Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Allosync Cb Dbm Putty 5cc Abs-2014-05 [3644003]

Facility

$3,417.50

Service Code	HCPCS C1713
Hospital Charge Code	3644003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,913.80
Max. Negotiated Rate	$3,314.97
Rate for Payer: Cash Price	$2,221.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,392.25
Rate for Payer: Health Management Network Commercial	$2,904.88
Rate for Payer: MDX Hawaii PPO	$3,314.97
Rate for Payer: University Health Alliance Commercial	$1,913.80

Allosync Cb Dbm Putty 5cc Abs-2014-05 [3644003]

Facility

$3,417.50

Service Code	HCPCS C1713
Hospital Charge Code	3644003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,742.92
Max. Negotiated Rate	$3,314.97
Rate for Payer: Cash Price	$2,221.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,392.25
Rate for Payer: Health Management Network Commercial	$2,904.88
Rate for Payer: Kaiser Permanente Commercial	$2,153.03
Rate for Payer: Kaiser Permanente Medicaid	$1,742.92
Rate for Payer: MDX Hawaii PPO	$3,314.97
Rate for Payer: University Health Alliance Commercial	$1,913.80

Allosync Pure 2.5cc Abs-2010-02 [3643272]

Facility

$5,003.00

Service Code	HCPCS C1889
Hospital Charge Code	3643272
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.53
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: Kaiser Permanente Commercial	$3,151.89
Rate for Payer: Kaiser Permanente Medicaid	$2,551.53
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Allosync Pure 2.5cc Abs-2010-02 [3643272]

Facility

$5,003.00

Service Code	HCPCS C1889
Hospital Charge Code	3643272
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

ALPHA-FETOPROTEIN SERUM

Professional

Both

$34.00

Service Code	HCPCS 82105
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$28.90
Rate for Payer: AlohaCare Medicaid	$23.18
Rate for Payer: AlohaCare Medicare	$16.77
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.45
Rate for Payer: Hawaii Medical Service Association Medicare	$16.77
Rate for Payer: Hawaii Western Management Group Commercial	$23.18
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$20.12
Rate for Payer: Kaiser Permanente Medicaid	$20.12
Rate for Payer: Kaiser Permanente Medicare	$20.12
Rate for Payer: Ohana Health Plan Medicaid	$23.18
Rate for Payer: Ohana Health Plan Medicare	$16.77
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$16.77

Alphavent Knotless SP 4.75mm Peek Anchor 3911-956-547 [3644323]

Facility

$4,236.52

Service Code	HCPCS C1713
Hospital Charge Code	3644323
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.63
Max. Negotiated Rate	$4,109.42
Rate for Payer: Cash Price	$2,753.74
Rate for Payer: Hawaii Western Management Group Commercial	$2,965.56
Rate for Payer: Health Management Network Commercial	$3,601.04
Rate for Payer: Kaiser Permanente Commercial	$2,669.01
Rate for Payer: Kaiser Permanente Medicaid	$2,160.63
Rate for Payer: MDX Hawaii PPO	$4,109.42
Rate for Payer: University Health Alliance Commercial	$2,372.45

Alphavent Knotless SP 4.75mm Peek Anchor 3911-956-547 [3644323]

Facility

$4,236.52

Service Code	HCPCS C1713
Hospital Charge Code	3644323
Hospital Revenue Code	278
Min. Negotiated Rate	$2,372.45
Max. Negotiated Rate	$4,109.42
Rate for Payer: Cash Price	$2,753.74
Rate for Payer: Hawaii Western Management Group Commercial	$2,965.56
Rate for Payer: Health Management Network Commercial	$3,601.04
Rate for Payer: MDX Hawaii PPO	$4,109.42
Rate for Payer: University Health Alliance Commercial	$2,372.45

Alphavent Suture Anchor 5.5mm Peek 3910-955-020 [3644322]

Facility

$4,175.00

Service Code	HCPCS C1713
Hospital Charge Code	3644322
Hospital Revenue Code	278
Min. Negotiated Rate	$2,129.25
Max. Negotiated Rate	$4,049.75
Rate for Payer: Cash Price	$2,713.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,922.50
Rate for Payer: Health Management Network Commercial	$3,548.75
Rate for Payer: Kaiser Permanente Commercial	$2,630.25
Rate for Payer: Kaiser Permanente Medicaid	$2,129.25
Rate for Payer: MDX Hawaii PPO	$4,049.75
Rate for Payer: University Health Alliance Commercial	$2,338.00

Alphavent Suture Anchor 5.5mm Peek 3910-955-020 [3644322]

Facility

$4,175.00

Service Code	HCPCS C1713
Hospital Charge Code	3644322
Hospital Revenue Code	278
Min. Negotiated Rate	$2,338.00
Max. Negotiated Rate	$4,049.75
Rate for Payer: Cash Price	$2,713.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,922.50
Rate for Payer: Health Management Network Commercial	$3,548.75
Rate for Payer: MDX Hawaii PPO	$4,049.75
Rate for Payer: University Health Alliance Commercial	$2,338.00

Alphine Hip Stem Sz 9 STD 130 Deg Neck 700-0009 [3644517]

Facility

$8,503.00

Service Code	HCPCS C1776
Hospital Charge Code	3644517
Hospital Revenue Code	278
Min. Negotiated Rate	$4,761.68
Max. Negotiated Rate	$8,247.91
Rate for Payer: Cash Price	$5,526.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,952.10
Rate for Payer: Health Management Network Commercial	$7,227.55
Rate for Payer: MDX Hawaii PPO	$8,247.91
Rate for Payer: University Health Alliance Commercial	$4,761.68

Alphine Hip Stem Sz 9 STD 130 Deg Neck 700-0009 [3644517]

Facility

$8,503.00

Service Code	HCPCS C1776
Hospital Charge Code	3644517
Hospital Revenue Code	278
Min. Negotiated Rate	$4,336.53
Max. Negotiated Rate	$8,247.91
Rate for Payer: Cash Price	$5,526.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,952.10
Rate for Payer: Health Management Network Commercial	$7,227.55
Rate for Payer: Kaiser Permanente Commercial	$5,356.89
Rate for Payer: Kaiser Permanente Medicaid	$4,336.53
Rate for Payer: MDX Hawaii PPO	$8,247.91
Rate for Payer: University Health Alliance Commercial	$4,761.68

Alpine Hip Stem Sz 11 STD 130 Deg Neck 700-0011 [3644518]

Facility

$8,503.00

Service Code	HCPCS C1776
Hospital Charge Code	3644518
Hospital Revenue Code	278
Min. Negotiated Rate	$4,336.53
Max. Negotiated Rate	$8,247.91
Rate for Payer: Cash Price	$5,526.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,952.10
Rate for Payer: Health Management Network Commercial	$7,227.55
Rate for Payer: Kaiser Permanente Commercial	$5,356.89
Rate for Payer: Kaiser Permanente Medicaid	$4,336.53
Rate for Payer: MDX Hawaii PPO	$8,247.91
Rate for Payer: University Health Alliance Commercial	$4,761.68

Alpine Hip Stem Sz 11 STD 130 Deg Neck 700-0011 [3644518]

Facility

$8,503.00

Service Code	HCPCS C1776
Hospital Charge Code	3644518
Hospital Revenue Code	278
Min. Negotiated Rate	$4,761.68
Max. Negotiated Rate	$8,247.91
Rate for Payer: Cash Price	$5,526.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,952.10
Rate for Payer: Health Management Network Commercial	$7,227.55
Rate for Payer: MDX Hawaii PPO	$8,247.91
Rate for Payer: University Health Alliance Commercial	$4,761.68

ALPRAZOLAM 0.25 MG PO TABLET

Facility

$2.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.96
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Management Network Commercial	$1.72
Rate for Payer: MDX Hawaii PPO	$1.96

ALPRAZOLAM 0.25 MG PO TABLET

Facility

$2.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.96
Rate for Payer: Cash Price	$1.31
Rate for Payer: Hawaii Western Management Group Commercial	$1.92
Rate for Payer: Health Management Network Commercial	$1.72
Rate for Payer: Kaiser Permanente Commercial	$1.27
Rate for Payer: Kaiser Permanente Medicaid	$1.03
Rate for Payer: MDX Hawaii PPO	$1.96
Rate for Payer: UnitedHealthcare Medicaid	$1.21
Rate for Payer: University Health Alliance Commercial	$1.47

ALPRAZOLAM 0.5 MG PO TABLET

Facility

$2.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.37
Rate for Payer: Cash Price	$1.59
Rate for Payer: Hawaii Western Management Group Commercial	$2.32
Rate for Payer: Health Management Network Commercial	$2.07
Rate for Payer: Kaiser Permanente Commercial	$1.54
Rate for Payer: Kaiser Permanente Medicaid	$1.24
Rate for Payer: MDX Hawaii PPO	$2.37
Rate for Payer: UnitedHealthcare Medicaid	$1.46
Rate for Payer: University Health Alliance Commercial	$1.78

ALPRAZOLAM 0.5 MG PO TABLET

Facility

$2.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.37
Rate for Payer: Cash Price	$1.59
Rate for Payer: Health Management Network Commercial	$2.07
Rate for Payer: MDX Hawaii PPO	$2.37

ALPROSTADIL 500 MCG/ML INJ SOLN

Facility

$591.56

Service Code	HCPCS J0270
Hospital Revenue Code	250
Min. Negotiated Rate	$502.83
Max. Negotiated Rate	$573.81
Rate for Payer: Cash Price	$384.51
Rate for Payer: Health Management Network Commercial	$502.83
Rate for Payer: MDX Hawaii PPO	$573.81

ALPROSTADIL 500 MCG/ML INJ SOLN

Facility

$591.56

Service Code	HCPCS J0270
Hospital Revenue Code	637
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$573.81
Rate for Payer: Cash Price	$384.51
Rate for Payer: Hawaii Western Management Group Commercial	$561.98
Rate for Payer: Health Management Network Commercial	$502.83
Rate for Payer: Kaiser Permanente Commercial	$372.68
Rate for Payer: Kaiser Permanente Medicaid	$301.70
Rate for Payer: MDX Hawaii PPO	$573.81
Rate for Payer: University Health Alliance Commercial	$431.19

Alt Anat Ag Peg Glen Sz54 Fw-7 Rt 521-09-854 [3644195]

Facility

$11,474.50

Service Code	HCPCS C1776
Hospital Charge Code	3644195
Hospital Revenue Code	278
Min. Negotiated Rate	$5,851.99
Max. Negotiated Rate	$11,130.26
Rate for Payer: Cash Price	$7,458.42
Rate for Payer: Hawaii Western Management Group Commercial	$8,032.15
Rate for Payer: Health Management Network Commercial	$9,753.33
Rate for Payer: Kaiser Permanente Commercial	$7,228.94
Rate for Payer: Kaiser Permanente Medicaid	$5,851.99
Rate for Payer: MDX Hawaii PPO	$11,130.26
Rate for Payer: University Health Alliance Commercial	$6,425.72

Alt Anat Ag Peg Glen Sz54 Fw-7 Rt 521-09-854 [3644195]

Facility

$11,474.50

Service Code	HCPCS C1776
Hospital Charge Code	3644195
Hospital Revenue Code	278
Min. Negotiated Rate	$6,425.72
Max. Negotiated Rate	$11,130.26
Rate for Payer: Cash Price	$7,458.42
Rate for Payer: Hawaii Western Management Group Commercial	$8,032.15
Rate for Payer: Health Management Network Commercial	$9,753.33
Rate for Payer: MDX Hawaii PPO	$11,130.26
Rate for Payer: University Health Alliance Commercial	$6,425.72

ALTEPLASE 100 MG IV RECON.SOLN.

Facility

$11,678.84

Service Code	HCPCS J2997
Hospital Revenue Code	250
Min. Negotiated Rate	$9,927.01
Max. Negotiated Rate	$11,328.47
Rate for Payer: Cash Price	$7,591.25
Rate for Payer: Health Management Network Commercial	$9,927.01
Rate for Payer: MDX Hawaii PPO	$11,328.47

ALTEPLASE 100 MG IV RECON.SOLN.

Facility

$11,678.84

Service Code	HCPCS J2997
Hospital Revenue Code	636
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$11,328.47
Rate for Payer: AlohaCare Medicaid	$95.09
Rate for Payer: AlohaCare Medicare	$95.09
Rate for Payer: Cash Price	$7,591.25
Rate for Payer: Cash Price	$7,591.25
Rate for Payer: Devoted Health Medicare	$104.60
Rate for Payer: Hawaii Medical Service Association ABD	$94.15
Rate for Payer: Hawaii Medical Service Association Commercial	$118.86
Rate for Payer: Hawaii Medical Service Association Medicare	$95.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$94.15
Rate for Payer: Hawaii Western Management Group Commercial	$11,094.90
Rate for Payer: Health Management Network Commercial	$9,927.01
Rate for Payer: Humana Medicare	$95.09
Rate for Payer: Kaiser Permanente Commercial	$7,357.67
Rate for Payer: Kaiser Permanente Medicaid	$5,956.21
Rate for Payer: Kaiser Permanente Medicare	$95.09
Rate for Payer: MDX Hawaii PPO	$11,328.47
Rate for Payer: Ohana Health Plan Medicaid	$104.60
Rate for Payer: Ohana Health Plan Medicare	$95.09
Rate for Payer: UnitedHealthcare Medicaid	$7,007.30
Rate for Payer: UnitedHealthcare Medicare	$95.09
Rate for Payer: University Health Alliance Commercial	$8,512.71

ALTEPLASE 2 MG INTRA-CATHET RECON.SOLN.

Facility

$624.42

Service Code	HCPCS J2997
Hospital Revenue Code	636
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$605.69
Rate for Payer: AlohaCare Medicare	$95.09
Rate for Payer: AlohaCare Medicaid	$95.09
Rate for Payer: Cash Price	$405.87
Rate for Payer: Cash Price	$405.87
Rate for Payer: Devoted Health Medicare	$104.60
Rate for Payer: Hawaii Medical Service Association ABD	$94.15
Rate for Payer: Hawaii Medical Service Association Commercial	$118.86
Rate for Payer: Hawaii Medical Service Association Medicare	$95.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$94.15
Rate for Payer: Hawaii Western Management Group Commercial	$593.20
Rate for Payer: Health Management Network Commercial	$530.76
Rate for Payer: Humana Medicare	$95.09
Rate for Payer: Kaiser Permanente Commercial	$393.38
Rate for Payer: Kaiser Permanente Medicaid	$318.45
Rate for Payer: Kaiser Permanente Medicare	$95.09
Rate for Payer: MDX Hawaii PPO	$605.69
Rate for Payer: Ohana Health Plan Medicaid	$104.60
Rate for Payer: Ohana Health Plan Medicare	$95.09
Rate for Payer: UnitedHealthcare Medicaid	$374.65
Rate for Payer: UnitedHealthcare Medicare	$95.09
Rate for Payer: University Health Alliance Commercial	$455.14

ALTEPLASE 2 MG INTRA-CATHET RECON.SOLN.

Facility

$624.42

Service Code	HCPCS J2997
Hospital Revenue Code	250
Min. Negotiated Rate	$530.76
Max. Negotiated Rate	$605.69
Rate for Payer: Cash Price	$405.87
Rate for Payer: Health Management Network Commercial	$530.76
Rate for Payer: MDX Hawaii PPO	$605.69

Know your out-of-pocket cost for care.

All Charges