Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Guidwire Zipwire Stiff .035X150cm Straight M0066802220 [3642754]

Facility

$395.48

Service Code	HCPCS C1769
Hospital Charge Code	3642754
Hospital Revenue Code	272
Min. Negotiated Rate	$336.16
Max. Negotiated Rate	$383.62
Rate for Payer: Cash Price	$257.06
Rate for Payer: Health Management Network Commercial	$336.16
Rate for Payer: MDX Hawaii PPO	$383.62

Guidwire Zipwire Stiff .035X150cm Straight M0066802220 [3642754]

Facility

$395.48

Service Code	HCPCS C1769
Hospital Charge Code	3642754
Hospital Revenue Code	272
Min. Negotiated Rate	$201.69
Max. Negotiated Rate	$383.62
Rate for Payer: Cash Price	$257.06
Rate for Payer: Hawaii Western Management Group Commercial	$375.71
Rate for Payer: Health Management Network Commercial	$336.16
Rate for Payer: Kaiser Permanente Commercial	$249.15
Rate for Payer: Kaiser Permanente Medicaid	$201.69
Rate for Payer: MDX Hawaii PPO	$383.62
Rate for Payer: University Health Alliance Commercial	$288.27

Guidwire Zipwire Stiff .035X180cm Angled M00146308B1 [3641966]

Facility

$369.75

Service Code	HCPCS C1769
Hospital Charge Code	3641966
Hospital Revenue Code	272
Min. Negotiated Rate	$188.57
Max. Negotiated Rate	$358.66
Rate for Payer: Cash Price	$240.34
Rate for Payer: Hawaii Western Management Group Commercial	$351.26
Rate for Payer: Health Management Network Commercial	$314.29
Rate for Payer: Kaiser Permanente Commercial	$232.94
Rate for Payer: Kaiser Permanente Medicaid	$188.57
Rate for Payer: MDX Hawaii PPO	$358.66
Rate for Payer: University Health Alliance Commercial	$269.51

Guidwire Zipwire Stiff .035X180cm Angled M00146308B1 [3641966]

Facility

$369.75

Service Code	HCPCS C1769
Hospital Charge Code	3641966
Hospital Revenue Code	272
Min. Negotiated Rate	$314.29
Max. Negotiated Rate	$358.66
Rate for Payer: Cash Price	$240.34
Rate for Payer: Health Management Network Commercial	$314.29
Rate for Payer: MDX Hawaii PPO	$358.66

HAEMOPH B POLY CONJ-TET TOX-PF 10 MCG/0.5 ML IM RECON.SOLN.

Facility

$70.40

Service Code	HCPCS 90648
Hospital Revenue Code	250
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$68.29
Rate for Payer: Cash Price	$45.76
Rate for Payer: Cash Price	$45.77
Rate for Payer: Cash Price	$45.76
Rate for Payer: Cash Price	$45.77
Rate for Payer: Hawaii Medical Service Association ABD	$14.35
Rate for Payer: Hawaii Medical Service Association ABD	$14.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.35
Rate for Payer: Hawaii Western Management Group Commercial	$66.90
Rate for Payer: Hawaii Western Management Group Commercial	$66.88
Rate for Payer: Health Management Network Commercial	$59.86
Rate for Payer: Health Management Network Commercial	$59.84
Rate for Payer: Kaiser Permanente Commercial	$44.36
Rate for Payer: Kaiser Permanente Commercial	$44.35
Rate for Payer: Kaiser Permanente Medicaid	$35.90
Rate for Payer: Kaiser Permanente Medicaid	$35.91
Rate for Payer: MDX Hawaii PPO	$68.29
Rate for Payer: MDX Hawaii PPO	$68.31
Rate for Payer: UnitedHealthcare Medicaid	$42.25
Rate for Payer: UnitedHealthcare Medicaid	$42.24
Rate for Payer: University Health Alliance Commercial	$51.31
Rate for Payer: University Health Alliance Commercial	$51.33

HAEMOPH B POLY CONJ-TET TOX-PF 10 MCG/0.5 ML IM RECON.SOLN.

Facility

$70.40

Service Code	HCPCS 90648
Hospital Revenue Code	250
Min. Negotiated Rate	$59.84
Max. Negotiated Rate	$68.29
Rate for Payer: Cash Price	$45.76
Rate for Payer: Cash Price	$45.77
Rate for Payer: Health Management Network Commercial	$59.84
Rate for Payer: Health Management Network Commercial	$59.86
Rate for Payer: MDX Hawaii PPO	$68.29
Rate for Payer: MDX Hawaii PPO	$68.31

HALOPERIDOL 0.5 MG PO TABLET

Facility

$1.92

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.25
Rate for Payer: Hawaii Western Management Group Commercial	$1.82
Rate for Payer: Health Management Network Commercial	$1.63
Rate for Payer: Kaiser Permanente Commercial	$1.21
Rate for Payer: Kaiser Permanente Medicaid	$0.98
Rate for Payer: MDX Hawaii PPO	$1.86
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: University Health Alliance Commercial	$1.40

HALOPERIDOL 0.5 MG PO TABLET

Facility

$1.92

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.25
Rate for Payer: Health Management Network Commercial	$1.63
Rate for Payer: MDX Hawaii PPO	$1.86

HALOPERIDOL 5 MG PO TABLET

Facility

$6.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$5.85
Rate for Payer: Cash Price	$3.92
Rate for Payer: Hawaii Western Management Group Commercial	$5.73
Rate for Payer: Health Management Network Commercial	$5.13
Rate for Payer: Kaiser Permanente Commercial	$3.80
Rate for Payer: Kaiser Permanente Medicaid	$3.08
Rate for Payer: MDX Hawaii PPO	$5.85
Rate for Payer: UnitedHealthcare Medicaid	$3.62
Rate for Payer: University Health Alliance Commercial	$4.40

HALOPERIDOL 5 MG PO TABLET

Facility

$6.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$5.85
Rate for Payer: Cash Price	$3.92
Rate for Payer: Health Management Network Commercial	$5.13
Rate for Payer: MDX Hawaii PPO	$5.85

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN

Facility

$152.14

Service Code	HCPCS J1631
Hospital Revenue Code	250
Min. Negotiated Rate	$129.32
Max. Negotiated Rate	$147.58
Rate for Payer: Cash Price	$98.89
Rate for Payer: Cash Price	$108.58
Rate for Payer: Health Management Network Commercial	$141.98
Rate for Payer: Health Management Network Commercial	$129.32
Rate for Payer: MDX Hawaii PPO	$162.03
Rate for Payer: MDX Hawaii PPO	$147.58

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN

Facility

$167.04

Service Code	HCPCS J1631
Hospital Revenue Code	636
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$162.03
Rate for Payer: Cash Price	$108.58
Rate for Payer: Cash Price	$98.89
Rate for Payer: Cash Price	$98.89
Rate for Payer: Cash Price	$108.58
Rate for Payer: Hawaii Medical Service Association ABD	$4.68
Rate for Payer: Hawaii Medical Service Association ABD	$4.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.68
Rate for Payer: Hawaii Western Management Group Commercial	$144.53
Rate for Payer: Hawaii Western Management Group Commercial	$158.69
Rate for Payer: Health Management Network Commercial	$141.98
Rate for Payer: Health Management Network Commercial	$129.32
Rate for Payer: Kaiser Permanente Commercial	$105.24
Rate for Payer: Kaiser Permanente Commercial	$95.85
Rate for Payer: Kaiser Permanente Medicaid	$77.59
Rate for Payer: Kaiser Permanente Medicaid	$85.19
Rate for Payer: MDX Hawaii PPO	$147.58
Rate for Payer: MDX Hawaii PPO	$162.03
Rate for Payer: UnitedHealthcare Medicaid	$91.28
Rate for Payer: UnitedHealthcare Medicaid	$100.22
Rate for Payer: University Health Alliance Commercial	$110.89
Rate for Payer: University Health Alliance Commercial	$121.76

HALOPERIDOL LACTATE 5 MG/ML INJ SOLN

Facility

$7.95

Service Code	HCPCS J1630
Hospital Revenue Code	250
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$7.71
Rate for Payer: Cash Price	$5.17
Rate for Payer: Health Management Network Commercial	$6.76
Rate for Payer: MDX Hawaii PPO	$7.71

HALOPERIDOL LACTATE 5 MG/ML INJ SOLN

Facility

$7.95

Service Code	HCPCS J1630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$7.71
Rate for Payer: Cash Price	$5.17
Rate for Payer: Cash Price	$5.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$7.55
Rate for Payer: Health Management Network Commercial	$6.76
Rate for Payer: Kaiser Permanente Commercial	$5.01
Rate for Payer: Kaiser Permanente Medicaid	$4.05
Rate for Payer: MDX Hawaii PPO	$7.71
Rate for Payer: UnitedHealthcare Medicaid	$4.77
Rate for Payer: University Health Alliance Commercial	$5.79

Hand Drill 3.3mm Free Targ 00-2490-072-33 [3641942]

Facility

$1,492.78

Hospital Charge Code	3641942
Hospital Revenue Code	272
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,418.14
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$1,088.09

Hand Drill 3.3mm Free Targ 00-2490-072-33 [3641942]

Facility

$1,492.78

Hospital Charge Code	3641942
Hospital Revenue Code	272
Min. Negotiated Rate	$1,268.86
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00

Hand Drill 4.3mm Calibrated Short 00-2490-064-43 [3641407]

Facility

$1,180.86

Hospital Charge Code	3641407
Hospital Revenue Code	272
Min. Negotiated Rate	$1,003.73
Max. Negotiated Rate	$1,145.43
Rate for Payer: Cash Price	$767.56
Rate for Payer: Health Management Network Commercial	$1,003.73
Rate for Payer: MDX Hawaii PPO	$1,145.43

Hand Drill 4.3mm Calibrated Short 00-2490-064-43 [3641407]

Facility

$1,180.86

Hospital Charge Code	3641407
Hospital Revenue Code	272
Min. Negotiated Rate	$602.24
Max. Negotiated Rate	$1,145.43
Rate for Payer: Cash Price	$767.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,121.82
Rate for Payer: Health Management Network Commercial	$1,003.73
Rate for Payer: Kaiser Permanente Commercial	$743.94
Rate for Payer: Kaiser Permanente Medicaid	$602.24
Rate for Payer: MDX Hawaii PPO	$1,145.43
Rate for Payer: University Health Alliance Commercial	$860.73

Hand Drill 4.3mm Free 152.5mm 00-2490-075-43 [3640905]

Facility

$1,005.22

Hospital Charge Code	3640905
Hospital Revenue Code	272
Min. Negotiated Rate	$854.44
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: MDX Hawaii PPO	$975.06

Hand Drill 4.3mm Free 152.5mm 00-2490-075-43 [3640905]

Facility

$1,005.22

Hospital Charge Code	3640905
Hospital Revenue Code	272
Min. Negotiated Rate	$512.66
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$954.96
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: Kaiser Permanente Commercial	$633.29
Rate for Payer: Kaiser Permanente Medicaid	$512.66
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$732.70

Hand Drill 4.3mm Free 249007243 [3641697]

Facility

$645.75

Hospital Charge Code	3641697
Hospital Revenue Code	272
Min. Negotiated Rate	$548.89
Max. Negotiated Rate	$626.38
Rate for Payer: Cash Price	$419.74
Rate for Payer: Health Management Network Commercial	$548.89
Rate for Payer: MDX Hawaii PPO	$626.38

Hand Drill 4.3mm Free 249007243 [3641697]

Facility

$645.75

Hospital Charge Code	3641697
Hospital Revenue Code	272
Min. Negotiated Rate	$329.33
Max. Negotiated Rate	$626.38
Rate for Payer: Cash Price	$419.74
Rate for Payer: Hawaii Western Management Group Commercial	$613.46
Rate for Payer: Health Management Network Commercial	$548.89
Rate for Payer: Kaiser Permanente Commercial	$406.82
Rate for Payer: Kaiser Permanente Medicaid	$329.33
Rate for Payer: MDX Hawaii PPO	$626.38
Rate for Payer: University Health Alliance Commercial	$470.69

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$27,156.67

Service Code	MSDRG 513
Min. Negotiated Rate	$20,706.40
Max. Negotiated Rate	$27,156.67
Rate for Payer: AlohaCare Medicare	$20,706.40
Rate for Payer: Devoted Health Medicare	$22,777.04
Rate for Payer: Hawaii Medical Service Association Commercial	$27,096.27
Rate for Payer: Hawaii Medical Service Association Medicare	$20,706.40
Rate for Payer: Humana Medicare	$20,706.40
Rate for Payer: Kaiser Permanente Commercial	$27,156.67
Rate for Payer: Kaiser Permanente Medicare	$20,706.40
Rate for Payer: Ohana Health Plan Medicare	$20,706.40
Rate for Payer: UnitedHealthcare Medicare	$20,706.40

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$18,731.14

Service Code	MSDRG 514
Min. Negotiated Rate	$13,446.07
Max. Negotiated Rate	$18,731.14
Rate for Payer: AlohaCare Medicare	$13,446.07
Rate for Payer: Devoted Health Medicare	$14,790.68
Rate for Payer: Hawaii Medical Service Association Commercial	$18,731.14
Rate for Payer: Hawaii Medical Service Association Medicare	$13,446.07
Rate for Payer: Humana Medicare	$13,446.07
Rate for Payer: Kaiser Permanente Commercial	$17,634.67
Rate for Payer: Kaiser Permanente Medicare	$13,446.07
Rate for Payer: Ohana Health Plan Medicare	$13,446.07
Rate for Payer: UnitedHealthcare Medicare	$13,446.07

Handpiece Abc Bend-A-Beam 9" 134009 [3643506]

Facility

$473.27

Hospital Charge Code	3643506
Hospital Revenue Code	272
Min. Negotiated Rate	$241.37
Max. Negotiated Rate	$459.07
Rate for Payer: Cash Price	$307.63
Rate for Payer: Hawaii Western Management Group Commercial	$449.61
Rate for Payer: Health Management Network Commercial	$402.28
Rate for Payer: Kaiser Permanente Commercial	$298.16
Rate for Payer: Kaiser Permanente Medicaid	$241.37
Rate for Payer: MDX Hawaii PPO	$459.07
Rate for Payer: University Health Alliance Commercial	$344.97

Know your out-of-pocket cost for care.

All Charges