Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Arthros Electrode Hook 90 AR9606H90 [3600295]

Facility

$342.75

Hospital Charge Code	3600295
Hospital Revenue Code	272
Min. Negotiated Rate	$291.34
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: MDX Hawaii PPO	$332.47

Arthros Electrode Hook 90 AR9606H90 [3600295]

Facility

$342.75

Hospital Charge Code	3600295
Hospital Revenue Code	272
Min. Negotiated Rate	$174.80
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Hawaii Western Management Group Commercial	$325.61
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: Kaiser Permanente Commercial	$215.93
Rate for Payer: Kaiser Permanente Medicaid	$174.80
Rate for Payer: MDX Hawaii PPO	$332.47
Rate for Payer: University Health Alliance Commercial	$249.83

Artiss Fibrin Sealant 2ml 5500694 [3643803]

Facility

$965.61

Hospital Charge Code	3643803
Hospital Revenue Code	272
Min. Negotiated Rate	$820.77
Max. Negotiated Rate	$936.64
Rate for Payer: Cash Price	$627.65
Rate for Payer: Health Management Network Commercial	$820.77
Rate for Payer: MDX Hawaii PPO	$936.64

Artiss Fibrin Sealant 2ml 5500694 [3643803]

Facility

$965.61

Hospital Charge Code	3643803
Hospital Revenue Code	272
Min. Negotiated Rate	$492.46
Max. Negotiated Rate	$936.64
Rate for Payer: Cash Price	$627.65
Rate for Payer: Hawaii Western Management Group Commercial	$917.33
Rate for Payer: Health Management Network Commercial	$820.77
Rate for Payer: Kaiser Permanente Commercial	$608.33
Rate for Payer: Kaiser Permanente Medicaid	$492.46
Rate for Payer: MDX Hawaii PPO	$936.64
Rate for Payer: University Health Alliance Commercial	$703.83

ASCORBIC ACID (VITAMIN C) 1000 MG PO TABLET

Facility

$1.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$1.66
Rate for Payer: Health Management Network Commercial	$1.49
Rate for Payer: Kaiser Permanente Commercial	$1.10
Rate for Payer: Kaiser Permanente Medicaid	$0.89
Rate for Payer: MDX Hawaii PPO	$1.70
Rate for Payer: UnitedHealthcare Medicaid	$1.05
Rate for Payer: University Health Alliance Commercial	$1.28

ASCORBIC ACID (VITAMIN C) 1000 MG PO TABLET

Facility

$1.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.14
Rate for Payer: Health Management Network Commercial	$1.49
Rate for Payer: MDX Hawaii PPO	$1.70

ASCORBIC ACID (VITAMIN C) 500 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: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

ASCORBIC ACID (VITAMIN C) 500 MG PO TABLET

Facility

$1.20

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

ASENAPINE MALEATE 5 MG SL SUBL.TAB

Facility

$107.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$91.33
Max. Negotiated Rate	$104.23
Rate for Payer: Cash Price	$69.84
Rate for Payer: Cash Price	$25.12
Rate for Payer: Health Management Network Commercial	$91.33
Rate for Payer: Health Management Network Commercial	$32.84
Rate for Payer: MDX Hawaii PPO	$37.48
Rate for Payer: MDX Hawaii PPO	$104.23

ASENAPINE MALEATE 5 MG SL SUBL.TAB

Facility

$38.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.71
Max. Negotiated Rate	$37.48
Rate for Payer: Cash Price	$25.12
Rate for Payer: Cash Price	$69.84
Rate for Payer: Hawaii Western Management Group Commercial	$102.08
Rate for Payer: Hawaii Western Management Group Commercial	$36.71
Rate for Payer: Health Management Network Commercial	$91.33
Rate for Payer: Health Management Network Commercial	$32.84
Rate for Payer: Kaiser Permanente Commercial	$67.69
Rate for Payer: Kaiser Permanente Commercial	$24.34
Rate for Payer: Kaiser Permanente Medicaid	$19.71
Rate for Payer: Kaiser Permanente Medicaid	$54.80
Rate for Payer: MDX Hawaii PPO	$104.23
Rate for Payer: MDX Hawaii PPO	$37.48
Rate for Payer: UnitedHealthcare Medicaid	$64.47
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: University Health Alliance Commercial	$78.32
Rate for Payer: University Health Alliance Commercial	$28.16

ASPIRIN 300 MG PR SUPP

Facility

$8.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$7.81
Rate for Payer: Cash Price	$5.23
Rate for Payer: Hawaii Western Management Group Commercial	$7.65
Rate for Payer: Health Management Network Commercial	$6.84
Rate for Payer: Kaiser Permanente Commercial	$5.07
Rate for Payer: Kaiser Permanente Medicaid	$4.11
Rate for Payer: MDX Hawaii PPO	$7.81
Rate for Payer: UnitedHealthcare Medicaid	$4.83
Rate for Payer: University Health Alliance Commercial	$5.87

ASPIRIN 300 MG PR SUPP

Facility

$8.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$7.81
Rate for Payer: Cash Price	$5.23
Rate for Payer: Health Management Network Commercial	$6.84
Rate for Payer: MDX Hawaii PPO	$7.81

ASPIRIN 325 MG PO TAB DR EC

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: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

ASPIRIN 325 MG PO TAB DR EC

Facility

$1.20

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

ASPIRIN 325 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: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

ASPIRIN 325 MG PO TABLET

Facility

$1.20

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

ASPIRIN 81 MG PO CHEW

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: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

ASPIRIN 81 MG PO CHEW

Facility

$1.20

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

ASPIRIN 81 MG PO TAB DR EC

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: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

ASPIRIN 81 MG PO TAB DR EC

Facility

$1.20

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

ASPIRIN-DIPYRIDAMOLE 25-200 MG PO CM12

Facility

$50.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.51
Max. Negotiated Rate	$48.51
Rate for Payer: Cash Price	$32.51
Rate for Payer: Hawaii Western Management Group Commercial	$47.51
Rate for Payer: Health Management Network Commercial	$42.51
Rate for Payer: Kaiser Permanente Commercial	$31.51
Rate for Payer: Kaiser Permanente Medicaid	$25.51
Rate for Payer: MDX Hawaii PPO	$48.51
Rate for Payer: UnitedHealthcare Medicaid	$30.01
Rate for Payer: University Health Alliance Commercial	$36.45

ASPIRIN-DIPYRIDAMOLE 25-200 MG PO CM12

Facility

$50.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$48.51
Rate for Payer: Cash Price	$32.51
Rate for Payer: Health Management Network Commercial	$42.51
Rate for Payer: MDX Hawaii PPO	$48.51

ASSAY OF BLOOD/URIC ACID

Professional

Both

$9.00

Service Code	HCPCS 84550
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$7.65
Rate for Payer: AlohaCare Medicaid	$6.25
Rate for Payer: AlohaCare Medicare	$4.52
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$4.97
Rate for Payer: Hawaii Medical Service Association Medicare	$4.52
Rate for Payer: Hawaii Western Management Group Commercial	$6.25
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.42
Rate for Payer: Kaiser Permanente Medicaid	$5.42
Rate for Payer: Kaiser Permanente Medicare	$5.42
Rate for Payer: Ohana Health Plan Medicaid	$6.25
Rate for Payer: Ohana Health Plan Medicare	$4.52
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$4.52

ASSAY OF FERRITIN

Professional

Both

$27.00

Service Code	HCPCS 82728
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$22.95
Rate for Payer: AlohaCare Medicaid	$15.81
Rate for Payer: AlohaCare Medicare	$13.63
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Devoted Health Medicare	$14.99
Rate for Payer: Hawaii Medical Service Association Medicare	$13.63
Rate for Payer: Hawaii Western Management Group Commercial	$15.80
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$16.36
Rate for Payer: Kaiser Permanente Medicaid	$16.36
Rate for Payer: Kaiser Permanente Medicare	$16.36
Rate for Payer: Ohana Health Plan Medicaid	$15.81
Rate for Payer: Ohana Health Plan Medicare	$13.63
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$13.63

ASSAY OF FOLIC ACID SERUM

Professional

Both

$30.00

Service Code	HCPCS 82746
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$25.50
Rate for Payer: AlohaCare Medicaid	$20.32
Rate for Payer: AlohaCare Medicare	$14.70
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Devoted Health Medicare	$16.17
Rate for Payer: Hawaii Medical Service Association Medicare	$14.70
Rate for Payer: Hawaii Western Management Group Commercial	$20.33
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$17.64
Rate for Payer: Kaiser Permanente Medicaid	$17.64
Rate for Payer: Kaiser Permanente Medicare	$17.64
Rate for Payer: Ohana Health Plan Medicaid	$20.32
Rate for Payer: Ohana Health Plan Medicare	$14.70
Rate for Payer: UnitedHealthcare Medicaid	$20.32
Rate for Payer: UnitedHealthcare Medicare	$14.70

Know your out-of-pocket cost for care.

All Charges