Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Drain 0070740 Bulb Jvac Reserv 100 cc [3600881]

Facility

$44.29

Hospital Charge Code	3600881
Hospital Revenue Code	272
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$42.96
Rate for Payer: Cash Price	$28.79
Rate for Payer: Health Management Network Commercial	$37.65
Rate for Payer: MDX Hawaii PPO	$42.96

Drain 072215 10mm Blake Flat Fluted [3600858]

Facility

$149.52

Hospital Charge Code	3600858
Hospital Revenue Code	272
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$145.03
Rate for Payer: Cash Price	$97.19
Rate for Payer: Hawaii Western Management Group Commercial	$142.04
Rate for Payer: Health Management Network Commercial	$127.09
Rate for Payer: Kaiser Permanente Commercial	$94.20
Rate for Payer: Kaiser Permanente Medicaid	$76.26
Rate for Payer: MDX Hawaii PPO	$145.03
Rate for Payer: University Health Alliance Commercial	$108.99

Drain 072215 10mm Blake Flat Fluted [3600858]

Facility

$149.52

Hospital Charge Code	3600858
Hospital Revenue Code	272
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$145.03
Rate for Payer: Cash Price	$97.19
Rate for Payer: Health Management Network Commercial	$127.09
Rate for Payer: MDX Hawaii PPO	$145.03

Drain 072229 15Fr Blake 3/4 Fluted [3600875]

Facility

$163.68

Hospital Charge Code	3600875
Hospital Revenue Code	272
Min. Negotiated Rate	$83.48
Max. Negotiated Rate	$158.77
Rate for Payer: Cash Price	$106.39
Rate for Payer: Hawaii Western Management Group Commercial	$155.50
Rate for Payer: Health Management Network Commercial	$139.13
Rate for Payer: Kaiser Permanente Commercial	$103.12
Rate for Payer: Kaiser Permanente Medicaid	$83.48
Rate for Payer: MDX Hawaii PPO	$158.77
Rate for Payer: University Health Alliance Commercial	$119.31

Drain 072229 15Fr Blake 3/4 Fluted [3600875]

Facility

$163.68

Hospital Charge Code	3600875
Hospital Revenue Code	272
Min. Negotiated Rate	$139.13
Max. Negotiated Rate	$158.77
Rate for Payer: Cash Price	$106.39
Rate for Payer: Health Management Network Commercial	$139.13
Rate for Payer: MDX Hawaii PPO	$158.77

DRAIN CHEST (THORACIC) SAHARA S-1100-08LF [2700688]

Facility

$310.69

Hospital Charge Code	2700688
Hospital Revenue Code	272
Min. Negotiated Rate	$264.09
Max. Negotiated Rate	$301.37
Rate for Payer: Cash Price	$201.95
Rate for Payer: Health Management Network Commercial	$264.09
Rate for Payer: MDX Hawaii PPO	$301.37

DRAIN CHEST (THORACIC) SAHARA S-1100-08LF [2700688]

Facility

$310.69

Hospital Charge Code	2700688
Hospital Revenue Code	272
Min. Negotiated Rate	$158.45
Max. Negotiated Rate	$301.37
Rate for Payer: Cash Price	$201.95
Rate for Payer: Hawaii Western Management Group Commercial	$295.16
Rate for Payer: Health Management Network Commercial	$264.09
Rate for Payer: Kaiser Permanente Commercial	$195.73
Rate for Payer: Kaiser Permanente Medicaid	$158.45
Rate for Payer: MDX Hawaii PPO	$301.37
Rate for Payer: University Health Alliance Commercial	$226.46

Drain JP Hubless Flat Full Perforated 7mmX20cm SU1301310 [3600874]

Facility

$40.97

Hospital Charge Code	3600874
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$39.74
Rate for Payer: Cash Price	$26.63
Rate for Payer: Hawaii Western Management Group Commercial	$38.92
Rate for Payer: Health Management Network Commercial	$34.82
Rate for Payer: Kaiser Permanente Commercial	$25.81
Rate for Payer: Kaiser Permanente Medicaid	$20.89
Rate for Payer: MDX Hawaii PPO	$39.74
Rate for Payer: University Health Alliance Commercial	$29.86

Drain JP Hubless Flat Full Perforated 7mmX20cm SU1301310 [3600874]

Facility

$40.97

Hospital Charge Code	3600874
Hospital Revenue Code	272
Min. Negotiated Rate	$34.82
Max. Negotiated Rate	$39.74
Rate for Payer: Cash Price	$26.63
Rate for Payer: Health Management Network Commercial	$34.82
Rate for Payer: MDX Hawaii PPO	$39.74

Drain Kit BD PleurX 1000ml 507510 [3641994]

Facility

$658.77

Hospital Charge Code	3641994
Hospital Revenue Code	272
Min. Negotiated Rate	$335.97
Max. Negotiated Rate	$639.01
Rate for Payer: Cash Price	$428.20
Rate for Payer: Hawaii Western Management Group Commercial	$625.83
Rate for Payer: Health Management Network Commercial	$559.95
Rate for Payer: Kaiser Permanente Commercial	$415.03
Rate for Payer: Kaiser Permanente Medicaid	$335.97
Rate for Payer: MDX Hawaii PPO	$639.01
Rate for Payer: University Health Alliance Commercial	$480.18

Drain Kit BD PleurX 1000ml 507510 [3641994]

Facility

$658.77

Hospital Charge Code	3641994
Hospital Revenue Code	272
Min. Negotiated Rate	$559.95
Max. Negotiated Rate	$639.01
Rate for Payer: Cash Price	$428.20
Rate for Payer: Health Management Network Commercial	$559.95
Rate for Payer: MDX Hawaii PPO	$639.01

Drain & Starter Kit BD PleurX 1000ml 500071 [3641996]

Facility

$2,959.51

Hospital Charge Code	3641996
Hospital Revenue Code	272
Min. Negotiated Rate	$2,515.58
Max. Negotiated Rate	$2,870.72
Rate for Payer: Cash Price	$1,923.68
Rate for Payer: Health Management Network Commercial	$2,515.58
Rate for Payer: MDX Hawaii PPO	$2,870.72

Drain & Starter Kit BD PleurX 1000ml 500071 [3641996]

Facility

$2,959.51

Hospital Charge Code	3641996
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.35
Max. Negotiated Rate	$2,870.72
Rate for Payer: Cash Price	$1,923.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,811.53
Rate for Payer: Health Management Network Commercial	$2,515.58
Rate for Payer: Kaiser Permanente Commercial	$1,864.49
Rate for Payer: Kaiser Permanente Medicaid	$1,509.35
Rate for Payer: MDX Hawaii PPO	$2,870.72
Rate for Payer: University Health Alliance Commercial	$2,157.19

Dreamtome 44-20mmX260cm M00584040 [3642305]

Facility

$1,661.96

Service Code	HCPCS C1769
Hospital Charge Code	3642305
Hospital Revenue Code	272
Min. Negotiated Rate	$847.60
Max. Negotiated Rate	$1,612.10
Rate for Payer: Cash Price	$1,080.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,578.86
Rate for Payer: Health Management Network Commercial	$1,412.67
Rate for Payer: Kaiser Permanente Commercial	$1,047.03
Rate for Payer: Kaiser Permanente Medicaid	$847.60
Rate for Payer: MDX Hawaii PPO	$1,612.10
Rate for Payer: University Health Alliance Commercial	$1,211.40

Dreamtome 44-20mmX260cm M00584040 [3642305]

Facility

$1,661.96

Service Code	HCPCS C1769
Hospital Charge Code	3642305
Hospital Revenue Code	272
Min. Negotiated Rate	$1,412.67
Max. Negotiated Rate	$1,612.10
Rate for Payer: Cash Price	$1,080.27
Rate for Payer: Health Management Network Commercial	$1,412.67
Rate for Payer: MDX Hawaii PPO	$1,612.10

DRESSING AQUACEL 4 INCH [2702281]

Facility

$185.52

Service Code	HCPCS A6196
Hospital Charge Code	2702281
Hospital Revenue Code	272
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$179.95
Rate for Payer: Cash Price	$120.59
Rate for Payer: Cash Price	$120.59
Rate for Payer: Hawaii Western Management Group Commercial	$176.24
Rate for Payer: Health Management Network Commercial	$157.69
Rate for Payer: Kaiser Permanente Commercial	$116.88
Rate for Payer: Kaiser Permanente Medicaid	$94.62
Rate for Payer: MDX Hawaii PPO	$179.95
Rate for Payer: UnitedHealthcare Medicaid	$7.86
Rate for Payer: University Health Alliance Commercial	$135.23

DRESSING AQUACEL 4 INCH [2702281]

Facility

$185.52

Service Code	HCPCS A6196
Hospital Charge Code	2702281
Hospital Revenue Code	272
Min. Negotiated Rate	$157.69
Max. Negotiated Rate	$179.95
Rate for Payer: Cash Price	$120.59
Rate for Payer: Health Management Network Commercial	$157.69
Rate for Payer: MDX Hawaii PPO	$179.95

DRESSING AQUACEL 6 INCH [2702282]

Facility

$221.39

Service Code	HCPCS A6196
Hospital Charge Code	2702282
Hospital Revenue Code	272
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$214.75
Rate for Payer: Cash Price	$143.90
Rate for Payer: Cash Price	$143.90
Rate for Payer: Hawaii Western Management Group Commercial	$210.32
Rate for Payer: Health Management Network Commercial	$188.18
Rate for Payer: Kaiser Permanente Commercial	$139.48
Rate for Payer: Kaiser Permanente Medicaid	$112.91
Rate for Payer: MDX Hawaii PPO	$214.75
Rate for Payer: UnitedHealthcare Medicaid	$7.86
Rate for Payer: University Health Alliance Commercial	$161.37

DRESSING AQUACEL 6 INCH [2702282]

Facility

$221.39

Service Code	HCPCS A6196
Hospital Charge Code	2702282
Hospital Revenue Code	272
Min. Negotiated Rate	$188.18
Max. Negotiated Rate	$214.75
Rate for Payer: Cash Price	$143.90
Rate for Payer: Health Management Network Commercial	$188.18
Rate for Payer: MDX Hawaii PPO	$214.75

Dressing Interdry Ag Silver 10x18in [2709896]

Facility

$491.50

Service Code	HCPCS A6250
Hospital Charge Code	2709896
Hospital Revenue Code	272
Min. Negotiated Rate	$250.66
Max. Negotiated Rate	$476.75
Rate for Payer: Cash Price	$319.48
Rate for Payer: Hawaii Western Management Group Commercial	$466.93
Rate for Payer: Health Management Network Commercial	$417.77
Rate for Payer: Kaiser Permanente Commercial	$309.64
Rate for Payer: Kaiser Permanente Medicaid	$250.66
Rate for Payer: MDX Hawaii PPO	$476.75
Rate for Payer: University Health Alliance Commercial	$358.25

Dressing Interdry Ag Silver 10x18in [2709896]

Facility

$491.50

Service Code	HCPCS A6250
Hospital Charge Code	2709896
Hospital Revenue Code	272
Min. Negotiated Rate	$417.77
Max. Negotiated Rate	$476.75
Rate for Payer: Cash Price	$319.48
Rate for Payer: Health Management Network Commercial	$417.77
Rate for Payer: MDX Hawaii PPO	$476.75

Dressing Mepilex 6x6 [6258283]

Facility

$35.11

Hospital Charge Code	6258283
Hospital Revenue Code	272
Min. Negotiated Rate	$29.84
Max. Negotiated Rate	$34.06
Rate for Payer: Cash Price	$22.82
Rate for Payer: Health Management Network Commercial	$29.84
Rate for Payer: MDX Hawaii PPO	$34.06

Dressing Mepilex 6x6 [6258283]

Facility

$35.11

Hospital Charge Code	6258283
Hospital Revenue Code	272
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$34.06
Rate for Payer: Cash Price	$22.82
Rate for Payer: Hawaii Western Management Group Commercial	$33.35
Rate for Payer: Health Management Network Commercial	$29.84
Rate for Payer: Kaiser Permanente Commercial	$22.12
Rate for Payer: Kaiser Permanente Medicaid	$17.91
Rate for Payer: MDX Hawaii PPO	$34.06
Rate for Payer: University Health Alliance Commercial	$25.59

Dressing Mepilex 6x8 [6258263]

Facility

$46.84

Hospital Charge Code	6258263
Hospital Revenue Code	272
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$45.43
Rate for Payer: Cash Price	$30.45
Rate for Payer: Hawaii Western Management Group Commercial	$44.50
Rate for Payer: Health Management Network Commercial	$39.81
Rate for Payer: Kaiser Permanente Commercial	$29.51
Rate for Payer: Kaiser Permanente Medicaid	$23.89
Rate for Payer: MDX Hawaii PPO	$45.43
Rate for Payer: University Health Alliance Commercial	$34.14

Dressing Mepilex 6x8 [6258263]

Facility

$46.84

Hospital Charge Code	6258263
Hospital Revenue Code	272
Min. Negotiated Rate	$39.81
Max. Negotiated Rate	$45.43
Rate for Payer: Cash Price	$30.45
Rate for Payer: Health Management Network Commercial	$39.81
Rate for Payer: MDX Hawaii PPO	$45.43

Know your out-of-pocket cost for care.

All Charges