Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Nail Ti Elastic 2.0mm x 400mm 475.920 [3610672]

Facility

$1,898.01

Service Code	HCPCS C1713
Hospital Charge Code	3610672
Hospital Revenue Code	278
Min. Negotiated Rate	$967.99
Max. Negotiated Rate	$1,841.07
Rate for Payer: Cash Price	$1,233.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,328.61
Rate for Payer: Health Management Network Commercial	$1,613.31
Rate for Payer: Kaiser Permanente Commercial	$1,195.75
Rate for Payer: Kaiser Permanente Medicaid	$967.99
Rate for Payer: MDX Hawaii PPO	$1,841.07
Rate for Payer: University Health Alliance Commercial	$1,062.89

Nail Ti Elastic 2.0mm x 400mm 475.920 [3610672]

Facility

$1,898.01

Service Code	HCPCS C1713
Hospital Charge Code	3610672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.89
Max. Negotiated Rate	$1,841.07
Rate for Payer: Cash Price	$1,233.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,328.61
Rate for Payer: Health Management Network Commercial	$1,613.31
Rate for Payer: MDX Hawaii PPO	$1,841.07
Rate for Payer: University Health Alliance Commercial	$1,062.89

Nail Ti Elastic 2.5mm x 440mm 475.925 [3641534]

Facility

$2,028.85

Service Code	HCPCS C1713
Hospital Charge Code	3641534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,034.71
Max. Negotiated Rate	$1,967.98
Rate for Payer: Cash Price	$1,318.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,420.19
Rate for Payer: Health Management Network Commercial	$1,724.52
Rate for Payer: Kaiser Permanente Commercial	$1,278.18
Rate for Payer: Kaiser Permanente Medicaid	$1,034.71
Rate for Payer: MDX Hawaii PPO	$1,967.98
Rate for Payer: University Health Alliance Commercial	$1,136.16

Nail Ti Elastic 2.5mm x 440mm 475.925 [3641534]

Facility

$2,028.85

Service Code	HCPCS C1713
Hospital Charge Code	3641534
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.16
Max. Negotiated Rate	$1,967.98
Rate for Payer: Cash Price	$1,318.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,420.19
Rate for Payer: Health Management Network Commercial	$1,724.52
Rate for Payer: MDX Hawaii PPO	$1,967.98
Rate for Payer: University Health Alliance Commercial	$1,136.16

Nail Ti Elastic 3.0mm x 440mm 475.930 [3641532]

Facility

$2,131.40

Service Code	HCPCS C1713
Hospital Charge Code	3641532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.01
Max. Negotiated Rate	$2,067.46
Rate for Payer: Cash Price	$1,385.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,491.98
Rate for Payer: Health Management Network Commercial	$1,811.69
Rate for Payer: Kaiser Permanente Commercial	$1,342.78
Rate for Payer: Kaiser Permanente Medicaid	$1,087.01
Rate for Payer: MDX Hawaii PPO	$2,067.46
Rate for Payer: University Health Alliance Commercial	$1,193.58

Nail Ti Elastic 3.0mm x 440mm 475.930 [3641532]

Facility

$2,131.40

Service Code	HCPCS C1713
Hospital Charge Code	3641532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.58
Max. Negotiated Rate	$2,067.46
Rate for Payer: Cash Price	$1,385.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,491.98
Rate for Payer: Health Management Network Commercial	$1,811.69
Rate for Payer: MDX Hawaii PPO	$2,067.46
Rate for Payer: University Health Alliance Commercial	$1,193.58

Nail Ti Elastic 3.5mm x 440mm 475.935 [3610013]

Facility

$2,244.56

Service Code	HCPCS C1713
Hospital Charge Code	3610013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,144.73
Max. Negotiated Rate	$2,177.22
Rate for Payer: Cash Price	$1,458.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,571.19
Rate for Payer: Health Management Network Commercial	$1,907.88
Rate for Payer: Kaiser Permanente Commercial	$1,414.07
Rate for Payer: Kaiser Permanente Medicaid	$1,144.73
Rate for Payer: MDX Hawaii PPO	$2,177.22
Rate for Payer: University Health Alliance Commercial	$1,256.95

Nail Ti Elastic 3.5mm x 440mm 475.935 [3610013]

Facility

$2,244.56

Service Code	HCPCS C1713
Hospital Charge Code	3610013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.95
Max. Negotiated Rate	$2,177.22
Rate for Payer: Cash Price	$1,458.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,571.19
Rate for Payer: Health Management Network Commercial	$1,907.88
Rate for Payer: MDX Hawaii PPO	$2,177.22
Rate for Payer: University Health Alliance Commercial	$1,256.95

Nail Troch Short 10mmx20cmx130deg AR-9094-10-2030 [3645422]

Facility

$14,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3645422
Hospital Revenue Code	278
Min. Negotiated Rate	$7,297.85
Max. Negotiated Rate	$13,880.22
Rate for Payer: Cash Price	$9,301.18
Rate for Payer: Hawaii Western Management Group Commercial	$10,016.65
Rate for Payer: Health Management Network Commercial	$12,163.08
Rate for Payer: Kaiser Permanente Commercial	$9,014.99
Rate for Payer: Kaiser Permanente Medicaid	$7,297.85
Rate for Payer: MDX Hawaii PPO	$13,880.22
Rate for Payer: University Health Alliance Commercial	$8,013.32

Nail Troch Short 10mmx20cmx130deg AR-9094-10-2030 [3645422]

Facility

$14,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3645422
Hospital Revenue Code	278
Min. Negotiated Rate	$8,013.32
Max. Negotiated Rate	$13,880.22
Rate for Payer: Cash Price	$9,301.18
Rate for Payer: Hawaii Western Management Group Commercial	$10,016.65
Rate for Payer: Health Management Network Commercial	$12,163.08
Rate for Payer: MDX Hawaii PPO	$13,880.22
Rate for Payer: University Health Alliance Commercial	$8,013.32

Nail Troch Short 12mm x 20cm x 130Deg AR-9094-12-2030 [3645401]

Facility

$14,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3645401
Hospital Revenue Code	278
Min. Negotiated Rate	$7,297.85
Max. Negotiated Rate	$13,880.22
Rate for Payer: Cash Price	$9,301.18
Rate for Payer: Hawaii Western Management Group Commercial	$10,016.65
Rate for Payer: Health Management Network Commercial	$12,163.08
Rate for Payer: Kaiser Permanente Commercial	$9,014.99
Rate for Payer: Kaiser Permanente Medicaid	$7,297.85
Rate for Payer: MDX Hawaii PPO	$13,880.22
Rate for Payer: University Health Alliance Commercial	$8,013.32

Nail Troch Short 12mm x 20cm x 130Deg AR-9094-12-2030 [3645401]

Facility

$14,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3645401
Hospital Revenue Code	278
Min. Negotiated Rate	$8,013.32
Max. Negotiated Rate	$13,880.22
Rate for Payer: Cash Price	$9,301.18
Rate for Payer: Hawaii Western Management Group Commercial	$10,016.65
Rate for Payer: Health Management Network Commercial	$12,163.08
Rate for Payer: MDX Hawaii PPO	$13,880.22
Rate for Payer: University Health Alliance Commercial	$8,013.32

NALOXONE 0.4 MG/ML INJ SOLN 1 ML VIAL

Facility

$38.62

Service Code	HCPCS J2312
Hospital Revenue Code	250
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$37.46
Rate for Payer: Cash Price	$25.10
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: MDX Hawaii PPO	$37.46

NALOXONE 0.4 MG/ML INJ SOLN 1 ML VIAL

Facility

$38.62

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$37.46
Rate for Payer: Cash Price	$25.10
Rate for Payer: Cash Price	$25.10
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$36.69
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: Kaiser Permanente Commercial	$24.33
Rate for Payer: Kaiser Permanente Medicaid	$19.70
Rate for Payer: MDX Hawaii PPO	$37.46
Rate for Payer: UnitedHealthcare Medicaid	$23.17
Rate for Payer: University Health Alliance Commercial	$28.15

NALOXONE 0.4 MG/ML INJ SYR

Facility

$81.93

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$79.47
Rate for Payer: Cash Price	$53.25
Rate for Payer: Cash Price	$53.25
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$77.83
Rate for Payer: Health Management Network Commercial	$69.64
Rate for Payer: Kaiser Permanente Commercial	$51.62
Rate for Payer: Kaiser Permanente Medicaid	$41.78
Rate for Payer: MDX Hawaii PPO	$79.47
Rate for Payer: UnitedHealthcare Medicaid	$49.16
Rate for Payer: University Health Alliance Commercial	$59.72

NALOXONE 0.4 MG/ML INJ SYR

Facility

$81.93

Service Code	HCPCS J2312
Hospital Revenue Code	250
Min. Negotiated Rate	$69.64
Max. Negotiated Rate	$79.47
Rate for Payer: Cash Price	$53.25
Rate for Payer: Health Management Network Commercial	$69.64
Rate for Payer: MDX Hawaii PPO	$79.47

NALOXONE 1 MG/ML INJ SYR

Facility

$154.62

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$149.98
Rate for Payer: Cash Price	$100.50
Rate for Payer: Cash Price	$100.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$146.89
Rate for Payer: Health Management Network Commercial	$131.43
Rate for Payer: Kaiser Permanente Commercial	$97.41
Rate for Payer: Kaiser Permanente Medicaid	$78.86
Rate for Payer: MDX Hawaii PPO	$149.98
Rate for Payer: UnitedHealthcare Medicaid	$92.77
Rate for Payer: University Health Alliance Commercial	$112.70

NALOXONE 1 MG/ML INJ SYR

Facility

$154.62

Service Code	HCPCS J2312
Hospital Revenue Code	250
Min. Negotiated Rate	$131.43
Max. Negotiated Rate	$149.98
Rate for Payer: Cash Price	$100.50
Rate for Payer: Health Management Network Commercial	$131.43
Rate for Payer: MDX Hawaii PPO	$149.98

NALTREXONE 50 MG PO TABLET

Facility

$23.81

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$23.10
Rate for Payer: Cash Price	$15.48
Rate for Payer: Health Management Network Commercial	$20.24
Rate for Payer: MDX Hawaii PPO	$23.10

NALTREXONE 50 MG PO TABLET

Facility

$23.81

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$23.10
Rate for Payer: Cash Price	$15.48
Rate for Payer: Hawaii Western Management Group Commercial	$22.62
Rate for Payer: Health Management Network Commercial	$20.24
Rate for Payer: Kaiser Permanente Commercial	$15.00
Rate for Payer: Kaiser Permanente Medicaid	$12.14
Rate for Payer: MDX Hawaii PPO	$23.10
Rate for Payer: UnitedHealthcare Medicaid	$14.29
Rate for Payer: University Health Alliance Commercial	$17.36

NAPROXEN 250 MG PO TABLET

Facility

$4.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$4.15
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cash Price	$2.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.07
Rate for Payer: Hawaii Western Management Group Commercial	$4.08
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Health Management Network Commercial	$3.64
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$2.71
Rate for Payer: Kaiser Permanente Medicaid	$2.19
Rate for Payer: Kaiser Permanente Medicaid	$2.18
Rate for Payer: MDX Hawaii PPO	$4.17
Rate for Payer: MDX Hawaii PPO	$4.15
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicaid	$2.58
Rate for Payer: University Health Alliance Commercial	$3.13
Rate for Payer: University Health Alliance Commercial	$3.12

NAPROXEN 250 MG PO TABLET

Facility

$4.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$4.15
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cash Price	$2.80
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Health Management Network Commercial	$3.64
Rate for Payer: MDX Hawaii PPO	$4.17
Rate for Payer: MDX Hawaii PPO	$4.15

NAPROXEN 375 MG PO TABLET

Facility

$5.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$5.68
Rate for Payer: Cash Price	$3.81
Rate for Payer: Hawaii Western Management Group Commercial	$5.57
Rate for Payer: Health Management Network Commercial	$4.98
Rate for Payer: Kaiser Permanente Commercial	$3.69
Rate for Payer: Kaiser Permanente Medicaid	$2.99
Rate for Payer: MDX Hawaii PPO	$5.68
Rate for Payer: UnitedHealthcare Medicaid	$3.52
Rate for Payer: University Health Alliance Commercial	$4.27

NAPROXEN 375 MG PO TABLET

Facility

$5.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$5.68
Rate for Payer: Cash Price	$3.81
Rate for Payer: Health Management Network Commercial	$4.98
Rate for Payer: MDX Hawaii PPO	$5.68

NATALIZUMAB 300 MG/15 ML IV SOLN

Facility

$11,773.47

Service Code	HCPCS J2323
Hospital Revenue Code	636
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$11,420.27
Rate for Payer: AlohaCare Medicaid	$24.32
Rate for Payer: AlohaCare Medicare	$24.32
Rate for Payer: Cash Price	$7,652.76
Rate for Payer: Cash Price	$7,652.76
Rate for Payer: Devoted Health Medicare	$26.75
Rate for Payer: Hawaii Medical Service Association ABD	$24.13
Rate for Payer: Hawaii Medical Service Association Commercial	$30.40
Rate for Payer: Hawaii Medical Service Association Medicare	$24.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$11,184.80
Rate for Payer: Health Management Network Commercial	$10,007.45
Rate for Payer: Humana Medicare	$24.32
Rate for Payer: Kaiser Permanente Commercial	$7,417.29
Rate for Payer: Kaiser Permanente Medicaid	$6,004.47
Rate for Payer: Kaiser Permanente Medicare	$24.32
Rate for Payer: MDX Hawaii PPO	$11,420.27
Rate for Payer: Ohana Health Plan Medicaid	$26.75
Rate for Payer: Ohana Health Plan Medicare	$24.32
Rate for Payer: UnitedHealthcare Medicaid	$7,064.08
Rate for Payer: UnitedHealthcare Medicare	$24.32
Rate for Payer: University Health Alliance Commercial	$8,581.68

Know your out-of-pocket cost for care.

All Charges