Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Plate Volar Bearing 3H Rt VLBPR-3-7 [3640942]

Facility

$5,283.00

Service Code	HCPCS C1713
Hospital Charge Code	3640942
Hospital Revenue Code	278
Min. Negotiated Rate	$2,694.33
Max. Negotiated Rate	$5,124.51
Rate for Payer: Cash Price	$3,433.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,698.10
Rate for Payer: Health Management Network Commercial	$4,490.55
Rate for Payer: Kaiser Permanente Commercial	$3,328.29
Rate for Payer: Kaiser Permanente Medicaid	$2,694.33
Rate for Payer: MDX Hawaii PPO	$5,124.51
Rate for Payer: University Health Alliance Commercial	$2,958.48

Plate Volar Bearing 3H Rt VLBPR-3-7 [3640942]

Facility

$5,283.00

Service Code	HCPCS C1713
Hospital Charge Code	3640942
Hospital Revenue Code	278
Min. Negotiated Rate	$2,958.48
Max. Negotiated Rate	$5,124.51
Rate for Payer: Cash Price	$3,433.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,698.10
Rate for Payer: Health Management Network Commercial	$4,490.55
Rate for Payer: MDX Hawaii PPO	$5,124.51
Rate for Payer: University Health Alliance Commercial	$2,958.48

Plate Volt Condylar 2.7mm 2H HD 6H 58mm 02.527.069 [3645353]

Facility

$5,466.58

Service Code	HCPCS C1713
Hospital Charge Code	3645353
Hospital Revenue Code	278
Min. Negotiated Rate	$2,787.96
Max. Negotiated Rate	$5,302.58
Rate for Payer: Cash Price	$3,553.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,826.61
Rate for Payer: Health Management Network Commercial	$4,646.59
Rate for Payer: Kaiser Permanente Commercial	$3,443.95
Rate for Payer: Kaiser Permanente Medicaid	$2,787.96
Rate for Payer: MDX Hawaii PPO	$5,302.58
Rate for Payer: University Health Alliance Commercial	$3,061.28

Plate Volt Condylar 2.7mm 2H HD 6H 58mm 02.527.069 [3645353]

Facility

$5,466.58

Service Code	HCPCS C1713
Hospital Charge Code	3645353
Hospital Revenue Code	278
Min. Negotiated Rate	$3,061.28
Max. Negotiated Rate	$5,302.58
Rate for Payer: Cash Price	$3,553.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,826.61
Rate for Payer: Health Management Network Commercial	$4,646.59
Rate for Payer: MDX Hawaii PPO	$5,302.58
Rate for Payer: University Health Alliance Commercial	$3,061.28

Plate Volt Straight 2.7mm 8h 84mm 02.527.008 [3645338]

Facility

$4,995.13

Service Code	HCPCS C1713
Hospital Charge Code	3645338
Hospital Revenue Code	278
Min. Negotiated Rate	$2,547.52
Max. Negotiated Rate	$4,845.28
Rate for Payer: Cash Price	$3,246.83
Rate for Payer: Hawaii Western Management Group Commercial	$3,496.59
Rate for Payer: Health Management Network Commercial	$4,245.86
Rate for Payer: Kaiser Permanente Commercial	$3,146.93
Rate for Payer: Kaiser Permanente Medicaid	$2,547.52
Rate for Payer: MDX Hawaii PPO	$4,845.28
Rate for Payer: University Health Alliance Commercial	$2,797.27

Plate Volt Straight 2.7mm 8h 84mm 02.527.008 [3645338]

Facility

$4,995.13

Service Code	HCPCS C1713
Hospital Charge Code	3645338
Hospital Revenue Code	278
Min. Negotiated Rate	$2,797.27
Max. Negotiated Rate	$4,845.28
Rate for Payer: Cash Price	$3,246.83
Rate for Payer: Hawaii Western Management Group Commercial	$3,496.59
Rate for Payer: Health Management Network Commercial	$4,245.86
Rate for Payer: MDX Hawaii PPO	$4,845.28
Rate for Payer: University Health Alliance Commercial	$2,797.27

Plate Volt VDR Std 2C 6H HD 3H 55mm Rt 02.426.630 [3645405]

Facility

$8,002.85

Service Code	HCPCS C1713
Hospital Charge Code	3645405
Hospital Revenue Code	278
Min. Negotiated Rate	$4,081.45
Max. Negotiated Rate	$7,762.76
Rate for Payer: Cash Price	$5,201.85
Rate for Payer: Hawaii Western Management Group Commercial	$5,601.99
Rate for Payer: Health Management Network Commercial	$6,802.42
Rate for Payer: Kaiser Permanente Commercial	$5,041.80
Rate for Payer: Kaiser Permanente Medicaid	$4,081.45
Rate for Payer: MDX Hawaii PPO	$7,762.76
Rate for Payer: University Health Alliance Commercial	$4,481.60

Plate Volt VDR Std 2C 6H HD 3H 55mm Rt 02.426.630 [3645405]

Facility

$8,002.85

Service Code	HCPCS C1713
Hospital Charge Code	3645405
Hospital Revenue Code	278
Min. Negotiated Rate	$4,481.60
Max. Negotiated Rate	$7,762.76
Rate for Payer: Cash Price	$5,201.85
Rate for Payer: Hawaii Western Management Group Commercial	$5,601.99
Rate for Payer: Health Management Network Commercial	$6,802.42
Rate for Payer: MDX Hawaii PPO	$7,762.76
Rate for Payer: University Health Alliance Commercial	$4,481.60

Plate Y 2.4mm 6 Hole AR-18724P-49 [3644587]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644587
Hospital Revenue Code	278
Min. Negotiated Rate	$3,131.66
Max. Negotiated Rate	$5,956.28
Rate for Payer: Cash Price	$3,991.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.35
Rate for Payer: Health Management Network Commercial	$5,219.43
Rate for Payer: Kaiser Permanente Commercial	$3,868.51
Rate for Payer: Kaiser Permanente Medicaid	$3,131.66
Rate for Payer: MDX Hawaii PPO	$5,956.28
Rate for Payer: University Health Alliance Commercial	$3,438.68

Plate Y 2.4mm 6 Hole AR-18724P-49 [3644587]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644587
Hospital Revenue Code	278
Min. Negotiated Rate	$3,438.68
Max. Negotiated Rate	$5,956.28
Rate for Payer: Cash Price	$3,991.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.35
Rate for Payer: Health Management Network Commercial	$5,219.43
Rate for Payer: MDX Hawaii PPO	$5,956.28
Rate for Payer: University Health Alliance Commercial	$3,438.68

PLEE60A Echelon Flex 60 Pwrd Cutter 44cm [3640190]

Facility

$6,173.75

Hospital Charge Code	3640190
Hospital Revenue Code	272
Min. Negotiated Rate	$3,148.61
Max. Negotiated Rate	$5,988.54
Rate for Payer: Cash Price	$4,012.94
Rate for Payer: Hawaii Western Management Group Commercial	$5,865.06
Rate for Payer: Health Management Network Commercial	$5,247.69
Rate for Payer: Kaiser Permanente Commercial	$3,889.46
Rate for Payer: Kaiser Permanente Medicaid	$3,148.61
Rate for Payer: MDX Hawaii PPO	$5,988.54
Rate for Payer: University Health Alliance Commercial	$4,500.05

PLEE60A Echelon Flex 60 Pwrd Cutter 44cm [3640190]

Facility

$6,173.75

Hospital Charge Code	3640190
Hospital Revenue Code	272
Min. Negotiated Rate	$5,247.69
Max. Negotiated Rate	$5,988.54
Rate for Payer: Cash Price	$4,012.94
Rate for Payer: Health Management Network Commercial	$5,247.69
Rate for Payer: MDX Hawaii PPO	$5,988.54

PLEURAL EFFUSION WITH CC

Facility

$28,036.44

Service Code	MSDRG 187
Min. Negotiated Rate	$13,009.40
Max. Negotiated Rate	$28,036.44
Rate for Payer: AlohaCare Medicare	$13,009.40
Rate for Payer: Devoted Health Medicare	$14,310.34
Rate for Payer: Hawaii Medical Service Association Commercial	$28,036.44
Rate for Payer: Hawaii Medical Service Association Medicare	$13,009.40
Rate for Payer: Humana Medicare	$13,009.40
Rate for Payer: Kaiser Permanente Commercial	$17,061.97
Rate for Payer: Kaiser Permanente Medicare	$13,009.40
Rate for Payer: Ohana Health Plan Medicare	$13,009.40
Rate for Payer: UnitedHealthcare Medicare	$13,009.40

PLEURAL EFFUSION WITH MCC

Facility

$28,687.33

Service Code	MSDRG 186
Min. Negotiated Rate	$20,498.58
Max. Negotiated Rate	$28,687.33
Rate for Payer: AlohaCare Medicare	$20,498.58
Rate for Payer: Devoted Health Medicare	$22,548.44
Rate for Payer: Hawaii Medical Service Association Commercial	$28,687.33
Rate for Payer: Hawaii Medical Service Association Medicare	$20,498.58
Rate for Payer: Humana Medicare	$20,498.58
Rate for Payer: Kaiser Permanente Commercial	$26,884.12
Rate for Payer: Kaiser Permanente Medicare	$20,498.58
Rate for Payer: Ohana Health Plan Medicare	$20,498.58
Rate for Payer: UnitedHealthcare Medicare	$20,498.58

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$22,901.65

Service Code	MSDRG 188
Min. Negotiated Rate	$9,433.17
Max. Negotiated Rate	$22,901.65
Rate for Payer: AlohaCare Medicare	$9,433.17
Rate for Payer: Devoted Health Medicare	$10,376.49
Rate for Payer: Hawaii Medical Service Association Commercial	$22,901.65
Rate for Payer: Hawaii Medical Service Association Medicare	$9,433.17
Rate for Payer: Humana Medicare	$9,433.17
Rate for Payer: Kaiser Permanente Commercial	$12,371.70
Rate for Payer: Kaiser Permanente Medicare	$9,433.17
Rate for Payer: Ohana Health Plan Medicare	$9,433.17
Rate for Payer: UnitedHealthcare Medicare	$9,433.17

PNEUMOC 15-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR

Facility

$737.98

Service Code	HCPCS 90671
Hospital Revenue Code	250
Min. Negotiated Rate	$253.56
Max. Negotiated Rate	$715.84
Rate for Payer: Cash Price	$479.69
Rate for Payer: Cash Price	$479.69
Rate for Payer: Hawaii Medical Service Association ABD	$253.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.56
Rate for Payer: Hawaii Western Management Group Commercial	$701.08
Rate for Payer: Health Management Network Commercial	$627.28
Rate for Payer: Kaiser Permanente Commercial	$464.93
Rate for Payer: Kaiser Permanente Medicaid	$376.37
Rate for Payer: MDX Hawaii PPO	$715.84
Rate for Payer: UnitedHealthcare Medicaid	$442.79
Rate for Payer: University Health Alliance Commercial	$537.91

PNEUMOC 15-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR

Facility

$737.98

Service Code	HCPCS 90671
Hospital Revenue Code	250
Min. Negotiated Rate	$627.28
Max. Negotiated Rate	$715.84
Rate for Payer: Cash Price	$479.69
Rate for Payer: Health Management Network Commercial	$627.28
Rate for Payer: MDX Hawaii PPO	$715.84

PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR

Facility

$808.52

Service Code	HCPCS 90677
Hospital Revenue Code	250
Min. Negotiated Rate	$687.24
Max. Negotiated Rate	$784.26
Rate for Payer: Cash Price	$525.54
Rate for Payer: Cash Price	$497.69
Rate for Payer: Health Management Network Commercial	$650.83
Rate for Payer: Health Management Network Commercial	$687.24
Rate for Payer: MDX Hawaii PPO	$742.71
Rate for Payer: MDX Hawaii PPO	$784.26

PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR

Facility

$765.68

Service Code	HCPCS 90677
Hospital Revenue Code	250
Min. Negotiated Rate	$298.04
Max. Negotiated Rate	$742.71
Rate for Payer: Cash Price	$497.69
Rate for Payer: Cash Price	$497.69
Rate for Payer: Cash Price	$525.54
Rate for Payer: Cash Price	$525.54
Rate for Payer: Hawaii Medical Service Association ABD	$298.04
Rate for Payer: Hawaii Medical Service Association ABD	$298.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$298.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$298.04
Rate for Payer: Hawaii Western Management Group Commercial	$727.40
Rate for Payer: Hawaii Western Management Group Commercial	$768.09
Rate for Payer: Health Management Network Commercial	$687.24
Rate for Payer: Health Management Network Commercial	$650.83
Rate for Payer: Kaiser Permanente Commercial	$509.37
Rate for Payer: Kaiser Permanente Commercial	$482.38
Rate for Payer: Kaiser Permanente Medicaid	$390.50
Rate for Payer: Kaiser Permanente Medicaid	$412.35
Rate for Payer: MDX Hawaii PPO	$784.26
Rate for Payer: MDX Hawaii PPO	$742.71
Rate for Payer: UnitedHealthcare Medicaid	$459.41
Rate for Payer: UnitedHealthcare Medicaid	$485.11
Rate for Payer: University Health Alliance Commercial	$589.33
Rate for Payer: University Health Alliance Commercial	$558.10

Pneumoclear Smoke Evac High-Flow Tube Set 0620050250 [3644398]

Facility

$346.13

Hospital Charge Code	3644398
Hospital Revenue Code	272
Min. Negotiated Rate	$176.53
Max. Negotiated Rate	$335.75
Rate for Payer: Cash Price	$224.98
Rate for Payer: Hawaii Western Management Group Commercial	$328.82
Rate for Payer: Health Management Network Commercial	$294.21
Rate for Payer: Kaiser Permanente Commercial	$218.06
Rate for Payer: Kaiser Permanente Medicaid	$176.53
Rate for Payer: MDX Hawaii PPO	$335.75
Rate for Payer: University Health Alliance Commercial	$252.29

Pneumoclear Smoke Evac High-Flow Tube Set 0620050250 [3644398]

Facility

$346.13

Hospital Charge Code	3644398
Hospital Revenue Code	272
Min. Negotiated Rate	$294.21
Max. Negotiated Rate	$335.75
Rate for Payer: Cash Price	$224.98
Rate for Payer: Health Management Network Commercial	$294.21
Rate for Payer: MDX Hawaii PPO	$335.75

PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYR

Facility

$483.07

Service Code	HCPCS 90732
Hospital Revenue Code	250
Min. Negotiated Rate	$410.61
Max. Negotiated Rate	$468.58
Rate for Payer: Cash Price	$314.00
Rate for Payer: Health Management Network Commercial	$410.61
Rate for Payer: MDX Hawaii PPO	$468.58

PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYR

Facility

$483.07

Service Code	HCPCS 90732
Hospital Revenue Code	250
Min. Negotiated Rate	$133.47
Max. Negotiated Rate	$468.58
Rate for Payer: Cash Price	$314.00
Rate for Payer: Cash Price	$314.00
Rate for Payer: Hawaii Medical Service Association ABD	$133.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$133.47
Rate for Payer: Hawaii Western Management Group Commercial	$458.92
Rate for Payer: Health Management Network Commercial	$410.61
Rate for Payer: Kaiser Permanente Commercial	$304.33
Rate for Payer: Kaiser Permanente Medicaid	$246.37
Rate for Payer: MDX Hawaii PPO	$468.58
Rate for Payer: UnitedHealthcare Medicaid	$289.84
Rate for Payer: University Health Alliance Commercial	$352.11

PNEUMOTHORAX WITH CC

Facility

$18,962.92

Service Code	MSDRG 200
Min. Negotiated Rate	$14,458.85
Max. Negotiated Rate	$18,962.92
Rate for Payer: AlohaCare Medicare	$14,458.85
Rate for Payer: Devoted Health Medicare	$15,904.74
Rate for Payer: Hawaii Medical Service Association Commercial	$17,670.43
Rate for Payer: Hawaii Medical Service Association Medicare	$14,458.85
Rate for Payer: Humana Medicare	$14,458.85
Rate for Payer: Kaiser Permanente Commercial	$18,962.92
Rate for Payer: Kaiser Permanente Medicare	$14,458.85
Rate for Payer: Ohana Health Plan Medicare	$14,458.85
Rate for Payer: UnitedHealthcare Medicare	$14,458.85

PNEUMOTHORAX WITH MCC

Facility

$30,430.72

Service Code	MSDRG 199
Min. Negotiated Rate	$18,634.71
Max. Negotiated Rate	$30,430.72
Rate for Payer: AlohaCare Medicare	$23,202.80
Rate for Payer: Devoted Health Medicare	$25,523.08
Rate for Payer: Hawaii Medical Service Association Commercial	$18,634.71
Rate for Payer: Hawaii Medical Service Association Medicare	$23,202.80
Rate for Payer: Humana Medicare	$23,202.80
Rate for Payer: Kaiser Permanente Commercial	$30,430.72
Rate for Payer: Kaiser Permanente Medicare	$23,202.80
Rate for Payer: Ohana Health Plan Medicare	$23,202.80
Rate for Payer: UnitedHealthcare Medicare	$23,202.80

Know your out-of-pocket cost for care.

All Charges