Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Thoracic Catheter Sharp Tip 28Fr 8888561068 [2700272]

Facility

$158.00

Service Code	HCPCS C1729
Hospital Charge Code	2700272
Hospital Revenue Code	272
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: MDX Hawaii PPO	$153.26

Thoracic Catheter Sharp Tip 28Fr 8888561068 [2700272]

Facility

$158.00

Service Code	HCPCS C1729
Hospital Charge Code	2700272
Hospital Revenue Code	272
Min. Negotiated Rate	$80.58
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$150.10
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$99.54
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$115.17

Three-Way Multipurpose Adapter G13070 [3642782]

Facility

$342.75

Hospital Charge Code	3642782
Hospital Revenue Code	272
Min. Negotiated Rate	$291.34
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: MDX Hawaii PPO	$332.47

Three-Way Multipurpose Adapter G13070 [3642782]

Facility

$342.75

Hospital Charge Code	3642782
Hospital Revenue Code	272
Min. Negotiated Rate	$174.80
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Hawaii Western Management Group Commercial	$325.61
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: Kaiser Permanente Commercial	$215.93
Rate for Payer: Kaiser Permanente Medicaid	$174.80
Rate for Payer: MDX Hawaii PPO	$332.47
Rate for Payer: University Health Alliance Commercial	$249.83

THROMBIN (RECOMBINANT) 5000 UNIT TOP RECON.SOLN.

Facility

$396.82

Service Code	NDC 00338032401
Hospital Revenue Code	250
Min. Negotiated Rate	$202.38
Max. Negotiated Rate	$384.92
Rate for Payer: Cash Price	$257.93
Rate for Payer: Hawaii Western Management Group Commercial	$376.98
Rate for Payer: Health Management Network Commercial	$337.30
Rate for Payer: Kaiser Permanente Commercial	$250.00
Rate for Payer: Kaiser Permanente Medicaid	$202.38
Rate for Payer: MDX Hawaii PPO	$384.92
Rate for Payer: UnitedHealthcare Medicaid	$238.09
Rate for Payer: University Health Alliance Commercial	$289.24

THROMBIN (RECOMBINANT) 5000 UNIT TOP RECON.SOLN.

Facility

$396.82

Service Code	NDC 00338032201
Hospital Revenue Code	250
Min. Negotiated Rate	$202.38
Max. Negotiated Rate	$384.92
Rate for Payer: Cash Price	$257.93
Rate for Payer: Hawaii Western Management Group Commercial	$376.98
Rate for Payer: Health Management Network Commercial	$337.30
Rate for Payer: Kaiser Permanente Commercial	$250.00
Rate for Payer: Kaiser Permanente Medicaid	$202.38
Rate for Payer: MDX Hawaii PPO	$384.92
Rate for Payer: UnitedHealthcare Medicaid	$238.09
Rate for Payer: University Health Alliance Commercial	$289.24

THROMBIN (RECOMBINANT) 5000 UNIT TOP RECON.SOLN.

Facility

$396.82

Service Code	NDC 00338032401
Hospital Revenue Code	250
Min. Negotiated Rate	$337.30
Max. Negotiated Rate	$384.92
Rate for Payer: Cash Price	$257.93
Rate for Payer: Health Management Network Commercial	$337.30
Rate for Payer: MDX Hawaii PPO	$384.92

THROMBIN (RECOMBINANT) 5000 UNIT TOP RECON.SOLN.

Facility

$396.82

Service Code	NDC 00338032201
Hospital Revenue Code	250
Min. Negotiated Rate	$337.30
Max. Negotiated Rate	$384.92
Rate for Payer: Cash Price	$257.93
Rate for Payer: Health Management Network Commercial	$337.30
Rate for Payer: MDX Hawaii PPO	$384.92

Th Taperloc Com Mp T1 Pps So 12 x 109mm 51-106120 [3644070]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644070
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Th Taperloc Com Mp T1 Pps So 12 x 109mm 51-106120 [3644070]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644070
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Th Taperloc Com Mp T1 Pps So 4x93mm 51-108040 [3645469]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3645469
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Th Taperloc Com Mp T1 Pps So 4x93mm 51-108040 [3645469]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3645469
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Th Taperloc Com Mp T1 Pps So 7 x 99mm 51-108070 [3644033]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3644033
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Th Taperloc Com Mp T1 Pps So 7 x 99mm 51-108070 [3644033]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3644033
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Th Taperloc Com Red Dis Stem Sz 14x113mm [3643669]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643669
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Th Taperloc Com Red Dis Stem Sz 14x113mm [3643669]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643669
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Th Vivacit E Dm Bearing 28x50mm [3643414]

Facility

$3,050.00

Service Code	HCPCS C1776
Hospital Charge Code	3643414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,555.50
Max. Negotiated Rate	$2,958.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,135.00
Rate for Payer: Health Management Network Commercial	$2,592.50
Rate for Payer: Kaiser Permanente Commercial	$1,921.50
Rate for Payer: Kaiser Permanente Medicaid	$1,555.50
Rate for Payer: MDX Hawaii PPO	$2,958.50
Rate for Payer: University Health Alliance Commercial	$1,708.00

Th Vivacit E Dm Bearing 28x50mm [3643414]

Facility

$3,050.00

Service Code	HCPCS C1776
Hospital Charge Code	3643414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,708.00
Max. Negotiated Rate	$2,958.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,135.00
Rate for Payer: Health Management Network Commercial	$2,592.50
Rate for Payer: MDX Hawaii PPO	$2,958.50
Rate for Payer: University Health Alliance Commercial	$1,708.00

Th Vivacit E Dm Bearing 28x54mm 110031017 [3643846]

Facility

$5,353.00

Service Code	HCPCS C1776
Hospital Charge Code	3643846
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.68
Max. Negotiated Rate	$5,192.41
Rate for Payer: Cash Price	$3,479.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,747.10
Rate for Payer: Health Management Network Commercial	$4,550.05
Rate for Payer: MDX Hawaii PPO	$5,192.41
Rate for Payer: University Health Alliance Commercial	$2,997.68

Th Vivacit E Dm Bearing 28x54mm 110031017 [3643846]

Facility

$5,353.00

Service Code	HCPCS C1776
Hospital Charge Code	3643846
Hospital Revenue Code	278
Min. Negotiated Rate	$2,730.03
Max. Negotiated Rate	$5,192.41
Rate for Payer: Cash Price	$3,479.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,747.10
Rate for Payer: Health Management Network Commercial	$4,550.05
Rate for Payer: Kaiser Permanente Commercial	$3,372.39
Rate for Payer: Kaiser Permanente Medicaid	$2,730.03
Rate for Payer: MDX Hawaii PPO	$5,192.41
Rate for Payer: University Health Alliance Commercial	$2,997.68

THYROID DISORDERS

Facility

$2,477.16

Service Code	APR-DRG 4271
Min. Negotiated Rate	$2,477.16
Max. Negotiated Rate	$2,477.16
Rate for Payer: AlohaCare Medicaid	$2,477.16
Rate for Payer: Hawaii Medical Service Association ABD	$2,477.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,477.16
Rate for Payer: Kaiser Permanente Medicaid	$2,477.16
Rate for Payer: Ohana Health Plan Medicaid	$2,477.16
Rate for Payer: UnitedHealthcare Medicaid	$2,477.16

THYROID DISORDERS

Facility

$5,030.74

Service Code	APR-DRG 4273
Min. Negotiated Rate	$5,030.74
Max. Negotiated Rate	$5,030.74
Rate for Payer: AlohaCare Medicaid	$5,030.74
Rate for Payer: Hawaii Medical Service Association ABD	$5,030.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,030.74
Rate for Payer: Kaiser Permanente Medicaid	$5,030.74
Rate for Payer: Ohana Health Plan Medicaid	$5,030.74
Rate for Payer: UnitedHealthcare Medicaid	$5,030.74

THYROID DISORDERS

Facility

$9,374.38

Service Code	APR-DRG 4274
Min. Negotiated Rate	$9,374.38
Max. Negotiated Rate	$9,374.38
Rate for Payer: AlohaCare Medicaid	$9,374.38
Rate for Payer: Hawaii Medical Service Association ABD	$9,374.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,374.38
Rate for Payer: Kaiser Permanente Medicaid	$9,374.38
Rate for Payer: Ohana Health Plan Medicaid	$9,374.38
Rate for Payer: UnitedHealthcare Medicaid	$9,374.38

THYROID DISORDERS

Facility

$3,382.70

Service Code	APR-DRG 4272
Min. Negotiated Rate	$3,382.70
Max. Negotiated Rate	$3,382.70
Rate for Payer: AlohaCare Medicaid	$3,382.70
Rate for Payer: Hawaii Medical Service Association ABD	$3,382.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,382.70
Rate for Payer: Kaiser Permanente Medicaid	$3,382.70
Rate for Payer: Ohana Health Plan Medicaid	$3,382.70
Rate for Payer: UnitedHealthcare Medicaid	$3,382.70

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$25,864.65

Service Code	MSDRG 626
Min. Negotiated Rate	$19,721.26
Max. Negotiated Rate	$25,864.65
Rate for Payer: AlohaCare Medicare	$19,721.26
Rate for Payer: Devoted Health Medicare	$21,693.39
Rate for Payer: Hawaii Medical Service Association Commercial	$21,407.02
Rate for Payer: Hawaii Medical Service Association Medicare	$19,721.26
Rate for Payer: Humana Medicare	$19,721.26
Rate for Payer: Kaiser Permanente Commercial	$25,864.65
Rate for Payer: Kaiser Permanente Medicare	$19,721.26
Rate for Payer: Ohana Health Plan Medicare	$19,721.26
Rate for Payer: UnitedHealthcare Medicare	$19,721.26

Know your out-of-pocket cost for care.

All Charges