Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Lens Tecnis Eyhance IOL 21.0 DIB00U0210 [3644990]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3644990
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance IOL 21.0 DIB00U0210 [3644990]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3644990
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance Iol 22.0 DIB00U0220 [3645440]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645440
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Eyhance Iol 22.0 DIB00U0220 [3645440]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3645440
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Mf 3-Piece 6.0mm 20.5 Us ZMA00U0205 [3643881]

Facility

$3,132.50

Service Code	HCPCS V2632
Hospital Charge Code	3643881
Hospital Revenue Code	276
Min. Negotiated Rate	$1,754.20
Max. Negotiated Rate	$3,038.53
Rate for Payer: Cash Price	$2,036.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,192.75
Rate for Payer: Health Management Network Commercial	$2,662.62
Rate for Payer: MDX Hawaii PPO	$3,038.53
Rate for Payer: University Health Alliance Commercial	$1,754.20

Lens Tecnis Mf 3-Piece 6.0mm 20.5 Us ZMA00U0205 [3643881]

Facility

$3,132.50

Service Code	HCPCS V2632
Hospital Charge Code	3643881
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$3,038.53
Rate for Payer: Cash Price	$2,036.12
Rate for Payer: Cash Price	$2,036.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,192.75
Rate for Payer: Health Management Network Commercial	$2,662.62
Rate for Payer: Kaiser Permanente Commercial	$1,973.47
Rate for Payer: Kaiser Permanente Medicaid	$1,597.58
Rate for Payer: MDX Hawaii PPO	$3,038.53
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$1,754.20

Lens Tecnis Odyssey IOL 16.0 DRN00V0160 [3645407]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645407
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey IOL 16.0 DRN00V0160 [3645407]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645407
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey IOL w/ SDS 14.0 DRN00V0140 [3645391]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645391
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey IOL w/ SDS 14.0 DRN00V0140 [3645391]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645391
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey IOL w/SDS 22.0 DRN00V0220 [3644991]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3644991
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey IOL w/SDS 22.0 DRN00V0220 [3644991]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3644991
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey Toric IOL 21.0 DRT3750210 [3645409]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645409
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey Toric IOL 21.0 DRT3750210 [3645409]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645409
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey Toric IOL 22.5 DRT300225 [3645410]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645410
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Odyssey Toric IOL 22.5 DRT300225 [3645410]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3645410
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Simplicity Iol 21.5 DIB00U0215 [3643827]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3643827
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Simplicity Iol 21.5 DIB00U0215 [3643827]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3643827
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Simplicity Iol 23.0 DIB00U0230 [3644166]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3644166
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: Kaiser Permanente Commercial	$636.67
Rate for Payer: Kaiser Permanente Medicaid	$515.40
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Simplicity Iol 23.0 DIB00U0230 [3644166]

Facility

$1,010.58

Service Code	HCPCS V2632
Hospital Charge Code	3644166
Hospital Revenue Code	276
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$980.26
Rate for Payer: Cash Price	$656.88
Rate for Payer: Hawaii Western Management Group Commercial	$707.41
Rate for Payer: Health Management Network Commercial	$858.99
Rate for Payer: MDX Hawaii PPO	$980.26
Rate for Payer: University Health Alliance Commercial	$565.92

Lens Tecnis Symfony Optiblue IOL 17.0 DXR00VU170 [3644343]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3644343
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Symfony Optiblue IOL 17.0 DXR00VU170 [3644343]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3644343
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Symfony Optiblue Iol 21.0 DXR00VU210 [3643880]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3643880
Hospital Revenue Code	276
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Symfony Optiblue Iol 21.0 DXR00VU210 [3643880]

Facility

$4,980.50

Service Code	HCPCS V2632
Hospital Charge Code	3643880
Hospital Revenue Code	276
Min. Negotiated Rate	$311.40
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: UnitedHealthcare Medicaid	$311.40
Rate for Payer: University Health Alliance Commercial	$2,789.08

Lens Tecnis Symfony Optiblue Iol 24.5 [3643820]

Facility

$3,482.50

Service Code	HCPCS V2632
Hospital Charge Code	3643820
Hospital Revenue Code	276
Min. Negotiated Rate	$1,950.20
Max. Negotiated Rate	$3,378.03
Rate for Payer: Cash Price	$2,263.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,437.75
Rate for Payer: Health Management Network Commercial	$2,960.12
Rate for Payer: MDX Hawaii PPO	$3,378.03
Rate for Payer: University Health Alliance Commercial	$1,950.20

Know your out-of-pocket cost for care.

All Charges