Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Driver Hcs 3.5mm DRVR-HCS-1420 [3644458]

Facility

$973.09

Hospital Charge Code	3644458
Hospital Revenue Code	272
Min. Negotiated Rate	$827.13
Max. Negotiated Rate	$943.90
Rate for Payer: Cash Price	$632.51
Rate for Payer: Health Management Network Commercial	$827.13
Rate for Payer: MDX Hawaii PPO	$943.90

Driver Hex Straight Mod 803-05-167 [3644119]

Facility

$4,125.50

Hospital Charge Code	3644119
Hospital Revenue Code	272
Min. Negotiated Rate	$3,506.68
Max. Negotiated Rate	$4,001.74
Rate for Payer: Cash Price	$2,681.58
Rate for Payer: Health Management Network Commercial	$3,506.68
Rate for Payer: MDX Hawaii PPO	$4,001.74

Driver Hex Straight Mod 803-05-167 [3644119]

Facility

$4,125.50

Hospital Charge Code	3644119
Hospital Revenue Code	272
Min. Negotiated Rate	$2,104.01
Max. Negotiated Rate	$4,001.74
Rate for Payer: Cash Price	$2,681.58
Rate for Payer: Hawaii Western Management Group Commercial	$3,919.22
Rate for Payer: Health Management Network Commercial	$3,506.68
Rate for Payer: Kaiser Permanente Commercial	$2,599.07
Rate for Payer: Kaiser Permanente Medicaid	$2,104.01
Rate for Payer: MDX Hawaii PPO	$4,001.74
Rate for Payer: University Health Alliance Commercial	$3,007.08

Driver Peg DRVR-S20 [3643255]

Facility

$699.99

Hospital Charge Code	3643255
Hospital Revenue Code	272
Min. Negotiated Rate	$594.99
Max. Negotiated Rate	$678.99
Rate for Payer: Cash Price	$454.99
Rate for Payer: Health Management Network Commercial	$594.99
Rate for Payer: MDX Hawaii PPO	$678.99

Driver Peg DRVR-S20 [3643255]

Facility

$699.99

Hospital Charge Code	3643255
Hospital Revenue Code	272
Min. Negotiated Rate	$356.99
Max. Negotiated Rate	$678.99
Rate for Payer: Cash Price	$454.99
Rate for Payer: Hawaii Western Management Group Commercial	$664.99
Rate for Payer: Health Management Network Commercial	$594.99
Rate for Payer: Kaiser Permanente Commercial	$440.99
Rate for Payer: Kaiser Permanente Medicaid	$356.99
Rate for Payer: MDX Hawaii PPO	$678.99
Rate for Payer: University Health Alliance Commercial	$510.22

Driver T10 So-113-Hf-619 [3643696]

Facility

$853.13

Hospital Charge Code	3643696
Hospital Revenue Code	272
Min. Negotiated Rate	$725.16
Max. Negotiated Rate	$827.54
Rate for Payer: Cash Price	$554.53
Rate for Payer: Health Management Network Commercial	$725.16
Rate for Payer: MDX Hawaii PPO	$827.54

Driver T10 So-113-Hf-619 [3643696]

Facility

$853.13

Hospital Charge Code	3643696
Hospital Revenue Code	272
Min. Negotiated Rate	$435.10
Max. Negotiated Rate	$827.54
Rate for Payer: Cash Price	$554.53
Rate for Payer: Hawaii Western Management Group Commercial	$810.47
Rate for Payer: Health Management Network Commercial	$725.16
Rate for Payer: Kaiser Permanente Commercial	$537.47
Rate for Payer: Kaiser Permanente Medicaid	$435.10
Rate for Payer: MDX Hawaii PPO	$827.54
Rate for Payer: University Health Alliance Commercial	$621.85

Driver T8 So-113-Hf-613 [3643695]

Facility

$853.13

Hospital Charge Code	3643695
Hospital Revenue Code	272
Min. Negotiated Rate	$725.16
Max. Negotiated Rate	$827.54
Rate for Payer: Cash Price	$554.53
Rate for Payer: Health Management Network Commercial	$725.16
Rate for Payer: MDX Hawaii PPO	$827.54

Driver T8 So-113-Hf-613 [3643695]

Facility

$853.13

Hospital Charge Code	3643695
Hospital Revenue Code	272
Min. Negotiated Rate	$435.10
Max. Negotiated Rate	$827.54
Rate for Payer: Cash Price	$554.53
Rate for Payer: Hawaii Western Management Group Commercial	$810.47
Rate for Payer: Health Management Network Commercial	$725.16
Rate for Payer: Kaiser Permanente Commercial	$537.47
Rate for Payer: Kaiser Permanente Medicaid	$435.10
Rate for Payer: MDX Hawaii PPO	$827.54
Rate for Payer: University Health Alliance Commercial	$621.85

Driver Univ Quick Connect T10 DRVR-UQC-T10 [3642643]

Facility

$699.99

Hospital Charge Code	3642643
Hospital Revenue Code	272
Min. Negotiated Rate	$356.99
Max. Negotiated Rate	$678.99
Rate for Payer: Cash Price	$454.99
Rate for Payer: Hawaii Western Management Group Commercial	$664.99
Rate for Payer: Health Management Network Commercial	$594.99
Rate for Payer: Kaiser Permanente Commercial	$440.99
Rate for Payer: Kaiser Permanente Medicaid	$356.99
Rate for Payer: MDX Hawaii PPO	$678.99
Rate for Payer: University Health Alliance Commercial	$510.22

Driver Univ Quick Connect T10 DRVR-UQC-T10 [3642643]

Facility

$699.99

Hospital Charge Code	3642643
Hospital Revenue Code	272
Min. Negotiated Rate	$594.99
Max. Negotiated Rate	$678.99
Rate for Payer: Cash Price	$454.99
Rate for Payer: Health Management Network Commercial	$594.99
Rate for Payer: MDX Hawaii PPO	$678.99

Driver Univ Quick Connect T15 DRVRUQCT15 [3642989]

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Charge Code	3642989
Hospital Revenue Code	278
Min. Negotiated Rate	$605.88
Max. Negotiated Rate	$1,152.36
Rate for Payer: Cash Price	$772.20
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: Kaiser Permanente Commercial	$748.44
Rate for Payer: Kaiser Permanente Medicaid	$605.88
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: University Health Alliance Commercial	$665.28

Driver Univ Quick Connect T15 DRVRUQCT15 [3642989]

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Charge Code	3642989
Hospital Revenue Code	278
Min. Negotiated Rate	$665.28
Max. Negotiated Rate	$1,152.36
Rate for Payer: Cash Price	$772.20
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: University Health Alliance Commercial	$665.28

Driver Univ Quick Connect T20 DRVR-UQC-T20 [3642886]

Facility

$673.21

Hospital Charge Code	3642886
Hospital Revenue Code	272
Min. Negotiated Rate	$343.34
Max. Negotiated Rate	$653.01
Rate for Payer: Cash Price	$437.59
Rate for Payer: Hawaii Western Management Group Commercial	$639.55
Rate for Payer: Health Management Network Commercial	$572.23
Rate for Payer: Kaiser Permanente Commercial	$424.12
Rate for Payer: Kaiser Permanente Medicaid	$343.34
Rate for Payer: MDX Hawaii PPO	$653.01
Rate for Payer: University Health Alliance Commercial	$490.70

Driver Univ Quick Connect T20 DRVR-UQC-T20 [3642886]

Facility

$673.21

Hospital Charge Code	3642886
Hospital Revenue Code	272
Min. Negotiated Rate	$572.23
Max. Negotiated Rate	$653.01
Rate for Payer: Cash Price	$437.59
Rate for Payer: Health Management Network Commercial	$572.23
Rate for Payer: MDX Hawaii PPO	$653.01

DROPERIDOL 2.5 MG/ML INJ SOLN

Facility

$61.01

Service Code	HCPCS J1790
Hospital Revenue Code	250
Min. Negotiated Rate	$51.86
Max. Negotiated Rate	$59.18
Rate for Payer: Cash Price	$39.66
Rate for Payer: Health Management Network Commercial	$51.86
Rate for Payer: MDX Hawaii PPO	$59.18

DROPERIDOL 2.5 MG/ML INJ SOLN

Facility

$61.01

Service Code	HCPCS J1790
Hospital Revenue Code	636
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$59.18
Rate for Payer: Cash Price	$39.66
Rate for Payer: Cash Price	$39.66
Rate for Payer: Hawaii Medical Service Association ABD	$5.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.36
Rate for Payer: Hawaii Western Management Group Commercial	$57.96
Rate for Payer: Health Management Network Commercial	$51.86
Rate for Payer: Kaiser Permanente Commercial	$38.44
Rate for Payer: Kaiser Permanente Medicaid	$31.12
Rate for Payer: MDX Hawaii PPO	$59.18
Rate for Payer: UnitedHealthcare Medicaid	$36.61
Rate for Payer: University Health Alliance Commercial	$44.47

DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$3,524.67

Service Code	APR-DRG 7703
Min. Negotiated Rate	$3,524.67
Max. Negotiated Rate	$3,524.67
Rate for Payer: AlohaCare Medicaid	$3,524.67
Rate for Payer: Hawaii Medical Service Association ABD	$3,524.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,524.67
Rate for Payer: Kaiser Permanente Medicaid	$3,524.67
Rate for Payer: Ohana Health Plan Medicaid	$3,524.67
Rate for Payer: UnitedHealthcare Medicaid	$3,524.67

DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$1,331.36

Service Code	APR-DRG 7701
Min. Negotiated Rate	$1,331.36
Max. Negotiated Rate	$1,331.36
Rate for Payer: AlohaCare Medicaid	$1,331.36
Rate for Payer: Hawaii Medical Service Association ABD	$1,331.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,331.36
Rate for Payer: Kaiser Permanente Medicaid	$1,331.36
Rate for Payer: Ohana Health Plan Medicaid	$1,331.36
Rate for Payer: UnitedHealthcare Medicaid	$1,331.36

DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$2,091.52

Service Code	APR-DRG 7702
Min. Negotiated Rate	$2,091.52
Max. Negotiated Rate	$2,091.52
Rate for Payer: AlohaCare Medicaid	$2,091.52
Rate for Payer: Hawaii Medical Service Association ABD	$2,091.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,091.52
Rate for Payer: Kaiser Permanente Medicaid	$2,091.52
Rate for Payer: Ohana Health Plan Medicaid	$2,091.52
Rate for Payer: UnitedHealthcare Medicaid	$2,091.52

DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$7,871.01

Service Code	APR-DRG 7704
Min. Negotiated Rate	$7,871.01
Max. Negotiated Rate	$7,871.01
Rate for Payer: AlohaCare Medicaid	$7,871.01
Rate for Payer: Hawaii Medical Service Association ABD	$7,871.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,871.01
Rate for Payer: Kaiser Permanente Medicaid	$7,871.01
Rate for Payer: Ohana Health Plan Medicaid	$7,871.01
Rate for Payer: UnitedHealthcare Medicaid	$7,871.01

DULOXETINE 20 MG PO CAP DR EC

Facility

$43.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.16
Max. Negotiated Rate	$42.15
Rate for Payer: Cash Price	$28.24
Rate for Payer: Hawaii Western Management Group Commercial	$41.28
Rate for Payer: Health Management Network Commercial	$36.93
Rate for Payer: Kaiser Permanente Commercial	$27.37
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: MDX Hawaii PPO	$42.15
Rate for Payer: UnitedHealthcare Medicaid	$26.07
Rate for Payer: University Health Alliance Commercial	$31.67

DULOXETINE 20 MG PO CAP DR EC

Facility

$43.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$36.93
Max. Negotiated Rate	$42.15
Rate for Payer: Cash Price	$28.24
Rate for Payer: Health Management Network Commercial	$36.93
Rate for Payer: MDX Hawaii PPO	$42.15

DULOXETINE 30 MG PO CAP DR EC

Facility

$47.58

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$40.44
Max. Negotiated Rate	$46.15
Rate for Payer: Cash Price	$30.93
Rate for Payer: Health Management Network Commercial	$40.44
Rate for Payer: MDX Hawaii PPO	$46.15

DULOXETINE 30 MG PO CAP DR EC

Facility

$47.58

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.27
Max. Negotiated Rate	$46.15
Rate for Payer: Cash Price	$30.93
Rate for Payer: Hawaii Western Management Group Commercial	$45.20
Rate for Payer: Health Management Network Commercial	$40.44
Rate for Payer: Kaiser Permanente Commercial	$29.98
Rate for Payer: Kaiser Permanente Medicaid	$24.27
Rate for Payer: MDX Hawaii PPO	$46.15
Rate for Payer: UnitedHealthcare Medicaid	$28.55
Rate for Payer: University Health Alliance Commercial	$34.68

Know your out-of-pocket cost for care.

All Charges