Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Modified Maryland Dissector Tip Disp 3322 [3642397]

Facility

$413.88

Hospital Charge Code	3642397
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Module B/h Blue Intubation [2707766]

Facility

$315.75

Hospital Charge Code	2707766
Hospital Revenue Code	272
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$306.28
Rate for Payer: Cash Price	$205.24
Rate for Payer: Hawaii Western Management Group Commercial	$299.96
Rate for Payer: Health Management Network Commercial	$268.39
Rate for Payer: Kaiser Permanente Commercial	$198.92
Rate for Payer: Kaiser Permanente Medicaid	$161.03
Rate for Payer: MDX Hawaii PPO	$306.28
Rate for Payer: University Health Alliance Commercial	$230.15

Module B/h Blue Intubation [2707766]

Facility

$315.75

Hospital Charge Code	2707766
Hospital Revenue Code	272
Min. Negotiated Rate	$268.39
Max. Negotiated Rate	$306.28
Rate for Payer: Cash Price	$205.24
Rate for Payer: Health Management Network Commercial	$268.39
Rate for Payer: MDX Hawaii PPO	$306.28

Module B/h Blue Iv [2707767]

Facility

$342.75

Hospital Charge Code	2707767
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

Module B/h Blue Iv [2707767]

Facility

$342.75

Hospital Charge Code	2707767
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

Module B/h White Intubation [2707762]

Facility

$315.75

Hospital Charge Code	2707762
Hospital Revenue Code	272
Min. Negotiated Rate	$268.39
Max. Negotiated Rate	$306.28
Rate for Payer: Cash Price	$205.24
Rate for Payer: Health Management Network Commercial	$268.39
Rate for Payer: MDX Hawaii PPO	$306.28

Module B/h White Intubation [2707762]

Facility

$315.75

Hospital Charge Code	2707762
Hospital Revenue Code	272
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$306.28
Rate for Payer: Cash Price	$205.24
Rate for Payer: Hawaii Western Management Group Commercial	$299.96
Rate for Payer: Health Management Network Commercial	$268.39
Rate for Payer: Kaiser Permanente Commercial	$198.92
Rate for Payer: Kaiser Permanente Medicaid	$161.03
Rate for Payer: MDX Hawaii PPO	$306.28
Rate for Payer: University Health Alliance Commercial	$230.15

Module B/h White Iv [2707763]

Facility

$342.75

Hospital Charge Code	2707763
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

Module B/h White Iv [2707763]

Facility

$342.75

Hospital Charge Code	2707763
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

Module B/h Yellow Iv [2707759]

Facility

$342.75

Hospital Charge Code	2707759
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

Module B/h Yellow Iv [2707759]

Facility

$342.75

Hospital Charge Code	2707759
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

Monster Cann Long Thrd Screw 5.5mm x 60mm P20-555-060L [3644904]

Facility

$3,365.00

Service Code	HCPCS C1713
Hospital Charge Code	3644904
Hospital Revenue Code	278
Min. Negotiated Rate	$1,884.40
Max. Negotiated Rate	$3,264.05
Rate for Payer: Cash Price	$2,187.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,355.50
Rate for Payer: Health Management Network Commercial	$2,860.25
Rate for Payer: MDX Hawaii PPO	$3,264.05
Rate for Payer: University Health Alliance Commercial	$1,884.40

Monster Cann Long Thrd Screw 5.5mm x 60mm P20-555-060L [3644904]

Facility

$3,365.00

Service Code	HCPCS C1713
Hospital Charge Code	3644904
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.15
Max. Negotiated Rate	$3,264.05
Rate for Payer: Cash Price	$2,187.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,355.50
Rate for Payer: Health Management Network Commercial	$2,860.25
Rate for Payer: Kaiser Permanente Commercial	$2,119.95
Rate for Payer: Kaiser Permanente Medicaid	$1,716.15
Rate for Payer: MDX Hawaii PPO	$3,264.05
Rate for Payer: University Health Alliance Commercial	$1,884.40

Monster Cann Short Thrd Screw 5.5mm x 60mm P20-555-060S [3644905]

Facility

$3,365.00

Service Code	HCPCS C1713
Hospital Charge Code	3644905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,884.40
Max. Negotiated Rate	$3,264.05
Rate for Payer: Cash Price	$2,187.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,355.50
Rate for Payer: Health Management Network Commercial	$2,860.25
Rate for Payer: MDX Hawaii PPO	$3,264.05
Rate for Payer: University Health Alliance Commercial	$1,884.40

Monster Cann Short Thrd Screw 5.5mm x 60mm P20-555-060S [3644905]

Facility

$3,365.00

Service Code	HCPCS C1713
Hospital Charge Code	3644905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.15
Max. Negotiated Rate	$3,264.05
Rate for Payer: Cash Price	$2,187.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,355.50
Rate for Payer: Health Management Network Commercial	$2,860.25
Rate for Payer: Kaiser Permanente Commercial	$2,119.95
Rate for Payer: Kaiser Permanente Medicaid	$1,716.15
Rate for Payer: MDX Hawaii PPO	$3,264.05
Rate for Payer: University Health Alliance Commercial	$1,884.40

Montage Flowable OS-MON-1501FL [3644984]

Facility

$13,049.50

Hospital Charge Code	3644984
Hospital Revenue Code	272
Min. Negotiated Rate	$6,655.24
Max. Negotiated Rate	$12,658.01
Rate for Payer: Cash Price	$8,482.18
Rate for Payer: Hawaii Western Management Group Commercial	$12,397.02
Rate for Payer: Health Management Network Commercial	$11,092.08
Rate for Payer: Kaiser Permanente Commercial	$8,221.18
Rate for Payer: Kaiser Permanente Medicaid	$6,655.24
Rate for Payer: MDX Hawaii PPO	$12,658.01
Rate for Payer: University Health Alliance Commercial	$9,511.78

Montage Flowable OS-MON-1501FL [3644984]

Facility

$13,049.50

Hospital Charge Code	3644984
Hospital Revenue Code	272
Min. Negotiated Rate	$11,092.08
Max. Negotiated Rate	$12,658.01
Rate for Payer: Cash Price	$8,482.18
Rate for Payer: Health Management Network Commercial	$11,092.08
Rate for Payer: MDX Hawaii PPO	$12,658.01

MONTELUKAST 10 MG PO TABLET

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: MDX Hawaii PPO	$1.78

MONTELUKAST 10 MG PO TABLET

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Kaiser Permanente Commercial	$1.15
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: UnitedHealthcare Medicaid	$1.10
Rate for Payer: University Health Alliance Commercial	$1.33

MORPHINE 10 MG/5 ML PO SOLN

Facility

$68.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$58.59
Max. Negotiated Rate	$66.86
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Management Network Commercial	$58.59
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$66.86
Rate for Payer: MDX Hawaii PPO	$8.73

MORPHINE 10 MG/5 ML PO SOLN

Facility

$9.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$44.80
Rate for Payer: Hawaii Western Management Group Commercial	$65.48
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$58.59
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.67
Rate for Payer: Kaiser Permanente Commercial	$43.43
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicaid	$35.15
Rate for Payer: MDX Hawaii PPO	$66.86
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: UnitedHealthcare Medicaid	$41.36
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: University Health Alliance Commercial	$6.56
Rate for Payer: University Health Alliance Commercial	$50.24

MORPHINE 10 MG/ML IV SOLN

Facility

$14.07

Service Code	HCPCS J2270
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$13.65
Rate for Payer: Cash Price	$9.15
Rate for Payer: Cash Price	$9.15
Rate for Payer: Hawaii Medical Service Association ABD	$4.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$13.37
Rate for Payer: Health Management Network Commercial	$11.96
Rate for Payer: Kaiser Permanente Commercial	$8.86
Rate for Payer: Kaiser Permanente Medicaid	$7.18
Rate for Payer: MDX Hawaii PPO	$13.65
Rate for Payer: UnitedHealthcare Medicaid	$8.44
Rate for Payer: University Health Alliance Commercial	$10.26

MORPHINE 10 MG/ML IV SOLN

Facility

$14.07

Service Code	HCPCS J2270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$13.65
Rate for Payer: Cash Price	$9.15
Rate for Payer: Health Management Network Commercial	$11.96
Rate for Payer: MDX Hawaii PPO	$13.65

MORPHINE 10 MG/ML IV SYR

Facility

$39.32

Service Code	HCPCS J2270
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$38.14
Rate for Payer: Cash Price	$25.56
Rate for Payer: Cash Price	$25.56
Rate for Payer: Hawaii Medical Service Association ABD	$4.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$37.35
Rate for Payer: Health Management Network Commercial	$33.42
Rate for Payer: Kaiser Permanente Commercial	$24.77
Rate for Payer: Kaiser Permanente Medicaid	$20.05
Rate for Payer: MDX Hawaii PPO	$38.14
Rate for Payer: UnitedHealthcare Medicaid	$23.59
Rate for Payer: University Health Alliance Commercial	$28.66

MORPHINE 10 MG/ML IV SYR

Facility

$39.32

Service Code	HCPCS J2270
Hospital Revenue Code	250
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$38.14
Rate for Payer: Cash Price	$25.56
Rate for Payer: Health Management Network Commercial	$33.42
Rate for Payer: MDX Hawaii PPO	$38.14

Know your out-of-pocket cost for care.

All Charges