Kona Community Hospital

All Charges

Charge

Type

Setting

Price

TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION) PFU/ML INJ SUSP

Facility

$9,501.35

Service Code	HCPCS J9325
Hospital Revenue Code	636
Min. Negotiated Rate	$73.55
Max. Negotiated Rate	$9,216.31
Rate for Payer: AlohaCare Medicaid	$73.94
Rate for Payer: AlohaCare Medicare	$73.94
Rate for Payer: Cash Price	$6,175.88
Rate for Payer: Cash Price	$6,175.88
Rate for Payer: Devoted Health Medicare	$81.33
Rate for Payer: Hawaii Medical Service Association ABD	$73.55
Rate for Payer: Hawaii Medical Service Association Commercial	$92.42
Rate for Payer: Hawaii Medical Service Association Medicare	$73.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$73.55
Rate for Payer: Hawaii Western Management Group Commercial	$9,026.28
Rate for Payer: Health Management Network Commercial	$8,076.15
Rate for Payer: Humana Medicare	$73.94
Rate for Payer: Kaiser Permanente Commercial	$5,985.85
Rate for Payer: Kaiser Permanente Medicaid	$4,845.69
Rate for Payer: Kaiser Permanente Medicare	$73.94
Rate for Payer: MDX Hawaii PPO	$9,216.31
Rate for Payer: Ohana Health Plan Medicaid	$81.33
Rate for Payer: Ohana Health Plan Medicare	$73.94
Rate for Payer: UnitedHealthcare Medicaid	$5,700.81
Rate for Payer: UnitedHealthcare Medicare	$73.94
Rate for Payer: University Health Alliance Commercial	$6,925.53

TALIMOGENE LAHERPAREPVEC 10EXP8 (100 MILLION) PFU/ML INJ SUSP

Facility

$9,501.35

Service Code	HCPCS J9325
Hospital Revenue Code	250
Min. Negotiated Rate	$8,076.15
Max. Negotiated Rate	$9,216.31
Rate for Payer: Cash Price	$6,175.88
Rate for Payer: Health Management Network Commercial	$8,076.15
Rate for Payer: MDX Hawaii PPO	$9,216.31

TAMOXIFEN 10 MG PO TABLET

Facility

$10.46

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$10.15
Rate for Payer: Cash Price	$6.80
Rate for Payer: Health Management Network Commercial	$8.89
Rate for Payer: MDX Hawaii PPO	$10.15

TAMOXIFEN 10 MG PO TABLET

Facility

$10.46

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$10.15
Rate for Payer: Cash Price	$6.80
Rate for Payer: Hawaii Western Management Group Commercial	$9.94
Rate for Payer: Health Management Network Commercial	$8.89
Rate for Payer: Kaiser Permanente Commercial	$6.59
Rate for Payer: Kaiser Permanente Medicaid	$5.33
Rate for Payer: MDX Hawaii PPO	$10.15
Rate for Payer: UnitedHealthcare Medicaid	$6.28
Rate for Payer: University Health Alliance Commercial	$7.62

TAMSULOSIN 0.4 MG PO CAP

Facility

$23.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$22.57
Rate for Payer: Cash Price	$15.13
Rate for Payer: Hawaii Western Management Group Commercial	$22.11
Rate for Payer: Health Management Network Commercial	$19.78
Rate for Payer: Kaiser Permanente Commercial	$14.66
Rate for Payer: Kaiser Permanente Medicaid	$11.87
Rate for Payer: MDX Hawaii PPO	$22.57
Rate for Payer: UnitedHealthcare Medicaid	$13.96
Rate for Payer: University Health Alliance Commercial	$16.96

TAMSULOSIN 0.4 MG PO CAP

Facility

$23.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$22.57
Rate for Payer: Cash Price	$15.13
Rate for Payer: Health Management Network Commercial	$19.78
Rate for Payer: MDX Hawaii PPO	$22.57

Tapestry Biointegrative Implant 30mmx30mm TP-3030-01 [3643957]

Facility

$7,775.00

Service Code	HCPCS C1763
Hospital Charge Code	3643957
Hospital Revenue Code	278
Min. Negotiated Rate	$3,965.25
Max. Negotiated Rate	$7,541.75
Rate for Payer: Cash Price	$5,053.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,442.50
Rate for Payer: Health Management Network Commercial	$6,608.75
Rate for Payer: Kaiser Permanente Commercial	$4,898.25
Rate for Payer: Kaiser Permanente Medicaid	$3,965.25
Rate for Payer: MDX Hawaii PPO	$7,541.75
Rate for Payer: University Health Alliance Commercial	$4,354.00

Tapestry Biointegrative Implant 30mmx30mm TP-3030-01 [3643957]

Facility

$7,775.00

Service Code	HCPCS C1763
Hospital Charge Code	3643957
Hospital Revenue Code	278
Min. Negotiated Rate	$4,354.00
Max. Negotiated Rate	$7,541.75
Rate for Payer: Cash Price	$5,053.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,442.50
Rate for Payer: Health Management Network Commercial	$6,608.75
Rate for Payer: MDX Hawaii PPO	$7,541.75
Rate for Payer: University Health Alliance Commercial	$4,354.00

Tapestry Biointegrative Implant 40mm x 30mm TP-4030-01 [3644300]

Facility

$12,388.00

Service Code	HCPCS C1889
Hospital Charge Code	3644300
Hospital Revenue Code	278
Min. Negotiated Rate	$6,317.88
Max. Negotiated Rate	$12,016.36
Rate for Payer: Cash Price	$8,052.20
Rate for Payer: Hawaii Western Management Group Commercial	$8,671.60
Rate for Payer: Health Management Network Commercial	$10,529.80
Rate for Payer: Kaiser Permanente Commercial	$7,804.44
Rate for Payer: Kaiser Permanente Medicaid	$6,317.88
Rate for Payer: MDX Hawaii PPO	$12,016.36
Rate for Payer: University Health Alliance Commercial	$6,937.28

Tapestry Biointegrative Implant 40mm x 30mm TP-4030-01 [3644300]

Facility

$12,388.00

Service Code	HCPCS C1889
Hospital Charge Code	3644300
Hospital Revenue Code	278
Min. Negotiated Rate	$6,937.28
Max. Negotiated Rate	$12,016.36
Rate for Payer: Cash Price	$8,052.20
Rate for Payer: Hawaii Western Management Group Commercial	$8,671.60
Rate for Payer: Health Management Network Commercial	$10,529.80
Rate for Payer: MDX Hawaii PPO	$12,016.36
Rate for Payer: University Health Alliance Commercial	$6,937.28

Tecnis Eyhance Iol Lens 22.5 DIB00U0225 [3645530]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645530
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Tecnis Eyhance Iol Lens 22.5 DIB00U0225 [3645530]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645530
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

TEMAZEPAM 15 MG PO CAP

Facility

$3.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$3.83
Rate for Payer: Cash Price	$2.57
Rate for Payer: Cash Price	$2.92
Rate for Payer: Hawaii Western Management Group Commercial	$3.75
Rate for Payer: Hawaii Western Management Group Commercial	$4.28
Rate for Payer: Health Management Network Commercial	$3.36
Rate for Payer: Health Management Network Commercial	$3.83
Rate for Payer: Kaiser Permanente Commercial	$2.49
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$2.01
Rate for Payer: Kaiser Permanente Medicaid	$2.29
Rate for Payer: MDX Hawaii PPO	$3.83
Rate for Payer: MDX Hawaii PPO	$4.37
Rate for Payer: UnitedHealthcare Medicaid	$2.70
Rate for Payer: UnitedHealthcare Medicaid	$2.37
Rate for Payer: University Health Alliance Commercial	$2.88
Rate for Payer: University Health Alliance Commercial	$3.28

TEMAZEPAM 15 MG PO CAP

Facility

$3.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$3.83
Rate for Payer: Cash Price	$2.57
Rate for Payer: Cash Price	$2.92
Rate for Payer: Health Management Network Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$3.36
Rate for Payer: MDX Hawaii PPO	$3.83
Rate for Payer: MDX Hawaii PPO	$4.37

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$25,649.03

Service Code	MSDRG 557
Min. Negotiated Rate	$19,556.86
Max. Negotiated Rate	$25,649.03
Rate for Payer: AlohaCare Medicare	$19,556.86
Rate for Payer: Devoted Health Medicare	$21,512.55
Rate for Payer: Hawaii Medical Service Association Commercial	$20,105.24
Rate for Payer: Hawaii Medical Service Association Medicare	$19,556.86
Rate for Payer: Humana Medicare	$19,556.86
Rate for Payer: Kaiser Permanente Commercial	$25,649.03
Rate for Payer: Kaiser Permanente Medicare	$19,556.86
Rate for Payer: Ohana Health Plan Medicare	$19,556.86
Rate for Payer: UnitedHealthcare Medicare	$19,556.86

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$20,105.24

Service Code	MSDRG 558
Min. Negotiated Rate	$11,748.06
Max. Negotiated Rate	$20,105.24
Rate for Payer: AlohaCare Medicare	$11,748.06
Rate for Payer: Devoted Health Medicare	$12,922.87
Rate for Payer: Hawaii Medical Service Association Commercial	$20,105.24
Rate for Payer: Hawaii Medical Service Association Medicare	$11,748.06
Rate for Payer: Humana Medicare	$11,748.06
Rate for Payer: Kaiser Permanente Commercial	$15,407.70
Rate for Payer: Kaiser Permanente Medicare	$11,748.06
Rate for Payer: Ohana Health Plan Medicare	$11,748.06
Rate for Payer: UnitedHealthcare Medicare	$11,748.06

TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$18,204.92

Service Code	APR-DRG 3174
Min. Negotiated Rate	$18,204.92
Max. Negotiated Rate	$18,204.92
Rate for Payer: AlohaCare Medicaid	$18,204.92
Rate for Payer: Hawaii Medical Service Association ABD	$18,204.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,204.92
Rate for Payer: Kaiser Permanente Medicaid	$18,204.92
Rate for Payer: Ohana Health Plan Medicaid	$18,204.92
Rate for Payer: UnitedHealthcare Medicaid	$18,204.92

TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$9,713.16

Service Code	APR-DRG 3173
Min. Negotiated Rate	$9,713.16
Max. Negotiated Rate	$9,713.16
Rate for Payer: AlohaCare Medicaid	$9,713.16
Rate for Payer: Hawaii Medical Service Association ABD	$9,713.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,713.16
Rate for Payer: Kaiser Permanente Medicaid	$9,713.16
Rate for Payer: Ohana Health Plan Medicaid	$9,713.16
Rate for Payer: UnitedHealthcare Medicaid	$9,713.16

TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$6,502.40

Service Code	APR-DRG 3172
Min. Negotiated Rate	$6,502.40
Max. Negotiated Rate	$6,502.40
Rate for Payer: AlohaCare Medicaid	$6,502.40
Rate for Payer: Hawaii Medical Service Association ABD	$6,502.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,502.40
Rate for Payer: Kaiser Permanente Medicaid	$6,502.40
Rate for Payer: Ohana Health Plan Medicaid	$6,502.40
Rate for Payer: UnitedHealthcare Medicaid	$6,502.40

TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$5,035.20

Service Code	APR-DRG 3171
Min. Negotiated Rate	$5,035.20
Max. Negotiated Rate	$5,035.20
Rate for Payer: AlohaCare Medicaid	$5,035.20
Rate for Payer: Hawaii Medical Service Association ABD	$5,035.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,035.20
Rate for Payer: Kaiser Permanente Medicaid	$5,035.20
Rate for Payer: Ohana Health Plan Medicaid	$5,035.20
Rate for Payer: UnitedHealthcare Medicaid	$5,035.20

TENECTEPLASE 50 MG IV RECON.SOLN.

Facility

$11,075.12

Service Code	HCPCS J3101
Hospital Revenue Code	636
Min. Negotiated Rate	$171.94
Max. Negotiated Rate	$10,742.87
Rate for Payer: AlohaCare Medicaid	$197.44
Rate for Payer: AlohaCare Medicare	$197.44
Rate for Payer: Cash Price	$7,198.83
Rate for Payer: Cash Price	$7,198.83
Rate for Payer: Devoted Health Medicare	$217.18
Rate for Payer: Hawaii Medical Service Association ABD	$171.94
Rate for Payer: Hawaii Medical Service Association Commercial	$246.80
Rate for Payer: Hawaii Medical Service Association Medicare	$197.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$171.94
Rate for Payer: Hawaii Western Management Group Commercial	$10,521.36
Rate for Payer: Health Management Network Commercial	$9,413.85
Rate for Payer: Humana Medicare	$197.44
Rate for Payer: Kaiser Permanente Commercial	$6,977.33
Rate for Payer: Kaiser Permanente Medicaid	$5,648.31
Rate for Payer: Kaiser Permanente Medicare	$197.44
Rate for Payer: MDX Hawaii PPO	$10,742.87
Rate for Payer: Ohana Health Plan Medicaid	$217.18
Rate for Payer: Ohana Health Plan Medicare	$197.44
Rate for Payer: UnitedHealthcare Medicaid	$6,645.07
Rate for Payer: UnitedHealthcare Medicare	$197.44
Rate for Payer: University Health Alliance Commercial	$8,072.65

TENECTEPLASE 50 MG IV RECON.SOLN.

Facility

$11,075.12

Service Code	HCPCS J3101
Hospital Revenue Code	250
Min. Negotiated Rate	$9,413.85
Max. Negotiated Rate	$10,742.87
Rate for Payer: Cash Price	$7,198.83
Rate for Payer: Health Management Network Commercial	$9,413.85
Rate for Payer: MDX Hawaii PPO	$10,742.87

Tenodesis Graft Sz Kit W/Fiberloop & Needle AR-1676ST [3644460]

Facility

$2,711.50

Hospital Charge Code	3644460
Hospital Revenue Code	272
Min. Negotiated Rate	$2,304.78
Max. Negotiated Rate	$2,630.16
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Health Management Network Commercial	$2,304.78

Tenodesis Graft Sz Kit W/Fiberloop & Needle AR-1676ST [3644460]

Facility

$2,711.50

Hospital Charge Code	3644460
Hospital Revenue Code	272
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,575.93
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,976.41

TENODESIS OF LONG TENDON OF BICEPS

Facility

$14,715.00

Service Code	CPT 23430
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$10,679.55

Know your out-of-pocket cost for care.

All Charges