for Payer: Ohana Health Plan Medicare	$6.87
Rate for Payer: UnitedHealthcare Medicaid	$9.50
Rate for Payer: UnitedHealthcare Medicare	$6.87

ASSAY OF TOTAL ESTRADIOL

Professional

Both

$55.00

Service Code	HCPCS 82670
Min. Negotiated Rate	$27.94
Max. Negotiated Rate	$46.75
Rate for Payer: AlohaCare Medicaid	$38.62
Rate for Payer: AlohaCare Medicare	$27.94
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$30.73
Rate for Payer: Hawaii Medical Service Association Medicare	$27.94
Rate for Payer: Hawaii Western Management Group Commercial	$38.63
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$33.53
Rate for Payer: Kaiser Permanente Medicaid	$33.53
Rate for Payer: Kaiser Permanente Medicare	$33.53
Rate for Payer: Ohana Health Plan Medicaid	$38.62
Rate for Payer: Ohana Health Plan Medicare	$27.94
Rate for Payer: UnitedHealthcare Medicaid	$38.62
Rate for Payer: UnitedHealthcare Medicare	$27.94

ASSAY OF TRIIODOTHYRONINE T3 FREE

Professional

Both

$34.00

Service Code	HCPCS 84481
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$28.90
Rate for Payer: AlohaCare Medicaid	$23.41
Rate for Payer: AlohaCare Medicare	$16.94
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.63
Rate for Payer: Hawaii Medical Service Association Medicare	$16.94
Rate for Payer: Hawaii Western Management Group Commercial	$23.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$20.33
Rate for Payer: Kaiser Permanente Medicaid	$20.33
Rate for Payer: Kaiser Permanente Medicare	$20.33
Rate for Payer: Ohana Health Plan Medicaid	$23.41
Rate for Payer: Ohana Health Plan Medicare	$16.94
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$16.94

ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3

Professional

Both

$28.00

Service Code	HCPCS 84480
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$23.80
Rate for Payer: AlohaCare Medicaid	$19.60
Rate for Payer: AlohaCare Medicare	$14.18
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.60
Rate for Payer: Hawaii Medical Service Association Medicare	$14.18
Rate for Payer: Hawaii Western Management Group Commercial	$19.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$17.02
Rate for Payer: Kaiser Permanente Medicaid	$17.02
Rate for Payer: Kaiser Permanente Medicare	$17.02
Rate for Payer: Ohana Health Plan Medicaid	$19.60
Rate for Payer: Ohana Health Plan Medicare	$14.18
Rate for Payer: UnitedHealthcare Medicaid	$19.60
Rate for Payer: UnitedHealthcare Medicare	$14.18

ASSAY OF UREA NITROGEN QUANTITATIVE

Professional

Both

$8.00

Service Code	HCPCS 84520
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$6.80
Rate for Payer: AlohaCare Medicaid	$5.45
Rate for Payer: AlohaCare Medicare	$3.95
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Devoted Health Medicare	$4.34
Rate for Payer: Hawaii Medical Service Association Medicare	$3.95
Rate for Payer: Hawaii Western Management Group Commercial	$5.45
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$4.74
Rate for Payer: Kaiser Permanente Medicaid	$4.74
Rate for Payer: Kaiser Permanente Medicare	$4.74
Rate for Payer: Ohana Health Plan Medicaid	$5.45
Rate for Payer: Ohana Health Plan Medicare	$3.95
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$3.95

ASTHMA

Facility

$2,062.60

Service Code	APR-DRG 1411
Min. Negotiated Rate	$2,062.60
Max. Negotiated Rate	$2,062.60
Rate for Payer: AlohaCare Medicaid	$2,062.60
Rate for Payer: Hawaii Medical Service Association ABD	$2,062.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,062.60
Rate for Payer: Kaiser Permanente Medicaid	$2,062.60
Rate for Payer: Ohana Health Plan Medicaid	$2,062.60
Rate for Payer: UnitedHealthcare Medicaid	$2,062.60

ASTHMA

Facility

$6,906.13

Service Code	APR-DRG 1414
Min. Negotiated Rate	$6,906.13
Max. Negotiated Rate	$6,906.13
Rate for Payer: AlohaCare Medicaid	$6,906.13
Rate for Payer: Hawaii Medical Service Association ABD	$6,906.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,906.13
Rate for Payer: Kaiser Permanente Medicaid	$6,906.13
Rate for Payer: Ohana Health Plan Medicaid	$6,906.13
Rate for Payer: UnitedHealthcare Medicaid	$6,906.13

ASTHMA

Facility

$2,903.18

Service Code	APR-DRG 1412
Min. Negotiated Rate	$2,903.18
Max. Negotiated Rate	$2,903.18
Rate for Payer: AlohaCare Medicaid	$2,903.18
Rate for Payer: Hawaii Medical Service Association ABD	$2,903.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,903.18
Rate for Payer: Kaiser Permanente Medicaid	$2,903.18
Rate for Payer: Ohana Health Plan Medicaid	$2,903.18
Rate for Payer: UnitedHealthcare Medicaid	$2,903.18

ASTHMA

Facility

$4,057.71

Service Code	APR-DRG 1413
Min. Negotiated Rate	$4,057.71
Max. Negotiated Rate	$4,057.71
Rate for Payer: AlohaCare Medicaid	$4,057.71
Rate for Payer: Hawaii Medical Service Association ABD	$4,057.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,057.71
Rate for Payer: Kaiser Permanente Medicaid	$4,057.71
Rate for Payer: Ohana Health Plan Medicaid	$4,057.71
Rate for Payer: UnitedHealthcare Medicaid	$4,057.71

ATENOLOL 25 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$2.87
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$4.20
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$2.78
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$2.25
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$4.29
Rate for Payer: UnitedHealthcare Medicaid	$2.65
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$3.22

ATENOLOL 25 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$4.29
Rate for Payer: Cash Price	$2.87
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$4.29

ATENOLOL 50 MG PO TABLET

Facility

$4.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.78
Rate for Payer: Cash Price	$3.20
Rate for Payer: Health Management Network Commercial	$4.19
Rate for Payer: MDX Hawaii PPO	$4.78

ATENOLOL 50 MG PO TABLET

Facility

$4.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$4.78
Rate for Payer: Cash Price	$3.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.68
Rate for Payer: Health Management Network Commercial	$4.19
Rate for Payer: Kaiser Permanente Commercial	$3.11
Rate for Payer: Kaiser Permanente Medicaid	$2.51
Rate for Payer: MDX Hawaii PPO	$4.78
Rate for Payer: UnitedHealthcare Medicaid	$2.96
Rate for Payer: University Health Alliance Commercial	$3.59

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) IV SOLN

Facility

$15,025.64

Service Code	HCPCS J9022
Hospital Revenue Code	636
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$14,574.87
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$94.00
Rate for Payer: Cash Price	$9,766.67
Rate for Payer: Cash Price	$9,766.67
Rate for Payer: Devoted Health Medicare	$103.40
Rate for Payer: Hawaii Medical Service Association ABD	$91.02
Rate for Payer: Hawaii Medical Service Association Commercial	$117.50
Rate for Payer: Hawaii Medical Service Association Medicare	$94.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$91.02
Rate for Payer: Hawaii Western Management Group Commercial	$14,274.36
Rate for Payer: Health Management Network Commercial	$12,771.79
Rate for Payer: Humana Medicare	$94.00
Rate for Payer: Kaiser Permanente Commercial	$9,466.15
Rate for Payer: Kaiser Permanente Medicaid	$7,663.08
Rate for Payer: Kaiser Permanente Medicare	$94.00
Rate for Payer: MDX Hawaii PPO	$14,574.87
Rate for Payer: Ohana Health Plan Medicaid	$103.40
Rate for Payer: Ohana Health Plan Medicare	$94.00
Rate for Payer: UnitedHealthcare Medicaid	$9,015.38
Rate for Payer: UnitedHealthcare Medicare	$94.00
Rate for Payer: University Health Alliance Commercial	$10,952.19

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) IV SOLN

Facility

$15,025.64

Service Code	HCPCS J9022
Hospital Revenue Code	250
Min. Negotiated Rate	$12,771.79
Max. Negotiated Rate	$14,574.87
Rate for Payer: Cash Price	$9,766.67
Rate for Payer: Health Management Network Commercial	$12,771.79
Rate for Payer: MDX Hawaii PPO	$14,574.87

ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) IV SOLN

Facility

$10,853.48

Service Code	HCPCS J9022
Hospital Revenue Code	250
Min. Negotiated Rate	$9,225.46
Max. Negotiated Rate	$10,527.88
Rate for Payer: Cash Price	$7,054.76
Rate for Payer: Health Management Network Commercial	$9,225.46
Rate for Payer: MDX Hawaii PPO	$10,527.88

Know your out-of-pocket cost for care.

All Charges