Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Z Nail Cortical Screw 5.0X45mm FA 47248404550 [3641701]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3641701
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 5.0X45mm FA 47248404550 [3641701]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3641701
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 5.0X50mm FA 47248405050 [3642488]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3642488
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 5.0X50mm FA 47248405050 [3642488]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3642488
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 Tibial Nail Cap 0mm 47248700500 [3642540]

Facility

$1,285.35

Hospital Charge Code	3642540
Hospital Revenue Code	272
Min. Negotiated Rate	$655.53
Max. Negotiated Rate	$1,246.79
Rate for Payer: Cash Price	$835.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,221.08
Rate for Payer: Health Management Network Commercial	$1,092.55
Rate for Payer: Kaiser Permanente Commercial	$809.77
Rate for Payer: Kaiser Permanente Medicaid	$655.53
Rate for Payer: MDX Hawaii PPO	$1,246.79
Rate for Payer: University Health Alliance Commercial	$936.89

Z Nail Tibial Nail Cap 0mm 47248700500 [3642540]

Facility

$1,285.35

Hospital Charge Code	3642540
Hospital Revenue Code	272
Min. Negotiated Rate	$1,092.55
Max. Negotiated Rate	$1,246.79
Rate for Payer: Cash Price	$835.48
Rate for Payer: Health Management Network Commercial	$1,092.55
Rate for Payer: MDX Hawaii PPO	$1,246.79

Z Nail Tibia Univ 10mmx34cm 47-2495-340-10 [3643891]

Facility

$6,125.00

Service Code	HCPCS C1713
Hospital Charge Code	3643891
Hospital Revenue Code	278
Min. Negotiated Rate	$3,430.00
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Z Nail Tibia Univ 10mmx34cm 47-2495-340-10 [3643891]

Facility

$6,125.00

Service Code	HCPCS C1713
Hospital Charge Code	3643891
Hospital Revenue Code	278
Min. Negotiated Rate	$3,123.75
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: Kaiser Permanente Commercial	$3,858.75
Rate for Payer: Kaiser Permanente Medicaid	$3,123.75
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Z Nail Tibia Univ 10mmx36cm 47-2495-360-10 [3643973]

Facility

$6,125.00

Service Code	HCPCS C1713
Hospital Charge Code	3643973
Hospital Revenue Code	278
Min. Negotiated Rate	$3,123.75
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: Kaiser Permanente Commercial	$3,858.75
Rate for Payer: Kaiser Permanente Medicaid	$3,123.75
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Z Nail Tibia Univ 10mmx36cm 47-2495-360-10 [3643973]

Facility

$6,125.00

Service Code	HCPCS C1713
Hospital Charge Code	3643973
Hospital Revenue Code	278
Min. Negotiated Rate	$3,430.00
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Z Nail Tibia Univ 8.3mmx32cm 47-2495-320-08 [3643870]

Facility

$6,125.00

Service Code	HCPCS C1713
Hospital Charge Code	3643870
Hospital Revenue Code	278
Min. Negotiated Rate	$3,123.75
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: Kaiser Permanente Commercial	$3,858.75
Rate for Payer: Kaiser Permanente Medicaid	$3,123.75
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Z Nail Tibia Univ 8.3mmx32cm 47-2495-320-08 [3643870]

Facility

$6,125.00

Service Code	HCPCS C1713
Hospital Charge Code	3643870
Hospital Revenue Code	278
Min. Negotiated Rate	$3,430.00
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

ZOLEDRONIC ACID 4 MG/5 ML IV SOLN

Facility

$1,709.81

Service Code	HCPCS J3489
Hospital Revenue Code	250
Min. Negotiated Rate	$1,453.34
Max. Negotiated Rate	$1,658.52
Rate for Payer: Cash Price	$1,111.38
Rate for Payer: Health Management Network Commercial	$1,453.34
Rate for Payer: MDX Hawaii PPO	$1,658.52

ZOLEDRONIC ACID 4 MG/5 ML IV SOLN

Facility

$1,709.81

Service Code	HCPCS J3489
Hospital Revenue Code	636
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$1,658.52
Rate for Payer: Cash Price	$1,111.38
Rate for Payer: Cash Price	$1,111.38
Rate for Payer: Hawaii Medical Service Association ABD	$5.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,624.32
Rate for Payer: Health Management Network Commercial	$1,453.34
Rate for Payer: Kaiser Permanente Commercial	$1,077.18
Rate for Payer: Kaiser Permanente Medicaid	$872.00
Rate for Payer: MDX Hawaii PPO	$1,658.52
Rate for Payer: UnitedHealthcare Medicaid	$1,025.89
Rate for Payer: University Health Alliance Commercial	$1,246.28

ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV IVPB

Facility

$2,323.68

Service Code	HCPCS J3489
Hospital Revenue Code	636
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$2,253.97
Rate for Payer: Cash Price	$1,510.39
Rate for Payer: Cash Price	$1,510.39
Rate for Payer: Hawaii Medical Service Association ABD	$5.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,207.50
Rate for Payer: Health Management Network Commercial	$1,975.13
Rate for Payer: Kaiser Permanente Commercial	$1,463.92
Rate for Payer: Kaiser Permanente Medicaid	$1,185.08
Rate for Payer: MDX Hawaii PPO	$2,253.97
Rate for Payer: UnitedHealthcare Medicaid	$1,394.21
Rate for Payer: University Health Alliance Commercial	$1,693.73

ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV IVPB

Facility

$2,323.68

Service Code	HCPCS J3489
Hospital Revenue Code	250
Min. Negotiated Rate	$1,975.13
Max. Negotiated Rate	$2,253.97
Rate for Payer: Cash Price	$1,510.39
Rate for Payer: Health Management Network Commercial	$1,975.13
Rate for Payer: MDX Hawaii PPO	$2,253.97

ZOLEDRONIC AC-MANNITOL-0.9NACL 4 MG/100 ML IV IVPB

Facility

$613.68

Service Code	HCPCS J3489
Hospital Revenue Code	250
Min. Negotiated Rate	$521.63
Max. Negotiated Rate	$595.27
Rate for Payer: Cash Price	$398.89
Rate for Payer: Health Management Network Commercial	$521.63
Rate for Payer: MDX Hawaii PPO	$595.27

ZOLEDRONIC AC-MANNITOL-0.9NACL 4 MG/100 ML IV IVPB

Facility

$613.68

Service Code	HCPCS J3489
Hospital Revenue Code	636
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$595.27
Rate for Payer: Cash Price	$398.89
Rate for Payer: Cash Price	$398.89
Rate for Payer: Hawaii Medical Service Association ABD	$5.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$583.00
Rate for Payer: Health Management Network Commercial	$521.63
Rate for Payer: Kaiser Permanente Commercial	$386.62
Rate for Payer: Kaiser Permanente Medicaid	$312.98
Rate for Payer: MDX Hawaii PPO	$595.27
Rate for Payer: UnitedHealthcare Medicaid	$368.21
Rate for Payer: University Health Alliance Commercial	$447.31

ZOLPIDEM 5 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: Cash Price	$18.44
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$24.11
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$27.52

ZOLPIDEM 5 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: Cash Price	$18.44
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$26.95
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$24.11
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$17.87
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$14.47
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$27.52
Rate for Payer: UnitedHealthcare Medicaid	$17.02
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$20.68

Know your out-of-pocket cost for care.

All Charges