Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,518.44
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: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Tightrope Ii Btb Recon Ib Ar-1588btb-Ib [3643829]

Facility

$2,687.50

Service Code	HCPCS C1713
Hospital Charge Code	3643829
Hospital Revenue Code	278
Min. Negotiated Rate	$1,370.62
Max. Negotiated Rate	$2,606.88
Rate for Payer: Cash Price	$1,746.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.25
Rate for Payer: Health Management Network Commercial	$2,284.38
Rate for Payer: Kaiser Permanente Commercial	$1,693.12
Rate for Payer: Kaiser Permanente Medicaid	$1,370.62
Rate for Payer: MDX Hawaii PPO	$2,606.88
Rate for Payer: University Health Alliance Commercial	$1,505.00

Tightrope Ii Btb Recon Ib Ar-1588btb-Ib [3643829]

Facility

$2,687.50

Service Code	HCPCS C1713
Hospital Charge Code	3643829
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$2,606.88
Rate for Payer: Cash Price	$1,746.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.25
Rate for Payer: Health Management Network Commercial	$2,284.38
Rate for Payer: MDX Hawaii PPO	$2,606.88
Rate for Payer: University Health Alliance Commercial	$1,505.00

Tightrope Knotless Syndesmosis XP Implant Kit AR8925SS [3641228]

Facility

$6,997.13

Service Code	HCPCS C1713
Hospital Charge Code	3641228
Hospital Revenue Code	278
Min. Negotiated Rate	$3,568.54
Max. Negotiated Rate	$6,787.22
Rate for Payer: Cash Price	$4,548.13
Rate for Payer: Hawaii Western Management Group Commercial	$4,897.99
Rate for Payer: Health Management Network Commercial	$5,947.56
Rate for Payer: Kaiser Permanente Commercial	$4,408.19
Rate for Payer: Kaiser Permanente Medicaid	$3,568.54
Rate for Payer: MDX Hawaii PPO	$6,787.22
Rate for Payer: University Health Alliance Commercial	$3,918.39

Tightrope Knotless Syndesmosis XP Implant Kit AR8925SS [3641228]

Facility

$6,997.13

Service Code	HCPCS C1713
Hospital Charge Code	3641228
Hospital Revenue Code	278
Min. Negotiated Rate	$3,918.39
Max. Negotiated Rate	$6,787.22
Rate for Payer: Cash Price	$4,548.13
Rate for Payer: Hawaii Western Management Group Commercial	$4,897.99
Rate for Payer: Health Management Network Commercial	$5,947.56
Rate for Payer: MDX Hawaii PPO	$6,787.22
Rate for Payer: University Health Alliance Commercial	$3,918.39

Ti Knot Device 030404 [3641168]

Facility

$1,192.65

Hospital Charge Code	3641168
Hospital Revenue Code	272
Min. Negotiated Rate	$1,013.75
Max. Negotiated Rate	$1,156.87
Rate for Payer: Cash Price	$775.22
Rate for Payer: Health Management Network Commercial	$1,013.75
Rate for Payer: MDX Hawaii PPO	$1,156.87

Ti Knot Device 030404 [3641168]

Facility

$1,192.65

Hospital Charge Code	3641168
Hospital Revenue Code	272
Min. Negotiated Rate	$608.25
Max. Negotiated Rate	$1,156.87
Rate for Payer: Cash Price	$775.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,133.02
Rate for Payer: Health Management Network Commercial	$1,013.75
Rate for Payer: Kaiser Permanente Commercial	$751.37
Rate for Payer: Kaiser Permanente Medicaid	$608.25
Rate for Payer: MDX Hawaii PPO	$1,156.87
Rate for Payer: University Health Alliance Commercial	$869.32

Ti Knot Quick Loads 030510 [3641169]

Facility

$329.25

Hospital Charge Code	3641169
Hospital Revenue Code	272
Min. Negotiated Rate	$167.92
Max. Negotiated Rate	$319.37
Rate for Payer: Cash Price	$214.01
Rate for Payer: Hawaii Western Management Group Commercial	$312.79
Rate for Payer: Health Management Network Commercial	$279.86
Rate for Payer: Kaiser Permanente Commercial	$207.43
Rate for Payer: Kaiser Permanente Medicaid	$167.92
Rate for Payer: MDX Hawaii PPO	$319.37
Rate for Payer: University Health Alliance Commercial	$239.99

Ti Knot Quick Loads 030510 [3641169]

Facility

$329.25

Hospital Charge Code	3641169
Hospital Revenue Code	272
Min. Negotiated Rate	$279.86
Max. Negotiated Rate	$319.37
Rate for Payer: Cash Price	$214.01
Rate for Payer: Health Management Network Commercial	$279.86
Rate for Payer: MDX Hawaii PPO	$319.37

TIMOLOL MALEATE 0.25 % OPHT DROP

Facility

$19.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.18
Rate for Payer: Cash Price	$12.85
Rate for Payer: Hawaii Western Management Group Commercial	$18.78
Rate for Payer: Health Management Network Commercial	$16.80
Rate for Payer: Kaiser Permanente Commercial	$12.46
Rate for Payer: Kaiser Permanente Medicaid	$10.08
Rate for Payer: MDX Hawaii PPO	$19.18
Rate for Payer: UnitedHealthcare Medicaid	$11.86
Rate for Payer: University Health Alliance Commercial	$14.41

TIMOLOL MALEATE 0.25 % OPHT DROP

Facility

$19.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$19.18
Rate for Payer: Cash Price	$12.85
Rate for Payer: Health Management Network Commercial	$16.80
Rate for Payer: MDX Hawaii PPO	$19.18

TIMOLOL MALEATE 0.5 % OPHT DROP

Facility

$88.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$75.12
Max. Negotiated Rate	$85.73
Rate for Payer: Cash Price	$57.45
Rate for Payer: Cash Price	$26.86
Rate for Payer: Health Management Network Commercial	$35.13
Rate for Payer: Health Management Network Commercial	$75.12
Rate for Payer: MDX Hawaii PPO	$85.73
Rate for Payer: MDX Hawaii PPO	$40.09

TIMOLOL MALEATE 0.5 % OPHT DROP

Facility

$41.33

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$40.09
Rate for Payer: Cash Price	$26.86
Rate for Payer: Cash Price	$57.45
Rate for Payer: Hawaii Western Management Group Commercial	$39.26
Rate for Payer: Hawaii Western Management Group Commercial	$83.96
Rate for Payer: Health Management Network Commercial	$35.13
Rate for Payer: Health Management Network Commercial	$75.12
Rate for Payer: Kaiser Permanente Commercial	$26.04
Rate for Payer: Kaiser Permanente Commercial	$55.68
Rate for Payer: Kaiser Permanente Medicaid	$21.08
Rate for Payer: Kaiser Permanente Medicaid	$45.07
Rate for Payer: MDX Hawaii PPO	$40.09
Rate for Payer: MDX Hawaii PPO	$85.73
Rate for Payer: UnitedHealthcare Medicaid	$53.03
Rate for Payer: UnitedHealthcare Medicaid	$24.80
Rate for Payer: University Health Alliance Commercial	$30.13
Rate for Payer: University Health Alliance Commercial	$64.42

TIOTROPIUM BROMIDE 18 MCG INHAL CPDV

Facility

$1,395.88

Service Code	HCPCS J3535
Hospital Revenue Code	250
Min. Negotiated Rate	$1,186.50
Max. Negotiated Rate	$1,354.00
Rate for Payer: Cash Price	$907.32
Rate for Payer: Cash Price	$175.45
Rate for Payer: Health Management Network Commercial	$1,186.50
Rate for Payer: Health Management Network Commercial	$229.43
Rate for Payer: MDX Hawaii PPO	$1,354.00
Rate for Payer: MDX Hawaii PPO	$261.82

TIOTROPIUM BROMIDE 18 MCG INHAL CPDV

Facility

$269.92

Service Code	HCPCS J3535
Hospital Revenue Code	637
Min. Negotiated Rate	$137.66
Max. Negotiated Rate	$261.82
Rate for Payer: Cash Price	$175.45
Rate for Payer: Cash Price	$907.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,326.09
Rate for Payer: Hawaii Western Management Group Commercial	$256.42
Rate for Payer: Health Management Network Commercial	$229.43
Rate for Payer: Health Management Network Commercial	$1,186.50
Rate for Payer: Kaiser Permanente Commercial	$879.40
Rate for Payer: Kaiser Permanente Commercial	$170.05
Rate for Payer: Kaiser Permanente Medicaid	$137.66
Rate for Payer: Kaiser Permanente Medicaid	$711.90
Rate for Payer: MDX Hawaii PPO	$1,354.00
Rate for Payer: MDX Hawaii PPO	$261.82
Rate for Payer: University Health Alliance Commercial	$196.74
Rate for Payer: University Health Alliance Commercial	$1,017.46

TIOTROPIUM-OLODATEROL 2.5-2.5 MCG/ACTUATION INHAL MIST

Facility

$328.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$167.53
Max. Negotiated Rate	$318.64
Rate for Payer: Cash Price	$213.52
Rate for Payer: Hawaii Western Management Group Commercial	$312.07
Rate for Payer: Health Management Network Commercial	$279.23
Rate for Payer: Kaiser Permanente Commercial	$206.96
Rate for Payer: Kaiser Permanente Medicaid	$167.53
Rate for Payer: MDX Hawaii PPO	$318.64
Rate for Payer: UnitedHealthcare Medicaid	$197.10
Rate for Payer: University Health Alliance Commercial	$239.44

TIOTROPIUM-OLODATEROL 2.5-2.5 MCG/ACTUATION INHAL MIST

Facility

$328.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$279.23
Max. Negotiated Rate	$318.64
Rate for Payer: Cash Price	$213.52
Rate for Payer: Health Management Network Commercial	$279.23
Rate for Payer: MDX Hawaii PPO	$318.64

TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S)

Facility

$17,908.07

Service Code	CPT 19357
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$17,908.07
Rate for Payer: AlohaCare Medicaid	$16,280.06
Rate for Payer: AlohaCare Medicare	$16,280.06
Rate for Payer: Devoted Health Medicare	$17,908.07
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	$16,280.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$16,280.06
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$16,280.06
Rate for Payer: Ohana Health Plan Medicaid	$17,908.07
Rate for Payer: Ohana Health Plan Medicare	$16,280.06
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$16,280.06
Rate for Payer: University Health Alliance Commercial	$11,157.19

TIZANIDINE 4 MG PO TABLET

Facility

$8.36

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$8.11
Rate for Payer: Cash Price	$5.43
Rate for Payer: Health Management Network Commercial	$7.11
Rate for Payer: MDX Hawaii PPO	$8.11

TIZANIDINE 4 MG PO TABLET

Facility

$8.36

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$8.11
Rate for Payer: Cash Price	$5.43
Rate for Payer: Hawaii Western Management Group Commercial	$7.94
Rate for Payer: Health Management Network Commercial	$7.11
Rate for Payer: Kaiser Permanente Commercial	$5.27
Rate for Payer: Kaiser Permanente Medicaid	$4.26
Rate for Payer: MDX Hawaii PPO	$8.11
Rate for Payer: UnitedHealthcare Medicaid	$5.02
Rate for Payer: University Health Alliance Commercial	$6.09

Tk E-Vit Tibial Insert Uc Sz5 9mm 166-7509 [3643936]

Facility

$10,687.50

Service Code	HCPCS C1769
Hospital Charge Code	3643936
Hospital Revenue Code	272
Min. Negotiated Rate	$9,084.38
Max. Negotiated Rate	$10,366.88
Rate for Payer: Cash Price	$6,946.88
Rate for Payer: Health Management Network Commercial	$9,084.38
Rate for Payer: MDX Hawaii PPO	$10,366.88

Tk E-Vit Tibial Insert Uc Sz5 9mm 166-7509 [3643936]

Facility

$10,687.50

Service Code	HCPCS C1769
Hospital Charge Code	3643936
Hospital Revenue Code	272
Min. Negotiated Rate	$5,450.62
Max. Negotiated Rate	$10,366.88
Rate for Payer: Cash Price	$6,946.88
Rate for Payer: Hawaii Western Management Group Commercial	$10,153.12
Rate for Payer: Health Management Network Commercial	$9,084.38
Rate for Payer: Kaiser Permanente Commercial	$6,733.12
Rate for Payer: Kaiser Permanente Medicaid	$5,450.62
Rate for Payer: MDX Hawaii PPO	$10,366.88
Rate for Payer: University Health Alliance Commercial	$7,790.12

Tk Nexgen Lps Stem Tib Comp Sz 7 Blue Gh 10mm [3643666]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.75
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: Kaiser Permanente Commercial	$2,094.75
Rate for Payer: Kaiser Permanente Medicaid	$1,695.75
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Tk Nexgen Lps Stem Tib Comp Sz 7 Blue Gh 10mm [3643666]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.00
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Tk Nexgen Por Tm Patella 10mmx38mm [3643467]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3643467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,741.25
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: Kaiser Permanente Commercial	$3,386.25
Rate for Payer: Kaiser Permanente Medicaid	$2,741.25
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Know your out-of-pocket cost for care.

All Charges