Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Tri 2.0 Rad Xtra Thick 15mm SIGRADXT [3643866]

Facility

$2,250.56

Hospital Charge Code	3643866
Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.79
Max. Negotiated Rate	$2,183.04
Rate for Payer: Cash Price	$1,462.86
Rate for Payer: Hawaii Western Management Group Commercial	$2,138.03
Rate for Payer: Health Management Network Commercial	$1,912.98
Rate for Payer: Kaiser Permanente Commercial	$1,417.85
Rate for Payer: Kaiser Permanente Medicaid	$1,147.79
Rate for Payer: MDX Hawaii PPO	$2,183.04
Rate for Payer: University Health Alliance Commercial	$1,640.43

Tri 2.0 Rad Xtra Thick 15mm SIGRADXT [3643866]

Facility

$2,250.56

Hospital Charge Code	3643866
Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.98
Max. Negotiated Rate	$2,183.04
Rate for Payer: Cash Price	$1,462.86
Rate for Payer: Health Management Network Commercial	$1,912.98
Rate for Payer: MDX Hawaii PPO	$2,183.04

Tri 2.0 Reload 30mm Medium/Thick Purple SIG30AMT [3644200]

Facility

$924.04

Hospital Charge Code	3644200
Hospital Revenue Code	272
Min. Negotiated Rate	$785.43
Max. Negotiated Rate	$896.32
Rate for Payer: Cash Price	$600.63
Rate for Payer: Health Management Network Commercial	$785.43
Rate for Payer: MDX Hawaii PPO	$896.32

Tri 2.0 Reload 30mm Medium/Thick Purple SIG30AMT [3644200]

Facility

$924.04

Hospital Charge Code	3644200
Hospital Revenue Code	272
Min. Negotiated Rate	$471.26
Max. Negotiated Rate	$896.32
Rate for Payer: Cash Price	$600.63
Rate for Payer: Hawaii Western Management Group Commercial	$877.84
Rate for Payer: Health Management Network Commercial	$785.43
Rate for Payer: Kaiser Permanente Commercial	$582.15
Rate for Payer: Kaiser Permanente Medicaid	$471.26
Rate for Payer: MDX Hawaii PPO	$896.32
Rate for Payer: University Health Alliance Commercial	$673.53

Tri 2.0 Reload 45mm Extra Thick Black SIG45AXT [3644201]

Facility

$1,177.76

Hospital Charge Code	3644201
Hospital Revenue Code	272
Min. Negotiated Rate	$1,001.10
Max. Negotiated Rate	$1,142.43
Rate for Payer: Cash Price	$765.54
Rate for Payer: Health Management Network Commercial	$1,001.10
Rate for Payer: MDX Hawaii PPO	$1,142.43

Tri 2.0 Reload 45mm Extra Thick Black SIG45AXT [3644201]

Facility

$1,177.76

Hospital Charge Code	3644201
Hospital Revenue Code	272
Min. Negotiated Rate	$600.66
Max. Negotiated Rate	$1,142.43
Rate for Payer: Cash Price	$765.54
Rate for Payer: Hawaii Western Management Group Commercial	$1,118.87
Rate for Payer: Health Management Network Commercial	$1,001.10
Rate for Payer: Kaiser Permanente Commercial	$741.99
Rate for Payer: Kaiser Permanente Medicaid	$600.66
Rate for Payer: MDX Hawaii PPO	$1,142.43
Rate for Payer: University Health Alliance Commercial	$858.47

TRIAMCINOLONE ACETONIDE 0.1 % TOP CR

Facility

$21.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$20.81
Rate for Payer: Cash Price	$13.94
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Western Management Group Commercial	$20.38
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$18.23
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Commercial	$13.51
Rate for Payer: Kaiser Permanente Medicaid	$10.94
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$20.81
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: UnitedHealthcare Medicaid	$12.87
Rate for Payer: University Health Alliance Commercial	$15.63
Rate for Payer: University Health Alliance Commercial	$12.07

TRIAMCINOLONE ACETONIDE 0.1 % TOP CR

Facility

$16.56

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$13.94
Rate for Payer: Health Management Network Commercial	$18.23
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: MDX Hawaii PPO	$20.81

TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT

Facility

$25.67

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$24.90
Rate for Payer: Cash Price	$16.69
Rate for Payer: Hawaii Western Management Group Commercial	$24.39
Rate for Payer: Health Management Network Commercial	$21.82
Rate for Payer: Kaiser Permanente Commercial	$16.17
Rate for Payer: Kaiser Permanente Medicaid	$13.09
Rate for Payer: MDX Hawaii PPO	$24.90
Rate for Payer: UnitedHealthcare Medicaid	$15.40
Rate for Payer: University Health Alliance Commercial	$18.71

TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT

Facility

$25.67

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$24.90
Rate for Payer: Cash Price	$16.69
Rate for Payer: Health Management Network Commercial	$21.82
Rate for Payer: MDX Hawaii PPO	$24.90

TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP

Facility

$58.93

Service Code	HCPCS J3301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$57.16
Rate for Payer: Cash Price	$38.30
Rate for Payer: Cash Price	$38.30
Rate for Payer: Hawaii Medical Service Association ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.86
Rate for Payer: Hawaii Western Management Group Commercial	$55.98
Rate for Payer: Health Management Network Commercial	$50.09
Rate for Payer: Kaiser Permanente Commercial	$37.13
Rate for Payer: Kaiser Permanente Medicaid	$30.05
Rate for Payer: MDX Hawaii PPO	$57.16
Rate for Payer: UnitedHealthcare Medicaid	$35.36
Rate for Payer: University Health Alliance Commercial	$42.95

TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP

Facility

$58.93

Service Code	HCPCS J3301
Hospital Revenue Code	250
Min. Negotiated Rate	$50.09
Max. Negotiated Rate	$57.16
Rate for Payer: Cash Price	$38.30
Rate for Payer: Health Management Network Commercial	$50.09
Rate for Payer: MDX Hawaii PPO	$57.16

TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG PO CAP

Facility

$2.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.34
Rate for Payer: Hawaii Western Management Group Commercial	$1.96
Rate for Payer: Health Management Network Commercial	$1.75
Rate for Payer: Kaiser Permanente Commercial	$1.30
Rate for Payer: Kaiser Permanente Medicaid	$1.05
Rate for Payer: MDX Hawaii PPO	$2.00
Rate for Payer: UnitedHealthcare Medicaid	$1.24
Rate for Payer: University Health Alliance Commercial	$1.50

TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG PO CAP

Facility

$2.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.34
Rate for Payer: Health Management Network Commercial	$1.75
Rate for Payer: MDX Hawaii PPO	$2.00

TRIHEXYPHENIDYL 2 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

TRIHEXYPHENIDYL 2 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

TRIHEXYPHENIDYL 5 MG PO TABLET

Facility

$2.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.95
Rate for Payer: Cash Price	$1.31
Rate for Payer: Hawaii Western Management Group Commercial	$1.91
Rate for Payer: Health Management Network Commercial	$1.71
Rate for Payer: Kaiser Permanente Commercial	$1.27
Rate for Payer: Kaiser Permanente Medicaid	$1.03
Rate for Payer: MDX Hawaii PPO	$1.95
Rate for Payer: UnitedHealthcare Medicaid	$1.21
Rate for Payer: University Health Alliance Commercial	$1.47

TRIHEXYPHENIDYL 5 MG PO TABLET

Facility

$2.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.95
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Management Network Commercial	$1.71
Rate for Payer: MDX Hawaii PPO	$1.95

Trimed Bonalive Ortho Granules 0.5-0.8mm 2.5cc 14120 [3644405]

Facility

$8,258.00

Service Code	HCPCS C1713
Hospital Charge Code	3644405
Hospital Revenue Code	278
Min. Negotiated Rate	$4,624.48
Max. Negotiated Rate	$8,010.26
Rate for Payer: Cash Price	$5,367.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,780.60
Rate for Payer: Health Management Network Commercial	$7,019.30
Rate for Payer: MDX Hawaii PPO	$8,010.26
Rate for Payer: University Health Alliance Commercial	$4,624.48

Trimed Bonalive Ortho Granules 0.5-0.8mm 2.5cc 14120 [3644405]

Facility

$8,258.00

Service Code	HCPCS C1713
Hospital Charge Code	3644405
Hospital Revenue Code	278
Min. Negotiated Rate	$4,211.58
Max. Negotiated Rate	$8,010.26
Rate for Payer: Cash Price	$5,367.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,780.60
Rate for Payer: Health Management Network Commercial	$7,019.30
Rate for Payer: Kaiser Permanente Commercial	$5,202.54
Rate for Payer: Kaiser Permanente Medicaid	$4,211.58
Rate for Payer: MDX Hawaii PPO	$8,010.26
Rate for Payer: University Health Alliance Commercial	$4,624.48

Trimed Bonalive Ortho Granules 0.5-0.8mm 5cc [3643104]

Facility

$6,537.50

Service Code	HCPCS C1713
Hospital Charge Code	3643104
Hospital Revenue Code	278
Min. Negotiated Rate	$3,661.00
Max. Negotiated Rate	$6,341.38
Rate for Payer: Cash Price	$4,249.38
Rate for Payer: Hawaii Western Management Group Commercial	$4,576.25
Rate for Payer: Health Management Network Commercial	$5,556.88
Rate for Payer: MDX Hawaii PPO	$6,341.38
Rate for Payer: University Health Alliance Commercial	$3,661.00

Trimed Bonalive Ortho Granules 0.5-0.8mm 5cc [3643104]

Facility

$6,537.50

Service Code	HCPCS C1713
Hospital Charge Code	3643104
Hospital Revenue Code	278
Min. Negotiated Rate	$3,334.12
Max. Negotiated Rate	$6,341.38
Rate for Payer: Cash Price	$4,249.38
Rate for Payer: Hawaii Western Management Group Commercial	$4,576.25
Rate for Payer: Health Management Network Commercial	$5,556.88
Rate for Payer: Kaiser Permanente Commercial	$4,118.62
Rate for Payer: Kaiser Permanente Medicaid	$3,334.12
Rate for Payer: MDX Hawaii PPO	$6,341.38
Rate for Payer: University Health Alliance Commercial	$3,661.00

Trimed Bonalive Ortho Granules 1.0-2.0mm 5cc [3643105]

Facility

$10,655.50

Service Code	HCPCS C1713
Hospital Charge Code	3643105
Hospital Revenue Code	278
Min. Negotiated Rate	$5,434.31
Max. Negotiated Rate	$10,335.83
Rate for Payer: Cash Price	$6,926.08
Rate for Payer: Hawaii Western Management Group Commercial	$7,458.85
Rate for Payer: Health Management Network Commercial	$9,057.17
Rate for Payer: Kaiser Permanente Commercial	$6,712.97
Rate for Payer: Kaiser Permanente Medicaid	$5,434.31
Rate for Payer: MDX Hawaii PPO	$10,335.83
Rate for Payer: University Health Alliance Commercial	$5,967.08

Trimed Bonalive Ortho Granules 1.0-2.0mm 5cc [3643105]

Facility

$10,655.50

Service Code	HCPCS C1713
Hospital Charge Code	3643105
Hospital Revenue Code	278
Min. Negotiated Rate	$5,967.08
Max. Negotiated Rate	$10,335.83
Rate for Payer: Cash Price	$6,926.08
Rate for Payer: Hawaii Western Management Group Commercial	$7,458.85
Rate for Payer: Health Management Network Commercial	$9,057.17
Rate for Payer: MDX Hawaii PPO	$10,335.83
Rate for Payer: University Health Alliance Commercial	$5,967.08

Trimed Drill 1.8mm DRILL-1.8/090 [3640943]

Facility

$1,026.64

Hospital Charge Code	3640943
Hospital Revenue Code	272
Min. Negotiated Rate	$523.59
Max. Negotiated Rate	$995.84
Rate for Payer: Cash Price	$667.32
Rate for Payer: Hawaii Western Management Group Commercial	$975.31
Rate for Payer: Health Management Network Commercial	$872.64
Rate for Payer: Kaiser Permanente Commercial	$646.78
Rate for Payer: Kaiser Permanente Medicaid	$523.59
Rate for Payer: MDX Hawaii PPO	$995.84
Rate for Payer: University Health Alliance Commercial	$748.32

Know your out-of-pocket cost for care.

All Charges