Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Fiber Stick # 2 Fiberwire # 2 AR7209 [3621621]

Facility

$569.13

Service Code	HCPCS C1713
Hospital Charge Code	3621621
Hospital Revenue Code	278
Min. Negotiated Rate	$290.26
Max. Negotiated Rate	$552.06
Rate for Payer: Cash Price	$369.93
Rate for Payer: Hawaii Western Management Group Commercial	$398.39
Rate for Payer: Health Management Network Commercial	$483.76
Rate for Payer: Kaiser Permanente Commercial	$358.55
Rate for Payer: Kaiser Permanente Medicaid	$290.26
Rate for Payer: MDX Hawaii PPO	$552.06
Rate for Payer: University Health Alliance Commercial	$318.71

Fiber Stick # 2 Fiberwire # 2 AR7209 [3621621]

Facility

$569.13

Service Code	HCPCS C1713
Hospital Charge Code	3621621
Hospital Revenue Code	278
Min. Negotiated Rate	$318.71
Max. Negotiated Rate	$552.06
Rate for Payer: Cash Price	$369.93
Rate for Payer: Hawaii Western Management Group Commercial	$398.39
Rate for Payer: Health Management Network Commercial	$483.76
Rate for Payer: MDX Hawaii PPO	$552.06
Rate for Payer: University Health Alliance Commercial	$318.71

Fiberstitch Implant Curved 1.5 AR-19032C [3644858]

Facility

$4,629.50

Service Code	HCPCS C1713
Hospital Charge Code	3644858
Hospital Revenue Code	278
Min. Negotiated Rate	$2,361.05
Max. Negotiated Rate	$4,490.61
Rate for Payer: Cash Price	$3,009.18
Rate for Payer: Hawaii Western Management Group Commercial	$3,240.65
Rate for Payer: Health Management Network Commercial	$3,935.07
Rate for Payer: Kaiser Permanente Commercial	$2,916.59
Rate for Payer: Kaiser Permanente Medicaid	$2,361.05
Rate for Payer: MDX Hawaii PPO	$4,490.61
Rate for Payer: University Health Alliance Commercial	$2,592.52

Fiberstitch Implant Curved 1.5 AR-19032C [3644858]

Facility

$4,629.50

Service Code	HCPCS C1713
Hospital Charge Code	3644858
Hospital Revenue Code	278
Min. Negotiated Rate	$2,592.52
Max. Negotiated Rate	$4,490.61
Rate for Payer: Cash Price	$3,009.18
Rate for Payer: Hawaii Western Management Group Commercial	$3,240.65
Rate for Payer: Health Management Network Commercial	$3,935.07
Rate for Payer: MDX Hawaii PPO	$4,490.61
Rate for Payer: University Health Alliance Commercial	$2,592.52

Fiberstitch Implant Curved 1.5 AR-4580 [3644557]

Facility

$4,629.50

Service Code	HCPCS C1713
Hospital Charge Code	3644557
Hospital Revenue Code	278
Min. Negotiated Rate	$2,361.05
Max. Negotiated Rate	$4,490.61
Rate for Payer: Cash Price	$3,009.18
Rate for Payer: Hawaii Western Management Group Commercial	$3,240.65
Rate for Payer: Health Management Network Commercial	$3,935.07
Rate for Payer: Kaiser Permanente Commercial	$2,916.59
Rate for Payer: Kaiser Permanente Medicaid	$2,361.05
Rate for Payer: MDX Hawaii PPO	$4,490.61
Rate for Payer: University Health Alliance Commercial	$2,592.52

Fiberstitch Implant Curved 1.5 AR-4580 [3644557]

Facility

$4,629.50

Service Code	HCPCS C1713
Hospital Charge Code	3644557
Hospital Revenue Code	278
Min. Negotiated Rate	$2,592.52
Max. Negotiated Rate	$4,490.61
Rate for Payer: Cash Price	$3,009.18
Rate for Payer: Hawaii Western Management Group Commercial	$3,240.65
Rate for Payer: Health Management Network Commercial	$3,935.07
Rate for Payer: MDX Hawaii PPO	$4,490.61
Rate for Payer: University Health Alliance Commercial	$2,592.52

Fiberstitch Implant Curved AR-4570 [3642126]

Facility

$4,215.50

Service Code	HCPCS C1713
Hospital Charge Code	3642126
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.91
Max. Negotiated Rate	$4,089.03
Rate for Payer: Cash Price	$2,740.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,950.85
Rate for Payer: Health Management Network Commercial	$3,583.18
Rate for Payer: Kaiser Permanente Commercial	$2,655.76
Rate for Payer: Kaiser Permanente Medicaid	$2,149.91
Rate for Payer: MDX Hawaii PPO	$4,089.03
Rate for Payer: University Health Alliance Commercial	$2,360.68

Fiberstitch Implant Curved AR-4570 [3642126]

Facility

$4,215.50

Service Code	HCPCS C1713
Hospital Charge Code	3642126
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.68
Max. Negotiated Rate	$4,089.03
Rate for Payer: Cash Price	$2,740.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,950.85
Rate for Payer: Health Management Network Commercial	$3,583.18
Rate for Payer: MDX Hawaii PPO	$4,089.03
Rate for Payer: University Health Alliance Commercial	$2,360.68

Fiberstitch Implant Straight AR-4570S [3643253]

Facility

$2,887.50

Service Code	HCPCS C1776
Hospital Charge Code	3643253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,472.62
Max. Negotiated Rate	$2,800.88
Rate for Payer: Cash Price	$1,876.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,021.25
Rate for Payer: Health Management Network Commercial	$2,454.38
Rate for Payer: Kaiser Permanente Commercial	$1,819.12
Rate for Payer: Kaiser Permanente Medicaid	$1,472.62
Rate for Payer: MDX Hawaii PPO	$2,800.88
Rate for Payer: University Health Alliance Commercial	$1,617.00

Fiberstitch Implant Straight AR-4570S [3643253]

Facility

$2,887.50

Service Code	HCPCS C1776
Hospital Charge Code	3643253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.00
Max. Negotiated Rate	$2,800.88
Rate for Payer: Cash Price	$1,876.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,021.25
Rate for Payer: Health Management Network Commercial	$2,454.38
Rate for Payer: MDX Hawaii PPO	$2,800.88
Rate for Payer: University Health Alliance Commercial	$1,617.00

FiberTak 2.6 Anchor #5 Suture SP Knotless AR3641SP [3643112]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3643112
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.78
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: Kaiser Permanente Commercial	$2,443.14
Rate for Payer: Kaiser Permanente Medicaid	$1,977.78
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

FiberTak 2.6 Anchor #5 Suture SP Knotless AR3641SP [3643112]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3643112
Hospital Revenue Code	278
Min. Negotiated Rate	$2,171.68
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

FiberTak Biceps Implant AR-3671 [3642676]

Facility

$3,504.50

Service Code	HCPCS C1713
Hospital Charge Code	3642676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,962.52
Max. Negotiated Rate	$3,399.36
Rate for Payer: Cash Price	$2,277.93
Rate for Payer: Hawaii Western Management Group Commercial	$2,453.15
Rate for Payer: Health Management Network Commercial	$2,978.82
Rate for Payer: MDX Hawaii PPO	$3,399.36
Rate for Payer: University Health Alliance Commercial	$1,962.52

FiberTak Biceps Implant AR-3671 [3642676]

Facility

$3,504.50

Service Code	HCPCS C1713
Hospital Charge Code	3642676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,787.30
Max. Negotiated Rate	$3,399.36
Rate for Payer: Cash Price	$2,277.93
Rate for Payer: Hawaii Western Management Group Commercial	$2,453.15
Rate for Payer: Health Management Network Commercial	$2,978.82
Rate for Payer: Kaiser Permanente Commercial	$2,207.84
Rate for Payer: Kaiser Permanente Medicaid	$1,787.30
Rate for Payer: MDX Hawaii PPO	$3,399.36
Rate for Payer: University Health Alliance Commercial	$1,962.52

FiberTak Biceps Implant Sys Kit AR-3670 [3642523]

Facility

$5,150.00

Service Code	HCPCS C1713
Hospital Charge Code	3642523
Hospital Revenue Code	278
Min. Negotiated Rate	$2,626.50
Max. Negotiated Rate	$4,995.50
Rate for Payer: Cash Price	$3,347.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,605.00
Rate for Payer: Health Management Network Commercial	$4,377.50
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: Kaiser Permanente Medicaid	$2,626.50
Rate for Payer: MDX Hawaii PPO	$4,995.50
Rate for Payer: University Health Alliance Commercial	$2,884.00

FiberTak Biceps Implant Sys Kit AR-3670 [3642523]

Facility

$5,150.00

Service Code	HCPCS C1713
Hospital Charge Code	3642523
Hospital Revenue Code	278
Min. Negotiated Rate	$2,884.00
Max. Negotiated Rate	$4,995.50
Rate for Payer: Cash Price	$3,347.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,605.00
Rate for Payer: Health Management Network Commercial	$4,377.50
Rate for Payer: MDX Hawaii PPO	$4,995.50
Rate for Payer: University Health Alliance Commercial	$2,884.00

Fibertak Biceps Instrument Set AR-3671DS [3642677]

Facility

$2,111.88

Hospital Charge Code	3642677
Hospital Revenue Code	272
Min. Negotiated Rate	$1,795.10
Max. Negotiated Rate	$2,048.52
Rate for Payer: Cash Price	$1,372.72
Rate for Payer: Health Management Network Commercial	$1,795.10
Rate for Payer: MDX Hawaii PPO	$2,048.52

Fibertak Biceps Instrument Set AR-3671DS [3642677]

Facility

$2,111.88

Hospital Charge Code	3642677
Hospital Revenue Code	272
Min. Negotiated Rate	$1,077.06
Max. Negotiated Rate	$2,048.52
Rate for Payer: Cash Price	$1,372.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,006.29
Rate for Payer: Health Management Network Commercial	$1,795.10
Rate for Payer: Kaiser Permanente Commercial	$1,330.48
Rate for Payer: Kaiser Permanente Medicaid	$1,077.06
Rate for Payer: MDX Hawaii PPO	$2,048.52
Rate for Payer: University Health Alliance Commercial	$1,539.35

Fibertak Dbl Loaded Knee W/needle AR-3730SP [3645449]

Facility

$3,693.50

Service Code	HCPCS C1713
Hospital Charge Code	3645449
Hospital Revenue Code	278
Min. Negotiated Rate	$2,068.36
Max. Negotiated Rate	$3,582.70
Rate for Payer: Cash Price	$2,400.78
Rate for Payer: Hawaii Western Management Group Commercial	$2,585.45
Rate for Payer: Health Management Network Commercial	$3,139.47
Rate for Payer: MDX Hawaii PPO	$3,582.70
Rate for Payer: University Health Alliance Commercial	$2,068.36

Fibertak Dbl Loaded Knee W/needle AR-3730SP [3645449]

Facility

$3,693.50

Service Code	HCPCS C1713
Hospital Charge Code	3645449
Hospital Revenue Code	278
Min. Negotiated Rate	$1,883.68
Max. Negotiated Rate	$3,582.70
Rate for Payer: Cash Price	$2,400.78
Rate for Payer: Hawaii Western Management Group Commercial	$2,585.45
Rate for Payer: Health Management Network Commercial	$3,139.47
Rate for Payer: Kaiser Permanente Commercial	$2,326.91
Rate for Payer: Kaiser Permanente Medicaid	$1,883.68
Rate for Payer: MDX Hawaii PPO	$3,582.70
Rate for Payer: University Health Alliance Commercial	$2,068.36

Fibertak Disp Curved Kit Ar-3638DC [3644084]

Facility

$1,171.23

Hospital Charge Code	3644084
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

Fibertak Disp Curved Kit Ar-3638DC [3644084]

Facility

$1,171.23

Hospital Charge Code	3644084
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

Fibertak Disp Kit Straight AR-3638DS [3643951]

Facility

$1,686.50

Hospital Charge Code	3643951
Hospital Revenue Code	272
Min. Negotiated Rate	$860.12
Max. Negotiated Rate	$1,635.90
Rate for Payer: Cash Price	$1,096.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,602.17
Rate for Payer: Health Management Network Commercial	$1,433.53
Rate for Payer: Kaiser Permanente Commercial	$1,062.49
Rate for Payer: Kaiser Permanente Medicaid	$860.12
Rate for Payer: MDX Hawaii PPO	$1,635.90
Rate for Payer: University Health Alliance Commercial	$1,229.29

Fibertak Disp Kit Straight AR-3638DS [3643951]

Facility

$1,686.50

Hospital Charge Code	3643951
Hospital Revenue Code	272
Min. Negotiated Rate	$1,433.53
Max. Negotiated Rate	$1,635.90
Rate for Payer: Cash Price	$1,096.23
Rate for Payer: Health Management Network Commercial	$1,433.53
Rate for Payer: MDX Hawaii PPO	$1,635.90

FiberTak DX Knotless Disp Kit AR-8991DS [3643210]

Facility

$2,542.38

Hospital Charge Code	3643210
Hospital Revenue Code	272
Min. Negotiated Rate	$2,161.02
Max. Negotiated Rate	$2,466.11
Rate for Payer: Cash Price	$1,652.55
Rate for Payer: Health Management Network Commercial	$2,161.02
Rate for Payer: MDX Hawaii PPO	$2,466.11

Know your out-of-pocket cost for care.

All Charges