Kona Community Hospital

All Charges

Charge

Type

Setting

Price

DRESSING PETROLATUM 6 X 36 P-636 [2700733]

Facility

$8.33

Service Code	HCPCS A6224
Hospital Charge Code	2700733
Hospital Revenue Code	272
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$8.08
Rate for Payer: Cash Price	$5.41
Rate for Payer: Cash Price	$5.41
Rate for Payer: Hawaii Western Management Group Commercial	$7.91
Rate for Payer: Health Management Network Commercial	$7.08
Rate for Payer: Kaiser Permanente Commercial	$5.25
Rate for Payer: Kaiser Permanente Medicaid	$4.25
Rate for Payer: MDX Hawaii PPO	$8.08
Rate for Payer: UnitedHealthcare Medicaid	$3.78
Rate for Payer: University Health Alliance Commercial	$6.07

DRESSING PETROLATUM 6 X 36 P-636 [2700733]

Facility

$8.33

Service Code	HCPCS A6224
Hospital Charge Code	2700733
Hospital Revenue Code	272
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$8.08
Rate for Payer: Cash Price	$5.41
Rate for Payer: Health Management Network Commercial	$7.08
Rate for Payer: MDX Hawaii PPO	$8.08

DRESSING PETROLATUM XEROFORM 2X2 8884433400 [2700764]

Facility

$3.49

Hospital Charge Code	2700764
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$3.39
Rate for Payer: Cash Price	$2.27
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: MDX Hawaii PPO	$3.39

DRESSING PETROLATUM XEROFORM 2X2 8884433400 [2700764]

Facility

$3.49

Hospital Charge Code	2700764
Hospital Revenue Code	272
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$3.39
Rate for Payer: Cash Price	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$3.32
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: Kaiser Permanente Commercial	$2.20
Rate for Payer: Kaiser Permanente Medicaid	$1.78
Rate for Payer: MDX Hawaii PPO	$3.39
Rate for Payer: University Health Alliance Commercial	$2.54

DRESSING PETROLATUM XEROFORM 5X9 8884433605 [2700768]

Facility

$3.91

Hospital Charge Code	2700768
Hospital Revenue Code	272
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.79
Rate for Payer: Cash Price	$2.54
Rate for Payer: Health Management Network Commercial	$3.32
Rate for Payer: MDX Hawaii PPO	$3.79

DRESSING PETROLATUM XEROFORM 5X9 8884433605 [2700768]

Facility

$3.91

Hospital Charge Code	2700768
Hospital Revenue Code	272
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.79
Rate for Payer: Cash Price	$2.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.71
Rate for Payer: Health Management Network Commercial	$3.32
Rate for Payer: Kaiser Permanente Commercial	$2.46
Rate for Payer: Kaiser Permanente Medicaid	$1.99
Rate for Payer: MDX Hawaii PPO	$3.79
Rate for Payer: University Health Alliance Commercial	$2.85

Drill 1.0mm Manual 320-1210 [3643890]

Facility

$818.13

Hospital Charge Code	3643890
Hospital Revenue Code	272
Min. Negotiated Rate	$417.25
Max. Negotiated Rate	$793.59
Rate for Payer: Cash Price	$531.78
Rate for Payer: Hawaii Western Management Group Commercial	$777.22
Rate for Payer: Health Management Network Commercial	$695.41
Rate for Payer: Kaiser Permanente Commercial	$515.42
Rate for Payer: Kaiser Permanente Medicaid	$417.25
Rate for Payer: MDX Hawaii PPO	$793.59
Rate for Payer: University Health Alliance Commercial	$596.33

Drill 1.0mm Manual 320-1210 [3643890]

Facility

$818.13

Hospital Charge Code	3643890
Hospital Revenue Code	272
Min. Negotiated Rate	$695.41
Max. Negotiated Rate	$793.59
Rate for Payer: Cash Price	$531.78
Rate for Payer: Health Management Network Commercial	$695.41
Rate for Payer: MDX Hawaii PPO	$793.59

Drill 1.3mm Manual 320-1213 [3641777]

Facility

$1,171.23

Hospital Charge Code	3641777
Hospital Revenue Code	272
Min. Negotiated Rate	$995.55
Max. Negotiated Rate	$1,136.09
Rate for Payer: Cash Price	$761.30
Rate for Payer: Health Management Network Commercial	$995.55
Rate for Payer: MDX Hawaii PPO	$1,136.09

Drill 1.3mm Manual 320-1213 [3641777]

Facility

$1,171.23

Hospital Charge Code	3641777
Hospital Revenue Code	272
Min. Negotiated Rate	$597.33
Max. Negotiated Rate	$1,136.09
Rate for Payer: Cash Price	$761.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,112.67
Rate for Payer: Health Management Network Commercial	$995.55
Rate for Payer: Kaiser Permanente Commercial	$737.87
Rate for Payer: Kaiser Permanente Medicaid	$597.33
Rate for Payer: MDX Hawaii PPO	$1,136.09
Rate for Payer: University Health Alliance Commercial	$853.71

Drill 1.3mm Quick Release 320-1613 [3641739]

Facility

$1,171.23

Hospital Charge Code	3641739
Hospital Revenue Code	272
Min. Negotiated Rate	$597.33
Max. Negotiated Rate	$1,136.09
Rate for Payer: Cash Price	$761.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,112.67
Rate for Payer: Health Management Network Commercial	$995.55
Rate for Payer: Kaiser Permanente Commercial	$737.87
Rate for Payer: Kaiser Permanente Medicaid	$597.33
Rate for Payer: MDX Hawaii PPO	$1,136.09
Rate for Payer: University Health Alliance Commercial	$853.71

Drill 1.3mm Quick Release 320-1613 [3641739]

Facility

$1,171.23

Hospital Charge Code	3641739
Hospital Revenue Code	272
Min. Negotiated Rate	$995.55
Max. Negotiated Rate	$1,136.09
Rate for Payer: Cash Price	$761.30
Rate for Payer: Health Management Network Commercial	$995.55
Rate for Payer: MDX Hawaii PPO	$1,136.09

Drill 1.3 x 100mm Solid AO P99-100-1310 [3644494]

Facility

$1,455.04

Hospital Charge Code	3644494
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Drill 1.3 x 100mm Solid AO P99-100-1310 [3644494]

Facility

$1,455.04

Hospital Charge Code	3644494
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Drill 1.5mm Quick Release 320-1615 [3641848]

Facility

$762.34

Hospital Charge Code	3641848
Hospital Revenue Code	272
Min. Negotiated Rate	$388.79
Max. Negotiated Rate	$739.47
Rate for Payer: Cash Price	$495.52
Rate for Payer: Hawaii Western Management Group Commercial	$724.22
Rate for Payer: Health Management Network Commercial	$647.99
Rate for Payer: Kaiser Permanente Commercial	$480.27
Rate for Payer: Kaiser Permanente Medicaid	$388.79
Rate for Payer: MDX Hawaii PPO	$739.47
Rate for Payer: University Health Alliance Commercial	$555.67

Drill 1.5mm Quick Release 320-1615 [3641848]

Facility

$762.34

Hospital Charge Code	3641848
Hospital Revenue Code	272
Min. Negotiated Rate	$647.99
Max. Negotiated Rate	$739.47
Rate for Payer: Cash Price	$495.52
Rate for Payer: Health Management Network Commercial	$647.99
Rate for Payer: MDX Hawaii PPO	$739.47

Drill 1.6mm Quick Release 320-1616 [3641740]

Facility

$1,171.23

Hospital Charge Code	3641740
Hospital Revenue Code	272
Min. Negotiated Rate	$597.33
Max. Negotiated Rate	$1,136.09
Rate for Payer: Cash Price	$761.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,112.67
Rate for Payer: Health Management Network Commercial	$995.55
Rate for Payer: Kaiser Permanente Commercial	$737.87
Rate for Payer: Kaiser Permanente Medicaid	$597.33
Rate for Payer: MDX Hawaii PPO	$1,136.09
Rate for Payer: University Health Alliance Commercial	$853.71

Drill 1.6mm Quick Release 320-1616 [3641740]

Facility

$1,171.23

Hospital Charge Code	3641740
Hospital Revenue Code	272
Min. Negotiated Rate	$995.55
Max. Negotiated Rate	$1,136.09
Rate for Payer: Cash Price	$761.30
Rate for Payer: Health Management Network Commercial	$995.55
Rate for Payer: MDX Hawaii PPO	$1,136.09

Drill 1.6 x 110mm Solid AO P99-100-1611 [3644495]

Facility

$1,455.04

Hospital Charge Code	3644495
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Drill 1.6 x 110mm Solid AO P99-100-1611 [3644495]

Facility

$1,455.04

Hospital Charge Code	3644495
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Drill 1.7 x 120mm Cann AO P99-110-1712 [3644496]

Facility

$1,455.04

Hospital Charge Code	3644496
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Drill 1.7 x 120mm Cann AO P99-110-1712 [3644496]

Facility

$1,455.04

Hospital Charge Code	3644496
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Drill 2.0mm Quick Release 320-1620 [3642817]

Facility

$762.34

Hospital Charge Code	3642817
Hospital Revenue Code	272
Min. Negotiated Rate	$388.79
Max. Negotiated Rate	$739.47
Rate for Payer: Cash Price	$495.52
Rate for Payer: Hawaii Western Management Group Commercial	$724.22
Rate for Payer: Health Management Network Commercial	$647.99
Rate for Payer: Kaiser Permanente Commercial	$480.27
Rate for Payer: Kaiser Permanente Medicaid	$388.79
Rate for Payer: MDX Hawaii PPO	$739.47
Rate for Payer: University Health Alliance Commercial	$555.67

Drill 2.0mm Quick Release 320-1620 [3642817]

Facility

$762.34

Hospital Charge Code	3642817
Hospital Revenue Code	272
Min. Negotiated Rate	$647.99
Max. Negotiated Rate	$739.47
Rate for Payer: Cash Price	$495.52
Rate for Payer: Health Management Network Commercial	$647.99
Rate for Payer: MDX Hawaii PPO	$739.47

Drill 2.0 x 110mm Solid Measuring AO P99-100-2011 [3644543]

Facility

$1,455.04

Hospital Charge Code	3644543
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Know your out-of-pocket cost for care.

All Charges