Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Fibulock Nail Left 3.8x180mm Ar-8973l-38-180 [3645499]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3645499
Hospital Revenue Code	278
Min. Negotiated Rate	$9,677.25
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: Kaiser Permanente Commercial	$11,954.25
Rate for Payer: Kaiser Permanente Medicaid	$9,677.25
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Left 3.8x180mm Ar-8973l-38-180 [3645499]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3645499
Hospital Revenue Code	278
Min. Negotiated Rate	$10,626.00
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Right 3.0 x 130mm AR-8973R-30-130 [3644360]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644360
Hospital Revenue Code	278
Min. Negotiated Rate	$10,626.00
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Right 3.0 x 130mm AR-8973R-30-130 [3644360]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644360
Hospital Revenue Code	278
Min. Negotiated Rate	$9,677.25
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: Kaiser Permanente Commercial	$11,954.25
Rate for Payer: Kaiser Permanente Medicaid	$9,677.25
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Right 3.8 x 130mm AR-8973R-38-130 [3644831]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644831
Hospital Revenue Code	278
Min. Negotiated Rate	$9,677.25
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: Kaiser Permanente Commercial	$11,954.25
Rate for Payer: Kaiser Permanente Medicaid	$9,677.25
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Right 3.8 x 130mm AR-8973R-38-130 [3644831]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644831
Hospital Revenue Code	278
Min. Negotiated Rate	$10,626.00
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

FIDAXOMICIN 200 MG PO TABLET

Facility

$780.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$663.24
Max. Negotiated Rate	$756.87
Rate for Payer: Cash Price	$507.18
Rate for Payer: Health Management Network Commercial	$663.24
Rate for Payer: MDX Hawaii PPO	$756.87

FIDAXOMICIN 200 MG PO TABLET

Facility

$780.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$397.94
Max. Negotiated Rate	$756.87
Rate for Payer: Cash Price	$507.18
Rate for Payer: Hawaii Western Management Group Commercial	$741.27
Rate for Payer: Health Management Network Commercial	$663.24
Rate for Payer: Kaiser Permanente Commercial	$491.58
Rate for Payer: Kaiser Permanente Medicaid	$397.94
Rate for Payer: MDX Hawaii PPO	$756.87
Rate for Payer: UnitedHealthcare Medicaid	$468.17
Rate for Payer: University Health Alliance Commercial	$568.75

FILGRASTIM-SNDZ 300 MCG/0.5 ML INJ SYR

Facility

$809.58

Service Code	HCPCS Q5101
Hospital Revenue Code	250
Min. Negotiated Rate	$688.14
Max. Negotiated Rate	$785.29
Rate for Payer: Cash Price	$526.23
Rate for Payer: Health Management Network Commercial	$688.14
Rate for Payer: MDX Hawaii PPO	$785.29

FILGRASTIM-SNDZ 300 MCG/0.5 ML INJ SYR

Facility

$809.58

Service Code	HCPCS Q5101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$785.29
Rate for Payer: AlohaCare Medicaid	$0.35
Rate for Payer: AlohaCare Medicare	$0.35
Rate for Payer: Cash Price	$526.23
Rate for Payer: Cash Price	$526.23
Rate for Payer: Devoted Health Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Commercial	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Western Management Group Commercial	$769.10
Rate for Payer: Health Management Network Commercial	$688.14
Rate for Payer: Humana Medicare	$0.35
Rate for Payer: Kaiser Permanente Commercial	$510.04
Rate for Payer: Kaiser Permanente Medicaid	$412.89
Rate for Payer: Kaiser Permanente Medicare	$0.35
Rate for Payer: MDX Hawaii PPO	$785.29
Rate for Payer: Ohana Health Plan Medicaid	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.35
Rate for Payer: UnitedHealthcare Medicaid	$485.75
Rate for Payer: UnitedHealthcare Medicare	$0.35
Rate for Payer: University Health Alliance Commercial	$590.10

FILGRASTIM-SNDZ 480 MCG/0.8 ML INJ SYR

Facility

$1,151.33

Service Code	HCPCS Q5101
Hospital Revenue Code	250
Min. Negotiated Rate	$978.63
Max. Negotiated Rate	$1,116.79
Rate for Payer: Cash Price	$748.36
Rate for Payer: Health Management Network Commercial	$978.63
Rate for Payer: MDX Hawaii PPO	$1,116.79

FILGRASTIM-SNDZ 480 MCG/0.8 ML INJ SYR

Facility

$1,151.33

Service Code	HCPCS Q5101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$1,116.79
Rate for Payer: AlohaCare Medicaid	$0.35
Rate for Payer: AlohaCare Medicare	$0.35
Rate for Payer: Cash Price	$748.36
Rate for Payer: Cash Price	$748.36
Rate for Payer: Devoted Health Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Commercial	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.76
Rate for Payer: Health Management Network Commercial	$978.63
Rate for Payer: Humana Medicare	$0.35
Rate for Payer: Kaiser Permanente Commercial	$725.34
Rate for Payer: Kaiser Permanente Medicaid	$587.18
Rate for Payer: Kaiser Permanente Medicare	$0.35
Rate for Payer: MDX Hawaii PPO	$1,116.79
Rate for Payer: Ohana Health Plan Medicaid	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.35
Rate for Payer: UnitedHealthcare Medicaid	$690.80
Rate for Payer: UnitedHealthcare Medicare	$0.35
Rate for Payer: University Health Alliance Commercial	$839.20

FINASTERIDE 5 MG PO TABLET

Facility

$5.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$5.14
Rate for Payer: Cash Price	$3.44
Rate for Payer: Cash Price	$3.88
Rate for Payer: Hawaii Western Management Group Commercial	$5.04
Rate for Payer: Hawaii Western Management Group Commercial	$5.67
Rate for Payer: Health Management Network Commercial	$4.50
Rate for Payer: Health Management Network Commercial	$5.07
Rate for Payer: Kaiser Permanente Commercial	$3.34
Rate for Payer: Kaiser Permanente Commercial	$3.76
Rate for Payer: Kaiser Permanente Medicaid	$3.04
Rate for Payer: Kaiser Permanente Medicaid	$2.70
Rate for Payer: MDX Hawaii PPO	$5.14
Rate for Payer: MDX Hawaii PPO	$5.79
Rate for Payer: UnitedHealthcare Medicaid	$3.58
Rate for Payer: UnitedHealthcare Medicaid	$3.18
Rate for Payer: University Health Alliance Commercial	$3.86
Rate for Payer: University Health Alliance Commercial	$4.35

FINASTERIDE 5 MG PO TABLET

Facility

$5.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$5.14
Rate for Payer: Cash Price	$3.44
Rate for Payer: Cash Price	$3.88
Rate for Payer: Health Management Network Commercial	$5.07
Rate for Payer: Health Management Network Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$5.14
Rate for Payer: MDX Hawaii PPO	$5.79

Firstpass Mini Suture Passer Straight 72290128 [3644236]

Facility

$1,983.75

Hospital Charge Code	3644236
Hospital Revenue Code	272
Min. Negotiated Rate	$1,686.19
Max. Negotiated Rate	$1,924.24
Rate for Payer: Cash Price	$1,289.44
Rate for Payer: Health Management Network Commercial	$1,686.19
Rate for Payer: MDX Hawaii PPO	$1,924.24

Firstpass Mini Suture Passer Straight 72290128 [3644236]

Facility

$1,983.75

Hospital Charge Code	3644236
Hospital Revenue Code	272
Min. Negotiated Rate	$1,011.71
Max. Negotiated Rate	$1,924.24
Rate for Payer: Cash Price	$1,289.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.56
Rate for Payer: Health Management Network Commercial	$1,686.19
Rate for Payer: Kaiser Permanente Commercial	$1,249.76
Rate for Payer: Kaiser Permanente Medicaid	$1,011.71
Rate for Payer: MDX Hawaii PPO	$1,924.24
Rate for Payer: University Health Alliance Commercial	$1,445.96

FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED

Facility

$6,183.00

Service Code	CPT 46200
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$5,160.40

Flatcut Talar Dome Sz 3 Infinity Adaptis 33680033 [3645464]

Facility

$49,355.99

Service Code	HCPCS C1776
Hospital Charge Code	3645464
Hospital Revenue Code	278
Min. Negotiated Rate	$27,639.35
Max. Negotiated Rate	$47,875.31
Rate for Payer: Cash Price	$32,081.39
Rate for Payer: Hawaii Western Management Group Commercial	$34,549.19
Rate for Payer: Health Management Network Commercial	$41,952.59
Rate for Payer: MDX Hawaii PPO	$47,875.31
Rate for Payer: University Health Alliance Commercial	$27,639.35

Flatcut Talar Dome Sz 3 Infinity Adaptis 33680033 [3645464]

Facility

$49,355.99

Service Code	HCPCS C1776
Hospital Charge Code	3645464
Hospital Revenue Code	278
Min. Negotiated Rate	$25,171.55
Max. Negotiated Rate	$47,875.31
Rate for Payer: Cash Price	$32,081.39
Rate for Payer: Hawaii Western Management Group Commercial	$34,549.19
Rate for Payer: Health Management Network Commercial	$41,952.59
Rate for Payer: Kaiser Permanente Commercial	$31,094.27
Rate for Payer: Kaiser Permanente Medicaid	$25,171.55
Rate for Payer: MDX Hawaii PPO	$47,875.31
Rate for Payer: University Health Alliance Commercial	$27,639.35

FLECAINIDE 100 MG PO TABLET

Facility

$19.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.18
Rate for Payer: Cash Price	$12.85
Rate for Payer: Hawaii Western Management Group Commercial	$18.78
Rate for Payer: Health Management Network Commercial	$16.80
Rate for Payer: Kaiser Permanente Commercial	$12.46
Rate for Payer: Kaiser Permanente Medicaid	$10.08
Rate for Payer: MDX Hawaii PPO	$19.18
Rate for Payer: UnitedHealthcare Medicaid	$11.86
Rate for Payer: University Health Alliance Commercial	$14.41

FLECAINIDE 100 MG PO TABLET

Facility

$19.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$19.18
Rate for Payer: Cash Price	$12.85
Rate for Payer: Health Management Network Commercial	$16.80
Rate for Payer: MDX Hawaii PPO	$19.18

Flexband 0.3x32xm 31059 [3644563]

Facility

$10,953.00

Service Code	HCPCS C1713
Hospital Charge Code	3644563
Hospital Revenue Code	278
Min. Negotiated Rate	$5,586.03
Max. Negotiated Rate	$10,624.41
Rate for Payer: Cash Price	$7,119.45
Rate for Payer: Hawaii Western Management Group Commercial	$7,667.10
Rate for Payer: Health Management Network Commercial	$9,310.05
Rate for Payer: Kaiser Permanente Commercial	$6,900.39
Rate for Payer: Kaiser Permanente Medicaid	$5,586.03
Rate for Payer: MDX Hawaii PPO	$10,624.41
Rate for Payer: University Health Alliance Commercial	$6,133.68

Flexband 0.3x32xm 31059 [3644563]

Facility

$10,953.00

Service Code	HCPCS C1713
Hospital Charge Code	3644563
Hospital Revenue Code	278
Min. Negotiated Rate	$6,133.68
Max. Negotiated Rate	$10,624.41
Rate for Payer: Cash Price	$7,119.45
Rate for Payer: Hawaii Western Management Group Commercial	$7,667.10
Rate for Payer: Health Management Network Commercial	$9,310.05
Rate for Payer: MDX Hawaii PPO	$10,624.41
Rate for Payer: University Health Alliance Commercial	$6,133.68

FLUCICLOVINE F-18 DIAGNOSTIC 1 MILLICURIE

Professional

Both

$950.00

Service Code	HCPCS A9588
Min. Negotiated Rate	$807.50
Max. Negotiated Rate	$807.50
Rate for Payer: Cash Price	$617.50
Rate for Payer: Health Management Network Commercial	$807.50

FLUCONAZOLE 100 MG PO TABLET

Facility

$51.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$44.15
Max. Negotiated Rate	$50.38
Rate for Payer: Cash Price	$33.76
Rate for Payer: Cash Price	$76.28
Rate for Payer: Cash Price	$5.08
Rate for Payer: Health Management Network Commercial	$44.15
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: Health Management Network Commercial	$6.65
Rate for Payer: MDX Hawaii PPO	$113.84
Rate for Payer: MDX Hawaii PPO	$7.59
Rate for Payer: MDX Hawaii PPO	$50.38

Know your out-of-pocket cost for care.

All Charges