Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Guidewire .035 DualFlex Straight Sensor 670308 [3642085]

Facility

$323.58

Service Code	HCPCS C1769
Hospital Charge Code	3642085
Hospital Revenue Code	272
Min. Negotiated Rate	$165.03
Max. Negotiated Rate	$313.87
Rate for Payer: Cash Price	$210.33
Rate for Payer: Hawaii Western Management Group Commercial	$307.40
Rate for Payer: Health Management Network Commercial	$275.04
Rate for Payer: Kaiser Permanente Commercial	$203.86
Rate for Payer: Kaiser Permanente Medicaid	$165.03
Rate for Payer: MDX Hawaii PPO	$313.87
Rate for Payer: University Health Alliance Commercial	$235.86

Guidewire .035 DualFlex Straight Sensor 670308 [3642085]

Facility

$323.58

Service Code	HCPCS C1769
Hospital Charge Code	3642085
Hospital Revenue Code	272
Min. Negotiated Rate	$275.04
Max. Negotiated Rate	$313.87
Rate for Payer: Cash Price	$210.33
Rate for Payer: Health Management Network Commercial	$275.04
Rate for Payer: MDX Hawaii PPO	$313.87

Guide Wire .062mmX6" Long AR-8941-6 [3641323]

Facility

$419.63

Service Code	HCPCS C1769
Hospital Charge Code	3641323
Hospital Revenue Code	272
Min. Negotiated Rate	$356.69
Max. Negotiated Rate	$407.04
Rate for Payer: Cash Price	$272.76
Rate for Payer: Health Management Network Commercial	$356.69
Rate for Payer: MDX Hawaii PPO	$407.04

Guide Wire .062mmX6" Long AR-8941-6 [3641323]

Facility

$419.63

Service Code	HCPCS C1769
Hospital Charge Code	3641323
Hospital Revenue Code	272
Min. Negotiated Rate	$214.01
Max. Negotiated Rate	$407.04
Rate for Payer: Cash Price	$272.76
Rate for Payer: Hawaii Western Management Group Commercial	$398.65
Rate for Payer: Health Management Network Commercial	$356.69
Rate for Payer: Kaiser Permanente Commercial	$264.37
Rate for Payer: Kaiser Permanente Medicaid	$214.01
Rate for Payer: MDX Hawaii PPO	$407.04
Rate for Payer: University Health Alliance Commercial	$305.87

Guide Wire .062mmX7" Long AR-8941-7 [3641324]

Facility

$419.63

Service Code	HCPCS C1769
Hospital Charge Code	3641324
Hospital Revenue Code	272
Min. Negotiated Rate	$214.01
Max. Negotiated Rate	$407.04
Rate for Payer: Cash Price	$272.76
Rate for Payer: Hawaii Western Management Group Commercial	$398.65
Rate for Payer: Health Management Network Commercial	$356.69
Rate for Payer: Kaiser Permanente Commercial	$264.37
Rate for Payer: Kaiser Permanente Medicaid	$214.01
Rate for Payer: MDX Hawaii PPO	$407.04
Rate for Payer: University Health Alliance Commercial	$305.87

Guide Wire .062mmX7" Long AR-8941-7 [3641324]

Facility

$419.63

Service Code	HCPCS C1769
Hospital Charge Code	3641324
Hospital Revenue Code	272
Min. Negotiated Rate	$356.69
Max. Negotiated Rate	$407.04
Rate for Payer: Cash Price	$272.76
Rate for Payer: Health Management Network Commercial	$356.69
Rate for Payer: MDX Hawaii PPO	$407.04

Guidewire 0.8mm x 100mm Trocar Tip 03.333.000 [3644870]

Facility

$538.08

Hospital Charge Code	3644870
Hospital Revenue Code	272
Min. Negotiated Rate	$457.37
Max. Negotiated Rate	$521.94
Rate for Payer: Cash Price	$349.75
Rate for Payer: Health Management Network Commercial	$457.37
Rate for Payer: MDX Hawaii PPO	$521.94

Guidewire 0.8mm x 100mm Trocar Tip 03.333.000 [3644870]

Facility

$538.08

Hospital Charge Code	3644870
Hospital Revenue Code	272
Min. Negotiated Rate	$274.42
Max. Negotiated Rate	$521.94
Rate for Payer: Cash Price	$349.75
Rate for Payer: Hawaii Western Management Group Commercial	$511.18
Rate for Payer: Health Management Network Commercial	$457.37
Rate for Payer: Kaiser Permanente Commercial	$338.99
Rate for Payer: Kaiser Permanente Medicaid	$274.42
Rate for Payer: MDX Hawaii PPO	$521.94
Rate for Payer: University Health Alliance Commercial	$392.21

Guidewire 1.1mm x 150mm Trocar Tip 03.333.001 [3644873]

Facility

$588.68

Hospital Charge Code	3644873
Hospital Revenue Code	272
Min. Negotiated Rate	$300.23
Max. Negotiated Rate	$571.02
Rate for Payer: Cash Price	$382.64
Rate for Payer: Hawaii Western Management Group Commercial	$559.25
Rate for Payer: Health Management Network Commercial	$500.38
Rate for Payer: Kaiser Permanente Commercial	$370.87
Rate for Payer: Kaiser Permanente Medicaid	$300.23
Rate for Payer: MDX Hawaii PPO	$571.02
Rate for Payer: University Health Alliance Commercial	$429.09

Guidewire 1.1mm x 150mm Trocar Tip 03.333.001 [3644873]

Facility

$588.68

Hospital Charge Code	3644873
Hospital Revenue Code	272
Min. Negotiated Rate	$500.38
Max. Negotiated Rate	$571.02
Rate for Payer: Cash Price	$382.64
Rate for Payer: Health Management Network Commercial	$500.38
Rate for Payer: MDX Hawaii PPO	$571.02

Guidewire 2.5mm x 230mm 900.723 [3601797]

Facility

$445.04

Service Code	HCPCS C1769
Hospital Charge Code	3601797
Hospital Revenue Code	272
Min. Negotiated Rate	$226.97
Max. Negotiated Rate	$431.69
Rate for Payer: Cash Price	$289.28
Rate for Payer: Hawaii Western Management Group Commercial	$422.79
Rate for Payer: Health Management Network Commercial	$378.28
Rate for Payer: Kaiser Permanente Commercial	$280.38
Rate for Payer: Kaiser Permanente Medicaid	$226.97
Rate for Payer: MDX Hawaii PPO	$431.69
Rate for Payer: University Health Alliance Commercial	$324.39

Guidewire 2.5mm x 230mm 900.723 [3601797]

Facility

$445.04

Service Code	HCPCS C1769
Hospital Charge Code	3601797
Hospital Revenue Code	272
Min. Negotiated Rate	$378.28
Max. Negotiated Rate	$431.69
Rate for Payer: Cash Price	$289.28
Rate for Payer: Health Management Network Commercial	$378.28
Rate for Payer: MDX Hawaii PPO	$431.69

Guidewire 2.8mm X 220mm Fluted Tip 03.333.004 [3642347]

Facility

$865.99

Service Code	HCPCS C1769
Hospital Charge Code	3642347
Hospital Revenue Code	272
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	$822.69
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	$631.22

Guidewire 2.8mm X 220mm Fluted Tip 03.333.004 [3642347]

Facility

$865.99

Service Code	HCPCS C1769
Hospital Charge Code	3642347
Hospital Revenue Code	272
Min. Negotiated Rate	$736.09
Max. Negotiated Rate	$840.01
Rate for Payer: Cash Price	$562.89
Rate for Payer: Health Management Network Commercial	$736.09
Rate for Payer: MDX Hawaii PPO	$840.01

Guidewire 292.727 1.6Mm Nonthread 4.5Mm Cann Set [3601709]

Facility

$234.08

Service Code	HCPCS C1769
Hospital Charge Code	3601709
Hospital Revenue Code	272
Min. Negotiated Rate	$119.38
Max. Negotiated Rate	$227.06
Rate for Payer: Cash Price	$152.15
Rate for Payer: Hawaii Western Management Group Commercial	$222.38
Rate for Payer: Health Management Network Commercial	$198.97
Rate for Payer: Kaiser Permanente Commercial	$147.47
Rate for Payer: Kaiser Permanente Medicaid	$119.38
Rate for Payer: MDX Hawaii PPO	$227.06
Rate for Payer: University Health Alliance Commercial	$170.62

Guidewire 292.727 1.6Mm Nonthread 4.5Mm Cann Set [3601709]

Facility

$234.08

Service Code	HCPCS C1769
Hospital Charge Code	3601709
Hospital Revenue Code	272
Min. Negotiated Rate	$198.97
Max. Negotiated Rate	$227.06
Rate for Payer: Cash Price	$152.15
Rate for Payer: Health Management Network Commercial	$198.97
Rate for Payer: MDX Hawaii PPO	$227.06

Guidewire 3.2mm 290mm 03.010.115 [3640200]

Facility

$736.67

Service Code	HCPCS C1769
Hospital Charge Code	3640200
Hospital Revenue Code	272
Min. Negotiated Rate	$626.17
Max. Negotiated Rate	$714.57
Rate for Payer: Cash Price	$478.84
Rate for Payer: Health Management Network Commercial	$626.17
Rate for Payer: MDX Hawaii PPO	$714.57

Guidewire 3.2mm 290mm 03.010.115 [3640200]

Facility

$736.67

Service Code	HCPCS C1769
Hospital Charge Code	3640200
Hospital Revenue Code	272
Min. Negotiated Rate	$375.70
Max. Negotiated Rate	$714.57
Rate for Payer: Cash Price	$478.84
Rate for Payer: Hawaii Western Management Group Commercial	$699.84
Rate for Payer: Health Management Network Commercial	$626.17
Rate for Payer: Kaiser Permanente Commercial	$464.10
Rate for Payer: Kaiser Permanente Medicaid	$375.70
Rate for Payer: MDX Hawaii PPO	$714.57
Rate for Payer: University Health Alliance Commercial	$536.96

Guidewire 3.2mm Tfn 400mm 357.399 [3601799]

Facility

$847.89

Service Code	HCPCS C1769
Hospital Charge Code	3601799
Hospital Revenue Code	272
Min. Negotiated Rate	$432.42
Max. Negotiated Rate	$822.45
Rate for Payer: Cash Price	$551.13
Rate for Payer: Hawaii Western Management Group Commercial	$805.50
Rate for Payer: Health Management Network Commercial	$720.71
Rate for Payer: Kaiser Permanente Commercial	$534.17
Rate for Payer: Kaiser Permanente Medicaid	$432.42
Rate for Payer: MDX Hawaii PPO	$822.45
Rate for Payer: University Health Alliance Commercial	$618.03

Guidewire 3.2mm Tfn 400mm 357.399 [3601799]

Facility

$847.89

Service Code	HCPCS C1769
Hospital Charge Code	3601799
Hospital Revenue Code	272
Min. Negotiated Rate	$720.71
Max. Negotiated Rate	$822.45
Rate for Payer: Cash Price	$551.13
Rate for Payer: Health Management Network Commercial	$720.71
Rate for Payer: MDX Hawaii PPO	$822.45

Guidewire Affixus Hum Ball Nose St 110035668 [3641947]

Facility

$2,711.50

Service Code	HCPCS C1769
Hospital Charge Code	3641947
Hospital Revenue Code	272
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,575.93
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,976.41

Guidewire Affixus Hum Ball Nose St 110035668 [3641947]

Facility

$2,711.50

Service Code	HCPCS C1769
Hospital Charge Code	3641947
Hospital Revenue Code	272
Min. Negotiated Rate	$2,304.78
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16

Guidewire Amplatz Super Stiff .035"X145cm M0066401041 [3643810]

Facility

$212.54

Service Code	HCPCS C1769
Hospital Charge Code	3643810
Hospital Revenue Code	272
Min. Negotiated Rate	$108.40
Max. Negotiated Rate	$206.16
Rate for Payer: Cash Price	$138.15
Rate for Payer: Hawaii Western Management Group Commercial	$201.91
Rate for Payer: Health Management Network Commercial	$180.66
Rate for Payer: Kaiser Permanente Commercial	$133.90
Rate for Payer: Kaiser Permanente Medicaid	$108.40
Rate for Payer: MDX Hawaii PPO	$206.16
Rate for Payer: University Health Alliance Commercial	$154.92

Guidewire Amplatz Super Stiff .035"X145cm M0066401041 [3643810]

Facility

$212.54

Service Code	HCPCS C1769
Hospital Charge Code	3643810
Hospital Revenue Code	272
Min. Negotiated Rate	$180.66
Max. Negotiated Rate	$206.16
Rate for Payer: Cash Price	$138.15
Rate for Payer: Health Management Network Commercial	$180.66
Rate for Payer: MDX Hawaii PPO	$206.16

Guidewire Amplatz Super Stiff .035X180cm Straight M001465251 [3641967]

Facility

$322.50

Service Code	HCPCS C1769
Hospital Charge Code	3641967
Hospital Revenue Code	272
Min. Negotiated Rate	$164.47
Max. Negotiated Rate	$312.82
Rate for Payer: Cash Price	$209.62
Rate for Payer: Hawaii Western Management Group Commercial	$306.38
Rate for Payer: Health Management Network Commercial	$274.12
Rate for Payer: Kaiser Permanente Commercial	$203.18
Rate for Payer: Kaiser Permanente Medicaid	$164.47
Rate for Payer: MDX Hawaii PPO	$312.82
Rate for Payer: University Health Alliance Commercial	$235.07

Know your out-of-pocket cost for care.

All Charges