Kona Community Hospital

All Charges

Charge

Type

Setting

Price

LATANOPROST 0.005 % OPHT DROP

Facility

$428.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$364.53
Max. Negotiated Rate	$415.99
Rate for Payer: Cash Price	$278.76
Rate for Payer: Cash Price	$278.15
Rate for Payer: Health Management Network Commercial	$363.73
Rate for Payer: Health Management Network Commercial	$364.53
Rate for Payer: MDX Hawaii PPO	$415.08
Rate for Payer: MDX Hawaii PPO	$415.99

LATANOPROSTENE BUNOD 0.024 % OPHT DROP

Facility

$778.04

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$396.80
Max. Negotiated Rate	$754.70
Rate for Payer: Cash Price	$505.73
Rate for Payer: Hawaii Western Management Group Commercial	$739.14
Rate for Payer: Health Management Network Commercial	$661.33
Rate for Payer: Kaiser Permanente Commercial	$490.17
Rate for Payer: Kaiser Permanente Medicaid	$396.80
Rate for Payer: MDX Hawaii PPO	$754.70
Rate for Payer: UnitedHealthcare Medicaid	$466.82
Rate for Payer: University Health Alliance Commercial	$567.11

LATANOPROSTENE BUNOD 0.024 % OPHT DROP

Facility

$778.04

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$661.33
Max. Negotiated Rate	$754.70
Rate for Payer: Cash Price	$505.73
Rate for Payer: Health Management Network Commercial	$661.33
Rate for Payer: MDX Hawaii PPO	$754.70

Lead Tachy MRI for ICD Quartet 1458Q/86 [3641188]

Facility

$9,250.00

Service Code	HCPCS C1900
Hospital Charge Code	3641188
Hospital Revenue Code	278
Min. Negotiated Rate	$5,180.00
Max. Negotiated Rate	$8,972.50
Rate for Payer: Cash Price	$6,012.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

Lead Tachy MRI for ICD Quartet 1458Q/86 [3641188]

Facility

$9,250.00

Service Code	HCPCS C1900
Hospital Charge Code	3641188
Hospital Revenue Code	278
Min. Negotiated Rate	$4,717.50
Max. Negotiated Rate	$8,972.50
Rate for Payer: Cash Price	$6,012.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: Kaiser Permanente Commercial	$5,827.50
Rate for Payer: Kaiser Permanente Medicaid	$4,717.50
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

Lens Acrysof Iq Restor Iol 18.5d MN6AD1U185 [3645439]

Facility

$4,530.50

Service Code	HCPCS V2632
Hospital Charge Code	3645439
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,394.59
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.35
Rate for Payer: Health Management Network Commercial	$3,850.93
Rate for Payer: Kaiser Permanente Commercial	$2,854.22
Rate for Payer: Kaiser Permanente Medicaid	$2,310.55
Rate for Payer: MDX Hawaii PPO	$4,394.59
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,537.08

Lens Acrysof Iq Restor Iol 18.5d MN6AD1U185 [3645439]

Facility

$4,530.50

Service Code	HCPCS V2632
Hospital Charge Code	3645439
Hospital Revenue Code	276
Min. Negotiated Rate	$2,537.08
Max. Negotiated Rate	$4,394.59
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.35
Rate for Payer: Health Management Network Commercial	$3,850.93
Rate for Payer: MDX Hawaii PPO	$4,394.59
Rate for Payer: University Health Alliance Commercial	$2,537.08

Lens AcrySof IQ Restor IOL 19.5D MN6AD1U195 [3645388]

Facility

$4,530.50

Service Code	HCPCS V2632
Hospital Charge Code	3645388
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,394.59
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.35
Rate for Payer: Health Management Network Commercial	$3,850.93
Rate for Payer: Kaiser Permanente Commercial	$2,854.22
Rate for Payer: Kaiser Permanente Medicaid	$2,310.55
Rate for Payer: MDX Hawaii PPO	$4,394.59
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,537.08

Lens AcrySof IQ Restor IOL 19.5D MN6AD1U195 [3645388]

Facility

$4,530.50

Service Code	HCPCS V2632
Hospital Charge Code	3645388
Hospital Revenue Code	276
Min. Negotiated Rate	$2,537.08
Max. Negotiated Rate	$4,394.59
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.35
Rate for Payer: Health Management Network Commercial	$3,850.93
Rate for Payer: MDX Hawaii PPO	$4,394.59
Rate for Payer: University Health Alliance Commercial	$2,537.08

Lens AcrySof IQ Restor IOL 20.0D MN6AD1U200 [3645389]

Facility

$4,530.50

Service Code	HCPCS V2632
Hospital Charge Code	3645389
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,394.59
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.35
Rate for Payer: Health Management Network Commercial	$3,850.93
Rate for Payer: Kaiser Permanente Commercial	$2,854.22
Rate for Payer: Kaiser Permanente Medicaid	$2,310.55
Rate for Payer: MDX Hawaii PPO	$4,394.59
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,537.08

Lens AcrySof IQ Restor IOL 20.0D MN6AD1U200 [3645389]

Facility

$4,530.50

Service Code	HCPCS V2632
Hospital Charge Code	3645389
Hospital Revenue Code	276
Min. Negotiated Rate	$2,537.08
Max. Negotiated Rate	$4,394.59
Rate for Payer: Cash Price	$2,944.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.35
Rate for Payer: Health Management Network Commercial	$3,850.93
Rate for Payer: MDX Hawaii PPO	$4,394.59
Rate for Payer: University Health Alliance Commercial	$2,537.08

Lens Amo Sensar Iol 19.0 AR40E00190 [3644448]

Facility

$1,144.45

Service Code	HCPCS V2632
Hospital Charge Code	3644448
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$1,110.12
Rate for Payer: Cash Price	$743.89
Rate for Payer: Cash Price	$743.89
Rate for Payer: Hawaii Western Management Group Commercial	$801.12
Rate for Payer: Health Management Network Commercial	$972.78
Rate for Payer: Kaiser Permanente Commercial	$721.00
Rate for Payer: Kaiser Permanente Medicaid	$583.67
Rate for Payer: MDX Hawaii PPO	$1,110.12
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$640.89

Lens Amo Sensar Iol 19.0 AR40E00190 [3644448]

Facility

$1,144.45

Service Code	HCPCS V2632
Hospital Charge Code	3644448
Hospital Revenue Code	276
Min. Negotiated Rate	$640.89
Max. Negotiated Rate	$1,110.12
Rate for Payer: Cash Price	$743.89
Rate for Payer: Hawaii Western Management Group Commercial	$801.12
Rate for Payer: Health Management Network Commercial	$972.78
Rate for Payer: MDX Hawaii PPO	$1,110.12
Rate for Payer: University Health Alliance Commercial	$640.89

Lens Apthera IC-8 IOL 25.5 Diopter IC-8 25.5 [3644897]

Facility

$5,003.00

Service Code	HCPCS V2632
Hospital Charge Code	3644897
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
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: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,801.68

Lens Apthera IC-8 IOL 25.5 Diopter IC-8 25.5 [3644897]

Facility

$5,003.00

Service Code	HCPCS V2632
Hospital Charge Code	3644897
Hospital Revenue Code	276
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

Lens Tecnis Aspheric Iol 21.0 Za90030210 [3643819]

Facility

$634.38

Service Code	HCPCS V2632
Hospital Charge Code	3643819
Hospital Revenue Code	276
Min. Negotiated Rate	$355.25
Max. Negotiated Rate	$615.35
Rate for Payer: Cash Price	$412.35
Rate for Payer: Hawaii Western Management Group Commercial	$444.07
Rate for Payer: Health Management Network Commercial	$539.22
Rate for Payer: MDX Hawaii PPO	$615.35
Rate for Payer: University Health Alliance Commercial	$355.25

Lens Tecnis Aspheric Iol 21.0 Za90030210 [3643819]

Facility

$634.38

Service Code	HCPCS V2632
Hospital Charge Code	3643819
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$615.35
Rate for Payer: Cash Price	$412.35
Rate for Payer: Cash Price	$412.35
Rate for Payer: Hawaii Western Management Group Commercial	$444.07
Rate for Payer: Health Management Network Commercial	$539.22
Rate for Payer: Kaiser Permanente Commercial	$399.66
Rate for Payer: Kaiser Permanente Medicaid	$323.53
Rate for Payer: MDX Hawaii PPO	$615.35
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$355.25

Lens Tecnis Eyhance IOL 14.5D DIB00U0145 [3645390]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645390
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 14.5D DIB00U0145 [3645390]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645390
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 15.5 DIB00U0155 [3645406]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645406
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 15.5 DIB00U0155 [3645406]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645406
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 16.5 DIB00U0165 [3645411]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645411
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 16.5 DIB00U0165 [3645411]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645411
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 17.5 DIB00U0175 [3645408]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645408
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 17.5 DIB00U0175 [3645408]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645408
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Know your out-of-pocket cost for care.

All Charges