Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Lap Tip Clinch Grasper 3252 [3640644]

Facility

$413.88

Hospital Charge Code	3640644
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Lap Tip Fenestrated Grasper 3222 [3640728]

Facility

$413.88

Hospital Charge Code	3640728
Hospital Revenue Code	272
Min. Negotiated Rate	$351.80
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: MDX Hawaii PPO	$401.46

Lap Tip Fenestrated Grasper 3222 [3640728]

Facility

$413.88

Hospital Charge Code	3640728
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Lap Tip Fenestrated Long Grasper 3262 [3640323]

Facility

$413.88

Hospital Charge Code	3640323
Hospital Revenue Code	272
Min. Negotiated Rate	$351.80
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: MDX Hawaii PPO	$401.46

Lap Tip Fenestrated Long Grasper 3262 [3640323]

Facility

$413.88

Hospital Charge Code	3640323
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Lap Tip Grabber Atraumatic 3622 [3603152]

Facility

$382.25

Hospital Charge Code	3603152
Hospital Revenue Code	272
Min. Negotiated Rate	$324.91
Max. Negotiated Rate	$370.78
Rate for Payer: Cash Price	$248.46
Rate for Payer: Health Management Network Commercial	$324.91
Rate for Payer: MDX Hawaii PPO	$370.78

Lap Tip Grabber Atraumatic 3622 [3603152]

Facility

$382.25

Hospital Charge Code	3603152
Hospital Revenue Code	272
Min. Negotiated Rate	$194.95
Max. Negotiated Rate	$370.78
Rate for Payer: Cash Price	$248.46
Rate for Payer: Hawaii Western Management Group Commercial	$363.14
Rate for Payer: Health Management Network Commercial	$324.91
Rate for Payer: Kaiser Permanente Commercial	$240.82
Rate for Payer: Kaiser Permanente Medicaid	$194.95
Rate for Payer: MDX Hawaii PPO	$370.78
Rate for Payer: University Health Alliance Commercial	$278.62

Lap Tip Grabber Grasper Disp 3242 [3642398]

Facility

$448.44

Hospital Charge Code	3642398
Hospital Revenue Code	272
Min. Negotiated Rate	$381.17
Max. Negotiated Rate	$434.99
Rate for Payer: Cash Price	$291.49
Rate for Payer: Health Management Network Commercial	$381.17
Rate for Payer: MDX Hawaii PPO	$434.99

Lap Tip Grabber Grasper Disp 3242 [3642398]

Facility

$448.44

Hospital Charge Code	3642398
Hospital Revenue Code	272
Min. Negotiated Rate	$228.70
Max. Negotiated Rate	$434.99
Rate for Payer: Cash Price	$291.49
Rate for Payer: Hawaii Western Management Group Commercial	$426.02
Rate for Payer: Health Management Network Commercial	$381.17
Rate for Payer: Kaiser Permanente Commercial	$282.52
Rate for Payer: Kaiser Permanente Medicaid	$228.70
Rate for Payer: MDX Hawaii PPO	$434.99
Rate for Payer: University Health Alliance Commercial	$326.87

Lap Tip Maryland Dissector 3352 [3640261]

Facility

$413.88

Hospital Charge Code	3640261
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Lap Tip Maryland Dissector 3352 [3640261]

Facility

$413.88

Hospital Charge Code	3640261
Hospital Revenue Code	272
Min. Negotiated Rate	$351.80
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: MDX Hawaii PPO	$401.46

Lap Tip Right Angle 10mm Dissector 3342 [3640727]

Facility

$413.88

Hospital Charge Code	3640727
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Lap Tip Right Angle 10mm Dissector 3342 [3640727]

Facility

$413.88

Hospital Charge Code	3640727
Hospital Revenue Code	272
Min. Negotiated Rate	$351.80
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: MDX Hawaii PPO	$401.46

Lap Tip Right Angle 5mm Dissector 3332 [3640726]

Facility

$413.88

Hospital Charge Code	3640726
Hospital Revenue Code	272
Min. Negotiated Rate	$351.80
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: MDX Hawaii PPO	$401.46

Lap Tip Right Angle 5mm Dissector 3332 [3640726]

Facility

$413.88

Hospital Charge Code	3640726
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

Lap Tip Scissors Endocut 3142 [3602050]

Facility

$298.88

Hospital Charge Code	3602050
Hospital Revenue Code	272
Min. Negotiated Rate	$254.05
Max. Negotiated Rate	$289.91
Rate for Payer: Cash Price	$194.27
Rate for Payer: Health Management Network Commercial	$254.05
Rate for Payer: MDX Hawaii PPO	$289.91

Lap Tip Scissors Endocut 3142 [3602050]

Facility

$298.88

Hospital Charge Code	3602050
Hospital Revenue Code	272
Min. Negotiated Rate	$152.43
Max. Negotiated Rate	$289.91
Rate for Payer: Cash Price	$194.27
Rate for Payer: Hawaii Western Management Group Commercial	$283.94
Rate for Payer: Health Management Network Commercial	$254.05
Rate for Payer: Kaiser Permanente Commercial	$188.29
Rate for Payer: Kaiser Permanente Medicaid	$152.43
Rate for Payer: MDX Hawaii PPO	$289.91
Rate for Payer: University Health Alliance Commercial	$217.85

Lap Trocar Endoclose Device 173022 [3640047]

Facility

$194.96

Hospital Charge Code	3640047
Hospital Revenue Code	272
Min. Negotiated Rate	$165.72
Max. Negotiated Rate	$189.11
Rate for Payer: Cash Price	$126.72
Rate for Payer: Health Management Network Commercial	$165.72
Rate for Payer: MDX Hawaii PPO	$189.11

Lap Trocar Endoclose Device 173022 [3640047]

Facility

$194.96

Hospital Charge Code	3640047
Hospital Revenue Code	272
Min. Negotiated Rate	$99.43
Max. Negotiated Rate	$189.11
Rate for Payer: Cash Price	$126.72
Rate for Payer: Hawaii Western Management Group Commercial	$185.21
Rate for Payer: Health Management Network Commercial	$165.72
Rate for Payer: Kaiser Permanente Commercial	$122.82
Rate for Payer: Kaiser Permanente Medicaid	$99.43
Rate for Payer: MDX Hawaii PPO	$189.11
Rate for Payer: University Health Alliance Commercial	$142.11

Lap Trocar Versaport 8mm Bladeless NB8STF [3640417]

Facility

$350.31

Hospital Charge Code	3640417
Hospital Revenue Code	272
Min. Negotiated Rate	$297.76
Max. Negotiated Rate	$339.80
Rate for Payer: Cash Price	$227.70
Rate for Payer: Health Management Network Commercial	$297.76
Rate for Payer: MDX Hawaii PPO	$339.80

Lap Trocar Versaport 8mm Bladeless NB8STF [3640417]

Facility

$350.31

Hospital Charge Code	3640417
Hospital Revenue Code	272
Min. Negotiated Rate	$178.66
Max. Negotiated Rate	$339.80
Rate for Payer: Cash Price	$227.70
Rate for Payer: Hawaii Western Management Group Commercial	$332.79
Rate for Payer: Health Management Network Commercial	$297.76
Rate for Payer: Kaiser Permanente Commercial	$220.70
Rate for Payer: Kaiser Permanente Medicaid	$178.66
Rate for Payer: MDX Hawaii PPO	$339.80
Rate for Payer: University Health Alliance Commercial	$255.34

Lap Trocar Xcel Bladeless 11MM B11LT [3603173]

Facility

$694.52

Hospital Charge Code	3603173
Hospital Revenue Code	272
Min. Negotiated Rate	$354.21
Max. Negotiated Rate	$673.68
Rate for Payer: Cash Price	$451.44
Rate for Payer: Hawaii Western Management Group Commercial	$659.79
Rate for Payer: Health Management Network Commercial	$590.34
Rate for Payer: Kaiser Permanente Commercial	$437.55
Rate for Payer: Kaiser Permanente Medicaid	$354.21
Rate for Payer: MDX Hawaii PPO	$673.68
Rate for Payer: University Health Alliance Commercial	$506.24

Lap Trocar Xcel Bladeless 11MM B11LT [3603173]

Facility

$694.52

Hospital Charge Code	3603173
Hospital Revenue Code	272
Min. Negotiated Rate	$590.34
Max. Negotiated Rate	$673.68
Rate for Payer: Cash Price	$451.44
Rate for Payer: Health Management Network Commercial	$590.34
Rate for Payer: MDX Hawaii PPO	$673.68

Lap Trocar Xcel Bladeless 12MM B12LT [3603174]

Facility

$651.81

Hospital Charge Code	3603174
Hospital Revenue Code	272
Min. Negotiated Rate	$332.42
Max. Negotiated Rate	$632.26
Rate for Payer: Cash Price	$423.68
Rate for Payer: Hawaii Western Management Group Commercial	$619.22
Rate for Payer: Health Management Network Commercial	$554.04
Rate for Payer: Kaiser Permanente Commercial	$410.64
Rate for Payer: Kaiser Permanente Medicaid	$332.42
Rate for Payer: MDX Hawaii PPO	$632.26
Rate for Payer: University Health Alliance Commercial	$475.10

Lap Trocar Xcel Bladeless 12MM B12LT [3603174]

Facility

$651.81

Hospital Charge Code	3603174
Hospital Revenue Code	272
Min. Negotiated Rate	$554.04
Max. Negotiated Rate	$632.26
Rate for Payer: Cash Price	$423.68
Rate for Payer: Health Management Network Commercial	$554.04
Rate for Payer: MDX Hawaii PPO	$632.26

Know your out-of-pocket cost for care.

All Charges