Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Tube Levin 14fr [2702106]

Facility

$9.35

Hospital Charge Code	2702106
Hospital Revenue Code	272
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$9.07
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Management Network Commercial	$7.95
Rate for Payer: MDX Hawaii PPO	$9.07

Tube Levin 14fr [2702106]

Facility

$9.35

Hospital Charge Code	2702106
Hospital Revenue Code	272
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$9.07
Rate for Payer: Cash Price	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.88
Rate for Payer: Health Management Network Commercial	$7.95
Rate for Payer: Kaiser Permanente Commercial	$5.89
Rate for Payer: Kaiser Permanente Medicaid	$4.77
Rate for Payer: MDX Hawaii PPO	$9.07
Rate for Payer: University Health Alliance Commercial	$6.82

Tube Ng 8fr X 16 Inch [2702096]

Facility

$12.84

Hospital Charge Code	2702096
Hospital Revenue Code	272
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$12.45
Rate for Payer: Cash Price	$8.35
Rate for Payer: Health Management Network Commercial	$10.91
Rate for Payer: MDX Hawaii PPO	$12.45

Tube Ng 8fr X 16 Inch [2702096]

Facility

$12.84

Hospital Charge Code	2702096
Hospital Revenue Code	272
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$12.45
Rate for Payer: Cash Price	$8.35
Rate for Payer: Hawaii Western Management Group Commercial	$12.20
Rate for Payer: Health Management Network Commercial	$10.91
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: Kaiser Permanente Medicaid	$6.55
Rate for Payer: MDX Hawaii PPO	$12.45
Rate for Payer: University Health Alliance Commercial	$9.36

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$1,176.24

Service Code	NDC 49281075222
Hospital Revenue Code	250
Min. Negotiated Rate	$999.80
Max. Negotiated Rate	$1,140.95
Rate for Payer: Cash Price	$764.56
Rate for Payer: Health Management Network Commercial	$999.80
Rate for Payer: MDX Hawaii PPO	$1,140.95

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$480.28

Service Code	NDC 49281075221
Hospital Revenue Code	250
Min. Negotiated Rate	$244.94
Max. Negotiated Rate	$465.87
Rate for Payer: Cash Price	$312.18
Rate for Payer: Hawaii Western Management Group Commercial	$456.27
Rate for Payer: Health Management Network Commercial	$408.24
Rate for Payer: Kaiser Permanente Commercial	$302.58
Rate for Payer: Kaiser Permanente Medicaid	$244.94
Rate for Payer: MDX Hawaii PPO	$465.87
Rate for Payer: UnitedHealthcare Medicaid	$288.17
Rate for Payer: University Health Alliance Commercial	$350.08

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$1,176.24

Service Code	NDC 49281075222
Hospital Revenue Code	250
Min. Negotiated Rate	$599.88
Max. Negotiated Rate	$1,140.95
Rate for Payer: Cash Price	$764.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,117.43
Rate for Payer: Health Management Network Commercial	$999.80
Rate for Payer: Kaiser Permanente Commercial	$741.03
Rate for Payer: Kaiser Permanente Medicaid	$599.88
Rate for Payer: MDX Hawaii PPO	$1,140.95
Rate for Payer: UnitedHealthcare Medicaid	$705.74
Rate for Payer: University Health Alliance Commercial	$857.36

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$480.28

Service Code	NDC 42023010401
Hospital Revenue Code	250
Min. Negotiated Rate	$244.94
Max. Negotiated Rate	$465.87
Rate for Payer: Cash Price	$312.18
Rate for Payer: Hawaii Western Management Group Commercial	$456.27
Rate for Payer: Health Management Network Commercial	$408.24
Rate for Payer: Kaiser Permanente Commercial	$302.58
Rate for Payer: Kaiser Permanente Medicaid	$244.94
Rate for Payer: MDX Hawaii PPO	$465.87
Rate for Payer: UnitedHealthcare Medicaid	$288.17
Rate for Payer: University Health Alliance Commercial	$350.08

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$1,176.24

Service Code	NDC 42023010405
Hospital Revenue Code	250
Min. Negotiated Rate	$999.80
Max. Negotiated Rate	$1,140.95
Rate for Payer: Cash Price	$764.56
Rate for Payer: Health Management Network Commercial	$999.80
Rate for Payer: MDX Hawaii PPO	$1,140.95

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$1,176.24

Service Code	NDC 42023010405
Hospital Revenue Code	250
Min. Negotiated Rate	$599.88
Max. Negotiated Rate	$1,140.95
Rate for Payer: Cash Price	$764.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,117.43
Rate for Payer: Health Management Network Commercial	$999.80
Rate for Payer: Kaiser Permanente Commercial	$741.03
Rate for Payer: Kaiser Permanente Medicaid	$599.88
Rate for Payer: MDX Hawaii PPO	$1,140.95
Rate for Payer: UnitedHealthcare Medicaid	$705.74
Rate for Payer: University Health Alliance Commercial	$857.36

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$480.28

Service Code	NDC 42023010401
Hospital Revenue Code	250
Min. Negotiated Rate	$408.24
Max. Negotiated Rate	$465.87
Rate for Payer: Cash Price	$312.18
Rate for Payer: Health Management Network Commercial	$408.24
Rate for Payer: MDX Hawaii PPO	$465.87

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$480.28

Service Code	NDC 49281075221
Hospital Revenue Code	250
Min. Negotiated Rate	$408.24
Max. Negotiated Rate	$465.87
Rate for Payer: Cash Price	$312.18
Rate for Payer: Health Management Network Commercial	$408.24
Rate for Payer: MDX Hawaii PPO	$465.87

Tube Salem Sump 14fr [2702120]

Facility

$18.19

Hospital Charge Code	2702120
Hospital Revenue Code	272
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$17.64
Rate for Payer: Cash Price	$11.82
Rate for Payer: Hawaii Western Management Group Commercial	$17.28
Rate for Payer: Health Management Network Commercial	$15.46
Rate for Payer: Kaiser Permanente Commercial	$11.46
Rate for Payer: Kaiser Permanente Medicaid	$9.28
Rate for Payer: MDX Hawaii PPO	$17.64
Rate for Payer: University Health Alliance Commercial	$13.26

Tube Salem Sump 14fr [2702120]

Facility

$18.19

Hospital Charge Code	2702120
Hospital Revenue Code	272
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$17.64
Rate for Payer: Cash Price	$11.82
Rate for Payer: Health Management Network Commercial	$15.46
Rate for Payer: MDX Hawaii PPO	$17.64

Tube Tracheal Cuffed 7.0 [2702069]

Facility

$13.18

Hospital Charge Code	2702069
Hospital Revenue Code	272
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$12.78
Rate for Payer: Cash Price	$8.57
Rate for Payer: Health Management Network Commercial	$11.20
Rate for Payer: MDX Hawaii PPO	$12.78

Tube Tracheal Cuffed 7.0 [2702069]

Facility

$13.18

Hospital Charge Code	2702069
Hospital Revenue Code	272
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$12.78
Rate for Payer: Cash Price	$8.57
Rate for Payer: Hawaii Western Management Group Commercial	$12.52
Rate for Payer: Health Management Network Commercial	$11.20
Rate for Payer: Kaiser Permanente Commercial	$8.30
Rate for Payer: Kaiser Permanente Medicaid	$6.72
Rate for Payer: MDX Hawaii PPO	$12.78
Rate for Payer: University Health Alliance Commercial	$9.61

Tube Tracheal Uncuffed 2.5 [2702075]

Facility

$8.76

Hospital Charge Code	2702075
Hospital Revenue Code	272
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$5.69
Rate for Payer: Hawaii Western Management Group Commercial	$8.32
Rate for Payer: Health Management Network Commercial	$7.45
Rate for Payer: Kaiser Permanente Commercial	$5.52
Rate for Payer: Kaiser Permanente Medicaid	$4.47
Rate for Payer: MDX Hawaii PPO	$8.50
Rate for Payer: University Health Alliance Commercial	$6.39

Tube Tracheal Uncuffed 2.5 [2702075]

Facility

$8.76

Hospital Charge Code	2702075
Hospital Revenue Code	272
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$5.69
Rate for Payer: Health Management Network Commercial	$7.45
Rate for Payer: MDX Hawaii PPO	$8.50

TUBE TRACH EXTENDED 7.0 CUFFED XLT [2702969]

Facility

$549.86

Hospital Charge Code	2702969
Hospital Revenue Code	272
Min. Negotiated Rate	$280.43
Max. Negotiated Rate	$533.36
Rate for Payer: Cash Price	$357.41
Rate for Payer: Hawaii Western Management Group Commercial	$522.37
Rate for Payer: Health Management Network Commercial	$467.38
Rate for Payer: Kaiser Permanente Commercial	$346.41
Rate for Payer: Kaiser Permanente Medicaid	$280.43
Rate for Payer: MDX Hawaii PPO	$533.36
Rate for Payer: University Health Alliance Commercial	$400.79

TUBE TRACH EXTENDED 7.0 CUFFED XLT [2702969]

Facility

$549.86

Hospital Charge Code	2702969
Hospital Revenue Code	272
Min. Negotiated Rate	$467.38
Max. Negotiated Rate	$533.36
Rate for Payer: Cash Price	$357.41
Rate for Payer: Health Management Network Commercial	$467.38
Rate for Payer: MDX Hawaii PPO	$533.36

TUBE TRACH EXTENDED 8.0 CUFFED XLT [2702971]

Facility

$549.86

Hospital Charge Code	2702971
Hospital Revenue Code	272
Min. Negotiated Rate	$280.43
Max. Negotiated Rate	$533.36
Rate for Payer: Cash Price	$357.41
Rate for Payer: Hawaii Western Management Group Commercial	$522.37
Rate for Payer: Health Management Network Commercial	$467.38
Rate for Payer: Kaiser Permanente Commercial	$346.41
Rate for Payer: Kaiser Permanente Medicaid	$280.43
Rate for Payer: MDX Hawaii PPO	$533.36
Rate for Payer: University Health Alliance Commercial	$400.79

TUBE TRACH EXTENDED 8.0 CUFFED XLT [2702971]

Facility

$549.86

Hospital Charge Code	2702971
Hospital Revenue Code	272
Min. Negotiated Rate	$467.38
Max. Negotiated Rate	$533.36
Rate for Payer: Cash Price	$357.41
Rate for Payer: Health Management Network Commercial	$467.38
Rate for Payer: MDX Hawaii PPO	$533.36

TUBE TRACH SHILEY #6 6CN75H [2702444]

Facility

$434.29

Hospital Charge Code	2702444
Hospital Revenue Code	272
Min. Negotiated Rate	$369.15
Max. Negotiated Rate	$421.26
Rate for Payer: Cash Price	$282.29
Rate for Payer: Health Management Network Commercial	$369.15
Rate for Payer: MDX Hawaii PPO	$421.26

TUBE TRACH SHILEY #6 6CN75H [2702444]

Facility

$434.29

Hospital Charge Code	2702444
Hospital Revenue Code	272
Min. Negotiated Rate	$221.49
Max. Negotiated Rate	$421.26
Rate for Payer: Cash Price	$282.29
Rate for Payer: Hawaii Western Management Group Commercial	$412.58
Rate for Payer: Health Management Network Commercial	$369.15
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: Kaiser Permanente Medicaid	$221.49
Rate for Payer: MDX Hawaii PPO	$421.26
Rate for Payer: University Health Alliance Commercial	$316.55

Tube Trach Shiley 6 Cfn [2702259]

Facility

$377.08

Service Code	HCPCS A7521
Hospital Charge Code	2702259
Hospital Revenue Code	272
Min. Negotiated Rate	$320.52
Max. Negotiated Rate	$365.77
Rate for Payer: Cash Price	$245.10
Rate for Payer: Health Management Network Commercial	$320.52
Rate for Payer: MDX Hawaii PPO	$365.77

Know your out-of-pocket cost for care.

All Charges