Kona Community Hospital

All Charges

Charge

Type

Setting

Price

End Cap For RFNA 0mm 04.233.000S [3644728]

Facility

$1,865.88

Hospital Charge Code	3644728
Hospital Revenue Code	272
Min. Negotiated Rate	$951.60
Max. Negotiated Rate	$1,809.90
Rate for Payer: Cash Price	$1,212.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,772.59
Rate for Payer: Health Management Network Commercial	$1,586.00
Rate for Payer: Kaiser Permanente Commercial	$1,175.50
Rate for Payer: Kaiser Permanente Medicaid	$951.60
Rate for Payer: MDX Hawaii PPO	$1,809.90
Rate for Payer: University Health Alliance Commercial	$1,360.04

End Cap For RFNA 0mm 04.233.000S [3644728]

Facility

$1,865.88

Hospital Charge Code	3644728
Hospital Revenue Code	272
Min. Negotiated Rate	$1,586.00
Max. Negotiated Rate	$1,809.90
Rate for Payer: Cash Price	$1,212.82
Rate for Payer: Health Management Network Commercial	$1,586.00
Rate for Payer: MDX Hawaii PPO	$1,809.90

End Cap For Tna 0mm 04.045.850s [3643795]

Facility

$1,748.72

Service Code	HCPCS C1713
Hospital Charge Code	3643795
Hospital Revenue Code	278
Min. Negotiated Rate	$891.85
Max. Negotiated Rate	$1,696.26
Rate for Payer: Cash Price	$1,136.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.10
Rate for Payer: Health Management Network Commercial	$1,486.41
Rate for Payer: Kaiser Permanente Commercial	$1,101.69
Rate for Payer: Kaiser Permanente Medicaid	$891.85
Rate for Payer: MDX Hawaii PPO	$1,696.26
Rate for Payer: University Health Alliance Commercial	$979.28

End Cap For Tna 0mm 04.045.850s [3643795]

Facility

$1,748.72

Service Code	HCPCS C1713
Hospital Charge Code	3643795
Hospital Revenue Code	278
Min. Negotiated Rate	$979.28
Max. Negotiated Rate	$1,696.26
Rate for Payer: Cash Price	$1,136.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.10
Rate for Payer: Health Management Network Commercial	$1,486.41
Rate for Payer: MDX Hawaii PPO	$1,696.26
Rate for Payer: University Health Alliance Commercial	$979.28

End Cap For Tna 10mm 04.045.860s [3643797]

Facility

$1,748.72

Service Code	HCPCS C1713
Hospital Charge Code	3643797
Hospital Revenue Code	278
Min. Negotiated Rate	$891.85
Max. Negotiated Rate	$1,696.26
Rate for Payer: Cash Price	$1,136.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.10
Rate for Payer: Health Management Network Commercial	$1,486.41
Rate for Payer: Kaiser Permanente Commercial	$1,101.69
Rate for Payer: Kaiser Permanente Medicaid	$891.85
Rate for Payer: MDX Hawaii PPO	$1,696.26
Rate for Payer: University Health Alliance Commercial	$979.28

End Cap For Tna 10mm 04.045.860s [3643797]

Facility

$1,748.72

Service Code	HCPCS C1713
Hospital Charge Code	3643797
Hospital Revenue Code	278
Min. Negotiated Rate	$979.28
Max. Negotiated Rate	$1,696.26
Rate for Payer: Cash Price	$1,136.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.10
Rate for Payer: Health Management Network Commercial	$1,486.41
Rate for Payer: MDX Hawaii PPO	$1,696.26
Rate for Payer: University Health Alliance Commercial	$979.28

End Cap For Tna 5mm 04.045.855s [3643796]

Facility

$1,748.72

Service Code	HCPCS C1713
Hospital Charge Code	3643796
Hospital Revenue Code	278
Min. Negotiated Rate	$891.85
Max. Negotiated Rate	$1,696.26
Rate for Payer: Cash Price	$1,136.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.10
Rate for Payer: Health Management Network Commercial	$1,486.41
Rate for Payer: Kaiser Permanente Commercial	$1,101.69
Rate for Payer: Kaiser Permanente Medicaid	$891.85
Rate for Payer: MDX Hawaii PPO	$1,696.26
Rate for Payer: University Health Alliance Commercial	$979.28

End Cap For Tna 5mm 04.045.855s [3643796]

Facility

$1,748.72

Service Code	HCPCS C1713
Hospital Charge Code	3643796
Hospital Revenue Code	278
Min. Negotiated Rate	$979.28
Max. Negotiated Rate	$1,696.26
Rate for Payer: Cash Price	$1,136.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.10
Rate for Payer: Health Management Network Commercial	$1,486.41
Rate for Payer: MDX Hawaii PPO	$1,696.26
Rate for Payer: University Health Alliance Commercial	$979.28

End Cap Ti Ext Retro Fem Nail Ex 0mm 04.013.000S [3640571]

Facility

$1,053.11

Hospital Charge Code	3640571
Hospital Revenue Code	272
Min. Negotiated Rate	$537.09
Max. Negotiated Rate	$1,021.52
Rate for Payer: Cash Price	$684.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,000.45
Rate for Payer: Health Management Network Commercial	$895.14
Rate for Payer: Kaiser Permanente Commercial	$663.46
Rate for Payer: Kaiser Permanente Medicaid	$537.09
Rate for Payer: MDX Hawaii PPO	$1,021.52
Rate for Payer: University Health Alliance Commercial	$767.61

End Cap Ti Ext Retro Fem Nail Ex 0mm 04.013.000S [3640571]

Facility

$1,053.11

Hospital Charge Code	3640571
Hospital Revenue Code	272
Min. Negotiated Rate	$895.14
Max. Negotiated Rate	$1,021.52
Rate for Payer: Cash Price	$684.52
Rate for Payer: Health Management Network Commercial	$895.14
Rate for Payer: MDX Hawaii PPO	$1,021.52

End Cap Ti Ext Tibial Nail EX 10mm 04.004.002S [3640362]

Facility

$1,332.05

Hospital Charge Code	3640362
Hospital Revenue Code	278
Min. Negotiated Rate	$679.35
Max. Negotiated Rate	$1,292.09
Rate for Payer: Cash Price	$865.83
Rate for Payer: Hawaii Western Management Group Commercial	$932.43
Rate for Payer: Health Management Network Commercial	$1,132.24
Rate for Payer: Kaiser Permanente Commercial	$839.19
Rate for Payer: Kaiser Permanente Medicaid	$679.35
Rate for Payer: MDX Hawaii PPO	$1,292.09
Rate for Payer: University Health Alliance Commercial	$745.95

End Cap Ti Ext Tibial Nail EX 10mm 04.004.002S [3640362]

Facility

$1,332.05

Hospital Charge Code	3640362
Hospital Revenue Code	278
Min. Negotiated Rate	$745.95
Max. Negotiated Rate	$1,292.09
Rate for Payer: Cash Price	$865.83
Rate for Payer: Hawaii Western Management Group Commercial	$932.43
Rate for Payer: Health Management Network Commercial	$1,132.24
Rate for Payer: MDX Hawaii PPO	$1,292.09
Rate for Payer: University Health Alliance Commercial	$745.95

Endo Barrx 90 Focal RFA Catheter 909500 [3640241]

Facility

$5,082.80

Service Code	HCPCS C1886
Hospital Charge Code	3640241
Hospital Revenue Code	272
Min. Negotiated Rate	$2,592.23
Max. Negotiated Rate	$4,930.32
Rate for Payer: Cash Price	$3,303.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,828.66
Rate for Payer: Health Management Network Commercial	$4,320.38
Rate for Payer: Kaiser Permanente Commercial	$3,202.16
Rate for Payer: Kaiser Permanente Medicaid	$2,592.23
Rate for Payer: MDX Hawaii PPO	$4,930.32
Rate for Payer: University Health Alliance Commercial	$3,704.85

Endo Barrx 90 Focal RFA Catheter 909500 [3640241]

Facility

$5,082.80

Service Code	HCPCS C1886
Hospital Charge Code	3640241
Hospital Revenue Code	272
Min. Negotiated Rate	$4,320.38
Max. Negotiated Rate	$4,930.32
Rate for Payer: Cash Price	$3,303.82
Rate for Payer: Health Management Network Commercial	$4,320.38
Rate for Payer: MDX Hawaii PPO	$4,930.32

Endo Barrx RFA 360 Express Balloon Catheter 64082 [3640604]

Facility

$10,494.50

Service Code	HCPCS C1886
Hospital Charge Code	3640604
Hospital Revenue Code	272
Min. Negotiated Rate	$5,352.19
Max. Negotiated Rate	$10,179.67
Rate for Payer: Cash Price	$6,821.42
Rate for Payer: Hawaii Western Management Group Commercial	$9,969.77
Rate for Payer: Health Management Network Commercial	$8,920.33
Rate for Payer: Kaiser Permanente Commercial	$6,611.53
Rate for Payer: Kaiser Permanente Medicaid	$5,352.19
Rate for Payer: MDX Hawaii PPO	$10,179.67
Rate for Payer: University Health Alliance Commercial	$7,649.44

Endo Barrx RFA 360 Express Balloon Catheter 64082 [3640604]

Facility

$10,494.50

Service Code	HCPCS C1886
Hospital Charge Code	3640604
Hospital Revenue Code	272
Min. Negotiated Rate	$8,920.33
Max. Negotiated Rate	$10,179.67
Rate for Payer: Cash Price	$6,821.42
Rate for Payer: Health Management Network Commercial	$8,920.33
Rate for Payer: MDX Hawaii PPO	$10,179.67

Endo Barrx RFA Cleaning Cap Med CP-002A [3644773]

Facility

$311.03

Hospital Charge Code	3644773
Hospital Revenue Code	272
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$301.70
Rate for Payer: Cash Price	$202.17
Rate for Payer: Health Management Network Commercial	$264.38
Rate for Payer: MDX Hawaii PPO	$301.70

Endo Barrx RFA Cleaning Cap Med CP-002A [3644773]

Facility

$311.03

Hospital Charge Code	3644773
Hospital Revenue Code	272
Min. Negotiated Rate	$158.63
Max. Negotiated Rate	$301.70
Rate for Payer: Cash Price	$202.17
Rate for Payer: Hawaii Western Management Group Commercial	$295.48
Rate for Payer: Health Management Network Commercial	$264.38
Rate for Payer: Kaiser Permanente Commercial	$195.95
Rate for Payer: Kaiser Permanente Medicaid	$158.63
Rate for Payer: MDX Hawaii PPO	$301.70
Rate for Payer: University Health Alliance Commercial	$226.71

Endo Barrx RFA Endoscopic Guidewire GW002B [3640307]

Facility

$1,015.93

Service Code	HCPCS C1769
Hospital Charge Code	3640307
Hospital Revenue Code	272
Min. Negotiated Rate	$863.54
Max. Negotiated Rate	$985.45
Rate for Payer: Cash Price	$660.35
Rate for Payer: Health Management Network Commercial	$863.54
Rate for Payer: MDX Hawaii PPO	$985.45

Endo Barrx RFA Endoscopic Guidewire GW002B [3640307]

Facility

$1,015.93

Service Code	HCPCS C1769
Hospital Charge Code	3640307
Hospital Revenue Code	272
Min. Negotiated Rate	$518.12
Max. Negotiated Rate	$985.45
Rate for Payer: Cash Price	$660.35
Rate for Payer: Hawaii Western Management Group Commercial	$965.13
Rate for Payer: Health Management Network Commercial	$863.54
Rate for Payer: Kaiser Permanente Commercial	$640.04
Rate for Payer: Kaiser Permanente Medicaid	$518.12
Rate for Payer: MDX Hawaii PPO	$985.45
Rate for Payer: University Health Alliance Commercial	$740.51

Endoblade Plantar Fascia Release Sys AR-8856DS [3644846]

Facility

$6,725.00

Hospital Charge Code	3644846
Hospital Revenue Code	272
Min. Negotiated Rate	$3,429.75
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$6,388.75
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: Kaiser Permanente Commercial	$4,236.75
Rate for Payer: Kaiser Permanente Medicaid	$3,429.75
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$4,901.85

Endoblade Plantar Fascia Release Sys AR-8856DS [3644846]

Facility

$6,725.00

Hospital Charge Code	3644846
Hospital Revenue Code	272
Min. Negotiated Rate	$5,716.25
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: MDX Hawaii PPO	$6,523.25

Endobronchial Blocker Set MG02770002 [3642967]

Facility

$1,642.74

Hospital Charge Code	3642967
Hospital Revenue Code	272
Min. Negotiated Rate	$837.80
Max. Negotiated Rate	$1,593.46
Rate for Payer: Cash Price	$1,067.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.60
Rate for Payer: Health Management Network Commercial	$1,396.33
Rate for Payer: Kaiser Permanente Commercial	$1,034.93
Rate for Payer: Kaiser Permanente Medicaid	$837.80
Rate for Payer: MDX Hawaii PPO	$1,593.46
Rate for Payer: University Health Alliance Commercial	$1,197.39

Endobronchial Blocker Set MG02770002 [3642967]

Facility

$1,642.74

Hospital Charge Code	3642967
Hospital Revenue Code	272
Min. Negotiated Rate	$1,396.33
Max. Negotiated Rate	$1,593.46
Rate for Payer: Cash Price	$1,067.78
Rate for Payer: Health Management Network Commercial	$1,396.33
Rate for Payer: MDX Hawaii PPO	$1,593.46

Endobutton 1.2 Cl Ultra Pac Set 72202799 [3644381]

Facility

$2,753.00

Service Code	HCPCS C1713
Hospital Charge Code	3644381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Know your out-of-pocket cost for care.

All Charges