Kona Community Hospital

All Charges

Charge

Type

Setting

Price

R3Con Non-Locking Plate Screw 4.2 x 55mm P50-453-4255 [3644351]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644351
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

R3Con Non Locking Plate Screw 4.2 x 65mm P50-453-4265 [3644352]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644352
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

R3Con Non Locking Plate Screw 4.2 x 65mm P50-453-4265 [3644352]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644352
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

R3con Non-Lock Plate Screw 3.5 x 30mm P50-453-3530 [3644477]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644477
Hospital Revenue Code	278
Min. Negotiated Rate	$589.13
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: Kaiser Permanente Commercial	$727.75
Rate for Payer: Kaiser Permanente Medicaid	$589.13
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

R3con Non-Lock Plate Screw 3.5 x 30mm P50-453-3530 [3644477]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644477
Hospital Revenue Code	278
Min. Negotiated Rate	$646.89
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

R3con Non-Lock Plate Screw 3.5 x 40mm P50-453-3540 [3644478]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644478
Hospital Revenue Code	278
Min. Negotiated Rate	$589.13
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: Kaiser Permanente Commercial	$727.75
Rate for Payer: Kaiser Permanente Medicaid	$589.13
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

R3con Non-Lock Plate Screw 3.5 x 40mm P50-453-3540 [3644478]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644478
Hospital Revenue Code	278
Min. Negotiated Rate	$646.89
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

R3con Non-Lock Plate Screw 3.5 x 50mm P50-453-3550 [3644479]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644479
Hospital Revenue Code	278
Min. Negotiated Rate	$589.13
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: Kaiser Permanente Commercial	$727.75
Rate for Payer: Kaiser Permanente Medicaid	$589.13
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

R3con Non-Lock Plate Screw 3.5 x 50mm P50-453-3550 [3644479]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644479
Hospital Revenue Code	278
Min. Negotiated Rate	$646.89
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

RABIES IMMUNE GLOBULIN (PF) 300 UNITS/ML IM SOLN

Facility

$3,568.19

Service Code	HCPCS 90375
Hospital Revenue Code	250
Min. Negotiated Rate	$275.18
Max. Negotiated Rate	$3,461.14
Rate for Payer: AlohaCare Medicaid	$275.18
Rate for Payer: AlohaCare Medicare	$275.18
Rate for Payer: Cash Price	$2,319.32
Rate for Payer: Cash Price	$2,319.32
Rate for Payer: Devoted Health Medicare	$302.70
Rate for Payer: Hawaii Medical Service Association Commercial	$343.98
Rate for Payer: Hawaii Medical Service Association Medicare	$275.18
Rate for Payer: Hawaii Western Management Group Commercial	$3,389.78
Rate for Payer: Health Management Network Commercial	$3,032.96
Rate for Payer: Humana Medicare	$275.18
Rate for Payer: Kaiser Permanente Commercial	$2,247.96
Rate for Payer: Kaiser Permanente Medicaid	$1,819.78
Rate for Payer: Kaiser Permanente Medicare	$275.18
Rate for Payer: MDX Hawaii PPO	$3,461.14
Rate for Payer: Ohana Health Plan Medicaid	$302.70
Rate for Payer: Ohana Health Plan Medicare	$275.18
Rate for Payer: UnitedHealthcare Medicaid	$2,140.91
Rate for Payer: UnitedHealthcare Medicare	$275.18
Rate for Payer: University Health Alliance Commercial	$2,600.85

RABIES IMMUNE GLOBULIN (PF) 300 UNITS/ML IM SOLN

Facility

$3,568.19

Service Code	HCPCS 90375
Hospital Revenue Code	250
Min. Negotiated Rate	$3,032.96
Max. Negotiated Rate	$3,461.14
Rate for Payer: Cash Price	$2,319.32
Rate for Payer: Health Management Network Commercial	$3,032.96
Rate for Payer: MDX Hawaii PPO	$3,461.14

RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR

Facility

$1,322.70

Service Code	HCPCS 90675
Hospital Revenue Code	250
Min. Negotiated Rate	$315.22
Max. Negotiated Rate	$1,283.02
Rate for Payer: AlohaCare Medicaid	$315.22
Rate for Payer: AlohaCare Medicare	$315.22
Rate for Payer: Cash Price	$859.76
Rate for Payer: Cash Price	$859.76
Rate for Payer: Devoted Health Medicare	$346.74
Rate for Payer: Hawaii Medical Service Association ABD	$327.78
Rate for Payer: Hawaii Medical Service Association Commercial	$394.02
Rate for Payer: Hawaii Medical Service Association Medicare	$315.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$327.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,256.57
Rate for Payer: Health Management Network Commercial	$1,124.30
Rate for Payer: Humana Medicare	$315.22
Rate for Payer: Kaiser Permanente Commercial	$833.30
Rate for Payer: Kaiser Permanente Medicaid	$674.58
Rate for Payer: Kaiser Permanente Medicare	$315.22
Rate for Payer: MDX Hawaii PPO	$1,283.02
Rate for Payer: Ohana Health Plan Medicaid	$346.74
Rate for Payer: Ohana Health Plan Medicare	$315.22
Rate for Payer: UnitedHealthcare Medicaid	$793.62
Rate for Payer: UnitedHealthcare Medicare	$315.22
Rate for Payer: University Health Alliance Commercial	$964.12

RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR

Facility

$1,322.70

Service Code	HCPCS 90675
Hospital Revenue Code	250
Min. Negotiated Rate	$1,124.30
Max. Negotiated Rate	$1,283.02
Rate for Payer: Cash Price	$859.76
Rate for Payer: Health Management Network Commercial	$1,124.30
Rate for Payer: MDX Hawaii PPO	$1,283.02

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487278401
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Hawaii Western Management Group Commercial	$13.11
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Kaiser Permanente Commercial	$8.69
Rate for Payer: Kaiser Permanente Medicaid	$7.04
Rate for Payer: MDX Hawaii PPO	$13.39
Rate for Payer: UnitedHealthcare Medicaid	$8.28
Rate for Payer: University Health Alliance Commercial	$10.06

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487278401
Hospital Revenue Code	250
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: MDX Hawaii PPO	$13.39

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487590199
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Hawaii Western Management Group Commercial	$13.11
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Kaiser Permanente Commercial	$8.69
Rate for Payer: Kaiser Permanente Medicaid	$7.04
Rate for Payer: MDX Hawaii PPO	$13.39
Rate for Payer: UnitedHealthcare Medicaid	$8.28
Rate for Payer: University Health Alliance Commercial	$10.06

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487590199
Hospital Revenue Code	250
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: MDX Hawaii PPO	$13.39

Radial Head Align 24mm ALN-RHI-240 [3644001]

Facility

$9,028.00

Service Code	HCPCS C1776
Hospital Charge Code	3644001
Hospital Revenue Code	278
Min. Negotiated Rate	$4,604.28
Max. Negotiated Rate	$8,757.16
Rate for Payer: Cash Price	$5,868.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,319.60
Rate for Payer: Health Management Network Commercial	$7,673.80
Rate for Payer: Kaiser Permanente Commercial	$5,687.64
Rate for Payer: Kaiser Permanente Medicaid	$4,604.28
Rate for Payer: MDX Hawaii PPO	$8,757.16
Rate for Payer: University Health Alliance Commercial	$5,055.68

Radial Head Align 24mm ALN-RHI-240 [3644001]

Facility

$9,028.00

Service Code	HCPCS C1776
Hospital Charge Code	3644001
Hospital Revenue Code	278
Min. Negotiated Rate	$5,055.68
Max. Negotiated Rate	$8,757.16
Rate for Payer: Cash Price	$5,868.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,319.60
Rate for Payer: Health Management Network Commercial	$7,673.80
Rate for Payer: MDX Hawaii PPO	$8,757.16
Rate for Payer: University Health Alliance Commercial	$5,055.68

Radial Stem ALIGN 10mmX0mm ALNRST1000 [3642635]

Facility

$9,857.50

Service Code	HCPCS C1776
Hospital Charge Code	3642635
Hospital Revenue Code	278
Min. Negotiated Rate	$5,027.32
Max. Negotiated Rate	$9,561.77
Rate for Payer: Cash Price	$6,407.38
Rate for Payer: Hawaii Western Management Group Commercial	$6,900.25
Rate for Payer: Health Management Network Commercial	$8,378.88
Rate for Payer: Kaiser Permanente Commercial	$6,210.23
Rate for Payer: Kaiser Permanente Medicaid	$5,027.32
Rate for Payer: MDX Hawaii PPO	$9,561.77
Rate for Payer: University Health Alliance Commercial	$5,520.20

Radial Stem ALIGN 10mmX0mm ALNRST1000 [3642635]

Facility

$9,857.50

Service Code	HCPCS C1776
Hospital Charge Code	3642635
Hospital Revenue Code	278
Min. Negotiated Rate	$5,520.20
Max. Negotiated Rate	$9,561.77
Rate for Payer: Cash Price	$6,407.38
Rate for Payer: Hawaii Western Management Group Commercial	$6,900.25
Rate for Payer: Health Management Network Commercial	$8,378.88
Rate for Payer: MDX Hawaii PPO	$9,561.77
Rate for Payer: University Health Alliance Commercial	$5,520.20

Radial Stem Align 9mmx0mm ALN-RST-0900 [3644002]

Facility

$5,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3644002
Hospital Revenue Code	278
Min. Negotiated Rate	$2,982.00
Max. Negotiated Rate	$5,165.25
Rate for Payer: Cash Price	$3,461.25
Rate for Payer: Hawaii Western Management Group Commercial	$3,727.50
Rate for Payer: Health Management Network Commercial	$4,526.25
Rate for Payer: MDX Hawaii PPO	$5,165.25
Rate for Payer: University Health Alliance Commercial	$2,982.00

Radial Stem Align 9mmx0mm ALN-RST-0900 [3644002]

Facility

$5,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3644002
Hospital Revenue Code	278
Min. Negotiated Rate	$2,715.75
Max. Negotiated Rate	$5,165.25
Rate for Payer: Cash Price	$3,461.25
Rate for Payer: Hawaii Western Management Group Commercial	$3,727.50
Rate for Payer: Health Management Network Commercial	$4,526.25
Rate for Payer: Kaiser Permanente Commercial	$3,354.75
Rate for Payer: Kaiser Permanente Medicaid	$2,715.75
Rate for Payer: MDX Hawaii PPO	$5,165.25
Rate for Payer: University Health Alliance Commercial	$2,982.00

RADIOTHERAPY

Facility

$3,874.95

Service Code	APR-DRG 6921
Min. Negotiated Rate	$3,874.95
Max. Negotiated Rate	$3,874.95
Rate for Payer: AlohaCare Medicaid	$3,874.95
Rate for Payer: Hawaii Medical Service Association ABD	$3,874.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,874.95
Rate for Payer: Kaiser Permanente Medicaid	$3,874.95
Rate for Payer: Ohana Health Plan Medicaid	$3,874.95
Rate for Payer: UnitedHealthcare Medicaid	$3,874.95

RADIOTHERAPY

Facility

$6,638.67

Service Code	APR-DRG 6922
Min. Negotiated Rate	$6,638.67
Max. Negotiated Rate	$6,638.67
Rate for Payer: AlohaCare Medicaid	$6,638.67
Rate for Payer: Hawaii Medical Service Association ABD	$6,638.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,638.67
Rate for Payer: Kaiser Permanente Medicaid	$6,638.67
Rate for Payer: Ohana Health Plan Medicaid	$6,638.67
Rate for Payer: UnitedHealthcare Medicaid	$6,638.67

Know your out-of-pocket cost for care.

All Charges