Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CARFILZOMIB 60 MG IV RECON.SOLN.

Facility

$5,363.03

Service Code	HCPCS J9047
Hospital Revenue Code	250
Min. Negotiated Rate	$4,558.58
Max. Negotiated Rate	$5,202.14
Rate for Payer: Cash Price	$3,485.97
Rate for Payer: Health Management Network Commercial	$4,558.58
Rate for Payer: MDX Hawaii PPO	$5,202.14

CARISOPRODOL 350 MG PO TABLET

Facility

$3.29

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Management Network Commercial	$2.80
Rate for Payer: MDX Hawaii PPO	$3.19

CARISOPRODOL 350 MG PO TABLET

Facility

$3.29

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.14
Rate for Payer: Hawaii Western Management Group Commercial	$3.13
Rate for Payer: Health Management Network Commercial	$2.80
Rate for Payer: Kaiser Permanente Commercial	$2.07
Rate for Payer: Kaiser Permanente Medicaid	$1.68
Rate for Payer: MDX Hawaii PPO	$3.19
Rate for Payer: UnitedHealthcare Medicaid	$1.97
Rate for Payer: University Health Alliance Commercial	$2.40

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$41,236.12

Service Code	MSDRG 035
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$41,236.12
Rate for Payer: AlohaCare Medicare	$31,441.69
Rate for Payer: Devoted Health Medicare	$34,585.86
Rate for Payer: Hawaii Medical Service Association Medicare	$31,441.69
Rate for Payer: Humana Medicare	$31,441.69
Rate for Payer: Kaiser Permanente Commercial	$41,236.12
Rate for Payer: Kaiser Permanente Medicare	$31,441.69
Rate for Payer: Ohana Health Plan Medicare	$31,441.69
Rate for Payer: UnitedHealthcare Medicare	$31,441.69
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$66,769.57

Service Code	MSDRG 034
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$66,769.57
Rate for Payer: AlohaCare Medicare	$50,910.41
Rate for Payer: Devoted Health Medicare	$56,001.45
Rate for Payer: Hawaii Medical Service Association Medicare	$50,910.41
Rate for Payer: Humana Medicare	$50,910.41
Rate for Payer: Kaiser Permanente Commercial	$66,769.57
Rate for Payer: Kaiser Permanente Medicare	$50,910.41
Rate for Payer: Ohana Health Plan Medicare	$50,910.41
Rate for Payer: UnitedHealthcare Medicare	$50,910.41
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$33,513.30

Service Code	MSDRG 036
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$33,513.30
Rate for Payer: AlohaCare Medicare	$25,553.19
Rate for Payer: Devoted Health Medicare	$28,108.51
Rate for Payer: Hawaii Medical Service Association Medicare	$25,553.19
Rate for Payer: Humana Medicare	$25,553.19
Rate for Payer: Kaiser Permanente Commercial	$33,513.30
Rate for Payer: Kaiser Permanente Medicare	$25,553.19
Rate for Payer: Ohana Health Plan Medicare	$25,553.19
Rate for Payer: UnitedHealthcare Medicare	$25,553.19
Rate for Payer: University Health Alliance Commercial	$10,400.00

Carr-Locke Inj Ndl 23g 5mm 230cm 2.5mm Od BX00711812 [3645453]

Facility

$569.70

Hospital Charge Code	3645453
Hospital Revenue Code	272
Min. Negotiated Rate	$484.25
Max. Negotiated Rate	$552.61
Rate for Payer: Cash Price	$370.31
Rate for Payer: Health Management Network Commercial	$484.25
Rate for Payer: MDX Hawaii PPO	$552.61

Carr-Locke Inj Ndl 23g 5mm 230cm 2.5mm Od BX00711812 [3645453]

Facility

$569.70

Hospital Charge Code	3645453
Hospital Revenue Code	272
Min. Negotiated Rate	$290.55
Max. Negotiated Rate	$552.61
Rate for Payer: Cash Price	$370.31
Rate for Payer: Hawaii Western Management Group Commercial	$541.22
Rate for Payer: Health Management Network Commercial	$484.25
Rate for Payer: Kaiser Permanente Commercial	$358.91
Rate for Payer: Kaiser Permanente Medicaid	$290.55
Rate for Payer: MDX Hawaii PPO	$552.61
Rate for Payer: University Health Alliance Commercial	$415.25

Carr-Locke Inj Ndl 25g 5mm 230cm 2.5mm Od BX00711811 [3645452]

Facility

$487.48

Hospital Charge Code	3645452
Hospital Revenue Code	272
Min. Negotiated Rate	$414.36
Max. Negotiated Rate	$472.86
Rate for Payer: Cash Price	$316.86
Rate for Payer: Health Management Network Commercial	$414.36
Rate for Payer: MDX Hawaii PPO	$472.86

Carr-Locke Inj Ndl 25g 5mm 230cm 2.5mm Od BX00711811 [3645452]

Facility

$487.48

Hospital Charge Code	3645452
Hospital Revenue Code	272
Min. Negotiated Rate	$248.61
Max. Negotiated Rate	$472.86
Rate for Payer: Cash Price	$316.86
Rate for Payer: Hawaii Western Management Group Commercial	$463.11
Rate for Payer: Health Management Network Commercial	$414.36
Rate for Payer: Kaiser Permanente Commercial	$307.11
Rate for Payer: Kaiser Permanente Medicaid	$248.61
Rate for Payer: MDX Hawaii PPO	$472.86
Rate for Payer: University Health Alliance Commercial	$355.32

Carter Thomason II Closure Syst CTI-1015P [3626877]

Facility

$1,079.28

Hospital Charge Code	3626877
Hospital Revenue Code	272
Min. Negotiated Rate	$550.43
Max. Negotiated Rate	$1,046.90
Rate for Payer: Cash Price	$701.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,025.32
Rate for Payer: Health Management Network Commercial	$917.39
Rate for Payer: Kaiser Permanente Commercial	$679.95
Rate for Payer: Kaiser Permanente Medicaid	$550.43
Rate for Payer: MDX Hawaii PPO	$1,046.90
Rate for Payer: University Health Alliance Commercial	$786.69

Carter Thomason II Closure Syst CTI-1015P [3626877]

Facility

$1,079.28

Hospital Charge Code	3626877
Hospital Revenue Code	272
Min. Negotiated Rate	$917.39
Max. Negotiated Rate	$1,046.90
Rate for Payer: Cash Price	$701.53
Rate for Payer: Health Management Network Commercial	$917.39
Rate for Payer: MDX Hawaii PPO	$1,046.90

Cartridge 80mm Med Thk Tristp Purple GIA80MTC [3644073]

Facility

$515.36

Hospital Charge Code	3644073
Hospital Revenue Code	272
Min. Negotiated Rate	$262.83
Max. Negotiated Rate	$499.90
Rate for Payer: Cash Price	$334.98
Rate for Payer: Hawaii Western Management Group Commercial	$489.59
Rate for Payer: Health Management Network Commercial	$438.06
Rate for Payer: Kaiser Permanente Commercial	$324.68
Rate for Payer: Kaiser Permanente Medicaid	$262.83
Rate for Payer: MDX Hawaii PPO	$499.90
Rate for Payer: University Health Alliance Commercial	$375.65

Cartridge 80mm Med Thk Tristp Purple GIA80MTC [3644073]

Facility

$515.36

Hospital Charge Code	3644073
Hospital Revenue Code	272
Min. Negotiated Rate	$438.06
Max. Negotiated Rate	$499.90
Rate for Payer: Cash Price	$334.98
Rate for Payer: Health Management Network Commercial	$438.06
Rate for Payer: MDX Hawaii PPO	$499.90

CARVEDILOL 12.5 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$11.45
Rate for Payer: Cash Price	$7.67
Rate for Payer: Hawaii Western Management Group Commercial	$11.21
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Kaiser Permanente Commercial	$7.43
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: UnitedHealthcare Medicaid	$7.08
Rate for Payer: University Health Alliance Commercial	$8.60

CARVEDILOL 12.5 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$11.45
Rate for Payer: Cash Price	$7.67
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: MDX Hawaii PPO	$11.45

CARVEDILOL 3.125 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$11.45
Rate for Payer: Cash Price	$7.67
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: MDX Hawaii PPO	$1.16

CARVEDILOL 3.125 MG PO TABLET

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: Cash Price	$7.67
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.21
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Kaiser Permanente Commercial	$7.43
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$7.08
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$8.60
Rate for Payer: University Health Alliance Commercial	$0.87

CARVEDILOL 6.25 MG PO TABLET

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: Cash Price	$6.99
Rate for Payer: Cash Price	$7.67
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Health Management Network Commercial	$9.15
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: MDX Hawaii PPO	$10.44
Rate for Payer: MDX Hawaii PPO	$1.16

CARVEDILOL 6.25 MG PO TABLET

Facility

$10.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$10.44
Rate for Payer: Cash Price	$6.99
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$7.67
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.21
Rate for Payer: Hawaii Western Management Group Commercial	$10.22
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$9.15
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Kaiser Permanente Commercial	$6.78
Rate for Payer: Kaiser Permanente Commercial	$7.43
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: Kaiser Permanente Medicaid	$5.49
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: MDX Hawaii PPO	$10.44
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$7.08
Rate for Payer: UnitedHealthcare Medicaid	$6.46
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$7.84
Rate for Payer: University Health Alliance Commercial	$8.60
Rate for Payer: University Health Alliance Commercial	$0.87

CASPOFUNGIN 50 MG IV RECON.SOLN.

Facility

$483.93

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$411.34
Max. Negotiated Rate	$469.41
Rate for Payer: Cash Price	$314.55
Rate for Payer: Cash Price	$610.75
Rate for Payer: Health Management Network Commercial	$411.34
Rate for Payer: Health Management Network Commercial	$798.68
Rate for Payer: MDX Hawaii PPO	$469.41
Rate for Payer: MDX Hawaii PPO	$911.43

CASPOFUNGIN 50 MG IV RECON.SOLN.

Facility

$939.62

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$911.43
Rate for Payer: Cash Price	$610.75
Rate for Payer: Cash Price	$314.55
Rate for Payer: Cash Price	$314.55
Rate for Payer: Cash Price	$610.75
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$459.73
Rate for Payer: Hawaii Western Management Group Commercial	$892.64
Rate for Payer: Health Management Network Commercial	$798.68
Rate for Payer: Health Management Network Commercial	$411.34
Rate for Payer: Kaiser Permanente Commercial	$591.96
Rate for Payer: Kaiser Permanente Commercial	$304.88
Rate for Payer: Kaiser Permanente Medicaid	$246.80
Rate for Payer: Kaiser Permanente Medicaid	$479.21
Rate for Payer: MDX Hawaii PPO	$911.43
Rate for Payer: MDX Hawaii PPO	$469.41
Rate for Payer: UnitedHealthcare Medicaid	$290.36
Rate for Payer: UnitedHealthcare Medicaid	$563.77
Rate for Payer: University Health Alliance Commercial	$352.74
Rate for Payer: University Health Alliance Commercial	$684.89

CASPOFUNGIN 70 MG IV RECON.SOLN.

Facility

$372.63

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$316.74
Max. Negotiated Rate	$361.45
Rate for Payer: Cash Price	$242.21
Rate for Payer: Cash Price	$322.99
Rate for Payer: Health Management Network Commercial	$316.74
Rate for Payer: Health Management Network Commercial	$422.37
Rate for Payer: MDX Hawaii PPO	$361.45
Rate for Payer: MDX Hawaii PPO	$482.00

CASPOFUNGIN 70 MG IV RECON.SOLN.

Facility

$372.63

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$361.45
Rate for Payer: Cash Price	$242.21
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cash Price	$242.21
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$354.00
Rate for Payer: Hawaii Western Management Group Commercial	$472.06
Rate for Payer: Health Management Network Commercial	$422.37
Rate for Payer: Health Management Network Commercial	$316.74
Rate for Payer: Kaiser Permanente Commercial	$234.76
Rate for Payer: Kaiser Permanente Commercial	$313.05
Rate for Payer: Kaiser Permanente Medicaid	$253.42
Rate for Payer: Kaiser Permanente Medicaid	$190.04
Rate for Payer: MDX Hawaii PPO	$482.00
Rate for Payer: MDX Hawaii PPO	$361.45
Rate for Payer: UnitedHealthcare Medicaid	$223.58
Rate for Payer: UnitedHealthcare Medicaid	$298.15
Rate for Payer: University Health Alliance Commercial	$362.20
Rate for Payer: University Health Alliance Commercial	$271.61

CAST ORTHO GLASS 2 INCH/FOOT [2707092]

Facility

$280.25

Hospital Charge Code	2707092
Hospital Revenue Code	272
Min. Negotiated Rate	$142.93
Max. Negotiated Rate	$271.84
Rate for Payer: Cash Price	$182.16
Rate for Payer: Hawaii Western Management Group Commercial	$266.24
Rate for Payer: Health Management Network Commercial	$238.21
Rate for Payer: Kaiser Permanente Commercial	$176.56
Rate for Payer: Kaiser Permanente Medicaid	$142.93
Rate for Payer: MDX Hawaii PPO	$271.84
Rate for Payer: University Health Alliance Commercial	$204.27

Know your out-of-pocket cost for care.

All Charges