Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Cable w/Crimp 1.7mm 750mm 298.801.01 [3640220]

Facility

$3,235.40

Service Code	HCPCS C1713
Hospital Charge Code	3640220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.82
Max. Negotiated Rate	$3,138.34
Rate for Payer: Cash Price	$2,103.01
Rate for Payer: Hawaii Western Management Group Commercial	$2,264.78
Rate for Payer: Health Management Network Commercial	$2,750.09
Rate for Payer: MDX Hawaii PPO	$3,138.34
Rate for Payer: University Health Alliance Commercial	$1,811.82

Cable w/Crimp 1.7mm 750mm 298.801.01 [3640220]

Facility

$3,235.40

Service Code	HCPCS C1713
Hospital Charge Code	3640220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.05
Max. Negotiated Rate	$3,138.34
Rate for Payer: Cash Price	$2,103.01
Rate for Payer: Hawaii Western Management Group Commercial	$2,264.78
Rate for Payer: Health Management Network Commercial	$2,750.09
Rate for Payer: Kaiser Permanente Commercial	$2,038.30
Rate for Payer: Kaiser Permanente Medicaid	$1,650.05
Rate for Payer: MDX Hawaii PPO	$3,138.34
Rate for Payer: University Health Alliance Commercial	$1,811.82

Caddy Drill Bit 11/64 4.3mm x 127mm 210445 [3600957]

Facility

$1,214.07

Hospital Charge Code	3600957
Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.96
Max. Negotiated Rate	$1,177.65
Rate for Payer: Cash Price	$789.15
Rate for Payer: Health Management Network Commercial	$1,031.96
Rate for Payer: MDX Hawaii PPO	$1,177.65

Caddy Drill Bit 11/64 4.3mm x 127mm 210445 [3600957]

Facility

$1,214.07

Hospital Charge Code	3600957
Hospital Revenue Code	272
Min. Negotiated Rate	$619.18
Max. Negotiated Rate	$1,177.65
Rate for Payer: Cash Price	$789.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,153.37
Rate for Payer: Health Management Network Commercial	$1,031.96
Rate for Payer: Kaiser Permanente Commercial	$764.86
Rate for Payer: Kaiser Permanente Medicaid	$619.18
Rate for Payer: MDX Hawaii PPO	$1,177.65
Rate for Payer: University Health Alliance Commercial	$884.94

Caddy Drill Bit 3/32 2.4mm x 127mm 210440 [3600952]

Facility

$882.06

Hospital Charge Code	3600952
Hospital Revenue Code	272
Min. Negotiated Rate	$449.85
Max. Negotiated Rate	$855.60
Rate for Payer: Cash Price	$573.34
Rate for Payer: Hawaii Western Management Group Commercial	$837.96
Rate for Payer: Health Management Network Commercial	$749.75
Rate for Payer: Kaiser Permanente Commercial	$555.70
Rate for Payer: Kaiser Permanente Medicaid	$449.85
Rate for Payer: MDX Hawaii PPO	$855.60
Rate for Payer: University Health Alliance Commercial	$642.93

Caddy Drill Bit 3/32 2.4mm x 127mm 210440 [3600952]

Facility

$882.06

Hospital Charge Code	3600952
Hospital Revenue Code	272
Min. Negotiated Rate	$749.75
Max. Negotiated Rate	$855.60
Rate for Payer: Cash Price	$573.34
Rate for Payer: Health Management Network Commercial	$749.75
Rate for Payer: MDX Hawaii PPO	$855.60

Caddy Drill Bit 5/64 2.0mm x 127mm 210439 [3600951]

Facility

$927.57

Hospital Charge Code	3600951
Hospital Revenue Code	272
Min. Negotiated Rate	$788.43
Max. Negotiated Rate	$899.74
Rate for Payer: Cash Price	$602.92
Rate for Payer: Health Management Network Commercial	$788.43
Rate for Payer: MDX Hawaii PPO	$899.74

Caddy Drill Bit 5/64 2.0mm x 127mm 210439 [3600951]

Facility

$927.57

Hospital Charge Code	3600951
Hospital Revenue Code	272
Min. Negotiated Rate	$473.06
Max. Negotiated Rate	$899.74
Rate for Payer: Cash Price	$602.92
Rate for Payer: Hawaii Western Management Group Commercial	$881.19
Rate for Payer: Health Management Network Commercial	$788.43
Rate for Payer: Kaiser Permanente Commercial	$584.37
Rate for Payer: Kaiser Permanente Medicaid	$473.06
Rate for Payer: MDX Hawaii PPO	$899.74
Rate for Payer: University Health Alliance Commercial	$676.11

Caddy Drill Bit 7/64 2.7mm x 127mm 210441 [3600953]

Facility

$882.06

Hospital Charge Code	3600953
Hospital Revenue Code	272
Min. Negotiated Rate	$449.85
Max. Negotiated Rate	$855.60
Rate for Payer: Cash Price	$573.34
Rate for Payer: Hawaii Western Management Group Commercial	$837.96
Rate for Payer: Health Management Network Commercial	$749.75
Rate for Payer: Kaiser Permanente Commercial	$555.70
Rate for Payer: Kaiser Permanente Medicaid	$449.85
Rate for Payer: MDX Hawaii PPO	$855.60
Rate for Payer: University Health Alliance Commercial	$642.93

Caddy Drill Bit 7/64 2.7mm x 127mm 210441 [3600953]

Facility

$882.06

Hospital Charge Code	3600953
Hospital Revenue Code	272
Min. Negotiated Rate	$749.75
Max. Negotiated Rate	$855.60
Rate for Payer: Cash Price	$573.34
Rate for Payer: Health Management Network Commercial	$749.75
Rate for Payer: MDX Hawaii PPO	$855.60

CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) IV SOLN

Facility

$67.68

Service Code	HCPCS J0706
Hospital Revenue Code	636
Min. Negotiated Rate	$34.52
Max. Negotiated Rate	$65.65
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$65.53
Rate for Payer: Hawaii Western Management Group Commercial	$95.77
Rate for Payer: Hawaii Western Management Group Commercial	$64.30
Rate for Payer: Health Management Network Commercial	$85.69
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Kaiser Permanente Commercial	$42.64
Rate for Payer: Kaiser Permanente Commercial	$63.51
Rate for Payer: Kaiser Permanente Medicaid	$34.52
Rate for Payer: Kaiser Permanente Medicaid	$51.41
Rate for Payer: MDX Hawaii PPO	$97.79
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: UnitedHealthcare Medicaid	$60.49
Rate for Payer: UnitedHealthcare Medicaid	$40.61
Rate for Payer: University Health Alliance Commercial	$49.33
Rate for Payer: University Health Alliance Commercial	$73.48

CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) IV SOLN

Facility

$100.81

Service Code	HCPCS J0706
Hospital Revenue Code	250
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$97.79
Rate for Payer: Cash Price	$65.53
Rate for Payer: Cash Price	$43.99
Rate for Payer: Health Management Network Commercial	$85.69
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: MDX Hawaii PPO	$97.79
Rate for Payer: MDX Hawaii PPO	$65.65

CALAMINE-ZINC OXIDE 8-8 % TOP LOTN

Facility

$24.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$23.70
Rate for Payer: Cash Price	$15.88
Rate for Payer: Cash Price	$5.08
Rate for Payer: Health Management Network Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$20.77
Rate for Payer: MDX Hawaii PPO	$7.59
Rate for Payer: MDX Hawaii PPO	$23.70

CALAMINE-ZINC OXIDE 8-8 % TOP LOTN

Facility

$24.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$23.70
Rate for Payer: Cash Price	$15.88
Rate for Payer: Cash Price	$5.08
Rate for Payer: Hawaii Western Management Group Commercial	$23.21
Rate for Payer: Hawaii Western Management Group Commercial	$7.43
Rate for Payer: Health Management Network Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$20.77
Rate for Payer: Kaiser Permanente Commercial	$15.39
Rate for Payer: Kaiser Permanente Commercial	$4.93
Rate for Payer: Kaiser Permanente Medicaid	$3.99
Rate for Payer: Kaiser Permanente Medicaid	$12.46
Rate for Payer: MDX Hawaii PPO	$7.59
Rate for Payer: MDX Hawaii PPO	$23.70
Rate for Payer: UnitedHealthcare Medicaid	$14.66
Rate for Payer: UnitedHealthcare Medicaid	$4.69
Rate for Payer: University Health Alliance Commercial	$5.70
Rate for Payer: University Health Alliance Commercial	$17.81

CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL NON-AER.SPRY

Facility

$486.10

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$413.19
Max. Negotiated Rate	$471.52
Rate for Payer: Cash Price	$315.97
Rate for Payer: Health Management Network Commercial	$413.19
Rate for Payer: MDX Hawaii PPO	$471.52

CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL NON-AER.SPRY

Facility

$486.10

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$247.91
Max. Negotiated Rate	$471.52
Rate for Payer: Cash Price	$315.97
Rate for Payer: Hawaii Western Management Group Commercial	$461.80
Rate for Payer: Health Management Network Commercial	$413.19
Rate for Payer: Kaiser Permanente Commercial	$306.24
Rate for Payer: Kaiser Permanente Medicaid	$247.91
Rate for Payer: MDX Hawaii PPO	$471.52
Rate for Payer: UnitedHealthcare Medicaid	$291.66
Rate for Payer: University Health Alliance Commercial	$354.32

CALCITONIN (SALMON) 200 UNIT/ML INJ SOLN

Facility

$1,900.80

Service Code	HCPCS J0630
Hospital Revenue Code	636
Min. Negotiated Rate	$969.41
Max. Negotiated Rate	$1,843.78
Rate for Payer: Cash Price	$1,235.52
Rate for Payer: Cash Price	$1,235.52
Rate for Payer: Hawaii Medical Service Association ABD	$1,142.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,142.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,805.76
Rate for Payer: Health Management Network Commercial	$1,615.68
Rate for Payer: Kaiser Permanente Commercial	$1,197.50
Rate for Payer: Kaiser Permanente Medicaid	$969.41
Rate for Payer: MDX Hawaii PPO	$1,843.78
Rate for Payer: UnitedHealthcare Medicaid	$1,140.48
Rate for Payer: University Health Alliance Commercial	$1,385.49

CALCITONIN (SALMON) 200 UNIT/ML INJ SOLN

Facility

$1,900.80

Service Code	HCPCS J0630
Hospital Revenue Code	250
Min. Negotiated Rate	$1,615.68
Max. Negotiated Rate	$1,843.78
Rate for Payer: Cash Price	$1,235.52
Rate for Payer: Health Management Network Commercial	$1,615.68
Rate for Payer: MDX Hawaii PPO	$1,843.78

CALCITRIOL 0.25 MCG PO CAP

Facility

$7.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$6.86
Rate for Payer: Cash Price	$4.60
Rate for Payer: Cash Price	$3.44
Rate for Payer: Hawaii Western Management Group Commercial	$5.04
Rate for Payer: Hawaii Western Management Group Commercial	$6.72
Rate for Payer: Health Management Network Commercial	$4.50
Rate for Payer: Health Management Network Commercial	$6.01
Rate for Payer: Kaiser Permanente Commercial	$3.34
Rate for Payer: Kaiser Permanente Commercial	$4.45
Rate for Payer: Kaiser Permanente Medicaid	$3.61
Rate for Payer: Kaiser Permanente Medicaid	$2.70
Rate for Payer: MDX Hawaii PPO	$5.14
Rate for Payer: MDX Hawaii PPO	$6.86
Rate for Payer: UnitedHealthcare Medicaid	$3.18
Rate for Payer: UnitedHealthcare Medicaid	$4.24
Rate for Payer: University Health Alliance Commercial	$5.15
Rate for Payer: University Health Alliance Commercial	$3.86

CALCITRIOL 0.25 MCG PO CAP

Facility

$5.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$5.14
Rate for Payer: Cash Price	$3.44
Rate for Payer: Cash Price	$4.60
Rate for Payer: Health Management Network Commercial	$6.01
Rate for Payer: Health Management Network Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$6.86
Rate for Payer: MDX Hawaii PPO	$5.14

CALCIUM ACETATE(PHOSPHAT BIND) 667 MG PO CAP

Facility

$5.67

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$5.50
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cash Price	$6.03
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Hawaii Western Management Group Commercial	$8.81
Rate for Payer: Health Management Network Commercial	$7.88
Rate for Payer: Health Management Network Commercial	$4.82
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: Kaiser Permanente Commercial	$5.84
Rate for Payer: Kaiser Permanente Medicaid	$4.73
Rate for Payer: Kaiser Permanente Medicaid	$2.89
Rate for Payer: MDX Hawaii PPO	$8.99
Rate for Payer: MDX Hawaii PPO	$5.50
Rate for Payer: UnitedHealthcare Medicaid	$3.40
Rate for Payer: UnitedHealthcare Medicaid	$5.56
Rate for Payer: University Health Alliance Commercial	$6.76
Rate for Payer: University Health Alliance Commercial	$4.13

CALCIUM ACETATE(PHOSPHAT BIND) 667 MG PO CAP

Facility

$5.67

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$5.50
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cash Price	$6.03
Rate for Payer: Health Management Network Commercial	$7.88
Rate for Payer: Health Management Network Commercial	$4.82
Rate for Payer: MDX Hawaii PPO	$8.99
Rate for Payer: MDX Hawaii PPO	$5.50

CALCIUM CARBONATE 300 MG (750 MG) PO CHEW

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

CALCIUM CARBONATE 300 MG (750 MG) PO CHEW

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYR

Facility

$60.38

Service Code	HCPCS J0618
Hospital Revenue Code	250
Min. Negotiated Rate	$51.32
Max. Negotiated Rate	$58.57
Rate for Payer: Cash Price	$39.25
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: MDX Hawaii PPO	$58.57

Know your out-of-pocket cost for care.

All Charges