Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Lap Insufflation Needle 13g x 150mm C2202 [3644634]

Facility

$184.00

Hospital Charge Code	3644634
Hospital Revenue Code	272
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: MDX Hawaii PPO	$178.48

Lap Insufflation Needle S100000 [3607149]

Facility

$139.12

Hospital Charge Code	3607149
Hospital Revenue Code	272
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$134.95
Rate for Payer: Cash Price	$90.43
Rate for Payer: Hawaii Western Management Group Commercial	$132.16
Rate for Payer: Health Management Network Commercial	$118.25
Rate for Payer: Kaiser Permanente Commercial	$87.65
Rate for Payer: Kaiser Permanente Medicaid	$70.95
Rate for Payer: MDX Hawaii PPO	$134.95
Rate for Payer: University Health Alliance Commercial	$101.40

Lap Insufflation Needle S100000 [3607149]

Facility

$139.12

Hospital Charge Code	3607149
Hospital Revenue Code	272
Min. Negotiated Rate	$118.25
Max. Negotiated Rate	$134.95
Rate for Payer: Cash Price	$90.43
Rate for Payer: Health Management Network Commercial	$118.25
Rate for Payer: MDX Hawaii PPO	$134.95

Lap Insufflation Tubing Heated 620040690 [3640404]

Facility

$385.18

Hospital Charge Code	3640404
Hospital Revenue Code	272
Min. Negotiated Rate	$327.40
Max. Negotiated Rate	$373.62
Rate for Payer: Cash Price	$250.37
Rate for Payer: Health Management Network Commercial	$327.40
Rate for Payer: MDX Hawaii PPO	$373.62

Lap Insufflation Tubing Heated 620040690 [3640404]

Facility

$385.18

Hospital Charge Code	3640404
Hospital Revenue Code	272
Min. Negotiated Rate	$196.44
Max. Negotiated Rate	$373.62
Rate for Payer: Cash Price	$250.37
Rate for Payer: Hawaii Western Management Group Commercial	$365.92
Rate for Payer: Health Management Network Commercial	$327.40
Rate for Payer: Kaiser Permanente Commercial	$242.66
Rate for Payer: Kaiser Permanente Medicaid	$196.44
Rate for Payer: MDX Hawaii PPO	$373.62
Rate for Payer: University Health Alliance Commercial	$280.76

Lap Intro Kit For Gastrostomy Feeding Tube 24Fr Dilator 10226 [3644567]

Facility

$1,473.66

Hospital Charge Code	3644567
Hospital Revenue Code	272
Min. Negotiated Rate	$751.57
Max. Negotiated Rate	$1,429.45
Rate for Payer: Cash Price	$957.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,399.98
Rate for Payer: Health Management Network Commercial	$1,252.61
Rate for Payer: Kaiser Permanente Commercial	$928.41
Rate for Payer: Kaiser Permanente Medicaid	$751.57
Rate for Payer: MDX Hawaii PPO	$1,429.45
Rate for Payer: University Health Alliance Commercial	$1,074.15

Lap Intro Kit For Gastrostomy Feeding Tube 24Fr Dilator 10226 [3644567]

Facility

$1,473.66

Hospital Charge Code	3644567
Hospital Revenue Code	272
Min. Negotiated Rate	$1,252.61
Max. Negotiated Rate	$1,429.45
Rate for Payer: Cash Price	$957.88
Rate for Payer: Health Management Network Commercial	$1,252.61
Rate for Payer: MDX Hawaii PPO	$1,429.45

Lap INZII Retrieval Sys 5mm CD003 [3640996]

Facility

$491.50

Hospital Charge Code	3640996
Hospital Revenue Code	272
Min. Negotiated Rate	$417.77
Max. Negotiated Rate	$476.75
Rate for Payer: Cash Price	$319.48
Rate for Payer: Health Management Network Commercial	$417.77
Rate for Payer: MDX Hawaii PPO	$476.75

Lap INZII Retrieval Sys 5mm CD003 [3640996]

Facility

$491.50

Hospital Charge Code	3640996
Hospital Revenue Code	272
Min. Negotiated Rate	$250.66
Max. Negotiated Rate	$476.75
Rate for Payer: Cash Price	$319.48
Rate for Payer: Hawaii Western Management Group Commercial	$466.93
Rate for Payer: Health Management Network Commercial	$417.77
Rate for Payer: Kaiser Permanente Commercial	$309.64
Rate for Payer: Kaiser Permanente Medicaid	$250.66
Rate for Payer: MDX Hawaii PPO	$476.75
Rate for Payer: University Health Alliance Commercial	$358.25

Lap Kii 12mm Adva Fixation Sleeve CFS22 [3640919]

Facility

$662.50

Hospital Charge Code	3640919
Hospital Revenue Code	272
Min. Negotiated Rate	$337.88
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$629.38
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: Kaiser Permanente Commercial	$417.38
Rate for Payer: Kaiser Permanente Medicaid	$337.88
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$482.90

Lap Kii 12mm Adva Fixation Sleeve CFS22 [3640919]

Facility

$662.50

Hospital Charge Code	3640919
Hospital Revenue Code	272
Min. Negotiated Rate	$563.12
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: MDX Hawaii PPO	$642.62

Lap Kii 12mm Blunt Balloon Tip Sys COR47 [3640920]

Facility

$662.50

Hospital Charge Code	3640920
Hospital Revenue Code	272
Min. Negotiated Rate	$563.12
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: MDX Hawaii PPO	$642.62

Lap Kii 12mm Blunt Balloon Tip Sys COR47 [3640920]

Facility

$662.50

Hospital Charge Code	3640920
Hospital Revenue Code	272
Min. Negotiated Rate	$337.88
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$629.38
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: Kaiser Permanente Commercial	$417.38
Rate for Payer: Kaiser Permanente Medicaid	$337.88
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$482.90

Lap Kii 12mm Optical Access System CFR73 [3640917]

Facility

$662.50

Hospital Charge Code	3640917
Hospital Revenue Code	272
Min. Negotiated Rate	$337.88
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$629.38
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: Kaiser Permanente Commercial	$417.38
Rate for Payer: Kaiser Permanente Medicaid	$337.88
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$482.90

Lap Kii 12mm Optical Access System CFR73 [3640917]

Facility

$662.50

Hospital Charge Code	3640917
Hospital Revenue Code	272
Min. Negotiated Rate	$563.12
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: MDX Hawaii PPO	$642.62

Lap Kii 12mmX150mm Optical Access System CFR71 [3642932]

Facility

$662.50

Hospital Charge Code	3642932
Hospital Revenue Code	272
Min. Negotiated Rate	$337.88
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$629.38
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: Kaiser Permanente Commercial	$417.38
Rate for Payer: Kaiser Permanente Medicaid	$337.88
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$482.90

Lap Kii 12mmX150mm Optical Access System CFR71 [3642932]

Facility

$662.50

Hospital Charge Code	3642932
Hospital Revenue Code	272
Min. Negotiated Rate	$563.12
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: MDX Hawaii PPO	$642.62

Lap Kii 15mmX150mm Optical Access System CFR39 [3642933]

Facility

$612.50

Hospital Charge Code	3642933
Hospital Revenue Code	272
Min. Negotiated Rate	$312.38
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$581.88
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: Kaiser Permanente Commercial	$385.88
Rate for Payer: Kaiser Permanente Medicaid	$312.38
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$446.45

Lap Kii 15mmX150mm Optical Access System CFR39 [3642933]

Facility

$612.50

Hospital Charge Code	3642933
Hospital Revenue Code	272
Min. Negotiated Rate	$520.62
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: MDX Hawaii PPO	$594.12

Lap Kii 5mm Adv Fixation Sleeve CFS02 [3640918]

Facility

$342.75

Hospital Charge Code	3640918
Hospital Revenue Code	272
Min. Negotiated Rate	$174.80
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Hawaii Western Management Group Commercial	$325.61
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: Kaiser Permanente Commercial	$215.93
Rate for Payer: Kaiser Permanente Medicaid	$174.80
Rate for Payer: MDX Hawaii PPO	$332.47
Rate for Payer: University Health Alliance Commercial	$249.83

Lap Kii 5mm Adv Fixation Sleeve CFS02 [3640918]

Facility

$342.75

Hospital Charge Code	3640918
Hospital Revenue Code	272
Min. Negotiated Rate	$291.34
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: MDX Hawaii PPO	$332.47

Lap Kii 5mm Blunt Balloon Tip Sys COQ20 [3640997]

Facility

$606.50

Hospital Charge Code	3640997
Hospital Revenue Code	272
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$576.17
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$442.08

Lap Kii 5mm Blunt Balloon Tip Sys COQ20 [3640997]

Facility

$606.50

Hospital Charge Code	3640997
Hospital Revenue Code	272
Min. Negotiated Rate	$515.52
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30

Lap Kii 5mm Optical Access System CFR03 [3640916]

Facility

$606.50

Hospital Charge Code	3640916
Hospital Revenue Code	272
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$576.17
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$442.08

Lap Kii 5mm Optical Access System CFR03 [3640916]

Facility

$606.50

Hospital Charge Code	3640916
Hospital Revenue Code	272
Min. Negotiated Rate	$515.52
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30

Know your out-of-pocket cost for care.

All Charges