Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Endo Endocuff Vision Med Blue ID 11.0 ARV110 [3644640]

Facility

$273.90

Hospital Charge Code	3644640
Hospital Revenue Code	272
Min. Negotiated Rate	$232.81
Max. Negotiated Rate	$265.68
Rate for Payer: Cash Price	$178.04
Rate for Payer: Health Management Network Commercial	$232.81
Rate for Payer: MDX Hawaii PPO	$265.68

Endo Endoscopic Hemospray 10fr 220cm G21049 [3644643]

Facility

$10,253.00

Service Code	HCPCS C1052
Hospital Charge Code	3644643
Hospital Revenue Code	272
Min. Negotiated Rate	$5,229.03
Max. Negotiated Rate	$9,945.41
Rate for Payer: Cash Price	$6,664.45
Rate for Payer: Hawaii Western Management Group Commercial	$9,740.35
Rate for Payer: Health Management Network Commercial	$8,715.05
Rate for Payer: Kaiser Permanente Commercial	$6,459.39
Rate for Payer: Kaiser Permanente Medicaid	$5,229.03
Rate for Payer: MDX Hawaii PPO	$9,945.41
Rate for Payer: University Health Alliance Commercial	$7,473.41

Endo Endoscopic Hemospray 10fr 220cm G21049 [3644643]

Facility

$10,253.00

Service Code	HCPCS C1052
Hospital Charge Code	3644643
Hospital Revenue Code	272
Min. Negotiated Rate	$8,715.05
Max. Negotiated Rate	$9,945.41
Rate for Payer: Cash Price	$6,664.45
Rate for Payer: Health Management Network Commercial	$8,715.05
Rate for Payer: MDX Hawaii PPO	$9,945.41

Endo Endoscopic Hemospray 7fr 220cm G56572 [3644642]

Facility

$10,253.00

Service Code	HCPCS C1052
Hospital Charge Code	3644642
Hospital Revenue Code	272
Min. Negotiated Rate	$8,715.05
Max. Negotiated Rate	$9,945.41
Rate for Payer: Cash Price	$6,664.45
Rate for Payer: Health Management Network Commercial	$8,715.05
Rate for Payer: MDX Hawaii PPO	$9,945.41

Endo Endoscopic Hemospray 7fr 220cm G56572 [3644642]

Facility

$10,253.00

Service Code	HCPCS C1052
Hospital Charge Code	3644642
Hospital Revenue Code	272
Min. Negotiated Rate	$5,229.03
Max. Negotiated Rate	$9,945.41
Rate for Payer: Cash Price	$6,664.45
Rate for Payer: Hawaii Western Management Group Commercial	$9,740.35
Rate for Payer: Health Management Network Commercial	$8,715.05
Rate for Payer: Kaiser Permanente Commercial	$6,459.39
Rate for Payer: Kaiser Permanente Medicaid	$5,229.03
Rate for Payer: MDX Hawaii PPO	$9,945.41
Rate for Payer: University Health Alliance Commercial	$7,473.41

Endo Forcep Biopsy Colon M00513332 [3600418]

Facility

$79.22

Hospital Charge Code	3600418
Hospital Revenue Code	272
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$76.84
Rate for Payer: Cash Price	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$75.26
Rate for Payer: Health Management Network Commercial	$67.34
Rate for Payer: Kaiser Permanente Commercial	$49.91
Rate for Payer: Kaiser Permanente Medicaid	$40.40
Rate for Payer: MDX Hawaii PPO	$76.84
Rate for Payer: University Health Alliance Commercial	$57.74

Endo Forcep Biopsy Colon M00513332 [3600418]

Facility

$79.22

Hospital Charge Code	3600418
Hospital Revenue Code	272
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$76.84
Rate for Payer: Cash Price	$51.49
Rate for Payer: Health Management Network Commercial	$67.34
Rate for Payer: MDX Hawaii PPO	$76.84

Endo Forcep Biopsy EGD M00513300 [3600417]

Facility

$79.22

Hospital Charge Code	3600417
Hospital Revenue Code	272
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$76.84
Rate for Payer: Cash Price	$51.49
Rate for Payer: Health Management Network Commercial	$67.34
Rate for Payer: MDX Hawaii PPO	$76.84

Endo Forcep Biopsy EGD M00513300 [3600417]

Facility

$79.22

Hospital Charge Code	3600417
Hospital Revenue Code	272
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$76.84
Rate for Payer: Cash Price	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$75.26
Rate for Payer: Health Management Network Commercial	$67.34
Rate for Payer: Kaiser Permanente Commercial	$49.91
Rate for Payer: Kaiser Permanente Medicaid	$40.40
Rate for Payer: MDX Hawaii PPO	$76.84
Rate for Payer: University Health Alliance Commercial	$57.74

Endo Forcep Biopsy Hot M00515031 [3640784]

Facility

$214.50

Hospital Charge Code	3640784
Hospital Revenue Code	272
Min. Negotiated Rate	$109.39
Max. Negotiated Rate	$208.06
Rate for Payer: Cash Price	$139.43
Rate for Payer: Hawaii Western Management Group Commercial	$203.78
Rate for Payer: Health Management Network Commercial	$182.32
Rate for Payer: Kaiser Permanente Commercial	$135.13
Rate for Payer: Kaiser Permanente Medicaid	$109.39
Rate for Payer: MDX Hawaii PPO	$208.06
Rate for Payer: University Health Alliance Commercial	$156.35

Endo Forcep Biopsy Hot M00515031 [3640784]

Facility

$214.50

Hospital Charge Code	3640784
Hospital Revenue Code	272
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$208.06
Rate for Payer: Cash Price	$139.43
Rate for Payer: Health Management Network Commercial	$182.32
Rate for Payer: MDX Hawaii PPO	$208.06

Endo Forcep Biopsy Pediatric M00513443 [3640785]

Facility

$270.19

Hospital Charge Code	3640785
Hospital Revenue Code	272
Min. Negotiated Rate	$229.66
Max. Negotiated Rate	$262.08
Rate for Payer: Cash Price	$175.62
Rate for Payer: Health Management Network Commercial	$229.66
Rate for Payer: MDX Hawaii PPO	$262.08

Endo Forcep Biopsy Pediatric M00513443 [3640785]

Facility

$270.19

Hospital Charge Code	3640785
Hospital Revenue Code	272
Min. Negotiated Rate	$137.80
Max. Negotiated Rate	$262.08
Rate for Payer: Cash Price	$175.62
Rate for Payer: Hawaii Western Management Group Commercial	$256.68
Rate for Payer: Health Management Network Commercial	$229.66
Rate for Payer: Kaiser Permanente Commercial	$170.22
Rate for Payer: Kaiser Permanente Medicaid	$137.80
Rate for Payer: MDX Hawaii PPO	$262.08
Rate for Payer: University Health Alliance Commercial	$196.94

Endo Forcep Biopsy Radial Jaw 4 Jumbo w/Ndle 3.2mm M00513370 [3640507]

Facility

$297.73

Hospital Charge Code	3640507
Hospital Revenue Code	272
Min. Negotiated Rate	$253.07
Max. Negotiated Rate	$288.80
Rate for Payer: Cash Price	$193.52
Rate for Payer: Health Management Network Commercial	$253.07
Rate for Payer: MDX Hawaii PPO	$288.80

Endo Forcep Biopsy Radial Jaw 4 Jumbo w/Ndle 3.2mm M00513370 [3640507]

Facility

$297.73

Hospital Charge Code	3640507
Hospital Revenue Code	272
Min. Negotiated Rate	$151.84
Max. Negotiated Rate	$288.80
Rate for Payer: Cash Price	$193.52
Rate for Payer: Hawaii Western Management Group Commercial	$282.84
Rate for Payer: Health Management Network Commercial	$253.07
Rate for Payer: Kaiser Permanente Commercial	$187.57
Rate for Payer: Kaiser Permanente Medicaid	$151.84
Rate for Payer: MDX Hawaii PPO	$288.80
Rate for Payer: University Health Alliance Commercial	$217.02

Endo Hemostasis 11mm Clip Rotatable M00521230 [3640701]

Facility

$1,192.65

Hospital Charge Code	3640701
Hospital Revenue Code	272
Min. Negotiated Rate	$608.25
Max. Negotiated Rate	$1,156.87
Rate for Payer: Cash Price	$775.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,133.02
Rate for Payer: Health Management Network Commercial	$1,013.75
Rate for Payer: Kaiser Permanente Commercial	$751.37
Rate for Payer: Kaiser Permanente Medicaid	$608.25
Rate for Payer: MDX Hawaii PPO	$1,156.87
Rate for Payer: University Health Alliance Commercial	$869.32

Endo Hemostasis 11mm Clip Rotatable M00521230 [3640701]

Facility

$1,192.65

Hospital Charge Code	3640701
Hospital Revenue Code	272
Min. Negotiated Rate	$1,013.75
Max. Negotiated Rate	$1,156.87
Rate for Payer: Cash Price	$775.22
Rate for Payer: Health Management Network Commercial	$1,013.75
Rate for Payer: MDX Hawaii PPO	$1,156.87

Endo Hemostasis 17mm Clip Rotatable M00521400 [3642367]

Facility

$1,334.93

Hospital Charge Code	3642367
Hospital Revenue Code	272
Min. Negotiated Rate	$1,134.69
Max. Negotiated Rate	$1,294.88
Rate for Payer: Cash Price	$867.70
Rate for Payer: Health Management Network Commercial	$1,134.69
Rate for Payer: MDX Hawaii PPO	$1,294.88

Endo Hemostasis 17mm Clip Rotatable M00521400 [3642367]

Facility

$1,334.93

Hospital Charge Code	3642367
Hospital Revenue Code	272
Min. Negotiated Rate	$680.81
Max. Negotiated Rate	$1,294.88
Rate for Payer: Cash Price	$867.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,268.18
Rate for Payer: Health Management Network Commercial	$1,134.69
Rate for Payer: Kaiser Permanente Commercial	$841.01
Rate for Payer: Kaiser Permanente Medicaid	$680.81
Rate for Payer: MDX Hawaii PPO	$1,294.88
Rate for Payer: University Health Alliance Commercial	$973.03

Endo Hemostasis Clip 2261 [3606030]

Facility

$998.20

Hospital Charge Code	3606030
Hospital Revenue Code	272
Min. Negotiated Rate	$848.47
Max. Negotiated Rate	$968.25
Rate for Payer: Cash Price	$648.83
Rate for Payer: Health Management Network Commercial	$848.47
Rate for Payer: MDX Hawaii PPO	$968.25

Endo Hemostasis Clip 2261 [3606030]

Facility

$998.20

Hospital Charge Code	3606030
Hospital Revenue Code	272
Min. Negotiated Rate	$509.08
Max. Negotiated Rate	$968.25
Rate for Payer: Cash Price	$648.83
Rate for Payer: Hawaii Western Management Group Commercial	$948.29
Rate for Payer: Health Management Network Commercial	$848.47
Rate for Payer: Kaiser Permanente Commercial	$628.87
Rate for Payer: Kaiser Permanente Medicaid	$509.08
Rate for Payer: MDX Hawaii PPO	$968.25
Rate for Payer: University Health Alliance Commercial	$727.59

Endo Ii Mod Endo Head Sz 42 12-139008 [3645546]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645546
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Endo Ii Mod Endo Head Sz 42 12-139008 [3645546]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645546
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Endo Ii Mod Endo Mead Sz 47 12-139018 [3645563]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645563
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Endo Ii Mod Endo Mead Sz 47 12-139018 [3645563]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645563
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Know your out-of-pocket cost for care.

All Charges