Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Electrode Utahloop 20mmW x 15mmD DLP-L11 [3644384]

Facility

$136.80

Hospital Charge Code	3644384
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 20mmW x 15mmD DLP-L11 [3644384]

Facility

$136.80

Hospital Charge Code	3644384
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

ELECTROLYTE PANEL

Professional

Both

$14.00

Service Code	HCPCS 80051
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$11.90
Rate for Payer: AlohaCare Medicaid	$9.69
Rate for Payer: AlohaCare Medicare	$7.01
Rate for Payer: Cash Price	$9.10
Rate for Payer: Cash Price	$9.10
Rate for Payer: Devoted Health Medicare	$7.71
Rate for Payer: Hawaii Medical Service Association Medicare	$7.01
Rate for Payer: Hawaii Western Management Group Commercial	$9.70
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$8.41
Rate for Payer: Kaiser Permanente Medicaid	$8.41
Rate for Payer: Kaiser Permanente Medicare	$8.41
Rate for Payer: Ohana Health Plan Medicaid	$9.69
Rate for Payer: Ohana Health Plan Medicare	$7.01
Rate for Payer: UnitedHealthcare Medicaid	$9.69
Rate for Payer: UnitedHealthcare Medicare	$7.01

Eleview Submucosal Injectable Composition 10m 9000020 [3644550]

Facility

$642.15

Hospital Charge Code	3644550
Hospital Revenue Code	272
Min. Negotiated Rate	$545.83
Max. Negotiated Rate	$622.89
Rate for Payer: Cash Price	$417.40
Rate for Payer: Health Management Network Commercial	$545.83
Rate for Payer: MDX Hawaii PPO	$622.89

Eleview Submucosal Injectable Composition 10m 9000020 [3644550]

Facility

$642.15

Hospital Charge Code	3644550
Hospital Revenue Code	272
Min. Negotiated Rate	$327.50
Max. Negotiated Rate	$622.89
Rate for Payer: Cash Price	$417.40
Rate for Payer: Hawaii Western Management Group Commercial	$610.04
Rate for Payer: Health Management Network Commercial	$545.83
Rate for Payer: Kaiser Permanente Commercial	$404.55
Rate for Payer: Kaiser Permanente Medicaid	$327.50
Rate for Payer: MDX Hawaii PPO	$622.89
Rate for Payer: University Health Alliance Commercial	$468.06

Elite Compression Drilling Template ELDTS [3641021]

Facility

$498.75

Hospital Charge Code	3641021
Hospital Revenue Code	272
Min. Negotiated Rate	$254.36
Max. Negotiated Rate	$483.79
Rate for Payer: Cash Price	$324.19
Rate for Payer: Hawaii Western Management Group Commercial	$473.81
Rate for Payer: Health Management Network Commercial	$423.94
Rate for Payer: Kaiser Permanente Commercial	$314.21
Rate for Payer: Kaiser Permanente Medicaid	$254.36
Rate for Payer: MDX Hawaii PPO	$483.79
Rate for Payer: University Health Alliance Commercial	$363.54

Elite Compression Drilling Template ELDTS [3641021]

Facility

$498.75

Hospital Charge Code	3641021
Hospital Revenue Code	272
Min. Negotiated Rate	$423.94
Max. Negotiated Rate	$483.79
Rate for Payer: Cash Price	$324.19
Rate for Payer: Health Management Network Commercial	$423.94
Rate for Payer: MDX Hawaii PPO	$483.79

Elite Compression Implant Kit El-181852 [3641518]

Facility

$4,595.40

Service Code	HCPCS C1713
Hospital Charge Code	3641518
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.65
Max. Negotiated Rate	$4,457.54
Rate for Payer: Cash Price	$2,987.01
Rate for Payer: Hawaii Western Management Group Commercial	$3,216.78
Rate for Payer: Health Management Network Commercial	$3,906.09
Rate for Payer: Kaiser Permanente Commercial	$2,895.10
Rate for Payer: Kaiser Permanente Medicaid	$2,343.65
Rate for Payer: MDX Hawaii PPO	$4,457.54
Rate for Payer: University Health Alliance Commercial	$2,573.42

Elite Compression Implant Kit El-181852 [3641518]

Facility

$4,595.40

Service Code	HCPCS C1713
Hospital Charge Code	3641518
Hospital Revenue Code	278
Min. Negotiated Rate	$2,573.42
Max. Negotiated Rate	$4,457.54
Rate for Payer: Cash Price	$2,987.01
Rate for Payer: Hawaii Western Management Group Commercial	$3,216.78
Rate for Payer: Health Management Network Commercial	$3,906.09
Rate for Payer: MDX Hawaii PPO	$4,457.54
Rate for Payer: University Health Alliance Commercial	$2,573.42

Elite Compression Implant Kit EL2520S4 [3641507]

Facility

$5,122.65

Service Code	HCPCS C1713
Hospital Charge Code	3641507
Hospital Revenue Code	278
Min. Negotiated Rate	$2,612.55
Max. Negotiated Rate	$4,968.97
Rate for Payer: Cash Price	$3,329.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,585.86
Rate for Payer: Health Management Network Commercial	$4,354.25
Rate for Payer: Kaiser Permanente Commercial	$3,227.27
Rate for Payer: Kaiser Permanente Medicaid	$2,612.55
Rate for Payer: MDX Hawaii PPO	$4,968.97
Rate for Payer: University Health Alliance Commercial	$2,868.68

Elite Compression Implant Kit EL2520S4 [3641507]

Facility

$5,122.65

Service Code	HCPCS C1713
Hospital Charge Code	3641507
Hospital Revenue Code	278
Min. Negotiated Rate	$2,868.68
Max. Negotiated Rate	$4,968.97
Rate for Payer: Cash Price	$3,329.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,585.86
Rate for Payer: Health Management Network Commercial	$4,354.25
Rate for Payer: MDX Hawaii PPO	$4,968.97
Rate for Payer: University Health Alliance Commercial	$2,868.68

EMPAGLIFLOZIN 10 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$89.14
Max. Negotiated Rate	$101.72
Rate for Payer: Cash Price	$68.17
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: MDX Hawaii PPO	$101.72

EMPAGLIFLOZIN 10 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$53.48
Max. Negotiated Rate	$101.72
Rate for Payer: Cash Price	$68.17
Rate for Payer: Hawaii Western Management Group Commercial	$99.63
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: Kaiser Permanente Commercial	$66.07
Rate for Payer: Kaiser Permanente Medicaid	$53.48
Rate for Payer: MDX Hawaii PPO	$101.72
Rate for Payer: UnitedHealthcare Medicaid	$62.92
Rate for Payer: University Health Alliance Commercial	$76.44

EMPAGLIFLOZIN 25 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$53.48
Max. Negotiated Rate	$101.72
Rate for Payer: Cash Price	$68.17
Rate for Payer: Hawaii Western Management Group Commercial	$99.63
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: Kaiser Permanente Commercial	$66.07
Rate for Payer: Kaiser Permanente Medicaid	$53.48
Rate for Payer: MDX Hawaii PPO	$101.72
Rate for Payer: UnitedHealthcare Medicaid	$62.92
Rate for Payer: University Health Alliance Commercial	$76.44

EMPAGLIFLOZIN 25 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$89.14
Max. Negotiated Rate	$101.72
Rate for Payer: Cash Price	$68.17
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: MDX Hawaii PPO	$101.72

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978601
Hospital Revenue Code	250
Min. Negotiated Rate	$28.28
Max. Negotiated Rate	$53.80
Rate for Payer: Cash Price	$36.05
Rate for Payer: Hawaii Western Management Group Commercial	$52.69
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: Kaiser Permanente Commercial	$34.94
Rate for Payer: Kaiser Permanente Medicaid	$28.28
Rate for Payer: MDX Hawaii PPO	$53.80
Rate for Payer: UnitedHealthcare Medicaid	$33.28
Rate for Payer: University Health Alliance Commercial	$40.42

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$29.31

Service Code	NDC 00143978710
Hospital Revenue Code	250
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$28.43
Rate for Payer: Cash Price	$19.05
Rate for Payer: Hawaii Western Management Group Commercial	$27.84
Rate for Payer: Health Management Network Commercial	$24.91
Rate for Payer: Kaiser Permanente Commercial	$18.47
Rate for Payer: Kaiser Permanente Medicaid	$14.95
Rate for Payer: MDX Hawaii PPO	$28.43
Rate for Payer: UnitedHealthcare Medicaid	$17.59
Rate for Payer: University Health Alliance Commercial	$21.36

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978601
Hospital Revenue Code	250
Min. Negotiated Rate	$47.14
Max. Negotiated Rate	$53.80
Rate for Payer: Cash Price	$36.05
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: MDX Hawaii PPO	$53.80

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978610
Hospital Revenue Code	250
Min. Negotiated Rate	$28.28
Max. Negotiated Rate	$53.80
Rate for Payer: Cash Price	$36.05
Rate for Payer: Hawaii Western Management Group Commercial	$52.69
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: Kaiser Permanente Commercial	$34.94
Rate for Payer: Kaiser Permanente Medicaid	$28.28
Rate for Payer: MDX Hawaii PPO	$53.80
Rate for Payer: UnitedHealthcare Medicaid	$33.28
Rate for Payer: University Health Alliance Commercial	$40.42

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$29.31

Service Code	NDC 00143978701
Hospital Revenue Code	250
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$28.43
Rate for Payer: Cash Price	$19.05
Rate for Payer: Hawaii Western Management Group Commercial	$27.84
Rate for Payer: Health Management Network Commercial	$24.91
Rate for Payer: Kaiser Permanente Commercial	$18.47
Rate for Payer: Kaiser Permanente Medicaid	$14.95
Rate for Payer: MDX Hawaii PPO	$28.43
Rate for Payer: UnitedHealthcare Medicaid	$17.59
Rate for Payer: University Health Alliance Commercial	$21.36

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$29.31

Service Code	NDC 00143978710
Hospital Revenue Code	250
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$28.43
Rate for Payer: Cash Price	$19.05
Rate for Payer: Health Management Network Commercial	$24.91
Rate for Payer: MDX Hawaii PPO	$28.43

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978610
Hospital Revenue Code	250
Min. Negotiated Rate	$47.14
Max. Negotiated Rate	$53.80
Rate for Payer: Cash Price	$36.05
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: MDX Hawaii PPO	$53.80

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$29.31

Service Code	NDC 00143978701
Hospital Revenue Code	250
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$28.43
Rate for Payer: Cash Price	$19.05
Rate for Payer: Health Management Network Commercial	$24.91
Rate for Payer: MDX Hawaii PPO	$28.43

Encore Rev Shoulder Hum Sckt Lnr Extractor 804-06-073 [3644138]

Facility

$2,035.00

Hospital Charge Code	3644138
Hospital Revenue Code	272
Min. Negotiated Rate	$1,037.85
Max. Negotiated Rate	$1,973.95
Rate for Payer: Cash Price	$1,322.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,933.25
Rate for Payer: Health Management Network Commercial	$1,729.75
Rate for Payer: Kaiser Permanente Commercial	$1,282.05
Rate for Payer: Kaiser Permanente Medicaid	$1,037.85
Rate for Payer: MDX Hawaii PPO	$1,973.95
Rate for Payer: University Health Alliance Commercial	$1,483.31

Encore Rev Shoulder Hum Sckt Lnr Extractor 804-06-073 [3644138]

Facility

$2,035.00

Hospital Charge Code	3644138
Hospital Revenue Code	272
Min. Negotiated Rate	$1,729.75
Max. Negotiated Rate	$1,973.95
Rate for Payer: Cash Price	$1,322.75
Rate for Payer: Health Management Network Commercial	$1,729.75
Rate for Payer: MDX Hawaii PPO	$1,973.95

Know your out-of-pocket cost for care.

All Charges