Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Pacemaker Lead Tendril 2088TC/58 [3640968]

Facility

$3,653.00

Service Code	HCPCS C1898
Hospital Charge Code	3640968
Hospital Revenue Code	275
Min. Negotiated Rate	$2,045.68
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Pacemaker Lead Tendril 2088TC/58 [3640968]

Facility

$3,653.00

Service Code	HCPCS C1898
Hospital Charge Code	3640968
Hospital Revenue Code	275
Min. Negotiated Rate	$1,863.03
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$1,863.03
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Pacemaker Lead Tendril MRI LPA1200M/58 [3641006]

Facility

$2,450.00

Service Code	HCPCS C1898
Hospital Charge Code	3641006
Hospital Revenue Code	275
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,592.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

Pacemaker Lead Tendril MRI LPA1200M/58 [3641006]

Facility

$2,450.00

Service Code	HCPCS C1898
Hospital Charge Code	3641006
Hospital Revenue Code	275
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,592.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: Kaiser Permanente Commercial	$1,543.50
Rate for Payer: Kaiser Permanente Medicaid	$1,249.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

Pacemaker Sheath 6 Fr Merit Prelude PLS1006 [3642001]

Facility

$370.50

Service Code	HCPCS C1892
Hospital Charge Code	3642001
Hospital Revenue Code	272
Min. Negotiated Rate	$188.96
Max. Negotiated Rate	$359.38
Rate for Payer: Cash Price	$240.82
Rate for Payer: Hawaii Western Management Group Commercial	$351.98
Rate for Payer: Health Management Network Commercial	$314.93
Rate for Payer: Kaiser Permanente Commercial	$233.41
Rate for Payer: Kaiser Permanente Medicaid	$188.96
Rate for Payer: MDX Hawaii PPO	$359.38
Rate for Payer: University Health Alliance Commercial	$270.06

Pacemaker Sheath 6 Fr Merit Prelude PLS1006 [3642001]

Facility

$370.50

Service Code	HCPCS C1892
Hospital Charge Code	3642001
Hospital Revenue Code	272
Min. Negotiated Rate	$314.93
Max. Negotiated Rate	$359.38
Rate for Payer: Cash Price	$240.82
Rate for Payer: Health Management Network Commercial	$314.93
Rate for Payer: MDX Hawaii PPO	$359.38

Pacemaker Sheath 7 Fr Merit Prelude PLS1007 [3641126]

Facility

$130.40

Service Code	HCPCS C1892
Hospital Charge Code	3641126
Hospital Revenue Code	272
Min. Negotiated Rate	$110.84
Max. Negotiated Rate	$126.49
Rate for Payer: Cash Price	$84.76
Rate for Payer: Health Management Network Commercial	$110.84
Rate for Payer: MDX Hawaii PPO	$126.49

Pacemaker Sheath 7 Fr Merit Prelude PLS1007 [3641126]

Facility

$130.40

Service Code	HCPCS C1892
Hospital Charge Code	3641126
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$126.49
Rate for Payer: MDX Hawaii PPO	$126.49
Rate for Payer: Cash Price	$84.76
Rate for Payer: Hawaii Western Management Group Commercial	$123.88
Rate for Payer: Health Management Network Commercial	$110.84
Rate for Payer: Kaiser Permanente Commercial	$82.15
Rate for Payer: Kaiser Permanente Medicaid	$66.50
Rate for Payer: University Health Alliance Commercial	$95.05

Pacemaker Sheath 8 Fr Merit Prelude PLS1008 [3642204]

Facility

$537.50

Service Code	HCPCS C1892
Hospital Charge Code	3642204
Hospital Revenue Code	272
Min. Negotiated Rate	$274.12
Max. Negotiated Rate	$521.38
Rate for Payer: Cash Price	$349.38
Rate for Payer: Hawaii Western Management Group Commercial	$510.62
Rate for Payer: Health Management Network Commercial	$456.88
Rate for Payer: Kaiser Permanente Commercial	$338.62
Rate for Payer: Kaiser Permanente Medicaid	$274.12
Rate for Payer: MDX Hawaii PPO	$521.38
Rate for Payer: University Health Alliance Commercial	$391.78

Pacemaker Sheath 8 Fr Merit Prelude PLS1008 [3642204]

Facility

$537.50

Service Code	HCPCS C1892
Hospital Charge Code	3642204
Hospital Revenue Code	272
Min. Negotiated Rate	$456.88
Max. Negotiated Rate	$521.38
Rate for Payer: Cash Price	$349.38
Rate for Payer: Health Management Network Commercial	$456.88
Rate for Payer: MDX Hawaii PPO	$521.38

Pacemaker Wrench Kit 5873W (Charge CDM) [3641251]

Facility

$235.75

Hospital Charge Code	3641251
Hospital Revenue Code	272
Min. Negotiated Rate	$120.23
Max. Negotiated Rate	$228.68
Rate for Payer: Cash Price	$153.24
Rate for Payer: Hawaii Western Management Group Commercial	$223.96
Rate for Payer: Health Management Network Commercial	$200.39
Rate for Payer: Kaiser Permanente Commercial	$148.52
Rate for Payer: Kaiser Permanente Medicaid	$120.23
Rate for Payer: MDX Hawaii PPO	$228.68
Rate for Payer: University Health Alliance Commercial	$171.84

Pacemaker Wrench Kit 5873W (Charge CDM) [3641251]

Facility

$235.75

Hospital Charge Code	3641251
Hospital Revenue Code	272
Min. Negotiated Rate	$200.39
Max. Negotiated Rate	$228.68
Rate for Payer: Cash Price	$153.24
Rate for Payer: Health Management Network Commercial	$200.39
Rate for Payer: MDX Hawaii PPO	$228.68

PACK BASIC #9113/SBA55BAKAA [3600927]

Facility

$160.64

Hospital Charge Code	3600927
Hospital Revenue Code	272
Min. Negotiated Rate	$81.93
Max. Negotiated Rate	$155.82
Rate for Payer: Cash Price	$104.42
Rate for Payer: Hawaii Western Management Group Commercial	$152.61
Rate for Payer: Health Management Network Commercial	$136.54
Rate for Payer: Kaiser Permanente Commercial	$101.20
Rate for Payer: Kaiser Permanente Medicaid	$81.93
Rate for Payer: MDX Hawaii PPO	$155.82
Rate for Payer: University Health Alliance Commercial	$117.09

PACK BASIC #9113/SBA55BAKAA [3600927]

Facility

$160.64

Hospital Charge Code	3600927
Hospital Revenue Code	272
Min. Negotiated Rate	$136.54
Max. Negotiated Rate	$155.82
Rate for Payer: Cash Price	$104.42
Rate for Payer: Health Management Network Commercial	$136.54
Rate for Payer: MDX Hawaii PPO	$155.82

PACK CYSTO #KM88618 [3600928]

Facility

$229.76

Hospital Charge Code	3600928
Hospital Revenue Code	272
Min. Negotiated Rate	$117.18
Max. Negotiated Rate	$222.87
Rate for Payer: Cash Price	$149.34
Rate for Payer: Hawaii Western Management Group Commercial	$218.27
Rate for Payer: Health Management Network Commercial	$195.30
Rate for Payer: Kaiser Permanente Commercial	$144.75
Rate for Payer: Kaiser Permanente Medicaid	$117.18
Rate for Payer: MDX Hawaii PPO	$222.87
Rate for Payer: University Health Alliance Commercial	$167.47

PACK CYSTO #KM88618 [3600928]

Facility

$229.76

Hospital Charge Code	3600928
Hospital Revenue Code	272
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$222.87
Rate for Payer: Cash Price	$149.34
Rate for Payer: Health Management Network Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$222.87

PACK EPISTAT NASAL [2701511]

Facility

$848.21

Hospital Charge Code	2701511
Hospital Revenue Code	272
Min. Negotiated Rate	$432.59
Max. Negotiated Rate	$822.76
Rate for Payer: Cash Price	$551.34
Rate for Payer: Hawaii Western Management Group Commercial	$805.80
Rate for Payer: Health Management Network Commercial	$720.98
Rate for Payer: Kaiser Permanente Commercial	$534.37
Rate for Payer: Kaiser Permanente Medicaid	$432.59
Rate for Payer: MDX Hawaii PPO	$822.76
Rate for Payer: University Health Alliance Commercial	$618.26

PACK EPISTAT NASAL [2701511]

Facility

$848.21

Hospital Charge Code	2701511
Hospital Revenue Code	272
Min. Negotiated Rate	$720.98
Max. Negotiated Rate	$822.76
Rate for Payer: Cash Price	$551.34
Rate for Payer: Health Management Network Commercial	$720.98
Rate for Payer: MDX Hawaii PPO	$822.76

Pack Gel Nasal 5.5cm [2707796]

Facility

$325.88

Hospital Charge Code	2707796
Hospital Revenue Code	272
Min. Negotiated Rate	$166.20
Max. Negotiated Rate	$316.10
Rate for Payer: Cash Price	$211.82
Rate for Payer: Hawaii Western Management Group Commercial	$309.59
Rate for Payer: Health Management Network Commercial	$277.00
Rate for Payer: Kaiser Permanente Commercial	$205.30
Rate for Payer: Kaiser Permanente Medicaid	$166.20
Rate for Payer: MDX Hawaii PPO	$316.10
Rate for Payer: University Health Alliance Commercial	$237.53

Pack Gel Nasal 5.5cm [2707796]

Facility

$325.88

Hospital Charge Code	2707796
Hospital Revenue Code	272
Min. Negotiated Rate	$277.00
Max. Negotiated Rate	$316.10
Rate for Payer: Cash Price	$211.82
Rate for Payer: Health Management Network Commercial	$277.00
Rate for Payer: MDX Hawaii PPO	$316.10

Pack Gel Nasal 7.5cm [2707797]

Facility

$252.37

Hospital Charge Code	2707797
Hospital Revenue Code	272
Min. Negotiated Rate	$128.71
Max. Negotiated Rate	$244.80
Rate for Payer: Cash Price	$164.04
Rate for Payer: Hawaii Western Management Group Commercial	$239.75
Rate for Payer: Health Management Network Commercial	$214.51
Rate for Payer: Kaiser Permanente Commercial	$158.99
Rate for Payer: Kaiser Permanente Medicaid	$128.71
Rate for Payer: MDX Hawaii PPO	$244.80
Rate for Payer: University Health Alliance Commercial	$183.95

Pack Gel Nasal 7.5cm [2707797]

Facility

$252.37

Hospital Charge Code	2707797
Hospital Revenue Code	272
Min. Negotiated Rate	$214.51
Max. Negotiated Rate	$244.80
Rate for Payer: Cash Price	$164.04
Rate for Payer: Health Management Network Commercial	$214.51
Rate for Payer: MDX Hawaii PPO	$244.80

PACLITAXEL 6 MG/ML IV CONC

Facility

$183.59

Service Code	HCPCS J9267
Hospital Revenue Code	250
Min. Negotiated Rate	$156.05
Max. Negotiated Rate	$178.08
Rate for Payer: Cash Price	$119.33
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$224.91
Rate for Payer: Cash Price	$232.10
Rate for Payer: Health Management Network Commercial	$294.12
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Health Management Network Commercial	$156.05
Rate for Payer: Health Management Network Commercial	$303.51
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: MDX Hawaii PPO	$178.08
Rate for Payer: MDX Hawaii PPO	$335.64
Rate for Payer: MDX Hawaii PPO	$346.36

PACLITAXEL 6 MG/ML IV CONC

Facility

$67.68

Service Code	HCPCS J9267
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$65.65
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$224.91
Rate for Payer: Cash Price	$224.91
Rate for Payer: Cash Price	$119.33
Rate for Payer: Cash Price	$232.10
Rate for Payer: Cash Price	$232.10
Rate for Payer: Cash Price	$119.33
Rate for Payer: Cash Price	$43.99
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$174.41
Rate for Payer: Hawaii Western Management Group Commercial	$64.30
Rate for Payer: Hawaii Western Management Group Commercial	$339.22
Rate for Payer: Hawaii Western Management Group Commercial	$328.72
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Health Management Network Commercial	$156.05
Rate for Payer: Health Management Network Commercial	$294.12
Rate for Payer: Health Management Network Commercial	$303.51
Rate for Payer: Kaiser Permanente Commercial	$224.95
Rate for Payer: Kaiser Permanente Commercial	$42.64
Rate for Payer: Kaiser Permanente Commercial	$115.66
Rate for Payer: Kaiser Permanente Commercial	$217.99
Rate for Payer: Kaiser Permanente Medicaid	$176.47
Rate for Payer: Kaiser Permanente Medicaid	$182.11
Rate for Payer: Kaiser Permanente Medicaid	$34.52
Rate for Payer: Kaiser Permanente Medicaid	$93.63
Rate for Payer: MDX Hawaii PPO	$178.08
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: MDX Hawaii PPO	$346.36
Rate for Payer: MDX Hawaii PPO	$335.64
Rate for Payer: UnitedHealthcare Medicaid	$214.24
Rate for Payer: UnitedHealthcare Medicaid	$207.61
Rate for Payer: UnitedHealthcare Medicaid	$110.15
Rate for Payer: UnitedHealthcare Medicaid	$40.61
Rate for Payer: University Health Alliance Commercial	$252.21
Rate for Payer: University Health Alliance Commercial	$49.33
Rate for Payer: University Health Alliance Commercial	$260.27
Rate for Payer: University Health Alliance Commercial	$133.82

PACLITAXEL PROTEIN-BOUND 100 MG IV SUSR

Facility

$3,014.48

Service Code	HCPCS J9264
Hospital Revenue Code	636
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$2,924.05
Rate for Payer: AlohaCare Medicaid	$6.02
Rate for Payer: AlohaCare Medicare	$6.02
Rate for Payer: Cash Price	$1,959.41
Rate for Payer: Cash Price	$1,959.41
Rate for Payer: Devoted Health Medicare	$6.62
Rate for Payer: Hawaii Medical Service Association ABD	$12.12
Rate for Payer: Hawaii Medical Service Association Commercial	$7.53
Rate for Payer: Hawaii Medical Service Association Medicare	$6.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,863.76
Rate for Payer: Health Management Network Commercial	$2,562.31
Rate for Payer: Humana Medicare	$6.02
Rate for Payer: Kaiser Permanente Commercial	$1,899.12
Rate for Payer: Kaiser Permanente Medicaid	$1,537.38
Rate for Payer: Kaiser Permanente Medicare	$6.02
Rate for Payer: MDX Hawaii PPO	$2,924.05
Rate for Payer: Ohana Health Plan Medicaid	$6.62
Rate for Payer: Ohana Health Plan Medicare	$6.02
Rate for Payer: UnitedHealthcare Medicaid	$1,808.69
Rate for Payer: UnitedHealthcare Medicare	$6.02
Rate for Payer: University Health Alliance Commercial	$2,197.25

Know your out-of-pocket cost for care.

All Charges