Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Triple Option Control Handpiece Monopolar, Coag, ABC 130321 [3641620]

Facility

$455.79

Hospital Charge Code	3641620
Hospital Revenue Code	272
Min. Negotiated Rate	$387.42
Max. Negotiated Rate	$442.12
Rate for Payer: Cash Price	$296.26
Rate for Payer: Health Management Network Commercial	$387.42
Rate for Payer: MDX Hawaii PPO	$442.12

Triple Option Control Handpiece Monopolar, Coag, ABC 130321 [3641620]

Facility

$455.79

Hospital Charge Code	3641620
Hospital Revenue Code	272
Min. Negotiated Rate	$232.45
Max. Negotiated Rate	$442.12
Rate for Payer: Cash Price	$296.26
Rate for Payer: Hawaii Western Management Group Commercial	$433.00
Rate for Payer: Health Management Network Commercial	$387.42
Rate for Payer: Kaiser Permanente Commercial	$287.15
Rate for Payer: Kaiser Permanente Medicaid	$232.45
Rate for Payer: MDX Hawaii PPO	$442.12
Rate for Payer: University Health Alliance Commercial	$332.23

Trocar For Sleeve Nails 8-11 Long 03.043.008s [3643801]

Facility

$1,018.61

Hospital Charge Code	3643801
Hospital Revenue Code	272
Min. Negotiated Rate	$519.49
Max. Negotiated Rate	$988.05
Rate for Payer: Cash Price	$662.10
Rate for Payer: Hawaii Western Management Group Commercial	$967.68
Rate for Payer: Health Management Network Commercial	$865.82
Rate for Payer: Kaiser Permanente Commercial	$641.72
Rate for Payer: Kaiser Permanente Medicaid	$519.49
Rate for Payer: MDX Hawaii PPO	$988.05
Rate for Payer: University Health Alliance Commercial	$742.46

Trocar For Sleeve Nails 8-11 Long 03.043.008s [3643801]

Facility

$1,018.61

Hospital Charge Code	3643801
Hospital Revenue Code	272
Min. Negotiated Rate	$865.82
Max. Negotiated Rate	$988.05
Rate for Payer: Cash Price	$662.10
Rate for Payer: Health Management Network Commercial	$865.82
Rate for Payer: MDX Hawaii PPO	$988.05

Trochanteric Nail, Rt, 10mmx36cmx130 AR-9094-10-3630R [3645537]

Facility

$16,640.50

Service Code	HCPCS C1713
Hospital Charge Code	3645537
Hospital Revenue Code	278
Min. Negotiated Rate	$9,318.68
Max. Negotiated Rate	$16,141.28
Rate for Payer: Cash Price	$10,816.32
Rate for Payer: Hawaii Western Management Group Commercial	$11,648.35
Rate for Payer: Health Management Network Commercial	$14,144.42
Rate for Payer: MDX Hawaii PPO	$16,141.28
Rate for Payer: University Health Alliance Commercial	$9,318.68

Trochanteric Nail, Rt, 10mmx36cmx130 AR-9094-10-3630R [3645537]

Facility

$16,640.50

Service Code	HCPCS C1713
Hospital Charge Code	3645537
Hospital Revenue Code	278
Min. Negotiated Rate	$8,486.66
Max. Negotiated Rate	$16,141.28
Rate for Payer: Cash Price	$10,816.32
Rate for Payer: Hawaii Western Management Group Commercial	$11,648.35
Rate for Payer: Health Management Network Commercial	$14,144.42
Rate for Payer: Kaiser Permanente Commercial	$10,483.51
Rate for Payer: Kaiser Permanente Medicaid	$8,486.66
Rate for Payer: MDX Hawaii PPO	$16,141.28
Rate for Payer: University Health Alliance Commercial	$9,318.68

TROPICAMIDE 1 % OPHT DROP

Facility

$165.49

Service Code	NDC 70069012101
Hospital Revenue Code	250
Min. Negotiated Rate	$84.40
Max. Negotiated Rate	$160.53
Rate for Payer: Cash Price	$107.57
Rate for Payer: Hawaii Western Management Group Commercial	$157.22
Rate for Payer: Health Management Network Commercial	$140.67
Rate for Payer: Kaiser Permanente Commercial	$104.26
Rate for Payer: Kaiser Permanente Medicaid	$84.40
Rate for Payer: MDX Hawaii PPO	$160.53
Rate for Payer: UnitedHealthcare Medicaid	$99.29
Rate for Payer: University Health Alliance Commercial	$120.63

TROPICAMIDE 1 % OPHT DROP

Facility

$165.49

Service Code	NDC 70069012101
Hospital Revenue Code	250
Min. Negotiated Rate	$140.67
Max. Negotiated Rate	$160.53
Rate for Payer: Cash Price	$107.57
Rate for Payer: Health Management Network Commercial	$140.67
Rate for Payer: MDX Hawaii PPO	$160.53

TRYPAN BLUE 0.06 % INTRAOC SYR

Facility

$455.82

Service Code	NDC 68803061210
Hospital Revenue Code	250
Min. Negotiated Rate	$387.45
Max. Negotiated Rate	$442.15
Rate for Payer: Cash Price	$296.28
Rate for Payer: Health Management Network Commercial	$387.45
Rate for Payer: MDX Hawaii PPO	$442.15

TRYPAN BLUE 0.06 % INTRAOC SYR

Facility

$455.82

Service Code	NDC 68803061210
Hospital Revenue Code	250
Min. Negotiated Rate	$232.47
Max. Negotiated Rate	$442.15
Rate for Payer: Cash Price	$296.28
Rate for Payer: Hawaii Western Management Group Commercial	$433.03
Rate for Payer: Health Management Network Commercial	$387.45
Rate for Payer: Kaiser Permanente Commercial	$287.17
Rate for Payer: Kaiser Permanente Medicaid	$232.47
Rate for Payer: MDX Hawaii PPO	$442.15
Rate for Payer: UnitedHealthcare Medicaid	$273.49
Rate for Payer: University Health Alliance Commercial	$332.25

Ts Dyn Vip Glenoid Pin Nitinol 2.8mm AR-5400-400NS [3643434]

Facility

$3,504.50

Hospital Charge Code	3643434
Hospital Revenue Code	272
Min. Negotiated Rate	$2,978.82
Max. Negotiated Rate	$3,399.36
Rate for Payer: Cash Price	$2,277.93
Rate for Payer: Health Management Network Commercial	$2,978.82
Rate for Payer: MDX Hawaii PPO	$3,399.36

Ts Dyn Vip Glenoid Pin Nitinol 2.8mm AR-5400-400NS [3643434]

Facility

$3,504.50

Hospital Charge Code	3643434
Hospital Revenue Code	272
Min. Negotiated Rate	$1,787.30
Max. Negotiated Rate	$3,399.36
Rate for Payer: Cash Price	$2,277.93
Rate for Payer: Hawaii Western Management Group Commercial	$3,329.28
Rate for Payer: Health Management Network Commercial	$2,978.82
Rate for Payer: Kaiser Permanente Commercial	$2,207.84
Rate for Payer: Kaiser Permanente Medicaid	$1,787.30
Rate for Payer: MDX Hawaii PPO	$3,399.36
Rate for Payer: University Health Alliance Commercial	$2,554.43

Ts Eclipse Univ Pin Set AR-9207S [3645470]

Facility

$2,542.38

Hospital Charge Code	3645470
Hospital Revenue Code	272
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	$2,415.26
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	$1,853.14

Ts Eclipse Univ Pin Set AR-9207S [3645470]

Facility

$2,542.38

Hospital Charge Code	3645470
Hospital Revenue Code	272
Min. Negotiated Rate	$2,161.02
Max. Negotiated Rate	$2,466.11
Rate for Payer: Cash Price	$1,652.55
Rate for Payer: Health Management Network Commercial	$2,161.02
Rate for Payer: MDX Hawaii PPO	$2,466.11

Ts Hum Insert S 36 +3 AR-9503S-03 [3645472]

Facility

$7,425.00

Service Code	HCPCS C1776
Hospital Charge Code	3645472
Hospital Revenue Code	278
Min. Negotiated Rate	$4,158.00
Max. Negotiated Rate	$7,202.25
Rate for Payer: Cash Price	$4,826.25
Rate for Payer: Hawaii Western Management Group Commercial	$5,197.50
Rate for Payer: Health Management Network Commercial	$6,311.25
Rate for Payer: MDX Hawaii PPO	$7,202.25
Rate for Payer: University Health Alliance Commercial	$4,158.00

Ts Hum Insert S 36 +3 AR-9503S-03 [3645472]

Facility

$7,425.00

Service Code	HCPCS C1776
Hospital Charge Code	3645472
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.75
Max. Negotiated Rate	$7,202.25
Rate for Payer: Cash Price	$4,826.25
Rate for Payer: Hawaii Western Management Group Commercial	$5,197.50
Rate for Payer: Health Management Network Commercial	$6,311.25
Rate for Payer: Kaiser Permanente Commercial	$4,677.75
Rate for Payer: Kaiser Permanente Medicaid	$3,786.75
Rate for Payer: MDX Hawaii PPO	$7,202.25
Rate for Payer: University Health Alliance Commercial	$4,158.00

Ts Pegged Glenoid Poly E-Plus 54mm 521-07-254 [3643981]

Facility

$14,820.00

Service Code	HCPCS C1776
Hospital Charge Code	3643981
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$14,375.40
Rate for Payer: Cash Price	$9,633.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,374.00
Rate for Payer: Health Management Network Commercial	$12,597.00
Rate for Payer: Kaiser Permanente Commercial	$9,336.60
Rate for Payer: Kaiser Permanente Medicaid	$7,558.20
Rate for Payer: MDX Hawaii PPO	$14,375.40
Rate for Payer: University Health Alliance Commercial	$8,299.20

Ts Pegged Glenoid Poly E-Plus 54mm 521-07-254 [3643981]

Facility

$14,820.00

Service Code	HCPCS C1776
Hospital Charge Code	3643981
Hospital Revenue Code	278
Min. Negotiated Rate	$8,299.20
Max. Negotiated Rate	$14,375.40
Rate for Payer: Cash Price	$9,633.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,374.00
Rate for Payer: Health Management Network Commercial	$12,597.00
Rate for Payer: MDX Hawaii PPO	$14,375.40
Rate for Payer: University Health Alliance Commercial	$8,299.20

Ts Rsp Bone Screw Lock 5.0mmx38mm 506-03-138 [3643396]

Facility

$1,031.25

Service Code	HCPCS C1713
Hospital Charge Code	3643396
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$1,000.31
Rate for Payer: Cash Price	$670.31
Rate for Payer: Hawaii Western Management Group Commercial	$721.88
Rate for Payer: Health Management Network Commercial	$876.56
Rate for Payer: MDX Hawaii PPO	$1,000.31
Rate for Payer: University Health Alliance Commercial	$577.50

Ts Rsp Bone Screw Lock 5.0mmx38mm 506-03-138 [3643396]

Facility

$1,031.25

Service Code	HCPCS C1713
Hospital Charge Code	3643396
Hospital Revenue Code	278
Min. Negotiated Rate	$525.94
Max. Negotiated Rate	$1,000.31
Rate for Payer: Cash Price	$670.31
Rate for Payer: Hawaii Western Management Group Commercial	$721.88
Rate for Payer: Health Management Network Commercial	$876.56
Rate for Payer: Kaiser Permanente Commercial	$649.69
Rate for Payer: Kaiser Permanente Medicaid	$525.94
Rate for Payer: MDX Hawaii PPO	$1,000.31
Rate for Payer: University Health Alliance Commercial	$577.50

Ts Screw Peripheral Non-Lock 4.5mmx24mm AR-9562-24NL [3645474]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645474
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Ts Screw Peripheral Non-Lock 4.5mmx24mm AR-9562-24NL [3645474]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645474
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Ts Univ Rev Spacer 36 +6mm AR-9555-06 [3645473]

Facility

$4,179.50

Service Code	HCPCS C1776
Hospital Charge Code	3645473
Hospital Revenue Code	278
Min. Negotiated Rate	$2,340.52
Max. Negotiated Rate	$4,054.11
Rate for Payer: Cash Price	$2,716.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,925.65
Rate for Payer: Health Management Network Commercial	$3,552.57
Rate for Payer: MDX Hawaii PPO	$4,054.11
Rate for Payer: University Health Alliance Commercial	$2,340.52

Ts Univ Rev Spacer 36 +6mm AR-9555-06 [3645473]

Facility

$4,179.50

Service Code	HCPCS C1776
Hospital Charge Code	3645473
Hospital Revenue Code	278
Min. Negotiated Rate	$2,131.55
Max. Negotiated Rate	$4,054.11
Rate for Payer: Cash Price	$2,716.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,925.65
Rate for Payer: Health Management Network Commercial	$3,552.57
Rate for Payer: Kaiser Permanente Commercial	$2,633.09
Rate for Payer: Kaiser Permanente Medicaid	$2,131.55
Rate for Payer: MDX Hawaii PPO	$4,054.11
Rate for Payer: University Health Alliance Commercial	$2,340.52

Ts Univ Rev Suture Cup 36 +2 Lt AR-9502F-36LCPC [3645471]

Facility

$11,915.50

Service Code	HCPCS C1776
Hospital Charge Code	3645471
Hospital Revenue Code	278
Min. Negotiated Rate	$6,672.68
Max. Negotiated Rate	$11,558.03
Rate for Payer: Cash Price	$7,745.08
Rate for Payer: Hawaii Western Management Group Commercial	$8,340.85
Rate for Payer: Health Management Network Commercial	$10,128.17
Rate for Payer: MDX Hawaii PPO	$11,558.03
Rate for Payer: University Health Alliance Commercial	$6,672.68

Know your out-of-pocket cost for care.

All Charges