Kona Community Hospital

All Charges

Charge

Type

Setting

Price

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$52,096.72

Service Code	MSDRG 625
Min. Negotiated Rate	$21,407.02
Max. Negotiated Rate	$52,096.72
Rate for Payer: AlohaCare Medicare	$39,722.67
Rate for Payer: Devoted Health Medicare	$43,694.94
Rate for Payer: Hawaii Medical Service Association Commercial	$21,407.02
Rate for Payer: Hawaii Medical Service Association Medicare	$39,722.67
Rate for Payer: Humana Medicare	$39,722.67
Rate for Payer: Kaiser Permanente Commercial	$52,096.72
Rate for Payer: Kaiser Permanente Medicare	$39,722.67
Rate for Payer: Ohana Health Plan Medicare	$39,722.67
Rate for Payer: UnitedHealthcare Medicare	$39,722.67

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$22,913.17

Service Code	MSDRG 627
Min. Negotiated Rate	$17,470.82
Max. Negotiated Rate	$22,913.17
Rate for Payer: AlohaCare Medicare	$17,470.82
Rate for Payer: Devoted Health Medicare	$19,217.90
Rate for Payer: Hawaii Medical Service Association Commercial	$21,407.02
Rate for Payer: Hawaii Medical Service Association Medicare	$17,470.82
Rate for Payer: Humana Medicare	$17,470.82
Rate for Payer: Kaiser Permanente Commercial	$22,913.17
Rate for Payer: Kaiser Permanente Medicare	$17,470.82
Rate for Payer: Ohana Health Plan Medicare	$17,470.82
Rate for Payer: UnitedHealthcare Medicare	$17,470.82

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$6,972.36

Service Code	APR-DRG 4042
Min. Negotiated Rate	$6,972.36
Max. Negotiated Rate	$6,972.36
Rate for Payer: AlohaCare Medicaid	$6,972.36
Rate for Payer: Hawaii Medical Service Association ABD	$6,972.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,972.36
Rate for Payer: Kaiser Permanente Medicaid	$6,972.36
Rate for Payer: Ohana Health Plan Medicaid	$6,972.36
Rate for Payer: UnitedHealthcare Medicaid	$6,972.36

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$4,748.64

Service Code	APR-DRG 4041
Min. Negotiated Rate	$4,748.64
Max. Negotiated Rate	$4,748.64
Rate for Payer: AlohaCare Medicaid	$4,748.64
Rate for Payer: Hawaii Medical Service Association ABD	$4,748.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,748.64
Rate for Payer: Kaiser Permanente Medicaid	$4,748.64
Rate for Payer: Ohana Health Plan Medicaid	$4,748.64
Rate for Payer: UnitedHealthcare Medicaid	$4,748.64

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$11,042.80

Service Code	APR-DRG 4043
Min. Negotiated Rate	$11,042.80
Max. Negotiated Rate	$11,042.80
Rate for Payer: AlohaCare Medicaid	$11,042.80
Rate for Payer: Hawaii Medical Service Association ABD	$11,042.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,042.80
Rate for Payer: Kaiser Permanente Medicaid	$11,042.80
Rate for Payer: Ohana Health Plan Medicaid	$11,042.80
Rate for Payer: UnitedHealthcare Medicaid	$11,042.80

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES

Facility

$22,343.51

Service Code	APR-DRG 4044
Min. Negotiated Rate	$22,343.51
Max. Negotiated Rate	$22,343.51
Rate for Payer: AlohaCare Medicaid	$22,343.51
Rate for Payer: Hawaii Medical Service Association ABD	$22,343.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,343.51
Rate for Payer: Kaiser Permanente Medicaid	$22,343.51
Rate for Payer: Ohana Health Plan Medicaid	$22,343.51
Rate for Payer: UnitedHealthcare Medicaid	$22,343.51

THYROID (PORK) 60 MG PO TABLET

Facility

$6.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$6.22
Rate for Payer: Cash Price	$4.17
Rate for Payer: Health Management Network Commercial	$5.45
Rate for Payer: MDX Hawaii PPO	$6.22

THYROID (PORK) 60 MG PO TABLET

Facility

$6.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$6.22
Rate for Payer: Cash Price	$4.17
Rate for Payer: Hawaii Western Management Group Commercial	$6.09
Rate for Payer: Health Management Network Commercial	$5.45
Rate for Payer: Kaiser Permanente Commercial	$4.04
Rate for Payer: Kaiser Permanente Medicaid	$3.27
Rate for Payer: MDX Hawaii PPO	$6.22
Rate for Payer: UnitedHealthcare Medicaid	$3.85
Rate for Payer: University Health Alliance Commercial	$4.67

THYROTROPIN ALFA 0.9 MG IM RECON.SOLN.

Facility

$3,544.95

Service Code	HCPCS J3240
Hospital Revenue Code	250
Min. Negotiated Rate	$3,013.21
Max. Negotiated Rate	$3,438.60
Rate for Payer: Cash Price	$2,304.22
Rate for Payer: Health Management Network Commercial	$3,013.21
Rate for Payer: MDX Hawaii PPO	$3,438.60

THYROTROPIN ALFA 0.9 MG IM RECON.SOLN.

Facility

$3,544.95

Service Code	HCPCS J3240
Hospital Revenue Code	636
Min. Negotiated Rate	$1,807.92
Max. Negotiated Rate	$3,438.60
Rate for Payer: AlohaCare Medicaid	$2,125.34
Rate for Payer: AlohaCare Medicare	$2,125.34
Rate for Payer: Cash Price	$2,304.22
Rate for Payer: Cash Price	$2,304.22
Rate for Payer: Devoted Health Medicare	$2,337.87
Rate for Payer: Hawaii Medical Service Association ABD	$2,113.24
Rate for Payer: Hawaii Medical Service Association Commercial	$2,656.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,125.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,113.24
Rate for Payer: Hawaii Western Management Group Commercial	$3,367.70
Rate for Payer: Health Management Network Commercial	$3,013.21
Rate for Payer: Humana Medicare	$2,125.34
Rate for Payer: Kaiser Permanente Commercial	$2,233.32
Rate for Payer: Kaiser Permanente Medicaid	$1,807.92
Rate for Payer: Kaiser Permanente Medicare	$2,125.34
Rate for Payer: MDX Hawaii PPO	$3,438.60
Rate for Payer: Ohana Health Plan Medicaid	$2,337.87
Rate for Payer: Ohana Health Plan Medicare	$2,125.34
Rate for Payer: UnitedHealthcare Medicaid	$2,126.97
Rate for Payer: UnitedHealthcare Medicare	$2,125.34
Rate for Payer: University Health Alliance Commercial	$2,583.91

TICAGRELOR 90 MG PO TABLET

Facility

$47.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$45.65
Rate for Payer: Cash Price	$30.59
Rate for Payer: Hawaii Western Management Group Commercial	$44.71
Rate for Payer: Health Management Network Commercial	$40.00
Rate for Payer: Kaiser Permanente Commercial	$29.65
Rate for Payer: Kaiser Permanente Medicaid	$24.00
Rate for Payer: MDX Hawaii PPO	$45.65
Rate for Payer: UnitedHealthcare Medicaid	$28.24
Rate for Payer: University Health Alliance Commercial	$34.30

TICAGRELOR 90 MG PO TABLET

Facility

$47.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$45.65
Rate for Payer: Cash Price	$30.59
Rate for Payer: Health Management Network Commercial	$40.00
Rate for Payer: MDX Hawaii PPO	$45.65

Tigerloop AR7234T [3641182]

Facility

$500.13

Service Code	HCPCS C1713
Hospital Charge Code	3641182
Hospital Revenue Code	278
Min. Negotiated Rate	$255.07
Max. Negotiated Rate	$485.13
Rate for Payer: Cash Price	$325.08
Rate for Payer: Hawaii Western Management Group Commercial	$350.09
Rate for Payer: Health Management Network Commercial	$425.11
Rate for Payer: Kaiser Permanente Commercial	$315.08
Rate for Payer: Kaiser Permanente Medicaid	$255.07
Rate for Payer: MDX Hawaii PPO	$485.13
Rate for Payer: University Health Alliance Commercial	$280.07

Tigerloop AR7234T [3641182]

Facility

$500.13

Service Code	HCPCS C1713
Hospital Charge Code	3641182
Hospital Revenue Code	278
Min. Negotiated Rate	$280.07
Max. Negotiated Rate	$485.13
Rate for Payer: Cash Price	$325.08
Rate for Payer: Hawaii Western Management Group Commercial	$350.09
Rate for Payer: Health Management Network Commercial	$425.11
Rate for Payer: MDX Hawaii PPO	$485.13
Rate for Payer: University Health Alliance Commercial	$280.07

Tigerwire # 2 Tigerstick AR-7209T [3623490]

Facility

$569.13

Hospital Charge Code	3623490
Hospital Revenue Code	272
Min. Negotiated Rate	$290.26
Max. Negotiated Rate	$552.06
Rate for Payer: Cash Price	$369.93
Rate for Payer: Hawaii Western Management Group Commercial	$540.67
Rate for Payer: Health Management Network Commercial	$483.76
Rate for Payer: Kaiser Permanente Commercial	$358.55
Rate for Payer: Kaiser Permanente Medicaid	$290.26
Rate for Payer: MDX Hawaii PPO	$552.06
Rate for Payer: University Health Alliance Commercial	$414.84

Tigerwire # 2 Tigerstick AR-7209T [3623490]

Facility

$569.13

Hospital Charge Code	3623490
Hospital Revenue Code	272
Min. Negotiated Rate	$483.76
Max. Negotiated Rate	$552.06
Rate for Payer: Cash Price	$369.93
Rate for Payer: Health Management Network Commercial	$483.76
Rate for Payer: MDX Hawaii PPO	$552.06

Tightrope Abs 3h Button 11mm Concave AR-1588TB-3IB [3645395]

Facility

$2,542.38

Service Code	HCPCS C1713
Hospital Charge Code	3645395
Hospital Revenue Code	278
Min. Negotiated Rate	$1,423.73
Max. Negotiated Rate	$2,466.11
Rate for Payer: Cash Price	$1,652.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,779.67
Rate for Payer: Health Management Network Commercial	$2,161.02
Rate for Payer: MDX Hawaii PPO	$2,466.11
Rate for Payer: University Health Alliance Commercial	$1,423.73

Tightrope Abs 3h Button 11mm Concave AR-1588TB-3IB [3645395]

Facility

$2,542.38

Service Code	HCPCS C1713
Hospital Charge Code	3645395
Hospital Revenue Code	278
Min. Negotiated Rate	$1,296.61
Max. Negotiated Rate	$2,466.11
Rate for Payer: Cash Price	$1,652.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,779.67
Rate for Payer: Health Management Network Commercial	$2,161.02
Rate for Payer: Kaiser Permanente Commercial	$1,601.70
Rate for Payer: Kaiser Permanente Medicaid	$1,296.61
Rate for Payer: MDX Hawaii PPO	$2,466.11
Rate for Payer: University Health Alliance Commercial	$1,423.73

Tightrope ABS Button Extender AR1589RT [3642220]

Facility

$1,840.25

Service Code	HCPCS C1713
Hospital Charge Code	3642220
Hospital Revenue Code	278
Min. Negotiated Rate	$938.53
Max. Negotiated Rate	$1,785.04
Rate for Payer: Cash Price	$1,196.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,288.17
Rate for Payer: Health Management Network Commercial	$1,564.21
Rate for Payer: Kaiser Permanente Commercial	$1,159.36
Rate for Payer: Kaiser Permanente Medicaid	$938.53
Rate for Payer: MDX Hawaii PPO	$1,785.04
Rate for Payer: University Health Alliance Commercial	$1,030.54

Tightrope ABS Button Extender AR1589RT [3642220]

Facility

$1,840.25

Service Code	HCPCS C1713
Hospital Charge Code	3642220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.54
Max. Negotiated Rate	$1,785.04
Rate for Payer: Cash Price	$1,196.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,288.17
Rate for Payer: Health Management Network Commercial	$1,564.21
Rate for Payer: MDX Hawaii PPO	$1,785.04
Rate for Payer: University Health Alliance Commercial	$1,030.54

Tightrope ABS Button Round Concave 11mm AR1588TB3 [3641133]

Facility

$1,320.00

Service Code	HCPCS C1713
Hospital Charge Code	3641133
Hospital Revenue Code	278
Min. Negotiated Rate	$673.20
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$858.00
Rate for Payer: Hawaii Western Management Group Commercial	$924.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$673.20
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: University Health Alliance Commercial	$739.20

Tightrope ABS Button Round Concave 11mm AR1588TB3 [3641133]

Facility

$1,320.00

Service Code	HCPCS C1713
Hospital Charge Code	3641133
Hospital Revenue Code	278
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$1,280.40
Rate for Payer: Cash Price	$858.00
Rate for Payer: Hawaii Western Management Group Commercial	$924.00
Rate for Payer: Health Management Network Commercial	$1,122.00
Rate for Payer: MDX Hawaii PPO	$1,280.40
Rate for Payer: University Health Alliance Commercial	$739.20

Tightrope ABS Button Round Concave 14 mm AR1588TB4 [3641135]

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Charge Code	3641135
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.80
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,189.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,281.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: University Health Alliance Commercial	$1,024.80

Tightrope ABS Button Round Concave 14 mm AR1588TB4 [3641135]

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Charge Code	3641135
Hospital Revenue Code	278
Min. Negotiated Rate	$933.30
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,189.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,281.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Kaiser Permanente Commercial	$1,152.90
Rate for Payer: Kaiser Permanente Medicaid	$933.30
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: University Health Alliance Commercial	$1,024.80

Tightrope Ii Abs Implant Open [3643409]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3643409
Hospital Revenue Code	278
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	$1,898.05
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	$1,518.44

Know your out-of-pocket cost for care.

All Charges