Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Pin Threaded 3.0mm x 305mm 00-2490-012-30 [3640904]

Facility

$917.40

Hospital Charge Code	3640904
Hospital Revenue Code	278
Min. Negotiated Rate	$467.87
Max. Negotiated Rate	$889.88
Rate for Payer: Cash Price	$596.31
Rate for Payer: Hawaii Western Management Group Commercial	$642.18
Rate for Payer: Health Management Network Commercial	$779.79
Rate for Payer: Kaiser Permanente Commercial	$577.96
Rate for Payer: Kaiser Permanente Medicaid	$467.87
Rate for Payer: MDX Hawaii PPO	$889.88
Rate for Payer: University Health Alliance Commercial	$513.74

Pin Threaded 3.0mm x 305mm 00-2490-012-30 [3640904]

Facility

$917.40

Hospital Charge Code	3640904
Hospital Revenue Code	278
Min. Negotiated Rate	$513.74
Max. Negotiated Rate	$889.88
Rate for Payer: Cash Price	$596.31
Rate for Payer: Hawaii Western Management Group Commercial	$642.18
Rate for Payer: Health Management Network Commercial	$779.79
Rate for Payer: MDX Hawaii PPO	$889.88
Rate for Payer: University Health Alliance Commercial	$513.74

Pin Threaded Headless 46mm 402395 [3644320]

Facility

$769.60

Hospital Charge Code	3644320
Hospital Revenue Code	272
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$731.12
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$560.96

Pin Threaded Headless 46mm 402395 [3644320]

Facility

$769.60

Hospital Charge Code	3644320
Hospital Revenue Code	272
Min. Negotiated Rate	$654.16
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51

Pin Threaded Headless 65mm 402394 [3644319]

Facility

$769.60

Hospital Charge Code	3644319
Hospital Revenue Code	272
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$731.12
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$560.96

Pin Threaded Headless 65mm 402394 [3644319]

Facility

$769.60

Hospital Charge Code	3644319
Hospital Revenue Code	272
Min. Negotiated Rate	$654.16
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51

PIOGLITAZONE 15 MG PO TABLET

Facility

$43.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$42.19
Rate for Payer: Cash Price	$28.27
Rate for Payer: Health Management Network Commercial	$36.97
Rate for Payer: MDX Hawaii PPO	$42.19

PIOGLITAZONE 15 MG PO TABLET

Facility

$43.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$42.19
Rate for Payer: Cash Price	$28.27
Rate for Payer: Hawaii Western Management Group Commercial	$41.32
Rate for Payer: Health Management Network Commercial	$36.97
Rate for Payer: Kaiser Permanente Commercial	$27.40
Rate for Payer: Kaiser Permanente Medicaid	$22.18
Rate for Payer: MDX Hawaii PPO	$42.19
Rate for Payer: UnitedHealthcare Medicaid	$26.09
Rate for Payer: University Health Alliance Commercial	$31.70

PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV RECON.SOLN.

Facility

$19.88

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$19.28
Rate for Payer: Cash Price	$12.92
Rate for Payer: Cash Price	$44.82
Rate for Payer: Cash Price	$44.82
Rate for Payer: Cash Price	$12.92
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Western Management Group Commercial	$18.89
Rate for Payer: Hawaii Western Management Group Commercial	$65.51
Rate for Payer: Health Management Network Commercial	$58.62
Rate for Payer: Health Management Network Commercial	$16.90
Rate for Payer: Kaiser Permanente Commercial	$12.52
Rate for Payer: Kaiser Permanente Commercial	$43.44
Rate for Payer: Kaiser Permanente Medicaid	$35.17
Rate for Payer: Kaiser Permanente Medicaid	$10.14
Rate for Payer: MDX Hawaii PPO	$19.28
Rate for Payer: MDX Hawaii PPO	$66.89
Rate for Payer: UnitedHealthcare Medicaid	$11.93
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: University Health Alliance Commercial	$14.49
Rate for Payer: University Health Alliance Commercial	$50.26

PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV RECON.SOLN.

Facility

$19.88

Service Code	HCPCS J2543
Hospital Revenue Code	250
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$19.28
Rate for Payer: Cash Price	$12.92
Rate for Payer: Cash Price	$44.82
Rate for Payer: Health Management Network Commercial	$58.62
Rate for Payer: Health Management Network Commercial	$16.90
Rate for Payer: MDX Hawaii PPO	$66.89
Rate for Payer: MDX Hawaii PPO	$19.28

PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV RECON.SOLN.

Facility

$89.11

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$86.44
Rate for Payer: Cash Price	$57.92
Rate for Payer: Cash Price	$26.99
Rate for Payer: Cash Price	$26.99
Rate for Payer: Cash Price	$61.39
Rate for Payer: Cash Price	$61.39
Rate for Payer: Cash Price	$57.92
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Western Management Group Commercial	$84.65
Rate for Payer: Hawaii Western Management Group Commercial	$39.44
Rate for Payer: Hawaii Western Management Group Commercial	$89.73
Rate for Payer: Health Management Network Commercial	$75.74
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Health Management Network Commercial	$80.28
Rate for Payer: Kaiser Permanente Commercial	$26.16
Rate for Payer: Kaiser Permanente Commercial	$56.14
Rate for Payer: Kaiser Permanente Commercial	$59.50
Rate for Payer: Kaiser Permanente Medicaid	$21.18
Rate for Payer: Kaiser Permanente Medicaid	$45.45
Rate for Payer: Kaiser Permanente Medicaid	$48.17
Rate for Payer: MDX Hawaii PPO	$91.62
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: MDX Hawaii PPO	$86.44
Rate for Payer: UnitedHealthcare Medicaid	$24.91
Rate for Payer: UnitedHealthcare Medicaid	$56.67
Rate for Payer: UnitedHealthcare Medicaid	$53.47
Rate for Payer: University Health Alliance Commercial	$68.84
Rate for Payer: University Health Alliance Commercial	$30.26
Rate for Payer: University Health Alliance Commercial	$64.95

PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV RECON.SOLN.

Facility

$94.45

Service Code	HCPCS J2543
Hospital Revenue Code	250
Min. Negotiated Rate	$80.28
Max. Negotiated Rate	$91.62
Rate for Payer: Cash Price	$61.39
Rate for Payer: Cash Price	$26.99
Rate for Payer: Cash Price	$57.92
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Health Management Network Commercial	$75.74
Rate for Payer: Health Management Network Commercial	$80.28
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: MDX Hawaii PPO	$91.62
Rate for Payer: MDX Hawaii PPO	$86.44

PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV RECON.SOLN.

Facility

$114.82

Service Code	HCPCS J2543
Hospital Revenue Code	250
Min. Negotiated Rate	$97.60
Max. Negotiated Rate	$111.38
Rate for Payer: Cash Price	$74.63
Rate for Payer: Cash Price	$70.23
Rate for Payer: Cash Price	$85.84
Rate for Payer: Cash Price	$30.76
Rate for Payer: Health Management Network Commercial	$91.84
Rate for Payer: Health Management Network Commercial	$40.23
Rate for Payer: Health Management Network Commercial	$112.25
Rate for Payer: Health Management Network Commercial	$97.60
Rate for Payer: MDX Hawaii PPO	$128.10
Rate for Payer: MDX Hawaii PPO	$111.38
Rate for Payer: MDX Hawaii PPO	$104.81
Rate for Payer: MDX Hawaii PPO	$45.91

PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV RECON.SOLN.

Facility

$114.82

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$111.38
Rate for Payer: Cash Price	$74.63
Rate for Payer: Cash Price	$74.63
Rate for Payer: Cash Price	$70.23
Rate for Payer: Cash Price	$85.84
Rate for Payer: Cash Price	$70.23
Rate for Payer: Cash Price	$85.84
Rate for Payer: Cash Price	$30.76
Rate for Payer: Cash Price	$30.76
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.11
Rate for Payer: Hawaii Western Management Group Commercial	$109.08
Rate for Payer: Hawaii Western Management Group Commercial	$125.46
Rate for Payer: Hawaii Western Management Group Commercial	$44.96
Rate for Payer: Hawaii Western Management Group Commercial	$102.65
Rate for Payer: Health Management Network Commercial	$97.60
Rate for Payer: Health Management Network Commercial	$91.84
Rate for Payer: Health Management Network Commercial	$112.25
Rate for Payer: Health Management Network Commercial	$40.23
Rate for Payer: Kaiser Permanente Commercial	$72.34
Rate for Payer: Kaiser Permanente Commercial	$29.82
Rate for Payer: Kaiser Permanente Commercial	$83.20
Rate for Payer: Kaiser Permanente Commercial	$68.07
Rate for Payer: Kaiser Permanente Medicaid	$24.14
Rate for Payer: Kaiser Permanente Medicaid	$67.35
Rate for Payer: Kaiser Permanente Medicaid	$58.56
Rate for Payer: Kaiser Permanente Medicaid	$55.11
Rate for Payer: MDX Hawaii PPO	$104.81
Rate for Payer: MDX Hawaii PPO	$128.10
Rate for Payer: MDX Hawaii PPO	$111.38
Rate for Payer: MDX Hawaii PPO	$45.91
Rate for Payer: UnitedHealthcare Medicaid	$68.89
Rate for Payer: UnitedHealthcare Medicaid	$28.40
Rate for Payer: UnitedHealthcare Medicaid	$79.24
Rate for Payer: UnitedHealthcare Medicaid	$64.83
Rate for Payer: University Health Alliance Commercial	$34.50
Rate for Payer: University Health Alliance Commercial	$78.76
Rate for Payer: University Health Alliance Commercial	$83.69
Rate for Payer: University Health Alliance Commercial	$96.26

Pivot Bipolar Cup 28 x 53mm 133-2853 [3644515]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3644515
Hospital Revenue Code	278
Min. Negotiated Rate	$2,171.68
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

Pivot Bipolar Cup 28 x 53mm 133-2853 [3644515]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3644515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.78
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: Kaiser Permanente Commercial	$2,443.14
Rate for Payer: Kaiser Permanente Medicaid	$1,977.78
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

PLACEMENT OF SETON

Facility

$6,743.44

Service Code	CPT 46020
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$6,743.44

Plate 3.5mm/4.5mm VA-LCP Prox Fem Hook Small Lt 02.221.085 [3644371]

Facility

$14,901.00

Service Code	HCPCS C1713
Hospital Charge Code	3644371
Hospital Revenue Code	278
Min. Negotiated Rate	$8,344.56
Max. Negotiated Rate	$14,453.97
Rate for Payer: Cash Price	$9,685.65
Rate for Payer: Hawaii Western Management Group Commercial	$10,430.70
Rate for Payer: Health Management Network Commercial	$12,665.85
Rate for Payer: MDX Hawaii PPO	$14,453.97
Rate for Payer: University Health Alliance Commercial	$8,344.56

Plate 3.5mm/4.5mm VA-LCP Prox Fem Hook Small Lt 02.221.085 [3644371]

Facility

$14,901.00

Service Code	HCPCS C1713
Hospital Charge Code	3644371
Hospital Revenue Code	278
Min. Negotiated Rate	$7,599.51
Max. Negotiated Rate	$14,453.97
Rate for Payer: Cash Price	$9,685.65
Rate for Payer: Hawaii Western Management Group Commercial	$10,430.70
Rate for Payer: Health Management Network Commercial	$12,665.85
Rate for Payer: Kaiser Permanente Commercial	$9,387.63
Rate for Payer: Kaiser Permanente Medicaid	$7,599.51
Rate for Payer: MDX Hawaii PPO	$14,453.97
Rate for Payer: University Health Alliance Commercial	$8,344.56

Plate Bridge BRGP [3640974]

Facility

$3,487.50

Service Code	HCPCS C1713
Hospital Charge Code	3640974
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$3,382.88
Rate for Payer: Cash Price	$2,266.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,441.25
Rate for Payer: Health Management Network Commercial	$2,964.38
Rate for Payer: MDX Hawaii PPO	$3,382.88
Rate for Payer: University Health Alliance Commercial	$1,953.00

Plate Bridge BRGP [3640974]

Facility

$3,487.50

Service Code	HCPCS C1713
Hospital Charge Code	3640974
Hospital Revenue Code	278
Min. Negotiated Rate	$1,778.62
Max. Negotiated Rate	$3,382.88
Rate for Payer: Cash Price	$2,266.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,441.25
Rate for Payer: Health Management Network Commercial	$2,964.38
Rate for Payer: Kaiser Permanente Commercial	$2,197.12
Rate for Payer: Kaiser Permanente Medicaid	$1,778.62
Rate for Payer: MDX Hawaii PPO	$3,382.88
Rate for Payer: University Health Alliance Commercial	$1,953.00

Plate Clav Frac Central Third Ss LT AR-2655CL [3644482]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3644482
Hospital Revenue Code	278
Min. Negotiated Rate	$3,619.00
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Plate Clav Frac Central Third Ss LT AR-2655CL [3644482]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3644482
Hospital Revenue Code	278
Min. Negotiated Rate	$3,295.88
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: Kaiser Permanente Commercial	$4,071.38
Rate for Payer: Kaiser Permanente Medicaid	$3,295.88
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Plate Clav Frac Central Third SS RT AR-2652CR [3644996]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3644996
Hospital Revenue Code	278
Min. Negotiated Rate	$3,295.88
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: Kaiser Permanente Commercial	$4,071.38
Rate for Payer: Kaiser Permanente Medicaid	$3,295.88
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Plate Clav Frac Central Third SS RT AR-2652CR [3644996]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3644996
Hospital Revenue Code	278
Min. Negotiated Rate	$3,619.00
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Know your out-of-pocket cost for care.

All Charges