Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Echelon Circular Pwrd Stapler 29mm CDH29P [3644111]

Facility

$9,125.48

Hospital Charge Code	3644111
Hospital Revenue Code	272
Min. Negotiated Rate	$7,756.66
Max. Negotiated Rate	$8,851.72
Rate for Payer: Cash Price	$5,931.56
Rate for Payer: Health Management Network Commercial	$7,756.66
Rate for Payer: MDX Hawaii PPO	$8,851.72

Echelon Circular Pwrd Stapler 29mm CDH29P [3644111]

Facility

$9,125.48

Hospital Charge Code	3644111
Hospital Revenue Code	272
Min. Negotiated Rate	$4,653.99
Max. Negotiated Rate	$8,851.72
Rate for Payer: Cash Price	$5,931.56
Rate for Payer: Hawaii Western Management Group Commercial	$8,669.21
Rate for Payer: Health Management Network Commercial	$7,756.66
Rate for Payer: Kaiser Permanente Commercial	$5,749.05
Rate for Payer: Kaiser Permanente Medicaid	$4,653.99
Rate for Payer: MDX Hawaii PPO	$8,851.72
Rate for Payer: University Health Alliance Commercial	$6,651.56

Echelon Flex 60 Pwrd Cutter 28cm ECH60C [3640413]

Facility

$4,135.08

Hospital Charge Code	3640413
Hospital Revenue Code	272
Min. Negotiated Rate	$3,514.82
Max. Negotiated Rate	$4,011.03
Rate for Payer: Cash Price	$2,687.80
Rate for Payer: Health Management Network Commercial	$3,514.82
Rate for Payer: MDX Hawaii PPO	$4,011.03

Echelon Flex 60 Pwrd Cutter 28cm ECH60C [3640413]

Facility

$4,135.08

Hospital Charge Code	3640413
Hospital Revenue Code	272
Min. Negotiated Rate	$2,108.89
Max. Negotiated Rate	$4,011.03
Rate for Payer: Cash Price	$2,687.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,928.33
Rate for Payer: Health Management Network Commercial	$3,514.82
Rate for Payer: Kaiser Permanente Commercial	$2,605.10
Rate for Payer: Kaiser Permanente Medicaid	$2,108.89
Rate for Payer: MDX Hawaii PPO	$4,011.03
Rate for Payer: University Health Alliance Commercial	$3,014.06

Echo Por Fmrl Nc 11x135mm 192011 [3645562]

Facility

$9,483.00

Service Code	HCPCS C1776
Hospital Charge Code	3645562
Hospital Revenue Code	278
Min. Negotiated Rate	$4,836.33
Max. Negotiated Rate	$9,198.51
Rate for Payer: Cash Price	$6,163.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,638.10
Rate for Payer: Health Management Network Commercial	$8,060.55
Rate for Payer: Kaiser Permanente Commercial	$5,974.29
Rate for Payer: Kaiser Permanente Medicaid	$4,836.33
Rate for Payer: MDX Hawaii PPO	$9,198.51
Rate for Payer: University Health Alliance Commercial	$5,310.48

Echo Por Fmrl Nc 11x135mm 192011 [3645562]

Facility

$9,483.00

Service Code	HCPCS C1776
Hospital Charge Code	3645562
Hospital Revenue Code	278
Min. Negotiated Rate	$5,310.48
Max. Negotiated Rate	$9,198.51
Rate for Payer: Cash Price	$6,163.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,638.10
Rate for Payer: Health Management Network Commercial	$8,060.55
Rate for Payer: MDX Hawaii PPO	$9,198.51
Rate for Payer: University Health Alliance Commercial	$5,310.48

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$474,763.26

Service Code	MSDRG 003
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$474,763.26
Rate for Payer: AlohaCare Medicare	$279,170.10
Rate for Payer: Devoted Health Medicare	$307,087.11
Rate for Payer: Hawaii Medical Service Association Commercial	$474,763.26
Rate for Payer: Hawaii Medical Service Association Medicare	$279,170.10
Rate for Payer: Humana Medicare	$279,170.10
Rate for Payer: Kaiser Permanente Commercial	$366,134.70
Rate for Payer: Kaiser Permanente Medicare	$279,170.10
Rate for Payer: Ohana Health Plan Medicare	$279,170.10
Rate for Payer: UnitedHealthcare Medicare	$279,170.10
Rate for Payer: University Health Alliance Commercial	$10,400.00

Electrode Ball Tip 5mm Dia DBL-511 [3644387]

Facility

$136.80

Hospital Charge Code	3644387
Hospital Revenue Code	272
Min. Negotiated Rate	$116.28
Max. Negotiated Rate	$132.70
Rate for Payer: Cash Price	$88.92
Rate for Payer: Health Management Network Commercial	$116.28
Rate for Payer: MDX Hawaii PPO	$132.70

Electrode Ball Tip 5mm Dia DBL-511 [3644387]

Facility

$136.80

Hospital Charge Code	3644387
Hospital Revenue Code	272
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$132.70
Rate for Payer: Cash Price	$88.92
Rate for Payer: Hawaii Western Management Group Commercial	$129.96
Rate for Payer: Health Management Network Commercial	$116.28
Rate for Payer: Kaiser Permanente Commercial	$86.18
Rate for Payer: Kaiser Permanente Medicaid	$69.77
Rate for Payer: MDX Hawaii PPO	$132.70
Rate for Payer: University Health Alliance Commercial	$99.71

Electrode Bipolar 30deg Med Cut Loop BIP30CLM [3644957]

Facility

$2,194.03

Hospital Charge Code	3644957
Hospital Revenue Code	272
Min. Negotiated Rate	$1,864.93
Max. Negotiated Rate	$2,128.21
Rate for Payer: Cash Price	$1,426.12
Rate for Payer: Health Management Network Commercial	$1,864.93
Rate for Payer: MDX Hawaii PPO	$2,128.21

Electrode Bipolar 30deg Med Cut Loop BIP30CLM [3644957]

Facility

$2,194.03

Hospital Charge Code	3644957
Hospital Revenue Code	272
Min. Negotiated Rate	$1,118.96
Max. Negotiated Rate	$2,128.21
Rate for Payer: Cash Price	$1,426.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,084.33
Rate for Payer: Health Management Network Commercial	$1,864.93
Rate for Payer: Kaiser Permanente Commercial	$1,382.24
Rate for Payer: Kaiser Permanente Medicaid	$1,118.96
Rate for Payer: MDX Hawaii PPO	$2,128.21
Rate for Payer: University Health Alliance Commercial	$1,599.23

Electrode Bipolar Plasma Disc BIPDDSC [3644958]

Facility

$2,194.03

Hospital Charge Code	3644958
Hospital Revenue Code	272
Min. Negotiated Rate	$1,118.96
Max. Negotiated Rate	$2,128.21
Rate for Payer: Cash Price	$1,426.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,084.33
Rate for Payer: Health Management Network Commercial	$1,864.93
Rate for Payer: Kaiser Permanente Commercial	$1,382.24
Rate for Payer: Kaiser Permanente Medicaid	$1,118.96
Rate for Payer: MDX Hawaii PPO	$2,128.21
Rate for Payer: University Health Alliance Commercial	$1,599.23

Electrode Bipolar Plasma Disc BIPDDSC [3644958]

Facility

$2,194.03

Hospital Charge Code	3644958
Hospital Revenue Code	272
Min. Negotiated Rate	$1,864.93
Max. Negotiated Rate	$2,128.21
Rate for Payer: Cash Price	$1,426.12
Rate for Payer: Health Management Network Commercial	$1,864.93
Rate for Payer: MDX Hawaii PPO	$2,128.21

Electrode Lap Flat L-Hook 36cm E3774-36C [3644519]

Facility

$279.84

Hospital Charge Code	3644519
Hospital Revenue Code	272
Min. Negotiated Rate	$237.86
Max. Negotiated Rate	$271.44
Rate for Payer: Cash Price	$181.90
Rate for Payer: Health Management Network Commercial	$237.86
Rate for Payer: MDX Hawaii PPO	$271.44

Electrode Lap Flat L-Hook 36cm E3774-36C [3644519]

Facility

$279.84

Hospital Charge Code	3644519
Hospital Revenue Code	272
Min. Negotiated Rate	$142.72
Max. Negotiated Rate	$271.44
Rate for Payer: Cash Price	$181.90
Rate for Payer: Hawaii Western Management Group Commercial	$265.85
Rate for Payer: Health Management Network Commercial	$237.86
Rate for Payer: Kaiser Permanente Commercial	$176.30
Rate for Payer: Kaiser Permanente Medicaid	$142.72
Rate for Payer: MDX Hawaii PPO	$271.44
Rate for Payer: University Health Alliance Commercial	$203.98

Electrode L-Diamond 45cm AEM Disp FC031145 [3640189]

Facility

$260.68

Hospital Charge Code	3640189
Hospital Revenue Code	272
Min. Negotiated Rate	$132.95
Max. Negotiated Rate	$252.86
Rate for Payer: Cash Price	$169.44
Rate for Payer: Hawaii Western Management Group Commercial	$247.65
Rate for Payer: Health Management Network Commercial	$221.58
Rate for Payer: Kaiser Permanente Commercial	$164.23
Rate for Payer: Kaiser Permanente Medicaid	$132.95
Rate for Payer: MDX Hawaii PPO	$252.86
Rate for Payer: University Health Alliance Commercial	$190.01

Electrode L-Diamond 45cm AEM Disp FC031145 [3640189]

Facility

$260.68

Hospital Charge Code	3640189
Hospital Revenue Code	272
Min. Negotiated Rate	$221.58
Max. Negotiated Rate	$252.86
Rate for Payer: Cash Price	$169.44
Rate for Payer: Health Management Network Commercial	$221.58
Rate for Payer: MDX Hawaii PPO	$252.86

ELECTRODE MULTI FUNCTION ADULT [2700780]

Facility

$489.32

Hospital Charge Code	2700780
Hospital Revenue Code	272
Min. Negotiated Rate	$249.55
Max. Negotiated Rate	$474.64
Rate for Payer: Cash Price	$318.06
Rate for Payer: Hawaii Western Management Group Commercial	$464.85
Rate for Payer: Health Management Network Commercial	$415.92
Rate for Payer: Kaiser Permanente Commercial	$308.27
Rate for Payer: Kaiser Permanente Medicaid	$249.55
Rate for Payer: MDX Hawaii PPO	$474.64
Rate for Payer: University Health Alliance Commercial	$356.67

ELECTRODE MULTI FUNCTION ADULT [2700780]

Facility

$489.32

Hospital Charge Code	2700780
Hospital Revenue Code	272
Min. Negotiated Rate	$415.92
Max. Negotiated Rate	$474.64
Rate for Payer: Cash Price	$318.06
Rate for Payer: Health Management Network Commercial	$415.92
Rate for Payer: MDX Hawaii PPO	$474.64

Electrode Short Tip Fulgurating 105cm BE202 [3642159]

Facility

$732.33

Hospital Charge Code	3642159
Hospital Revenue Code	272
Min. Negotiated Rate	$622.48
Max. Negotiated Rate	$710.36
Rate for Payer: Cash Price	$476.01
Rate for Payer: Health Management Network Commercial	$622.48
Rate for Payer: MDX Hawaii PPO	$710.36

Electrode Short Tip Fulgurating 105cm BE202 [3642159]

Facility

$732.33

Hospital Charge Code	3642159
Hospital Revenue Code	272
Min. Negotiated Rate	$373.49
Max. Negotiated Rate	$710.36
Rate for Payer: Cash Price	$476.01
Rate for Payer: Hawaii Western Management Group Commercial	$695.71
Rate for Payer: Health Management Network Commercial	$622.48
Rate for Payer: Kaiser Permanente Commercial	$461.37
Rate for Payer: Kaiser Permanente Medicaid	$373.49
Rate for Payer: MDX Hawaii PPO	$710.36
Rate for Payer: University Health Alliance Commercial	$533.80

Electrode Utahloop 10mmW x 10mmD DLP-S11 [3644386]

Facility

$136.80

Hospital Charge Code	3644386
Hospital Revenue Code	272
Min. Negotiated Rate	$116.28
Max. Negotiated Rate	$132.70
Rate for Payer: Cash Price	$88.92
Rate for Payer: Health Management Network Commercial	$116.28
Rate for Payer: MDX Hawaii PPO	$132.70

Electrode Utahloop 10mmW x 10mmD DLP-S11 [3644386]

Facility

$136.80

Hospital Charge Code	3644386
Hospital Revenue Code	272
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$132.70
Rate for Payer: Cash Price	$88.92
Rate for Payer: Hawaii Western Management Group Commercial	$129.96
Rate for Payer: Health Management Network Commercial	$116.28
Rate for Payer: Kaiser Permanente Commercial	$86.18
Rate for Payer: Kaiser Permanente Medicaid	$69.77
Rate for Payer: MDX Hawaii PPO	$132.70
Rate for Payer: University Health Alliance Commercial	$99.71

Electrode Utahloop 15mmW x 2mmD DLP-M11 [3644385]

Facility

$136.80

Hospital Charge Code	3644385
Hospital Revenue Code	272
Min. Negotiated Rate	$116.28
Max. Negotiated Rate	$132.70
Rate for Payer: Cash Price	$88.92
Rate for Payer: Health Management Network Commercial	$116.28
Rate for Payer: MDX Hawaii PPO	$132.70

Electrode Utahloop 15mmW x 2mmD DLP-M11 [3644385]

Facility

$136.80

Hospital Charge Code	3644385
Hospital Revenue Code	272
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$132.70
Rate for Payer: Kaiser Permanente Commercial	$86.18
Rate for Payer: Kaiser Permanente Medicaid	$69.77
Rate for Payer: MDX Hawaii PPO	$132.70
Rate for Payer: Cash Price	$88.92
Rate for Payer: Hawaii Western Management Group Commercial	$129.96
Rate for Payer: Health Management Network Commercial	$116.28
Rate for Payer: University Health Alliance Commercial	$99.71

Know your out-of-pocket cost for care.

All Charges