Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ZIPRASIDONE HCL 40 MG PO CAP

Facility

$52.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$26.76
Max. Negotiated Rate	$50.90
Rate for Payer: Cash Price	$34.11
Rate for Payer: Hawaii Western Management Group Commercial	$49.85
Rate for Payer: Health Management Network Commercial	$44.60
Rate for Payer: Kaiser Permanente Commercial	$33.06
Rate for Payer: Kaiser Permanente Medicaid	$26.76
Rate for Payer: MDX Hawaii PPO	$50.90
Rate for Payer: UnitedHealthcare Medicaid	$31.48
Rate for Payer: University Health Alliance Commercial	$38.25

ZIPRASIDONE MESYLATE 20 MG/ML (FINAL CONC.) IM RECON.SOLN.

Facility

$153.76

Service Code	HCPCS J3486
Hospital Revenue Code	250
Min. Negotiated Rate	$130.70
Max. Negotiated Rate	$149.15
Rate for Payer: Cash Price	$99.94
Rate for Payer: Cash Price	$138.18
Rate for Payer: Health Management Network Commercial	$180.69
Rate for Payer: Health Management Network Commercial	$130.70
Rate for Payer: MDX Hawaii PPO	$206.20
Rate for Payer: MDX Hawaii PPO	$149.15

ZIPRASIDONE MESYLATE 20 MG/ML (FINAL CONC.) IM RECON.SOLN.

Facility

$212.58

Service Code	HCPCS J3486
Hospital Revenue Code	636
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$206.20
Rate for Payer: Cash Price	$138.18
Rate for Payer: Cash Price	$99.94
Rate for Payer: Cash Price	$99.94
Rate for Payer: Cash Price	$138.18
Rate for Payer: Hawaii Medical Service Association ABD	$3.14
Rate for Payer: Hawaii Medical Service Association ABD	$3.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.14
Rate for Payer: Hawaii Western Management Group Commercial	$146.07
Rate for Payer: Hawaii Western Management Group Commercial	$201.95
Rate for Payer: Health Management Network Commercial	$180.69
Rate for Payer: Health Management Network Commercial	$130.70
Rate for Payer: Kaiser Permanente Commercial	$133.93
Rate for Payer: Kaiser Permanente Commercial	$96.87
Rate for Payer: Kaiser Permanente Medicaid	$78.42
Rate for Payer: Kaiser Permanente Medicaid	$108.42
Rate for Payer: MDX Hawaii PPO	$149.15
Rate for Payer: MDX Hawaii PPO	$206.20
Rate for Payer: UnitedHealthcare Medicaid	$92.26
Rate for Payer: UnitedHealthcare Medicaid	$127.55
Rate for Payer: University Health Alliance Commercial	$112.08
Rate for Payer: University Health Alliance Commercial	$154.95

ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) IV SOLN

Facility

$4,958.40

Service Code	HCPCS J9400
Hospital Revenue Code	250
Min. Negotiated Rate	$4,214.64
Max. Negotiated Rate	$4,809.65
Rate for Payer: Cash Price	$3,222.96
Rate for Payer: Health Management Network Commercial	$4,214.64
Rate for Payer: MDX Hawaii PPO	$4,809.65

ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) IV SOLN

Facility

$4,958.40

Service Code	HCPCS J9400
Hospital Revenue Code	636
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$4,809.65
Rate for Payer: AlohaCare Medicaid	$8.61
Rate for Payer: AlohaCare Medicare	$8.61
Rate for Payer: Cash Price	$3,222.96
Rate for Payer: Cash Price	$3,222.96
Rate for Payer: Devoted Health Medicare	$9.47
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Commercial	$10.76
Rate for Payer: Hawaii Medical Service Association Medicare	$8.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.98
Rate for Payer: Hawaii Western Management Group Commercial	$4,710.48
Rate for Payer: Health Management Network Commercial	$4,214.64
Rate for Payer: Humana Medicare	$8.61
Rate for Payer: Kaiser Permanente Commercial	$3,123.79
Rate for Payer: Kaiser Permanente Medicaid	$2,528.78
Rate for Payer: Kaiser Permanente Medicare	$8.61
Rate for Payer: MDX Hawaii PPO	$4,809.65
Rate for Payer: Ohana Health Plan Medicaid	$9.47
Rate for Payer: Ohana Health Plan Medicare	$8.61
Rate for Payer: UnitedHealthcare Medicaid	$2,975.04
Rate for Payer: UnitedHealthcare Medicare	$8.61
Rate for Payer: University Health Alliance Commercial	$3,614.18

Z Nail Cortical Screw 4.0x25mm Fa 47-2484-025-40 [3643872]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643872
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 4.0x25mm Fa 47-2484-025-40 [3643872]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643872
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 4.0x35mm Fa 47-2484-035-40 [3643871]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643871
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 4.0x35mm Fa 47-2484-035-40 [3643871]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643871
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0x27.5mm Fa [3643338]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643338
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0x27.5mm Fa [3643338]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643338
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 x 27.5mm PT 47248302750 [3643007]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643007
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 x 27.5mm PT 47248302750 [3643007]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643007
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 x 30mm FA 47248403050 [3640910A]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3640910A
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 x 30mm FA 47248403050 [3640910A]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3640910A
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 X 32.5mm Fa [3643594]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643594
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 X 32.5mm Fa [3643594]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643594
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0X35mm FA 47248403550 [3641702]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3641702
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Z Nail Cortical Screw 5.0X35mm FA 47248403550 [3641702]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3641702
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Z Nail Cortical Screw 5.0X37mm FA 47248403750 [3641700]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3641700
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0X37mm FA 47248403750 [3641700]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3641700
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Z Nail Cortical Screw 5.0 x 40mm FA 47248404050 [3640910]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640910
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Z Nail Cortical Screw 5.0 x 40mm FA 47248404050 [3640910]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640910
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Z Nail Cortical Screw 5.0 x 42.5mm FA 47248404250 [3640910B]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640910B
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Z Nail Cortical Screw 5.0 x 42.5mm FA 47248404250 [3640910B]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640910B
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Know your out-of-pocket cost for care.

All Charges