Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

Fibertak DX Suture Anchor #2 MTS & NDLS AR-8991 [3644798]

Facility

$3,314.38

Service Code	HCPCS C1713
Hospital Charge Code	3644798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,856.05
Max. Negotiated Rate	$3,214.95
Rate for Payer: Cash Price	$2,154.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,320.07
Rate for Payer: Health Management Network Commercial	$2,817.22
Rate for Payer: MDX Hawaii PPO	$3,214.95
Rate for Payer: University Health Alliance Commercial	$1,856.05

Fibertak DX Suture Anchor #2 MTS & NDLS AR-8991 [3644798]

Facility

$3,314.38

Service Code	HCPCS C1713
Hospital Charge Code	3644798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,690.33
Max. Negotiated Rate	$3,214.95
Rate for Payer: Cash Price	$2,154.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,320.07
Rate for Payer: Health Management Network Commercial	$2,817.22
Rate for Payer: Kaiser Permanente Commercial	$2,088.06
Rate for Payer: Kaiser Permanente Medicaid	$1,690.33
Rate for Payer: MDX Hawaii PPO	$3,214.95
Rate for Payer: University Health Alliance Commercial	$1,856.05

FiberTak DX Suture Anchor ST & NDLS AR-8990ST [3643209]

Facility

$3,990.50

Service Code	HCPCS C1713
Hospital Charge Code	3643209
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.15
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: Kaiser Permanente Commercial	$2,514.01
Rate for Payer: Kaiser Permanente Medicaid	$2,035.15
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

FiberTak DX Suture Anchor ST & NDLS AR-8990ST [3643209]

Facility

$3,990.50

Service Code	HCPCS C1713
Hospital Charge Code	3643209
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Fibertak Kl 1.8 Shoulder AR-3636 [3644083]

Facility

$2,557.75

Service Code	HCPCS C1713
Hospital Charge Code	3644083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,432.34
Max. Negotiated Rate	$2,481.02
Rate for Payer: Cash Price	$1,662.54
Rate for Payer: Hawaii Western Management Group Commercial	$1,790.42
Rate for Payer: Health Management Network Commercial	$2,174.09
Rate for Payer: MDX Hawaii PPO	$2,481.02
Rate for Payer: University Health Alliance Commercial	$1,432.34

Fibertak Kl 1.8 Shoulder AR-3636 [3644083]

Facility

$2,557.75

Service Code	HCPCS C1713
Hospital Charge Code	3644083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,304.45
Max. Negotiated Rate	$2,481.02
Rate for Payer: Cash Price	$1,662.54
Rate for Payer: Hawaii Western Management Group Commercial	$1,790.42
Rate for Payer: Health Management Network Commercial	$2,174.09
Rate for Payer: Kaiser Permanente Commercial	$1,611.38
Rate for Payer: Kaiser Permanente Medicaid	$1,304.45
Rate for Payer: MDX Hawaii PPO	$2,481.02
Rate for Payer: University Health Alliance Commercial	$1,432.34

FiberTak RC Disp Kit for Doubload Tape AR3650DS [3642514]

Facility

$1,150.88

Hospital Charge Code	3642514
Hospital Revenue Code	272
Min. Negotiated Rate	$978.25
Max. Negotiated Rate	$1,116.35
Rate for Payer: Cash Price	$748.07
Rate for Payer: Health Management Network Commercial	$978.25
Rate for Payer: MDX Hawaii PPO	$1,116.35

FiberTak RC Disp Kit for Doubload Tape AR3650DS [3642514]

Facility

$1,150.88

Hospital Charge Code	3642514
Hospital Revenue Code	272
Min. Negotiated Rate	$586.95
Max. Negotiated Rate	$1,116.35
Rate for Payer: Cash Price	$748.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.34
Rate for Payer: Health Management Network Commercial	$978.25
Rate for Payer: Kaiser Permanente Commercial	$725.05
Rate for Payer: Kaiser Permanente Medicaid	$586.95
Rate for Payer: MDX Hawaii PPO	$1,116.35
Rate for Payer: University Health Alliance Commercial	$838.88

Fibertape 17" w/Straight Needle AR723717LN [3642032]

Facility

$1,619.88

Hospital Charge Code	3642032
Hospital Revenue Code	272
Min. Negotiated Rate	$826.14
Max. Negotiated Rate	$1,571.28
Rate for Payer: Cash Price	$1,052.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.89
Rate for Payer: Health Management Network Commercial	$1,376.90
Rate for Payer: Kaiser Permanente Commercial	$1,020.52
Rate for Payer: Kaiser Permanente Medicaid	$826.14
Rate for Payer: MDX Hawaii PPO	$1,571.28
Rate for Payer: University Health Alliance Commercial	$1,180.73

Fibertape 17" w/Straight Needle AR723717LN [3642032]

Facility

$1,619.88

Hospital Charge Code	3642032
Hospital Revenue Code	272
Min. Negotiated Rate	$1,376.90
Max. Negotiated Rate	$1,571.28
Rate for Payer: Cash Price	$1,052.92
Rate for Payer: Health Management Network Commercial	$1,376.90
Rate for Payer: MDX Hawaii PPO	$1,571.28

Fibertape 2mm AR7237 [3621520]

Facility

$390.88

Hospital Charge Code	3621520
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

Fibertape 2mm AR7237 [3621520]

Facility

$390.88

Hospital Charge Code	3621520
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

Fiber Wire 0 38" Blue 22.2mm w/TPR 3/8 PNT NDL AR-7250 [3642532]

Facility

$251.63

Hospital Charge Code	3642532
Hospital Revenue Code	272
Min. Negotiated Rate	$128.33
Max. Negotiated Rate	$244.08
Rate for Payer: Cash Price	$163.56
Rate for Payer: Hawaii Western Management Group Commercial	$239.05
Rate for Payer: Health Management Network Commercial	$213.89
Rate for Payer: Kaiser Permanente Commercial	$158.53
Rate for Payer: Kaiser Permanente Medicaid	$128.33
Rate for Payer: MDX Hawaii PPO	$244.08
Rate for Payer: University Health Alliance Commercial	$183.41

Fiber Wire 0 38" Blue 22.2mm w/TPR 3/8 PNT NDL AR-7250 [3642532]

Facility

$251.63

Hospital Charge Code	3642532
Hospital Revenue Code	272
Min. Negotiated Rate	$213.89
Max. Negotiated Rate	$244.08
Rate for Payer: Cash Price	$163.56
Rate for Payer: Health Management Network Commercial	$213.89
Rate for Payer: MDX Hawaii PPO	$244.08

Fiberwire 2 AR7200 [3602005]

Facility

$184.00

Hospital Charge Code	3602005
Hospital Revenue Code	272
Min. Negotiated Rate	$93.84
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$115.92
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: University Health Alliance Commercial	$134.12

Fiberwire 2 AR7200 [3602005]

Facility

$184.00

Hospital Charge Code	3602005
Hospital Revenue Code	272
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: MDX Hawaii PPO	$178.48

Fiberwire 5 AR7211 [3602006]

Facility

$309.00

Hospital Charge Code	3602006
Hospital Revenue Code	272
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$194.67
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: University Health Alliance Commercial	$225.23

Fiberwire 5 AR7211 [3602006]

Facility

$309.00

Hospital Charge Code	3602006
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: MDX Hawaii PPO	$299.73

Fibulock Implant System Sterile AR-8973DS [3644348]

Facility

$5,587.50

Hospital Charge Code	3644348
Hospital Revenue Code	272
Min. Negotiated Rate	$4,749.38
Max. Negotiated Rate	$5,419.88
Rate for Payer: Cash Price	$3,631.88
Rate for Payer: Health Management Network Commercial	$4,749.38
Rate for Payer: MDX Hawaii PPO	$5,419.88

Fibulock Implant System Sterile AR-8973DS [3644348]

Facility

$5,587.50

Hospital Charge Code	3644348
Hospital Revenue Code	272
Min. Negotiated Rate	$2,849.62
Max. Negotiated Rate	$5,419.88
Rate for Payer: Cash Price	$3,631.88
Rate for Payer: Hawaii Western Management Group Commercial	$5,308.12
Rate for Payer: Health Management Network Commercial	$4,749.38
Rate for Payer: Kaiser Permanente Commercial	$3,520.12
Rate for Payer: Kaiser Permanente Medicaid	$2,849.62
Rate for Payer: MDX Hawaii PPO	$5,419.88
Rate for Payer: University Health Alliance Commercial	$4,072.73

Fibulock Nail Left 3.0 x 130mm AR-8973L-30-130 [3644349]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644349
Hospital Revenue Code	278
Min. Negotiated Rate	$9,677.25
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: Kaiser Permanente Commercial	$11,954.25
Rate for Payer: Kaiser Permanente Medicaid	$9,677.25
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Left 3.0 x 130mm AR-8973L-30-130 [3644349]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644349
Hospital Revenue Code	278
Min. Negotiated Rate	$10,626.00
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Left 3.8 x 130mm AR-8973L-38-130 [3644788]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644788
Hospital Revenue Code	278
Min. Negotiated Rate	$9,677.25
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: Kaiser Permanente Commercial	$11,954.25
Rate for Payer: Kaiser Permanente Medicaid	$9,677.25
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Fibulock Nail Left 3.8 x 130mm AR-8973L-38-130 [3644788]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3644788
Hospital Revenue Code	278
Min. Negotiated Rate	$10,626.00
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Know your out-of-pocket cost for care.

All Charges