Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

RADIOTHERAPY

Facility

$19,104.09

Service Code	APR-DRG 6924
Min. Negotiated Rate	$19,104.09
Max. Negotiated Rate	$19,104.09
Rate for Payer: AlohaCare Medicaid	$19,104.09
Rate for Payer: Hawaii Medical Service Association ABD	$19,104.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,104.09
Rate for Payer: Kaiser Permanente Medicaid	$19,104.09
Rate for Payer: Ohana Health Plan Medicaid	$19,104.09
Rate for Payer: UnitedHealthcare Medicaid	$19,104.09

RADIOTHERAPY

Facility

$46,738.88

Service Code	MSDRG 849
Min. Negotiated Rate	$17,670.43
Max. Negotiated Rate	$46,738.88
Rate for Payer: AlohaCare Medicare	$35,637.42
Rate for Payer: Devoted Health Medicare	$39,201.16
Rate for Payer: Hawaii Medical Service Association Commercial	$17,670.43
Rate for Payer: Hawaii Medical Service Association Medicare	$35,637.42
Rate for Payer: Humana Medicare	$35,637.42
Rate for Payer: Kaiser Permanente Commercial	$46,738.88
Rate for Payer: Kaiser Permanente Medicare	$35,637.42
Rate for Payer: Ohana Health Plan Medicare	$35,637.42
Rate for Payer: UnitedHealthcare Medicare	$35,637.42

RALTEGRAVIR 400 MG PO TABLET

Facility

$161.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$137.49
Max. Negotiated Rate	$156.90
Rate for Payer: Cash Price	$105.14
Rate for Payer: Health Management Network Commercial	$137.49
Rate for Payer: MDX Hawaii PPO	$156.90

RALTEGRAVIR 400 MG PO TABLET

Facility

$161.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$82.49
Max. Negotiated Rate	$156.90
Rate for Payer: Cash Price	$105.14
Rate for Payer: Hawaii Western Management Group Commercial	$153.66
Rate for Payer: Health Management Network Commercial	$137.49
Rate for Payer: Kaiser Permanente Commercial	$101.90
Rate for Payer: Kaiser Permanente Medicaid	$82.49
Rate for Payer: MDX Hawaii PPO	$156.90
Rate for Payer: UnitedHealthcare Medicaid	$97.05
Rate for Payer: University Health Alliance Commercial	$117.90

RAMUCIRUMAB 10 MG/ML IV SOLN

Facility

$10,123.14

Service Code	HCPCS J9308
Hospital Revenue Code	636
Min. Negotiated Rate	$74.45
Max. Negotiated Rate	$9,819.45
Rate for Payer: AlohaCare Medicaid	$75.47
Rate for Payer: AlohaCare Medicaid	$75.47
Rate for Payer: AlohaCare Medicare	$75.47
Rate for Payer: AlohaCare Medicare	$75.47
Rate for Payer: Cash Price	$6,580.04
Rate for Payer: Cash Price	$1,897.58
Rate for Payer: Cash Price	$1,897.58
Rate for Payer: Cash Price	$6,580.04
Rate for Payer: Devoted Health Medicare	$83.02
Rate for Payer: Devoted Health Medicare	$83.02
Rate for Payer: Hawaii Medical Service Association ABD	$74.45
Rate for Payer: Hawaii Medical Service Association ABD	$74.45
Rate for Payer: Hawaii Medical Service Association Commercial	$94.34
Rate for Payer: Hawaii Medical Service Association Commercial	$94.34
Rate for Payer: Hawaii Medical Service Association Medicare	$75.47
Rate for Payer: Hawaii Medical Service Association Medicare	$75.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,773.38
Rate for Payer: Hawaii Western Management Group Commercial	$9,616.98
Rate for Payer: Health Management Network Commercial	$8,604.67
Rate for Payer: Health Management Network Commercial	$2,481.45
Rate for Payer: Humana Medicare	$75.47
Rate for Payer: Humana Medicare	$75.47
Rate for Payer: Kaiser Permanente Commercial	$6,377.58
Rate for Payer: Kaiser Permanente Commercial	$1,839.19
Rate for Payer: Kaiser Permanente Medicaid	$1,488.87
Rate for Payer: Kaiser Permanente Medicaid	$5,162.80
Rate for Payer: Kaiser Permanente Medicare	$75.47
Rate for Payer: Kaiser Permanente Medicare	$75.47
Rate for Payer: MDX Hawaii PPO	$9,819.45
Rate for Payer: MDX Hawaii PPO	$2,831.77
Rate for Payer: Ohana Health Plan Medicaid	$83.02
Rate for Payer: Ohana Health Plan Medicaid	$83.02
Rate for Payer: Ohana Health Plan Medicare	$75.47
Rate for Payer: Ohana Health Plan Medicare	$75.47
Rate for Payer: UnitedHealthcare Medicaid	$1,751.61
Rate for Payer: UnitedHealthcare Medicaid	$6,073.88
Rate for Payer: UnitedHealthcare Medicare	$75.47
Rate for Payer: UnitedHealthcare Medicare	$75.47
Rate for Payer: University Health Alliance Commercial	$2,127.91
Rate for Payer: University Health Alliance Commercial	$7,378.76

RAMUCIRUMAB 10 MG/ML IV SOLN

Facility

$10,123.14

Service Code	HCPCS J9308
Hospital Revenue Code	250
Min. Negotiated Rate	$8,604.67
Max. Negotiated Rate	$9,819.45
Rate for Payer: Cash Price	$6,580.04
Rate for Payer: Cash Price	$1,897.58
Rate for Payer: Health Management Network Commercial	$2,481.45
Rate for Payer: Health Management Network Commercial	$8,604.67
Rate for Payer: MDX Hawaii PPO	$9,819.45
Rate for Payer: MDX Hawaii PPO	$2,831.77

Rapid Refill Microvasive M00566001 [3601100]

Facility

$147.00

Hospital Charge Code	3601100
Hospital Revenue Code	272
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$107.15

Rapid Refill Microvasive M00566001 [3601100]

Facility

$147.00

Hospital Charge Code	3601100
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: MDX Hawaii PPO	$142.59

Reamer 1.8mm Cannulated RHS-RMR-18 [3645379]

Facility

$3,180.50

Hospital Charge Code	3645379
Hospital Revenue Code	272
Min. Negotiated Rate	$2,703.43
Max. Negotiated Rate	$3,085.09
Rate for Payer: Cash Price	$2,067.33
Rate for Payer: Health Management Network Commercial	$2,703.43
Rate for Payer: MDX Hawaii PPO	$3,085.09

Reamer 1.8mm Cannulated RHS-RMR-18 [3645379]

Facility

$3,180.50

Hospital Charge Code	3645379
Hospital Revenue Code	272
Min. Negotiated Rate	$1,622.06
Max. Negotiated Rate	$3,085.09
Rate for Payer: Cash Price	$2,067.33
Rate for Payer: Hawaii Western Management Group Commercial	$3,021.47
Rate for Payer: Health Management Network Commercial	$2,703.43
Rate for Payer: Kaiser Permanente Commercial	$2,003.71
Rate for Payer: Kaiser Permanente Medicaid	$1,622.06
Rate for Payer: MDX Hawaii PPO	$3,085.09
Rate for Payer: University Health Alliance Commercial	$2,318.27

Reamer 2.4mm Cannulated RHS-RMR-24 [3645380]

Facility

$3,180.50

Hospital Charge Code	3645380
Hospital Revenue Code	272
Min. Negotiated Rate	$2,703.43
Max. Negotiated Rate	$3,085.09
Rate for Payer: MDX Hawaii PPO	$3,085.09
Rate for Payer: Cash Price	$2,067.33
Rate for Payer: Health Management Network Commercial	$2,703.43

Reamer 2.4mm Cannulated RHS-RMR-24 [3645380]

Facility

$3,180.50

Hospital Charge Code	3645380
Hospital Revenue Code	272
Min. Negotiated Rate	$1,622.06
Max. Negotiated Rate	$3,085.09
Rate for Payer: Cash Price	$2,067.33
Rate for Payer: Hawaii Western Management Group Commercial	$3,021.47
Rate for Payer: Health Management Network Commercial	$2,703.43
Rate for Payer: Kaiser Permanente Commercial	$2,003.71
Rate for Payer: Kaiser Permanente Medicaid	$1,622.06
Rate for Payer: MDX Hawaii PPO	$3,085.09
Rate for Payer: University Health Alliance Commercial	$2,318.27

Reamer Cannulated 4.0mm Sterile AR-8973-40S [3644787]

Facility

$1,471.25

Hospital Charge Code	3644787
Hospital Revenue Code	272
Min. Negotiated Rate	$750.34
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,397.69
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: Kaiser Permanente Commercial	$926.89
Rate for Payer: Kaiser Permanente Medicaid	$750.34
Rate for Payer: MDX Hawaii PPO	$1,427.11
Rate for Payer: University Health Alliance Commercial	$1,072.39

Reamer Cannulated 4.0mm Sterile AR-8973-40S [3644787]

Facility

$1,471.25

Hospital Charge Code	3644787
Hospital Revenue Code	272
Min. Negotiated Rate	$1,250.56
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: MDX Hawaii PPO	$1,427.11

Reamer Component 12.5mm 03.168.006 [3640054]

Facility

$6,755.63

Service Code	HCPCS C1713
Hospital Charge Code	3640054
Hospital Revenue Code	278
Min. Negotiated Rate	$3,445.37
Max. Negotiated Rate	$6,552.96
Rate for Payer: Cash Price	$4,391.16
Rate for Payer: Hawaii Western Management Group Commercial	$4,728.94
Rate for Payer: Health Management Network Commercial	$5,742.29
Rate for Payer: Kaiser Permanente Commercial	$4,256.05
Rate for Payer: Kaiser Permanente Medicaid	$3,445.37
Rate for Payer: MDX Hawaii PPO	$6,552.96
Rate for Payer: University Health Alliance Commercial	$3,783.15

Reamer Component 12.5mm 03.168.006 [3640054]

Facility

$6,755.63

Service Code	HCPCS C1713
Hospital Charge Code	3640054
Hospital Revenue Code	278
Min. Negotiated Rate	$3,783.15
Max. Negotiated Rate	$6,552.96
Rate for Payer: Cash Price	$4,391.16
Rate for Payer: Hawaii Western Management Group Commercial	$4,728.94
Rate for Payer: Health Management Network Commercial	$5,742.29
Rate for Payer: MDX Hawaii PPO	$6,552.96
Rate for Payer: University Health Alliance Commercial	$3,783.15

Reamer Hollow Complete For 1.5mm Screw [3643629]

Facility

$1,522.75

Hospital Charge Code	3643629
Hospital Revenue Code	272
Min. Negotiated Rate	$776.60
Max. Negotiated Rate	$1,477.07
Rate for Payer: Cash Price	$989.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,446.61
Rate for Payer: Health Management Network Commercial	$1,294.34
Rate for Payer: Kaiser Permanente Commercial	$959.33
Rate for Payer: Kaiser Permanente Medicaid	$776.60
Rate for Payer: MDX Hawaii PPO	$1,477.07
Rate for Payer: University Health Alliance Commercial	$1,109.93

Reamer Hollow Complete For 1.5mm Screw [3643629]

Facility

$1,522.75

Hospital Charge Code	3643629
Hospital Revenue Code	272
Min. Negotiated Rate	$1,294.34
Max. Negotiated Rate	$1,477.07
Rate for Payer: Cash Price	$989.79
Rate for Payer: Health Management Network Commercial	$1,294.34
Rate for Payer: MDX Hawaii PPO	$1,477.07

Reamer Hollow Spare Centering Pin 309.670 [3643630]

Facility

$582.62

Hospital Charge Code	3643630
Hospital Revenue Code	272
Min. Negotiated Rate	$495.23
Max. Negotiated Rate	$565.14
Rate for Payer: Cash Price	$378.70
Rate for Payer: Health Management Network Commercial	$495.23
Rate for Payer: MDX Hawaii PPO	$565.14

Reamer Hollow Spare Centering Pin 309.670 [3643630]

Facility

$582.62

Hospital Charge Code	3643630
Hospital Revenue Code	272
Min. Negotiated Rate	$297.14
Max. Negotiated Rate	$565.14
Rate for Payer: Cash Price	$378.70
Rate for Payer: Hawaii Western Management Group Commercial	$553.49
Rate for Payer: Health Management Network Commercial	$495.23
Rate for Payer: Kaiser Permanente Commercial	$367.05
Rate for Payer: Kaiser Permanente Medicaid	$297.14
Rate for Payer: MDX Hawaii PPO	$565.14
Rate for Payer: University Health Alliance Commercial	$424.67

Reamer Nut 03.168.007 [3641986]

Facility

$1,346.33

Service Code	HCPCS C1713
Hospital Charge Code	3641986
Hospital Revenue Code	278
Min. Negotiated Rate	$753.94
Max. Negotiated Rate	$1,305.94
Rate for Payer: Cash Price	$875.11
Rate for Payer: Hawaii Western Management Group Commercial	$942.43
Rate for Payer: Health Management Network Commercial	$1,144.38
Rate for Payer: MDX Hawaii PPO	$1,305.94
Rate for Payer: University Health Alliance Commercial	$753.94

Reamer Nut 03.168.007 [3641986]

Facility

$1,346.33

Service Code	HCPCS C1713
Hospital Charge Code	3641986
Hospital Revenue Code	278
Min. Negotiated Rate	$686.63
Max. Negotiated Rate	$1,305.94
Rate for Payer: Cash Price	$875.11
Rate for Payer: Hawaii Western Management Group Commercial	$942.43
Rate for Payer: Health Management Network Commercial	$1,144.38
Rate for Payer: Kaiser Permanente Commercial	$848.19
Rate for Payer: Kaiser Permanente Medicaid	$686.63
Rate for Payer: MDX Hawaii PPO	$1,305.94
Rate for Payer: University Health Alliance Commercial	$753.94

Reamer Tube for Hollow Reamers 309.038 [3623760]

Facility

$1,784.85

Hospital Charge Code	3623760
Hospital Revenue Code	272
Min. Negotiated Rate	$910.27
Max. Negotiated Rate	$1,731.30
Rate for Payer: Cash Price	$1,160.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,695.61
Rate for Payer: Health Management Network Commercial	$1,517.12
Rate for Payer: Kaiser Permanente Commercial	$1,124.46
Rate for Payer: Kaiser Permanente Medicaid	$910.27
Rate for Payer: MDX Hawaii PPO	$1,731.30
Rate for Payer: University Health Alliance Commercial	$1,300.98

Reamer Tube for Hollow Reamers 309.038 [3623760]

Facility

$1,784.85

Hospital Charge Code	3623760
Hospital Revenue Code	272
Min. Negotiated Rate	$1,517.12
Max. Negotiated Rate	$1,731.30
Rate for Payer: Cash Price	$1,160.15
Rate for Payer: Health Management Network Commercial	$1,517.12
Rate for Payer: MDX Hawaii PPO	$1,731.30

Know your out-of-pocket cost for care.

All Charges