Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Endo Inflator Syringe Alliance II M00550600 [3602157]

Facility

$249.94

Hospital Charge Code	3602157
Hospital Revenue Code	272
Min. Negotiated Rate	$127.47
Max. Negotiated Rate	$242.44
Rate for Payer: Cash Price	$162.46
Rate for Payer: Hawaii Western Management Group Commercial	$237.44
Rate for Payer: Health Management Network Commercial	$212.45
Rate for Payer: Kaiser Permanente Commercial	$157.46
Rate for Payer: Kaiser Permanente Medicaid	$127.47
Rate for Payer: MDX Hawaii PPO	$242.44
Rate for Payer: University Health Alliance Commercial	$182.18

Endo Inflator Syringe Alliance II M00550600 [3602157]

Facility

$249.94

Hospital Charge Code	3602157
Hospital Revenue Code	272
Min. Negotiated Rate	$212.45
Max. Negotiated Rate	$242.44
Rate for Payer: Cash Price	$162.46
Rate for Payer: Health Management Network Commercial	$212.45
Rate for Payer: MDX Hawaii PPO	$242.44

Endo Interject Needle Catheter 23ga x 200cm M00518100 [3606028]

Facility

$248.99

Hospital Charge Code	3606028
Hospital Revenue Code	272
Min. Negotiated Rate	$126.98
Max. Negotiated Rate	$241.52
Rate for Payer: Cash Price	$161.84
Rate for Payer: Hawaii Western Management Group Commercial	$236.54
Rate for Payer: Health Management Network Commercial	$211.64
Rate for Payer: Kaiser Permanente Commercial	$156.86
Rate for Payer: Kaiser Permanente Medicaid	$126.98
Rate for Payer: MDX Hawaii PPO	$241.52
Rate for Payer: University Health Alliance Commercial	$181.49

Endo Interject Needle Catheter 23ga x 200cm M00518100 [3606028]

Facility

$248.99

Hospital Charge Code	3606028
Hospital Revenue Code	272
Min. Negotiated Rate	$211.64
Max. Negotiated Rate	$241.52
Rate for Payer: Cash Price	$161.84
Rate for Payer: Health Management Network Commercial	$211.64
Rate for Payer: MDX Hawaii PPO	$241.52

Endo Interject Needle Catheter 25ga x 240cm M00518310 [3606027]

Facility

$242.85

Hospital Charge Code	3606027
Hospital Revenue Code	272
Min. Negotiated Rate	$206.42
Max. Negotiated Rate	$235.56
Rate for Payer: Cash Price	$157.85
Rate for Payer: Health Management Network Commercial	$206.42
Rate for Payer: MDX Hawaii PPO	$235.56

Endo Interject Needle Catheter 25ga x 240cm M00518310 [3606027]

Facility

$242.85

Hospital Charge Code	3606027
Hospital Revenue Code	272
Min. Negotiated Rate	$123.85
Max. Negotiated Rate	$235.56
Rate for Payer: Cash Price	$157.85
Rate for Payer: Hawaii Western Management Group Commercial	$230.71
Rate for Payer: Health Management Network Commercial	$206.42
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: Kaiser Permanente Medicaid	$123.85
Rate for Payer: MDX Hawaii PPO	$235.56
Rate for Payer: University Health Alliance Commercial	$177.01

Endo Ligator Multiband Super 7 M00542250 [3602951]

Facility

$1,369.73

Hospital Charge Code	3602951
Hospital Revenue Code	272
Min. Negotiated Rate	$1,164.27
Max. Negotiated Rate	$1,328.64
Rate for Payer: Cash Price	$890.32
Rate for Payer: Health Management Network Commercial	$1,164.27
Rate for Payer: MDX Hawaii PPO	$1,328.64

Endo Ligator Multiband Super 7 M00542250 [3602951]

Facility

$1,369.73

Hospital Charge Code	3602951
Hospital Revenue Code	272
Min. Negotiated Rate	$698.56
Max. Negotiated Rate	$1,328.64
Rate for Payer: Cash Price	$890.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,301.24
Rate for Payer: Health Management Network Commercial	$1,164.27
Rate for Payer: Kaiser Permanente Commercial	$862.93
Rate for Payer: Kaiser Permanente Medicaid	$698.56
Rate for Payer: MDX Hawaii PPO	$1,328.64
Rate for Payer: University Health Alliance Commercial	$998.40

Endo Monopolar Hemostatic Grasper 230cm SU FD-411UR [3644639]

Facility

$1,557.25

Hospital Charge Code	3644639
Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.66
Max. Negotiated Rate	$1,510.53
Rate for Payer: Cash Price	$1,012.21
Rate for Payer: Health Management Network Commercial	$1,323.66
Rate for Payer: MDX Hawaii PPO	$1,510.53

Endo Monopolar Hemostatic Grasper 230cm SU FD-411UR [3644639]

Facility

$1,557.25

Hospital Charge Code	3644639
Hospital Revenue Code	272
Min. Negotiated Rate	$794.20
Max. Negotiated Rate	$1,510.53
Rate for Payer: Cash Price	$1,012.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,479.39
Rate for Payer: Health Management Network Commercial	$1,323.66
Rate for Payer: Kaiser Permanente Commercial	$981.07
Rate for Payer: Kaiser Permanente Medicaid	$794.20
Rate for Payer: MDX Hawaii PPO	$1,510.53
Rate for Payer: University Health Alliance Commercial	$1,135.08

Endo Overtube Gastric 50cm Guardus 1711148 [3640343]

Facility

$1,452.36

Hospital Charge Code	3640343
Hospital Revenue Code	272
Min. Negotiated Rate	$740.70
Max. Negotiated Rate	$1,408.79
Rate for Payer: Cash Price	$944.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.74
Rate for Payer: Health Management Network Commercial	$1,234.51
Rate for Payer: Kaiser Permanente Commercial	$914.99
Rate for Payer: Kaiser Permanente Medicaid	$740.70
Rate for Payer: MDX Hawaii PPO	$1,408.79
Rate for Payer: University Health Alliance Commercial	$1,058.63

Endo Overtube Gastric 50cm Guardus 1711148 [3640343]

Facility

$1,452.36

Hospital Charge Code	3640343
Hospital Revenue Code	272
Min. Negotiated Rate	$1,234.51
Max. Negotiated Rate	$1,408.79
Rate for Payer: Cash Price	$944.03
Rate for Payer: Health Management Network Commercial	$1,234.51
Rate for Payer: MDX Hawaii PPO	$1,408.79

Endo Polyp Snare Aggressive SnareMaster SD-230U-20 [3644580]

Facility

$223.95

Hospital Charge Code	3644580
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 Polyp Snare Aggressive SnareMaster SD-230U-20 [3644580]

Facility

$223.95

Hospital Charge Code	3644580
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 Polyp Snare Captiflex 13mm M00562420 [3605195]

Facility

$115.18

Hospital Charge Code	3605195
Hospital Revenue Code	272
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$111.72
Rate for Payer: Cash Price	$74.87
Rate for Payer: Hawaii Western Management Group Commercial	$109.42
Rate for Payer: Health Management Network Commercial	$97.90
Rate for Payer: Kaiser Permanente Commercial	$72.56
Rate for Payer: Kaiser Permanente Medicaid	$58.74
Rate for Payer: MDX Hawaii PPO	$111.72
Rate for Payer: University Health Alliance Commercial	$83.95

Endo Polyp Snare Captiflex 13mm M00562420 [3605195]

Facility

$115.18

Hospital Charge Code	3605195
Hospital Revenue Code	272
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$111.72
Rate for Payer: Cash Price	$74.87
Rate for Payer: Health Management Network Commercial	$97.90
Rate for Payer: MDX Hawaii PPO	$111.72

Endo Polyp Snare Captiflex 27mm M00562400 [3601080]

Facility

$115.18

Hospital Charge Code	3601080
Hospital Revenue Code	272
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$111.72
Rate for Payer: Cash Price	$74.87
Rate for Payer: Hawaii Western Management Group Commercial	$109.42
Rate for Payer: Health Management Network Commercial	$97.90
Rate for Payer: Kaiser Permanente Commercial	$72.56
Rate for Payer: Kaiser Permanente Medicaid	$58.74
Rate for Payer: MDX Hawaii PPO	$111.72
Rate for Payer: University Health Alliance Commercial	$83.95

Endo Polyp Snare Captiflex 27mm M00562400 [3601080]

Facility

$115.18

Hospital Charge Code	3601080
Hospital Revenue Code	272
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$111.72
Rate for Payer: Cash Price	$74.87
Rate for Payer: Health Management Network Commercial	$97.90
Rate for Payer: MDX Hawaii PPO	$111.72

Endo Polyp Snare Captivator Cold 10mm M00561100 [3644579]

Facility

$110.50

Hospital Charge Code	3644579
Hospital Revenue Code	272
Min. Negotiated Rate	$56.35
Max. Negotiated Rate	$107.19
Rate for Payer: Cash Price	$71.82
Rate for Payer: Hawaii Western Management Group Commercial	$104.97
Rate for Payer: Health Management Network Commercial	$93.92
Rate for Payer: Kaiser Permanente Commercial	$69.61
Rate for Payer: Kaiser Permanente Medicaid	$56.35
Rate for Payer: MDX Hawaii PPO	$107.19
Rate for Payer: University Health Alliance Commercial	$80.54

Endo Polyp Snare Captivator Cold 10mm M00561100 [3644579]

Facility

$110.50

Hospital Charge Code	3644579
Hospital Revenue Code	272
Min. Negotiated Rate	$93.92
Max. Negotiated Rate	$107.19
Rate for Payer: MDX Hawaii PPO	$107.19
Rate for Payer: Cash Price	$71.82
Rate for Payer: Health Management Network Commercial	$93.92

Endo Polyp Snare Captivator II Round Stiff 10mm M00561220 [3644578]

Facility

$132.80

Hospital Charge Code	3644578
Hospital Revenue Code	272
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$128.82
Rate for Payer: Cash Price	$86.32
Rate for Payer: Health Management Network Commercial	$112.88
Rate for Payer: MDX Hawaii PPO	$128.82

Endo Polyp Snare Captivator II Round Stiff 10mm M00561220 [3644578]

Facility

$132.80

Hospital Charge Code	3644578
Hospital Revenue Code	272
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$128.82
Rate for Payer: Cash Price	$86.32
Rate for Payer: Hawaii Western Management Group Commercial	$126.16
Rate for Payer: Health Management Network Commercial	$112.88
Rate for Payer: Kaiser Permanente Commercial	$83.66
Rate for Payer: Kaiser Permanente Medicaid	$67.73
Rate for Payer: MDX Hawaii PPO	$128.82
Rate for Payer: University Health Alliance Commercial	$96.80

Endo Polyp Snare Ex-Lrg Rnd Stiff Captivator II 33mm M00561290 [3642382]

Facility

$129.12

Hospital Charge Code	3642382
Hospital Revenue Code	272
Min. Negotiated Rate	$65.85
Max. Negotiated Rate	$125.25
Rate for Payer: Cash Price	$83.93
Rate for Payer: Hawaii Western Management Group Commercial	$122.66
Rate for Payer: Health Management Network Commercial	$109.75
Rate for Payer: Kaiser Permanente Commercial	$81.35
Rate for Payer: Kaiser Permanente Medicaid	$65.85
Rate for Payer: MDX Hawaii PPO	$125.25
Rate for Payer: University Health Alliance Commercial	$94.12

Endo Polyp Snare Ex-Lrg Rnd Stiff Captivator II 33mm M00561290 [3642382]

Facility

$129.12

Hospital Charge Code	3642382
Hospital Revenue Code	272
Min. Negotiated Rate	$109.75
Max. Negotiated Rate	$125.25
Rate for Payer: Cash Price	$83.93
Rate for Payer: Health Management Network Commercial	$109.75
Rate for Payer: MDX Hawaii PPO	$125.25

Endo Polyp Snare Hex 13mm 6245 [3640412]

Facility

$111.78

Hospital Charge Code	3640412
Hospital Revenue Code	272
Min. Negotiated Rate	$95.01
Max. Negotiated Rate	$108.43
Rate for Payer: Cash Price	$72.66
Rate for Payer: Health Management Network Commercial	$95.01
Rate for Payer: MDX Hawaii PPO	$108.43

Know your out-of-pocket cost for care.

All Charges