Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Guide Pin Threaded 3.2 X 444mm 281001175 [3627534]

Facility

$1,586.56

Hospital Charge Code	3627534
Hospital Revenue Code	272
Min. Negotiated Rate	$809.15
Max. Negotiated Rate	$1,538.96
Rate for Payer: Cash Price	$1,031.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,507.23
Rate for Payer: Health Management Network Commercial	$1,348.58
Rate for Payer: Kaiser Permanente Commercial	$999.53
Rate for Payer: Kaiser Permanente Medicaid	$809.15
Rate for Payer: MDX Hawaii PPO	$1,538.96
Rate for Payer: University Health Alliance Commercial	$1,156.44

Guide Reamer Bone Tap 6.5mm Rsp Shoulder 804-03-008 [3644088]

Facility

$764.25

Service Code	HCPCS C1725
Hospital Charge Code	3644088
Hospital Revenue Code	272
Min. Negotiated Rate	$389.77
Max. Negotiated Rate	$741.32
Rate for Payer: Cash Price	$496.76
Rate for Payer: Hawaii Western Management Group Commercial	$726.04
Rate for Payer: Health Management Network Commercial	$649.61
Rate for Payer: Kaiser Permanente Commercial	$481.48
Rate for Payer: Kaiser Permanente Medicaid	$389.77
Rate for Payer: MDX Hawaii PPO	$741.32
Rate for Payer: University Health Alliance Commercial	$557.06

Guide Reamer Bone Tap 6.5mm Rsp Shoulder 804-03-008 [3644088]

Facility

$764.25

Service Code	HCPCS C1725
Hospital Charge Code	3644088
Hospital Revenue Code	272
Min. Negotiated Rate	$649.61
Max. Negotiated Rate	$741.32
Rate for Payer: Cash Price	$496.76
Rate for Payer: Health Management Network Commercial	$649.61
Rate for Payer: MDX Hawaii PPO	$741.32

Guide Rod 2.5mm W/Stop Trocar Tip 230mm 03.019.026 [3640530]

Facility

$384.61

Hospital Charge Code	3640530
Hospital Revenue Code	272
Min. Negotiated Rate	$196.15
Max. Negotiated Rate	$373.07
Rate for Payer: Cash Price	$250.00
Rate for Payer: Hawaii Western Management Group Commercial	$365.38
Rate for Payer: Health Management Network Commercial	$326.92
Rate for Payer: Kaiser Permanente Commercial	$242.30
Rate for Payer: Kaiser Permanente Medicaid	$196.15
Rate for Payer: MDX Hawaii PPO	$373.07
Rate for Payer: University Health Alliance Commercial	$280.34

Guide Rod 2.5mm W/Stop Trocar Tip 230mm 03.019.026 [3640530]

Facility

$384.61

Hospital Charge Code	3640530
Hospital Revenue Code	272
Min. Negotiated Rate	$326.92
Max. Negotiated Rate	$373.07
Rate for Payer: Cash Price	$250.00
Rate for Payer: Health Management Network Commercial	$326.92
Rate for Payer: MDX Hawaii PPO	$373.07

Guide Rod 3.0 x 950 Ball Tip Straight 351.76S [3601788]

Facility

$1,687.53

Service Code	HCPCS C1713
Hospital Charge Code	3601788
Hospital Revenue Code	278
Min. Negotiated Rate	$860.64
Max. Negotiated Rate	$1,636.90
Rate for Payer: Cash Price	$1,096.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.27
Rate for Payer: Health Management Network Commercial	$1,434.40
Rate for Payer: Kaiser Permanente Commercial	$1,063.14
Rate for Payer: Kaiser Permanente Medicaid	$860.64
Rate for Payer: MDX Hawaii PPO	$1,636.90
Rate for Payer: University Health Alliance Commercial	$945.02

Guide Rod 3.0 x 950 Ball Tip Straight 351.76S [3601788]

Facility

$1,687.53

Service Code	HCPCS C1713
Hospital Charge Code	3601788
Hospital Revenue Code	278
Min. Negotiated Rate	$945.02
Max. Negotiated Rate	$1,636.90
Rate for Payer: Cash Price	$1,096.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.27
Rate for Payer: Health Management Network Commercial	$1,434.40
Rate for Payer: MDX Hawaii PPO	$1,636.90
Rate for Payer: University Health Alliance Commercial	$945.02

Guide Rod 351.706S 2.5Mm W/Ball Tip 950Mm [3601773]

Facility

$865.99

Service Code	HCPCS C1713
Hospital Charge Code	3601773
Hospital Revenue Code	278
Min. Negotiated Rate	$441.65
Max. Negotiated Rate	$840.01
Rate for Payer: Cash Price	$562.89
Rate for Payer: Hawaii Western Management Group Commercial	$606.19
Rate for Payer: Health Management Network Commercial	$736.09
Rate for Payer: Kaiser Permanente Commercial	$545.57
Rate for Payer: Kaiser Permanente Medicaid	$441.65
Rate for Payer: MDX Hawaii PPO	$840.01
Rate for Payer: University Health Alliance Commercial	$484.95

Guide Rod 351.706S 2.5Mm W/Ball Tip 950Mm [3601773]

Facility

$865.99

Service Code	HCPCS C1713
Hospital Charge Code	3601773
Hospital Revenue Code	278
Min. Negotiated Rate	$484.95
Max. Negotiated Rate	$840.01
Rate for Payer: Cash Price	$562.89
Rate for Payer: Hawaii Western Management Group Commercial	$606.19
Rate for Payer: Health Management Network Commercial	$736.09
Rate for Payer: MDX Hawaii PPO	$840.01
Rate for Payer: University Health Alliance Commercial	$484.95

Guide Rod 351.71S 3.0 X 950 Ball Offset [3601781]

Facility

$1,246.57

Hospital Charge Code	3601781
Hospital Revenue Code	272
Min. Negotiated Rate	$635.75
Max. Negotiated Rate	$1,209.17
Rate for Payer: Cash Price	$810.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,184.24
Rate for Payer: Health Management Network Commercial	$1,059.58
Rate for Payer: Kaiser Permanente Commercial	$785.34
Rate for Payer: Kaiser Permanente Medicaid	$635.75
Rate for Payer: MDX Hawaii PPO	$1,209.17
Rate for Payer: University Health Alliance Commercial	$908.62

Guide Rod 351.71S 3.0 X 950 Ball Offset [3601781]

Facility

$1,246.57

Hospital Charge Code	3601781
Hospital Revenue Code	272
Min. Negotiated Rate	$1,059.58
Max. Negotiated Rate	$1,209.17
Rate for Payer: Cash Price	$810.27
Rate for Payer: Health Management Network Commercial	$1,059.58
Rate for Payer: MDX Hawaii PPO	$1,209.17

Guide Rod 355.041S 3.0 mm Smooth Tip [3601780]

Facility

$1,246.57

Hospital Charge Code	3601780
Hospital Revenue Code	272
Min. Negotiated Rate	$635.75
Max. Negotiated Rate	$1,209.17
Rate for Payer: Cash Price	$810.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,184.24
Rate for Payer: Health Management Network Commercial	$1,059.58
Rate for Payer: Kaiser Permanente Commercial	$785.34
Rate for Payer: Kaiser Permanente Medicaid	$635.75
Rate for Payer: MDX Hawaii PPO	$1,209.17
Rate for Payer: University Health Alliance Commercial	$908.62

Guide Rod 355.041S 3.0 mm Smooth Tip [3601780]

Facility

$1,246.57

Hospital Charge Code	3601780
Hospital Revenue Code	272
Min. Negotiated Rate	$1,059.58
Max. Negotiated Rate	$1,209.17
Rate for Payer: Cash Price	$810.27
Rate for Payer: Health Management Network Commercial	$1,059.58
Rate for Payer: MDX Hawaii PPO	$1,209.17

Guidewire .025 3cm Straight PTFE 66201070 [3640226]

Facility

$90.38

Service Code	HCPCS C1769
Hospital Charge Code	3640226
Hospital Revenue Code	272
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$87.67
Rate for Payer: Cash Price	$58.75
Rate for Payer: Hawaii Western Management Group Commercial	$85.86
Rate for Payer: Health Management Network Commercial	$76.82
Rate for Payer: Kaiser Permanente Commercial	$56.94
Rate for Payer: Kaiser Permanente Medicaid	$46.09
Rate for Payer: MDX Hawaii PPO	$87.67
Rate for Payer: University Health Alliance Commercial	$65.88

Guidewire .025 3cm Straight PTFE 66201070 [3640226]

Facility

$90.38

Service Code	HCPCS C1769
Hospital Charge Code	3640226
Hospital Revenue Code	272
Min. Negotiated Rate	$76.82
Max. Negotiated Rate	$87.67
Rate for Payer: Cash Price	$58.75
Rate for Payer: Health Management Network Commercial	$76.82
Rate for Payer: MDX Hawaii PPO	$87.67

Guidewire .025 Zipwire Glide Type M0066802011 [3642087]

Facility

$285.98

Service Code	HCPCS C1769
Hospital Charge Code	3642087
Hospital Revenue Code	272
Min. Negotiated Rate	$145.85
Max. Negotiated Rate	$277.40
Rate for Payer: Cash Price	$185.89
Rate for Payer: Hawaii Western Management Group Commercial	$271.68
Rate for Payer: Health Management Network Commercial	$243.08
Rate for Payer: Kaiser Permanente Commercial	$180.17
Rate for Payer: Kaiser Permanente Medicaid	$145.85
Rate for Payer: MDX Hawaii PPO	$277.40
Rate for Payer: University Health Alliance Commercial	$208.45

Guidewire .025 Zipwire Glide Type M0066802011 [3642087]

Facility

$285.98

Service Code	HCPCS C1769
Hospital Charge Code	3642087
Hospital Revenue Code	272
Min. Negotiated Rate	$243.08
Max. Negotiated Rate	$277.40
Rate for Payer: Cash Price	$185.89
Rate for Payer: Health Management Network Commercial	$243.08
Rate for Payer: MDX Hawaii PPO	$277.40

GUIDEWIRE .032X60 CM [2702274]

Facility

$92.82

Service Code	HCPCS C1769
Hospital Charge Code	2702274
Hospital Revenue Code	272
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$90.04
Rate for Payer: Cash Price	$60.33
Rate for Payer: Hawaii Western Management Group Commercial	$88.18
Rate for Payer: Health Management Network Commercial	$78.90
Rate for Payer: Kaiser Permanente Commercial	$58.48
Rate for Payer: Kaiser Permanente Medicaid	$47.34
Rate for Payer: MDX Hawaii PPO	$90.04
Rate for Payer: University Health Alliance Commercial	$67.66

GUIDEWIRE .032X60 CM [2702274]

Facility

$92.82

Service Code	HCPCS C1769
Hospital Charge Code	2702274
Hospital Revenue Code	272
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$90.04
Rate for Payer: Cash Price	$60.33
Rate for Payer: Health Management Network Commercial	$78.90
Rate for Payer: MDX Hawaii PPO	$90.04

Guidewire .035 15cm Straight Fixed Bentson PTFE M0066201250 [3642086]

Facility

$125.12

Service Code	HCPCS C1769
Hospital Charge Code	3642086
Hospital Revenue Code	272
Min. Negotiated Rate	$63.81
Max. Negotiated Rate	$121.37
Rate for Payer: Cash Price	$81.33
Rate for Payer: Hawaii Western Management Group Commercial	$118.86
Rate for Payer: Health Management Network Commercial	$106.35
Rate for Payer: Kaiser Permanente Commercial	$78.83
Rate for Payer: Kaiser Permanente Medicaid	$63.81
Rate for Payer: MDX Hawaii PPO	$121.37
Rate for Payer: University Health Alliance Commercial	$91.20

Guidewire .035 15cm Straight Fixed Bentson PTFE M0066201250 [3642086]

Facility

$125.12

Service Code	HCPCS C1769
Hospital Charge Code	3642086
Hospital Revenue Code	272
Min. Negotiated Rate	$106.35
Max. Negotiated Rate	$121.37
Rate for Payer: Cash Price	$81.33
Rate for Payer: Health Management Network Commercial	$106.35
Rate for Payer: MDX Hawaii PPO	$121.37

Guidewire .035 3 cm Angled Sensor 670306 [3601715]

Facility

$312.85

Service Code	HCPCS C1769
Hospital Charge Code	3601715
Hospital Revenue Code	272
Min. Negotiated Rate	$159.55
Max. Negotiated Rate	$303.46
Rate for Payer: Cash Price	$203.35
Rate for Payer: Hawaii Western Management Group Commercial	$297.21
Rate for Payer: Health Management Network Commercial	$265.92
Rate for Payer: Kaiser Permanente Commercial	$197.10
Rate for Payer: Kaiser Permanente Medicaid	$159.55
Rate for Payer: MDX Hawaii PPO	$303.46
Rate for Payer: University Health Alliance Commercial	$228.04

Guidewire .035 3 cm Angled Sensor 670306 [3601715]

Facility

$312.85

Service Code	HCPCS C1769
Hospital Charge Code	3601715
Hospital Revenue Code	272
Min. Negotiated Rate	$265.92
Max. Negotiated Rate	$303.46
Rate for Payer: Cash Price	$203.35
Rate for Payer: Health Management Network Commercial	$265.92
Rate for Payer: MDX Hawaii PPO	$303.46

Guidewire .035 5cm Straight Bentson 630224B [3640637]

Facility

$260.97

Service Code	HCPCS C1769
Hospital Charge Code	3640637
Hospital Revenue Code	272
Min. Negotiated Rate	$133.09
Max. Negotiated Rate	$253.14
Rate for Payer: Cash Price	$169.63
Rate for Payer: Hawaii Western Management Group Commercial	$247.92
Rate for Payer: Health Management Network Commercial	$221.82
Rate for Payer: Kaiser Permanente Commercial	$164.41
Rate for Payer: Kaiser Permanente Medicaid	$133.09
Rate for Payer: MDX Hawaii PPO	$253.14
Rate for Payer: University Health Alliance Commercial	$190.22

Guidewire .035 5cm Straight Bentson 630224B [3640637]

Facility

$260.97

Service Code	HCPCS C1769
Hospital Charge Code	3640637
Hospital Revenue Code	272
Min. Negotiated Rate	$221.82
Max. Negotiated Rate	$253.14
Rate for Payer: Cash Price	$169.63
Rate for Payer: Health Management Network Commercial	$221.82
Rate for Payer: MDX Hawaii PPO	$253.14

Know your out-of-pocket cost for care.

All Charges