Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,404.03
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: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

EndoButton CL Pac 7209216 [3640172]

Facility

$1,671.13

Service Code	HCPCS C1713
Hospital Charge Code	3640172
Hospital Revenue Code	278
Min. Negotiated Rate	$935.83
Max. Negotiated Rate	$1,621.00
Rate for Payer: Cash Price	$1,086.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,169.79
Rate for Payer: Health Management Network Commercial	$1,420.46
Rate for Payer: MDX Hawaii PPO	$1,621.00
Rate for Payer: University Health Alliance Commercial	$935.83

EndoButton CL Pac 7209216 [3640172]

Facility

$1,671.13

Service Code	HCPCS C1713
Hospital Charge Code	3640172
Hospital Revenue Code	278
Min. Negotiated Rate	$852.28
Max. Negotiated Rate	$1,621.00
Rate for Payer: Cash Price	$1,086.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,169.79
Rate for Payer: Health Management Network Commercial	$1,420.46
Rate for Payer: Kaiser Permanente Commercial	$1,052.81
Rate for Payer: Kaiser Permanente Medicaid	$852.28
Rate for Payer: MDX Hawaii PPO	$1,621.00
Rate for Payer: University Health Alliance Commercial	$935.83

Endo Cath Dil Baln CRE 10,11,12mm 240cm M00558680 [3601067]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3601067
Hospital Revenue Code	272
Min. Negotiated Rate	$647.77
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.62
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: Kaiser Permanente Commercial	$800.18
Rate for Payer: Kaiser Permanente Medicaid	$647.77
Rate for Payer: MDX Hawaii PPO	$1,232.03
Rate for Payer: University Health Alliance Commercial	$925.80

Endo Cath Dil Baln CRE 10,11,12mm 240cm M00558680 [3601067]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3601067
Hospital Revenue Code	272
Min. Negotiated Rate	$1,079.61
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: MDX Hawaii PPO	$1,232.03

Endo Cath Dil Baln CRE 12,13.5,15mm 240cm M00558690 [3601083]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3601083
Hospital Revenue Code	272
Min. Negotiated Rate	$1,079.61
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: MDX Hawaii PPO	$1,232.03

Endo Cath Dil Baln CRE 12,13.5,15mm 240cm M00558690 [3601083]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3601083
Hospital Revenue Code	272
Min. Negotiated Rate	$647.77
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.62
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: Kaiser Permanente Commercial	$800.18
Rate for Payer: Kaiser Permanente Medicaid	$647.77
Rate for Payer: MDX Hawaii PPO	$1,232.03
Rate for Payer: University Health Alliance Commercial	$925.80

Endo Cath Dil Baln CRE 15,16.5,18mm 240cm M00558700 [3600524]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3600524
Hospital Revenue Code	272
Min. Negotiated Rate	$1,079.61
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: MDX Hawaii PPO	$1,232.03

Endo Cath Dil Baln CRE 15,16.5,18mm 240cm M00558700 [3600524]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3600524
Hospital Revenue Code	272
Min. Negotiated Rate	$647.77
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.62
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: Kaiser Permanente Commercial	$800.18
Rate for Payer: Kaiser Permanente Medicaid	$647.77
Rate for Payer: MDX Hawaii PPO	$1,232.03
Rate for Payer: University Health Alliance Commercial	$925.80

Endo Cath Dil Baln CRE 18,19,20mm 240cm M00558710 [3600525]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3600525
Hospital Revenue Code	272
Min. Negotiated Rate	$647.77
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.62
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: Kaiser Permanente Commercial	$800.18
Rate for Payer: Kaiser Permanente Medicaid	$647.77
Rate for Payer: MDX Hawaii PPO	$1,232.03
Rate for Payer: University Health Alliance Commercial	$925.80

Endo Cath Dil Baln CRE 18,19,20mm 240cm M00558710 [3600525]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3600525
Hospital Revenue Code	272
Min. Negotiated Rate	$1,079.61
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: MDX Hawaii PPO	$1,232.03

Endo Cath Dil Baln CRE 6,7,8mm 240cm M00558660 [3640199]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3640199
Hospital Revenue Code	272
Min. Negotiated Rate	$1,079.61
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: MDX Hawaii PPO	$1,232.03

Endo Cath Dil Baln CRE 6,7,8mm 240cm M00558660 [3640199]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3640199
Hospital Revenue Code	272
Min. Negotiated Rate	$647.77
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.62
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: Kaiser Permanente Commercial	$800.18
Rate for Payer: Kaiser Permanente Medicaid	$647.77
Rate for Payer: MDX Hawaii PPO	$1,232.03
Rate for Payer: University Health Alliance Commercial	$925.80

Endo Cath Dil Baln CRE 8,9,10mm 240cm M00558670 [3601068]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3601068
Hospital Revenue Code	272
Min. Negotiated Rate	$647.77
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,206.62
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: Kaiser Permanente Commercial	$800.18
Rate for Payer: Kaiser Permanente Medicaid	$647.77
Rate for Payer: MDX Hawaii PPO	$1,232.03
Rate for Payer: University Health Alliance Commercial	$925.80

Endo Cath Dil Baln CRE 8,9,10mm 240cm M00558670 [3601068]

Facility

$1,270.13

Service Code	HCPCS C1726
Hospital Charge Code	3601068
Hospital Revenue Code	272
Min. Negotiated Rate	$1,079.61
Max. Negotiated Rate	$1,232.03
Rate for Payer: Cash Price	$825.58
Rate for Payer: Health Management Network Commercial	$1,079.61
Rate for Payer: MDX Hawaii PPO	$1,232.03

Endo Cautery Gold Probe Inj 10Fr M00560160 [3606874]

Facility

$1,251.87

Hospital Charge Code	3606874
Hospital Revenue Code	272
Min. Negotiated Rate	$638.45
Max. Negotiated Rate	$1,214.31
Rate for Payer: Cash Price	$813.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,189.28
Rate for Payer: Health Management Network Commercial	$1,064.09
Rate for Payer: Kaiser Permanente Commercial	$788.68
Rate for Payer: Kaiser Permanente Medicaid	$638.45
Rate for Payer: MDX Hawaii PPO	$1,214.31
Rate for Payer: University Health Alliance Commercial	$912.49

Endo Cautery Gold Probe Inj 10Fr M00560160 [3606874]

Facility

$1,251.87

Hospital Charge Code	3606874
Hospital Revenue Code	272
Min. Negotiated Rate	$1,064.09
Max. Negotiated Rate	$1,214.31
Rate for Payer: Cash Price	$813.72
Rate for Payer: Health Management Network Commercial	$1,064.09
Rate for Payer: MDX Hawaii PPO	$1,214.31

Endo Cautery Gold Probe Inj 7Fr M00560150 [3606875]

Facility

$1,285.61

Hospital Charge Code	3606875
Hospital Revenue Code	272
Min. Negotiated Rate	$1,092.77
Max. Negotiated Rate	$1,247.04
Rate for Payer: Cash Price	$835.65
Rate for Payer: Health Management Network Commercial	$1,092.77
Rate for Payer: MDX Hawaii PPO	$1,247.04

Endo Cautery Gold Probe Inj 7Fr M00560150 [3606875]

Facility

$1,285.61

Hospital Charge Code	3606875
Hospital Revenue Code	272
Min. Negotiated Rate	$655.66
Max. Negotiated Rate	$1,247.04
Rate for Payer: Cash Price	$835.65
Rate for Payer: Hawaii Western Management Group Commercial	$1,221.33
Rate for Payer: Health Management Network Commercial	$1,092.77
Rate for Payer: Kaiser Permanente Commercial	$809.93
Rate for Payer: Kaiser Permanente Medicaid	$655.66
Rate for Payer: MDX Hawaii PPO	$1,247.04
Rate for Payer: University Health Alliance Commercial	$937.08

ENDOCRINE DISORDERS WITH CC

Facility

$19,719.53

Service Code	MSDRG 644
Min. Negotiated Rate	$13,481.58
Max. Negotiated Rate	$19,719.53
Rate for Payer: AlohaCare Medicare	$13,481.58
Rate for Payer: Devoted Health Medicare	$14,829.74
Rate for Payer: Hawaii Medical Service Association Commercial	$19,719.53
Rate for Payer: Hawaii Medical Service Association Medicare	$13,481.58
Rate for Payer: Humana Medicare	$13,481.58
Rate for Payer: Kaiser Permanente Commercial	$17,681.25
Rate for Payer: Kaiser Permanente Medicare	$13,481.58
Rate for Payer: Ohana Health Plan Medicare	$13,481.58
Rate for Payer: UnitedHealthcare Medicare	$13,481.58

ENDOCRINE DISORDERS WITH MCC

Facility

$28,395.22

Service Code	MSDRG 643
Min. Negotiated Rate	$19,719.53
Max. Negotiated Rate	$28,395.22
Rate for Payer: AlohaCare Medicare	$21,650.77
Rate for Payer: Devoted Health Medicare	$23,815.85
Rate for Payer: Hawaii Medical Service Association Commercial	$19,719.53
Rate for Payer: Hawaii Medical Service Association Medicare	$21,650.77
Rate for Payer: Humana Medicare	$21,650.77
Rate for Payer: Kaiser Permanente Commercial	$28,395.22
Rate for Payer: Kaiser Permanente Medicare	$21,650.77
Rate for Payer: Ohana Health Plan Medicare	$21,650.77
Rate for Payer: UnitedHealthcare Medicare	$21,650.77

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$17,067.76

Service Code	MSDRG 645
Min. Negotiated Rate	$10,105.27
Max. Negotiated Rate	$17,067.76
Rate for Payer: AlohaCare Medicare	$10,105.27
Rate for Payer: Devoted Health Medicare	$11,115.80
Rate for Payer: Hawaii Medical Service Association Commercial	$17,067.76
Rate for Payer: Hawaii Medical Service Association Medicare	$10,105.27
Rate for Payer: Humana Medicare	$10,105.27
Rate for Payer: Kaiser Permanente Commercial	$13,253.17
Rate for Payer: Kaiser Permanente Medicare	$10,105.27
Rate for Payer: Ohana Health Plan Medicare	$10,105.27
Rate for Payer: UnitedHealthcare Medicare	$10,105.27

Endo Electrosurgical Snare 2.8mm x 230cm x 20mm SD-230U-20 [3644632]

Facility

$223.95

Hospital Charge Code	3644632
Hospital Revenue Code	272
Min. Negotiated Rate	$190.36
Max. Negotiated Rate	$217.23
Rate for Payer: Cash Price	$145.57
Rate for Payer: Health Management Network Commercial	$190.36
Rate for Payer: MDX Hawaii PPO	$217.23

Endo Electrosurgical Snare 2.8mm x 230cm x 20mm SD-230U-20 [3644632]

Facility

$223.95

Hospital Charge Code	3644632
Hospital Revenue Code	272
Min. Negotiated Rate	$114.21
Max. Negotiated Rate	$217.23
Rate for Payer: Cash Price	$145.57
Rate for Payer: Hawaii Western Management Group Commercial	$212.75
Rate for Payer: Health Management Network Commercial	$190.36
Rate for Payer: Kaiser Permanente Commercial	$141.09
Rate for Payer: Kaiser Permanente Medicaid	$114.21
Rate for Payer: MDX Hawaii PPO	$217.23
Rate for Payer: University Health Alliance Commercial	$163.24

Endo Endocuff Vision Med Blue ID 11.0 ARV110 [3644640]

Facility

$273.90

Hospital Charge Code	3644640
Hospital Revenue Code	272
Min. Negotiated Rate	$139.69
Max. Negotiated Rate	$265.68
Rate for Payer: Cash Price	$178.04
Rate for Payer: Hawaii Western Management Group Commercial	$260.20
Rate for Payer: Health Management Network Commercial	$232.81
Rate for Payer: Kaiser Permanente Commercial	$172.56
Rate for Payer: Kaiser Permanente Medicaid	$139.69
Rate for Payer: MDX Hawaii PPO	$265.68
Rate for Payer: University Health Alliance Commercial	$199.65

Know your out-of-pocket cost for care.

All Charges