Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Tray Pneumothorax 8.5 Fr [2702277]

Facility

$869.63

Hospital Charge Code	2702277
Hospital Revenue Code	272
Min. Negotiated Rate	$443.51
Max. Negotiated Rate	$843.54
Rate for Payer: Cash Price	$565.26
Rate for Payer: Hawaii Western Management Group Commercial	$826.15
Rate for Payer: Health Management Network Commercial	$739.19
Rate for Payer: Kaiser Permanente Commercial	$547.87
Rate for Payer: Kaiser Permanente Medicaid	$443.51
Rate for Payer: MDX Hawaii PPO	$843.54
Rate for Payer: University Health Alliance Commercial	$633.87

Tray Pneumothorax 8.5 Fr [2702277]

Facility

$869.63

Hospital Charge Code	2702277
Hospital Revenue Code	272
Min. Negotiated Rate	$739.19
Max. Negotiated Rate	$843.54
Rate for Payer: Cash Price	$565.26
Rate for Payer: Health Management Network Commercial	$739.19
Rate for Payer: MDX Hawaii PPO	$843.54

TRAY PUDENDAL [2702034]

Facility

$82.96

Hospital Charge Code	2702034
Hospital Revenue Code	272
Min. Negotiated Rate	$42.31
Max. Negotiated Rate	$80.47
Rate for Payer: Cash Price	$53.92
Rate for Payer: Hawaii Western Management Group Commercial	$78.81
Rate for Payer: Health Management Network Commercial	$70.52
Rate for Payer: Kaiser Permanente Commercial	$52.26
Rate for Payer: Kaiser Permanente Medicaid	$42.31
Rate for Payer: MDX Hawaii PPO	$80.47
Rate for Payer: University Health Alliance Commercial	$60.47

TRAY PUDENDAL [2702034]

Facility

$82.96

Hospital Charge Code	2702034
Hospital Revenue Code	272
Min. Negotiated Rate	$70.52
Max. Negotiated Rate	$80.47
Rate for Payer: Cash Price	$53.92
Rate for Payer: Health Management Network Commercial	$70.52
Rate for Payer: MDX Hawaii PPO	$80.47

Tray Spinal BD 405671 [3703055]

Facility

$154.00

Hospital Charge Code	3703055
Hospital Revenue Code	272
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: MDX Hawaii PPO	$149.38

Tray Spinal BD 405671 [3703055]

Facility

$154.00

Hospital Charge Code	3703055
Hospital Revenue Code	272
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Hawaii Western Management Group Commercial	$146.30
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$97.02
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: University Health Alliance Commercial	$112.25

TRAY THORACENTESIS [2702044]

Facility

$327.83

Hospital Charge Code	2702044
Hospital Revenue Code	272
Min. Negotiated Rate	$278.66
Max. Negotiated Rate	$318.00
Rate for Payer: Cash Price	$213.09
Rate for Payer: Health Management Network Commercial	$278.66
Rate for Payer: MDX Hawaii PPO	$318.00

TRAY THORACENTESIS [2702044]

Facility

$327.83

Hospital Charge Code	2702044
Hospital Revenue Code	272
Min. Negotiated Rate	$167.19
Max. Negotiated Rate	$318.00
Rate for Payer: Cash Price	$213.09
Rate for Payer: Hawaii Western Management Group Commercial	$311.44
Rate for Payer: Health Management Network Commercial	$278.66
Rate for Payer: Kaiser Permanente Commercial	$206.53
Rate for Payer: Kaiser Permanente Medicaid	$167.19
Rate for Payer: MDX Hawaii PPO	$318.00
Rate for Payer: University Health Alliance Commercial	$238.96

TRAY THORACIC VENT [2702254]

Facility

$1,385.43

Hospital Charge Code	2702254
Hospital Revenue Code	272
Min. Negotiated Rate	$1,177.62
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: MDX Hawaii PPO	$1,343.87

TRAY THORACIC VENT [2702254]

Facility

$1,385.43

Hospital Charge Code	2702254
Hospital Revenue Code	272
Min. Negotiated Rate	$706.57
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.16
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: Kaiser Permanente Commercial	$872.82
Rate for Payer: Kaiser Permanente Medicaid	$706.57
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$1,009.84

TRAZODONE 100 MG PO TABLET

Facility

$1.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.19
Rate for Payer: Cash Price	$0.80
Rate for Payer: Health Management Network Commercial	$1.05
Rate for Payer: MDX Hawaii PPO	$1.19

TRAZODONE 100 MG PO TABLET

Facility

$1.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.19
Rate for Payer: Cash Price	$0.80
Rate for Payer: Hawaii Western Management Group Commercial	$1.17
Rate for Payer: Health Management Network Commercial	$1.05
Rate for Payer: Kaiser Permanente Commercial	$0.77
Rate for Payer: Kaiser Permanente Medicaid	$0.63
Rate for Payer: MDX Hawaii PPO	$1.19
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: University Health Alliance Commercial	$0.90

TRAZODONE 50 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: 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

TRAZODONE 50 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: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS

Facility

$16,683.60

Service Code	CPT 24516
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$16,683.60
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
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	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$10,679.55

TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS

Facility

$16,683.60

Service Code	CPT 24516
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$16,683.60
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
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	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$10,679.55

TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY

Facility

$11,157.19

Service Code	CPT 59812
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$11,157.19

TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH PLATE/SCREW TYPE IMPLANT, WITH OR WITHOUT CERCLAGE

Facility

$10,715.11

Service Code	CPT 27244
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$10,715.11
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 Commercial	$10,715.11
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
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

TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER

Facility

$11,157.19

Service Code	CPT 59820
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$11,157.19

TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT MANIPULATION, EACH

Facility

$2,837.00

Service Code	CPT 28450
Hospital Revenue Code	360
Min. Negotiated Rate	$126.55
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicaid	$126.55
Rate for Payer: UnitedHealthcare Medicare	$291.40

TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE

Facility

$16,683.60

Service Code	CPT 27759
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$16,683.60
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
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	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$10,679.55

Tri 2.0 Curved Tip Reload 30mm Vas/med SIG30CTAVM [3643937]

Facility

$1,030.01

Hospital Charge Code	3643937
Hospital Revenue Code	272
Min. Negotiated Rate	$525.31
Max. Negotiated Rate	$999.11
Rate for Payer: Cash Price	$669.51
Rate for Payer: Hawaii Western Management Group Commercial	$978.51
Rate for Payer: Health Management Network Commercial	$875.51
Rate for Payer: Kaiser Permanente Commercial	$648.91
Rate for Payer: Kaiser Permanente Medicaid	$525.31
Rate for Payer: MDX Hawaii PPO	$999.11
Rate for Payer: University Health Alliance Commercial	$750.77

Tri 2.0 Curved Tip Reload 30mm Vas/med SIG30CTAVM [3643937]

Facility

$1,030.01

Hospital Charge Code	3643937
Hospital Revenue Code	272
Min. Negotiated Rate	$875.51
Max. Negotiated Rate	$999.11
Rate for Payer: Cash Price	$669.51
Rate for Payer: Health Management Network Commercial	$875.51
Rate for Payer: MDX Hawaii PPO	$999.11

Tri 2.0 Rad Med Thk 12mm Purple SIGRADMT [3644071]

Facility

$1,981.80

Hospital Charge Code	3644071
Hospital Revenue Code	272
Min. Negotiated Rate	$1,684.53
Max. Negotiated Rate	$1,922.35
Rate for Payer: Cash Price	$1,288.17
Rate for Payer: Health Management Network Commercial	$1,684.53
Rate for Payer: MDX Hawaii PPO	$1,922.35

Tri 2.0 Rad Med Thk 12mm Purple SIGRADMT [3644071]

Facility

$1,981.80

Hospital Charge Code	3644071
Hospital Revenue Code	272
Min. Negotiated Rate	$1,010.72
Max. Negotiated Rate	$1,922.35
Rate for Payer: Cash Price	$1,288.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,882.71
Rate for Payer: Health Management Network Commercial	$1,684.53
Rate for Payer: Kaiser Permanente Commercial	$1,248.53
Rate for Payer: Kaiser Permanente Medicaid	$1,010.72
Rate for Payer: MDX Hawaii PPO	$1,922.35
Rate for Payer: University Health Alliance Commercial	$1,444.53

Know your out-of-pocket cost for care.

All Charges