Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Quattro Link Anchor 4.5mm CM-9145SP [3641238]

Facility

$2,450.12

Service Code	HCPCS C1713
Hospital Charge Code	3641238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.56
Max. Negotiated Rate	$2,376.62
Rate for Payer: Cash Price	$1,592.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.08
Rate for Payer: Health Management Network Commercial	$2,082.60
Rate for Payer: Kaiser Permanente Commercial	$1,543.58
Rate for Payer: Kaiser Permanente Medicaid	$1,249.56
Rate for Payer: MDX Hawaii PPO	$2,376.62
Rate for Payer: University Health Alliance Commercial	$1,372.07

Quattro Link Anchor 4.5mm CM-9145SP [3641238]

Facility

$2,450.12

Service Code	HCPCS C1713
Hospital Charge Code	3641238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.07
Max. Negotiated Rate	$2,376.62
Rate for Payer: Cash Price	$1,592.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.08
Rate for Payer: Health Management Network Commercial	$2,082.60
Rate for Payer: MDX Hawaii PPO	$2,376.62
Rate for Payer: University Health Alliance Commercial	$1,372.07

QUETIAPINE 100 MG PO TABLET

Facility

$40.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.79
Max. Negotiated Rate	$39.70
Rate for Payer: Cash Price	$26.60
Rate for Payer: Cash Price	$27.81
Rate for Payer: Health Management Network Commercial	$36.36
Rate for Payer: Health Management Network Commercial	$34.79
Rate for Payer: MDX Hawaii PPO	$39.70
Rate for Payer: MDX Hawaii PPO	$41.50

QUETIAPINE 100 MG PO TABLET

Facility

$42.78

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$41.50
Rate for Payer: Cash Price	$27.81
Rate for Payer: Cash Price	$26.60
Rate for Payer: Hawaii Western Management Group Commercial	$38.88
Rate for Payer: Hawaii Western Management Group Commercial	$40.64
Rate for Payer: Health Management Network Commercial	$34.79
Rate for Payer: Health Management Network Commercial	$36.36
Rate for Payer: Kaiser Permanente Commercial	$25.79
Rate for Payer: Kaiser Permanente Commercial	$26.95
Rate for Payer: Kaiser Permanente Medicaid	$20.87
Rate for Payer: Kaiser Permanente Medicaid	$21.82
Rate for Payer: MDX Hawaii PPO	$39.70
Rate for Payer: MDX Hawaii PPO	$41.50
Rate for Payer: UnitedHealthcare Medicaid	$24.56
Rate for Payer: UnitedHealthcare Medicaid	$25.67
Rate for Payer: University Health Alliance Commercial	$31.18
Rate for Payer: University Health Alliance Commercial	$29.83

QUETIAPINE 200 MG PO TABLET

Facility

$5.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$5.09
Rate for Payer: Cash Price	$3.41
Rate for Payer: Hawaii Western Management Group Commercial	$4.99
Rate for Payer: Health Management Network Commercial	$4.46
Rate for Payer: Kaiser Permanente Commercial	$3.31
Rate for Payer: Kaiser Permanente Medicaid	$2.68
Rate for Payer: MDX Hawaii PPO	$5.09
Rate for Payer: UnitedHealthcare Medicaid	$3.15
Rate for Payer: University Health Alliance Commercial	$3.83

QUETIAPINE 200 MG PO TABLET

Facility

$5.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$5.09
Rate for Payer: Cash Price	$3.41
Rate for Payer: Health Management Network Commercial	$4.46
Rate for Payer: MDX Hawaii PPO	$5.09

QUETIAPINE 200 MG PO TAB SR 24H

Facility

$88.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$44.92
Max. Negotiated Rate	$85.44
Rate for Payer: Cash Price	$57.25
Rate for Payer: Hawaii Western Management Group Commercial	$83.68
Rate for Payer: Health Management Network Commercial	$74.87
Rate for Payer: Kaiser Permanente Commercial	$55.49
Rate for Payer: Kaiser Permanente Medicaid	$44.92
Rate for Payer: MDX Hawaii PPO	$85.44
Rate for Payer: UnitedHealthcare Medicaid	$52.85
Rate for Payer: University Health Alliance Commercial	$64.20

QUETIAPINE 200 MG PO TAB SR 24H

Facility

$88.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$74.87
Max. Negotiated Rate	$85.44
Rate for Payer: Cash Price	$57.25
Rate for Payer: Health Management Network Commercial	$74.87
Rate for Payer: MDX Hawaii PPO	$85.44

QUETIAPINE 25 MG PO TABLET

Facility

$20.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: MDX Hawaii PPO	$20.22

QUETIAPINE 25 MG PO TABLET

Facility

$20.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Hawaii Western Management Group Commercial	$19.81
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Kaiser Permanente Commercial	$13.14
Rate for Payer: Kaiser Permanente Medicaid	$10.63
Rate for Payer: MDX Hawaii PPO	$20.22
Rate for Payer: UnitedHealthcare Medicaid	$12.51
Rate for Payer: University Health Alliance Commercial	$15.20

QUETIAPINE 50 MG PO TABLET

Facility

$39.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$38.35
Rate for Payer: Cash Price	$25.70
Rate for Payer: Hawaii Western Management Group Commercial	$37.56
Rate for Payer: Health Management Network Commercial	$33.61
Rate for Payer: Kaiser Permanente Commercial	$24.91
Rate for Payer: Kaiser Permanente Medicaid	$20.17
Rate for Payer: MDX Hawaii PPO	$38.35
Rate for Payer: UnitedHealthcare Medicaid	$23.72
Rate for Payer: University Health Alliance Commercial	$28.82

QUETIAPINE 50 MG PO TABLET

Facility

$39.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$38.35
Rate for Payer: Cash Price	$25.70
Rate for Payer: Health Management Network Commercial	$33.61
Rate for Payer: MDX Hawaii PPO	$38.35

Quickanchor Micro Plus 3/0 212859 [3642106]

Facility

$2,187.50

Service Code	HCPCS C1713
Hospital Charge Code	3642106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.00
Max. Negotiated Rate	$2,121.88
Rate for Payer: Cash Price	$1,421.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,531.25
Rate for Payer: Health Management Network Commercial	$1,859.38
Rate for Payer: MDX Hawaii PPO	$2,121.88
Rate for Payer: University Health Alliance Commercial	$1,225.00

Quickanchor Micro Plus 3/0 212859 [3642106]

Facility

$2,187.50

Service Code	HCPCS C1713
Hospital Charge Code	3642106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.62
Max. Negotiated Rate	$2,121.88
Rate for Payer: Cash Price	$1,421.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,531.25
Rate for Payer: Health Management Network Commercial	$1,859.38
Rate for Payer: Kaiser Permanente Commercial	$1,378.12
Rate for Payer: Kaiser Permanente Medicaid	$1,115.62
Rate for Payer: MDX Hawaii PPO	$2,121.88
Rate for Payer: University Health Alliance Commercial	$1,225.00

Quick Pressure Monitor Set 0295-002-000 [3644764]

Facility

$907.92

Hospital Charge Code	3644764
Hospital Revenue Code	272
Min. Negotiated Rate	$463.04
Max. Negotiated Rate	$880.68
Rate for Payer: Cash Price	$590.15
Rate for Payer: Hawaii Western Management Group Commercial	$862.52
Rate for Payer: Health Management Network Commercial	$771.73
Rate for Payer: Kaiser Permanente Commercial	$571.99
Rate for Payer: Kaiser Permanente Medicaid	$463.04
Rate for Payer: MDX Hawaii PPO	$880.68
Rate for Payer: University Health Alliance Commercial	$661.78

Quick Pressure Monitor Set 0295-002-000 [3644764]

Facility

$907.92

Hospital Charge Code	3644764
Hospital Revenue Code	272
Min. Negotiated Rate	$771.73
Max. Negotiated Rate	$880.68
Rate for Payer: Cash Price	$590.15
Rate for Payer: Health Management Network Commercial	$771.73
Rate for Payer: MDX Hawaii PPO	$880.68

QUININE SULFATE 324 MG PO CAP

Facility

$45.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.97
Max. Negotiated Rate	$43.68
Rate for Payer: Cash Price	$29.27
Rate for Payer: Hawaii Western Management Group Commercial	$42.78
Rate for Payer: Health Management Network Commercial	$38.28
Rate for Payer: Kaiser Permanente Commercial	$28.37
Rate for Payer: Kaiser Permanente Medicaid	$22.97
Rate for Payer: MDX Hawaii PPO	$43.68
Rate for Payer: UnitedHealthcare Medicaid	$27.02
Rate for Payer: University Health Alliance Commercial	$32.82

QUININE SULFATE 324 MG PO CAP

Facility

$45.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$43.68
Rate for Payer: Cash Price	$29.27
Rate for Payer: Health Management Network Commercial	$38.28
Rate for Payer: MDX Hawaii PPO	$43.68

R3con Locking Plate Screw 2.7 x 40mm P50-353-2740 [3644532]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644532
Hospital Revenue Code	278
Min. Negotiated Rate	$864.08
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

R3con Locking Plate Screw 2.7 x 40mm P50-353-2740 [3644532]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644532
Hospital Revenue Code	278
Min. Negotiated Rate	$786.93
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: Kaiser Permanente Commercial	$972.09
Rate for Payer: Kaiser Permanente Medicaid	$786.93
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

R3con Locking Plate Screw 3.5 x 16mm P50-353-3516 [3644933]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644933
Hospital Revenue Code	278
Min. Negotiated Rate	$786.93
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: Kaiser Permanente Commercial	$972.09
Rate for Payer: Kaiser Permanente Medicaid	$786.93
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

R3con Locking Plate Screw 3.5 x 16mm P50-353-3516 [3644933]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644933
Hospital Revenue Code	278
Min. Negotiated Rate	$864.08
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

R3con Locking Plate Screw 3.5 x 20mm P50-353-3520 [3644328]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644328
Hospital Revenue Code	278
Min. Negotiated Rate	$864.08
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

R3con Locking Plate Screw 3.5 x 20mm P50-353-3520 [3644328]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644328
Hospital Revenue Code	278
Min. Negotiated Rate	$786.93
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: Kaiser Permanente Commercial	$972.09
Rate for Payer: Kaiser Permanente Medicaid	$786.93
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

R3con Locking Plate Screw 3.5 x 22mm P50-353-3522 [3644934]

Facility

$1,543.00

Service Code	HCPCS C1713
Hospital Charge Code	3644934
Hospital Revenue Code	278
Min. Negotiated Rate	$786.93
Max. Negotiated Rate	$1,496.71
Rate for Payer: Cash Price	$1,002.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.10
Rate for Payer: Health Management Network Commercial	$1,311.55
Rate for Payer: Kaiser Permanente Commercial	$972.09
Rate for Payer: Kaiser Permanente Medicaid	$786.93
Rate for Payer: MDX Hawaii PPO	$1,496.71
Rate for Payer: University Health Alliance Commercial	$864.08

Know your out-of-pocket cost for care.

All Charges