Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CAST ORTHO GLASS 2 INCH/FOOT [2707092]

Facility

$280.25

Hospital Charge Code	2707092
Hospital Revenue Code	272
Min. Negotiated Rate	$142.93
Max. Negotiated Rate	$271.84
Rate for Payer: Cash Price	$182.16
Rate for Payer: Hawaii Western Management Group Commercial	$266.24
Rate for Payer: Health Management Network Commercial	$238.21
Rate for Payer: Kaiser Permanente Commercial	$176.56
Rate for Payer: Kaiser Permanente Medicaid	$142.93
Rate for Payer: MDX Hawaii PPO	$271.84
Rate for Payer: University Health Alliance Commercial	$204.27

CAST ORTHO GLASS 3 INCH/FOOT [2707093]

Facility

$389.96

Hospital Charge Code	2707093
Hospital Revenue Code	272
Min. Negotiated Rate	$331.47
Max. Negotiated Rate	$378.26
Rate for Payer: Cash Price	$253.47
Rate for Payer: Health Management Network Commercial	$331.47
Rate for Payer: MDX Hawaii PPO	$378.26

CAST ORTHO GLASS 3 INCH/FOOT [2707093]

Facility

$389.96

Hospital Charge Code	2707093
Hospital Revenue Code	272
Min. Negotiated Rate	$198.88
Max. Negotiated Rate	$378.26
Rate for Payer: Cash Price	$253.47
Rate for Payer: Hawaii Western Management Group Commercial	$370.46
Rate for Payer: Health Management Network Commercial	$331.47
Rate for Payer: Kaiser Permanente Commercial	$245.67
Rate for Payer: Kaiser Permanente Medicaid	$198.88
Rate for Payer: MDX Hawaii PPO	$378.26
Rate for Payer: University Health Alliance Commercial	$284.24

CAST ORTHO GLASS 4 INCH/FOOT [2707094]

Facility

$450.10

Hospital Charge Code	2707094
Hospital Revenue Code	272
Min. Negotiated Rate	$382.58
Max. Negotiated Rate	$436.60
Rate for Payer: Cash Price	$292.56
Rate for Payer: Health Management Network Commercial	$382.58
Rate for Payer: MDX Hawaii PPO	$436.60

CAST ORTHO GLASS 4 INCH/FOOT [2707094]

Facility

$450.10

Hospital Charge Code	2707094
Hospital Revenue Code	272
Min. Negotiated Rate	$229.55
Max. Negotiated Rate	$436.60
Rate for Payer: Cash Price	$292.56
Rate for Payer: Hawaii Western Management Group Commercial	$427.60
Rate for Payer: Health Management Network Commercial	$382.58
Rate for Payer: Kaiser Permanente Commercial	$283.56
Rate for Payer: Kaiser Permanente Medicaid	$229.55
Rate for Payer: MDX Hawaii PPO	$436.60
Rate for Payer: University Health Alliance Commercial	$328.08

CAST ORTHO GLASS 5 INCH/FOOT [2707095]

Facility

$517.03

Hospital Charge Code	2707095
Hospital Revenue Code	272
Min. Negotiated Rate	$439.48
Max. Negotiated Rate	$501.52
Rate for Payer: Cash Price	$336.07
Rate for Payer: Health Management Network Commercial	$439.48
Rate for Payer: MDX Hawaii PPO	$501.52

CAST ORTHO GLASS 5 INCH/FOOT [2707095]

Facility

$517.03

Hospital Charge Code	2707095
Hospital Revenue Code	272
Min. Negotiated Rate	$263.69
Max. Negotiated Rate	$501.52
Rate for Payer: Cash Price	$336.07
Rate for Payer: Hawaii Western Management Group Commercial	$491.18
Rate for Payer: Health Management Network Commercial	$439.48
Rate for Payer: Kaiser Permanente Commercial	$325.73
Rate for Payer: Kaiser Permanente Medicaid	$263.69
Rate for Payer: MDX Hawaii PPO	$501.52
Rate for Payer: University Health Alliance Commercial	$376.86

Cast Shoe Darco X-Large [2702227]

Facility

$90.36

Service Code	HCPCS L3260
Hospital Charge Code	2702227
Hospital Revenue Code	274
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$87.65
Rate for Payer: Cash Price	$58.73
Rate for Payer: Cash Price	$58.73
Rate for Payer: Hawaii Western Management Group Commercial	$63.25
Rate for Payer: Health Management Network Commercial	$76.81
Rate for Payer: Kaiser Permanente Commercial	$56.93
Rate for Payer: Kaiser Permanente Medicaid	$46.08
Rate for Payer: MDX Hawaii PPO	$87.65
Rate for Payer: UnitedHealthcare Medicaid	$2.28
Rate for Payer: University Health Alliance Commercial	$50.60

Cast Shoe Darco X-Large [2702227]

Facility

$90.36

Service Code	HCPCS L3260
Hospital Charge Code	2702227
Hospital Revenue Code	274
Min. Negotiated Rate	$50.60
Max. Negotiated Rate	$87.65
Rate for Payer: Cash Price	$58.73
Rate for Payer: Hawaii Western Management Group Commercial	$63.25
Rate for Payer: Health Management Network Commercial	$76.81
Rate for Payer: MDX Hawaii PPO	$87.65
Rate for Payer: University Health Alliance Commercial	$50.60

Cath Art Embo 3Frx40Cm 120403F Fogarty [3600455]

Facility

$390.88

Service Code	HCPCS C1757
Hospital Charge Code	3600455
Hospital Revenue Code	272
Min. Negotiated Rate	$199.35
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Hawaii Western Management Group Commercial	$371.34
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: Kaiser Permanente Commercial	$246.25
Rate for Payer: Kaiser Permanente Medicaid	$199.35
Rate for Payer: MDX Hawaii PPO	$379.15
Rate for Payer: University Health Alliance Commercial	$284.91

Cath Art Embo 3Frx40Cm 120403F Fogarty [3600455]

Facility

$390.88

Service Code	HCPCS C1757
Hospital Charge Code	3600455
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: MDX Hawaii PPO	$379.15

Cath Art Embo 3Frx80Cm 120803F Fogarty [3600450]

Facility

$387.89

Service Code	HCPCS C1757
Hospital Charge Code	3600450
Hospital Revenue Code	272
Min. Negotiated Rate	$197.82
Max. Negotiated Rate	$376.25
Rate for Payer: Cash Price	$252.13
Rate for Payer: Hawaii Western Management Group Commercial	$368.50
Rate for Payer: Health Management Network Commercial	$329.71
Rate for Payer: Kaiser Permanente Commercial	$244.37
Rate for Payer: Kaiser Permanente Medicaid	$197.82
Rate for Payer: MDX Hawaii PPO	$376.25
Rate for Payer: University Health Alliance Commercial	$282.73

Cath Art Embo 3Frx80Cm 120803F Fogarty [3600450]

Facility

$387.89

Service Code	HCPCS C1757
Hospital Charge Code	3600450
Hospital Revenue Code	272
Min. Negotiated Rate	$329.71
Max. Negotiated Rate	$376.25
Rate for Payer: Cash Price	$252.13
Rate for Payer: Health Management Network Commercial	$329.71
Rate for Payer: MDX Hawaii PPO	$376.25

Cath Art Embo 4Frx40cm 120404F Fogarty [3600456]

Facility

$390.88

Service Code	HCPCS C1757
Hospital Charge Code	3600456
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: MDX Hawaii PPO	$379.15

Cath Art Embo 4Frx40cm 120404F Fogarty [3600456]

Facility

$390.88

Service Code	HCPCS C1757
Hospital Charge Code	3600456
Hospital Revenue Code	272
Min. Negotiated Rate	$199.35
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Hawaii Western Management Group Commercial	$371.34
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: Kaiser Permanente Commercial	$246.25
Rate for Payer: Kaiser Permanente Medicaid	$199.35
Rate for Payer: MDX Hawaii PPO	$379.15
Rate for Payer: University Health Alliance Commercial	$284.91

Cath Art Embo 4Frx80Cm 120804F Fogarty [3600451]

Facility

$387.89

Service Code	HCPCS C1757
Hospital Charge Code	3600451
Hospital Revenue Code	272
Min. Negotiated Rate	$329.71
Max. Negotiated Rate	$376.25
Rate for Payer: Cash Price	$252.13
Rate for Payer: Health Management Network Commercial	$329.71
Rate for Payer: MDX Hawaii PPO	$376.25

Cath Art Embo 4Frx80Cm 120804F Fogarty [3600451]

Facility

$387.89

Service Code	HCPCS C1757
Hospital Charge Code	3600451
Hospital Revenue Code	272
Min. Negotiated Rate	$197.82
Max. Negotiated Rate	$376.25
Rate for Payer: Cash Price	$252.13
Rate for Payer: Hawaii Western Management Group Commercial	$368.50
Rate for Payer: Health Management Network Commercial	$329.71
Rate for Payer: Kaiser Permanente Commercial	$244.37
Rate for Payer: Kaiser Permanente Medicaid	$197.82
Rate for Payer: MDX Hawaii PPO	$376.25
Rate for Payer: University Health Alliance Commercial	$282.73

Cath Art Embo 5Frx80Cm 120805F Fogarty [3600452]

Facility

$390.88

Service Code	HCPCS C1757
Hospital Charge Code	3600452
Hospital Revenue Code	272
Min. Negotiated Rate	$199.35
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Hawaii Western Management Group Commercial	$371.34
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: Kaiser Permanente Commercial	$246.25
Rate for Payer: Kaiser Permanente Medicaid	$199.35
Rate for Payer: MDX Hawaii PPO	$379.15
Rate for Payer: University Health Alliance Commercial	$284.91

Cath Art Embo 5Frx80Cm 120805F Fogarty [3600452]

Facility

$390.88

Service Code	HCPCS C1757
Hospital Charge Code	3600452
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: MDX Hawaii PPO	$379.15

Cath BD PleurX Pleural Kit 507000B [3641993]

Facility

$5,195.40

Service Code	HCPCS C1729
Hospital Charge Code	3641993
Hospital Revenue Code	272
Min. Negotiated Rate	$4,416.09
Max. Negotiated Rate	$5,039.54
Rate for Payer: Cash Price	$3,377.01
Rate for Payer: Health Management Network Commercial	$4,416.09
Rate for Payer: MDX Hawaii PPO	$5,039.54

Cath BD PleurX Pleural Kit 507000B [3641993]

Facility

$5,195.40

Service Code	HCPCS C1729
Hospital Charge Code	3641993
Hospital Revenue Code	272
Min. Negotiated Rate	$2,649.65
Max. Negotiated Rate	$5,039.54
Rate for Payer: Cash Price	$3,377.01
Rate for Payer: Hawaii Western Management Group Commercial	$4,935.63
Rate for Payer: Health Management Network Commercial	$4,416.09
Rate for Payer: Kaiser Permanente Commercial	$3,273.10
Rate for Payer: Kaiser Permanente Medicaid	$2,649.65
Rate for Payer: MDX Hawaii PPO	$5,039.54
Rate for Payer: University Health Alliance Commercial	$3,786.93

CATHETER ABDOMINAL PRESSURE MONITOR [2702462]

Facility

$361.67

Hospital Charge Code	2702462
Hospital Revenue Code	272
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$350.82
Rate for Payer: Cash Price	$235.09
Rate for Payer: Hawaii Western Management Group Commercial	$343.59
Rate for Payer: Health Management Network Commercial	$307.42
Rate for Payer: Kaiser Permanente Commercial	$227.85
Rate for Payer: Kaiser Permanente Medicaid	$184.45
Rate for Payer: MDX Hawaii PPO	$350.82
Rate for Payer: University Health Alliance Commercial	$263.62

CATHETER ABDOMINAL PRESSURE MONITOR [2702462]

Facility

$361.67

Hospital Charge Code	2702462
Hospital Revenue Code	272
Min. Negotiated Rate	$307.42
Max. Negotiated Rate	$350.82
Rate for Payer: Cash Price	$235.09
Rate for Payer: Health Management Network Commercial	$307.42
Rate for Payer: MDX Hawaii PPO	$350.82

CATHETER BARTHOLIN 10FR [2702287]

Facility

$217.07

Hospital Charge Code	2702287
Hospital Revenue Code	272
Min. Negotiated Rate	$110.71
Max. Negotiated Rate	$210.56
Rate for Payer: Kaiser Permanente Commercial	$136.75
Rate for Payer: Cash Price	$141.10
Rate for Payer: Hawaii Western Management Group Commercial	$206.22
Rate for Payer: Health Management Network Commercial	$184.51
Rate for Payer: Kaiser Permanente Medicaid	$110.71
Rate for Payer: MDX Hawaii PPO	$210.56
Rate for Payer: University Health Alliance Commercial	$158.22

CATHETER BARTHOLIN 10FR [2702287]

Facility

$217.07

Hospital Charge Code	2702287
Hospital Revenue Code	272
Min. Negotiated Rate	$184.51
Max. Negotiated Rate	$210.56
Rate for Payer: Cash Price	$141.10
Rate for Payer: Health Management Network Commercial	$184.51
Rate for Payer: MDX Hawaii PPO	$210.56

Know your out-of-pocket cost for care.

All Charges