Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$274.12
Max. Negotiated Rate	$312.82
Rate for Payer: Cash Price	$209.62
Rate for Payer: Health Management Network Commercial	$274.12
Rate for Payer: MDX Hawaii PPO	$312.82

Guidewire Ball Nose 2.0mm x 800mm 0103-800S [3644649]

Facility

$3,392.00

Hospital Charge Code	3644649
Hospital Revenue Code	272
Min. Negotiated Rate	$1,729.92
Max. Negotiated Rate	$3,290.24
Rate for Payer: Cash Price	$2,204.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,222.40
Rate for Payer: Health Management Network Commercial	$2,883.20
Rate for Payer: Kaiser Permanente Commercial	$2,136.96
Rate for Payer: Kaiser Permanente Medicaid	$1,729.92
Rate for Payer: MDX Hawaii PPO	$3,290.24
Rate for Payer: University Health Alliance Commercial	$2,472.43

Guidewire Ball Nose 2.0mm x 800mm 0103-800S [3644649]

Facility

$3,392.00

Hospital Charge Code	3644649
Hospital Revenue Code	272
Min. Negotiated Rate	$2,883.20
Max. Negotiated Rate	$3,290.24
Rate for Payer: Cash Price	$2,204.80
Rate for Payer: Health Management Network Commercial	$2,883.20
Rate for Payer: MDX Hawaii PPO	$3,290.24

Guidewire Ball Nose 3.0mm x 100cm 2810-01-100 [3641032]

Facility

$1,471.25

Service Code	HCPCS C1769
Hospital Charge Code	3641032
Hospital Revenue Code	272
Min. Negotiated Rate	$750.34
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,397.69
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: Kaiser Permanente Commercial	$926.89
Rate for Payer: Kaiser Permanente Medicaid	$750.34
Rate for Payer: MDX Hawaii PPO	$1,427.11
Rate for Payer: University Health Alliance Commercial	$1,072.39

Guidewire Ball Nose 3.0mm x 100cm 2810-01-100 [3641032]

Facility

$1,471.25

Service Code	HCPCS C1769
Hospital Charge Code	3641032
Hospital Revenue Code	272
Min. Negotiated Rate	$1,250.56
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: MDX Hawaii PPO	$1,427.11

Guidewire Ball Nose 3.0mm x 80cm 281001080 [3640741]

Facility

$1,412.20

Service Code	HCPCS C1769
Hospital Charge Code	3640741
Hospital Revenue Code	272
Min. Negotiated Rate	$720.22
Max. Negotiated Rate	$1,369.83
Rate for Payer: Cash Price	$917.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,341.59
Rate for Payer: Health Management Network Commercial	$1,200.37
Rate for Payer: Kaiser Permanente Commercial	$889.69
Rate for Payer: Kaiser Permanente Medicaid	$720.22
Rate for Payer: MDX Hawaii PPO	$1,369.83
Rate for Payer: University Health Alliance Commercial	$1,029.35

Guidewire Ball Nose 3.0mm x 80cm 281001080 [3640741]

Facility

$1,412.20

Service Code	HCPCS C1769
Hospital Charge Code	3640741
Hospital Revenue Code	272
Min. Negotiated Rate	$1,200.37
Max. Negotiated Rate	$1,369.83
Rate for Payer: Cash Price	$917.93
Rate for Payer: Health Management Network Commercial	$1,200.37
Rate for Payer: MDX Hawaii PPO	$1,369.83

Guidewire Ball Nose 3.0mm x 900mm 0101-900S [3644619]

Facility

$1,901.75

Hospital Charge Code	3644619
Hospital Revenue Code	272
Min. Negotiated Rate	$1,616.49
Max. Negotiated Rate	$1,844.70
Rate for Payer: Cash Price	$1,236.14
Rate for Payer: Health Management Network Commercial	$1,616.49
Rate for Payer: MDX Hawaii PPO	$1,844.70

Guidewire Ball Nose 3.0mm x 900mm 0101-900S [3644619]

Facility

$1,901.75

Hospital Charge Code	3644619
Hospital Revenue Code	272
Min. Negotiated Rate	$969.89
Max. Negotiated Rate	$1,844.70
Rate for Payer: Cash Price	$1,236.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.66
Rate for Payer: Health Management Network Commercial	$1,616.49
Rate for Payer: Kaiser Permanente Commercial	$1,198.10
Rate for Payer: Kaiser Permanente Medicaid	$969.89
Rate for Payer: MDX Hawaii PPO	$1,844.70
Rate for Payer: University Health Alliance Commercial	$1,386.19

Guidewire Beveled FT 1.4mm 3.5mm AR-8741-14 [3644510]

Facility

$384.84

Hospital Charge Code	3644510
Hospital Revenue Code	272
Min. Negotiated Rate	$327.11
Max. Negotiated Rate	$373.29
Rate for Payer: Cash Price	$250.15
Rate for Payer: Health Management Network Commercial	$327.11
Rate for Payer: MDX Hawaii PPO	$373.29

Guidewire Beveled FT 1.4mm 3.5mm AR-8741-14 [3644510]

Facility

$384.84

Hospital Charge Code	3644510
Hospital Revenue Code	272
Min. Negotiated Rate	$196.27
Max. Negotiated Rate	$373.29
Rate for Payer: Cash Price	$250.15
Rate for Payer: Hawaii Western Management Group Commercial	$365.60
Rate for Payer: Health Management Network Commercial	$327.11
Rate for Payer: Kaiser Permanente Commercial	$242.45
Rate for Payer: Kaiser Permanente Medicaid	$196.27
Rate for Payer: MDX Hawaii PPO	$373.29
Rate for Payer: University Health Alliance Commercial	$280.51

Guidewire Beveled FT 1.6mm 4mm AR-8741-15 [3644511]

Facility

$384.84

Hospital Charge Code	3644511
Hospital Revenue Code	272
Min. Negotiated Rate	$327.11
Max. Negotiated Rate	$373.29
Rate for Payer: Cash Price	$250.15
Rate for Payer: Health Management Network Commercial	$327.11
Rate for Payer: MDX Hawaii PPO	$373.29

Guidewire Beveled FT 1.6mm 4mm AR-8741-15 [3644511]

Facility

$384.84

Hospital Charge Code	3644511
Hospital Revenue Code	272
Min. Negotiated Rate	$196.27
Max. Negotiated Rate	$373.29
Rate for Payer: Cash Price	$250.15
Rate for Payer: Hawaii Western Management Group Commercial	$365.60
Rate for Payer: Health Management Network Commercial	$327.11
Rate for Payer: Kaiser Permanente Commercial	$242.45
Rate for Payer: Kaiser Permanente Medicaid	$196.27
Rate for Payer: MDX Hawaii PPO	$373.29
Rate for Payer: University Health Alliance Commercial	$280.51

Guidewire Calib w/Flute 2.8mm x 150mm 292.81 [3626308]

Facility

$781.01

Service Code	HCPCS C1769
Hospital Charge Code	3626308
Hospital Revenue Code	272
Min. Negotiated Rate	$398.32
Max. Negotiated Rate	$757.58
Rate for Payer: Cash Price	$507.66
Rate for Payer: Hawaii Western Management Group Commercial	$741.96
Rate for Payer: Health Management Network Commercial	$663.86
Rate for Payer: Kaiser Permanente Commercial	$492.04
Rate for Payer: Kaiser Permanente Medicaid	$398.32
Rate for Payer: MDX Hawaii PPO	$757.58
Rate for Payer: University Health Alliance Commercial	$569.28

Guidewire Calib w/Flute 2.8mm x 150mm 292.81 [3626308]

Facility

$781.01

Service Code	HCPCS C1769
Hospital Charge Code	3626308
Hospital Revenue Code	272
Min. Negotiated Rate	$663.86
Max. Negotiated Rate	$757.58
Rate for Payer: Cash Price	$507.66
Rate for Payer: Health Management Network Commercial	$663.86
Rate for Payer: MDX Hawaii PPO	$757.58

Guide Wire Graduated 2.5x450mm Dt070004 [3643930]

Facility

$1,546.88

Hospital Charge Code	3643930
Hospital Revenue Code	272
Min. Negotiated Rate	$788.91
Max. Negotiated Rate	$1,500.47
Rate for Payer: Cash Price	$1,005.47
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.54
Rate for Payer: Health Management Network Commercial	$1,314.85
Rate for Payer: Kaiser Permanente Commercial	$974.53
Rate for Payer: Kaiser Permanente Medicaid	$788.91
Rate for Payer: MDX Hawaii PPO	$1,500.47
Rate for Payer: University Health Alliance Commercial	$1,127.52

Guide Wire Graduated 2.5x450mm Dt070004 [3643930]

Facility

$1,546.88

Hospital Charge Code	3643930
Hospital Revenue Code	272
Min. Negotiated Rate	$1,314.85
Max. Negotiated Rate	$1,500.47
Rate for Payer: Cash Price	$1,005.47
Rate for Payer: Health Management Network Commercial	$1,314.85
Rate for Payer: MDX Hawaii PPO	$1,500.47

Guidewire Mailman 0.014 in x 182cm H74912136012 [3641334]

Facility

$566.25

Service Code	HCPCS C1769
Hospital Charge Code	3641334
Hospital Revenue Code	272
Min. Negotiated Rate	$288.79
Max. Negotiated Rate	$549.26
Rate for Payer: Cash Price	$368.06
Rate for Payer: Hawaii Western Management Group Commercial	$537.94
Rate for Payer: Health Management Network Commercial	$481.31
Rate for Payer: Kaiser Permanente Commercial	$356.74
Rate for Payer: Kaiser Permanente Medicaid	$288.79
Rate for Payer: MDX Hawaii PPO	$549.26
Rate for Payer: University Health Alliance Commercial	$412.74

Guidewire Mailman 0.014 in x 182cm H74912136012 [3641334]

Facility

$566.25

Service Code	HCPCS C1769
Hospital Charge Code	3641334
Hospital Revenue Code	272
Min. Negotiated Rate	$481.31
Max. Negotiated Rate	$549.26
Rate for Payer: Cash Price	$368.06
Rate for Payer: Health Management Network Commercial	$481.31
Rate for Payer: MDX Hawaii PPO	$549.26

Guidewire Non-Threaded 1.25mm x 150mm 900.721 [3621637]

Facility

$267.22

Service Code	HCPCS C1769
Hospital Charge Code	3621637
Hospital Revenue Code	272
Min. Negotiated Rate	$227.14
Max. Negotiated Rate	$259.20
Rate for Payer: Cash Price	$173.69
Rate for Payer: Health Management Network Commercial	$227.14
Rate for Payer: MDX Hawaii PPO	$259.20

Guidewire Non-Threaded 1.25mm x 150mm 900.721 [3621637]

Facility

$267.22

Service Code	HCPCS C1769
Hospital Charge Code	3621637
Hospital Revenue Code	272
Min. Negotiated Rate	$136.28
Max. Negotiated Rate	$259.20
Rate for Payer: Cash Price	$173.69
Rate for Payer: Hawaii Western Management Group Commercial	$253.86
Rate for Payer: Health Management Network Commercial	$227.14
Rate for Payer: Kaiser Permanente Commercial	$168.35
Rate for Payer: Kaiser Permanente Medicaid	$136.28
Rate for Payer: MDX Hawaii PPO	$259.20
Rate for Payer: University Health Alliance Commercial	$194.78

Guidewire Spade Pt 2.0x230mm 292.652 [3640073]

Facility

$273.76

Service Code	HCPCS C1769
Hospital Charge Code	3640073
Hospital Revenue Code	272
Min. Negotiated Rate	$139.62
Max. Negotiated Rate	$265.55
Rate for Payer: Cash Price	$177.94
Rate for Payer: Hawaii Western Management Group Commercial	$260.07
Rate for Payer: Health Management Network Commercial	$232.70
Rate for Payer: Kaiser Permanente Commercial	$172.47
Rate for Payer: Kaiser Permanente Medicaid	$139.62
Rate for Payer: MDX Hawaii PPO	$265.55
Rate for Payer: University Health Alliance Commercial	$199.54

Guidewire Spade Pt 2.0x230mm 292.652 [3640073]

Facility

$273.76

Service Code	HCPCS C1769
Hospital Charge Code	3640073
Hospital Revenue Code	272
Min. Negotiated Rate	$232.70
Max. Negotiated Rate	$265.55
Rate for Payer: Cash Price	$177.94
Rate for Payer: Health Management Network Commercial	$232.70
Rate for Payer: MDX Hawaii PPO	$265.55

Guidewire Tear DropTip 3mm X 100cm 47249009700 [3641512]

Facility

$1,400.42

Service Code	HCPCS C1769
Hospital Charge Code	3641512
Hospital Revenue Code	272
Min. Negotiated Rate	$714.21
Max. Negotiated Rate	$1,358.41
Rate for Payer: Cash Price	$910.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.40
Rate for Payer: Health Management Network Commercial	$1,190.36
Rate for Payer: Kaiser Permanente Commercial	$882.26
Rate for Payer: Kaiser Permanente Medicaid	$714.21
Rate for Payer: MDX Hawaii PPO	$1,358.41
Rate for Payer: University Health Alliance Commercial	$1,020.77

Guidewire Tear DropTip 3mm X 100cm 47249009700 [3641512]

Facility

$1,400.42

Service Code	HCPCS C1769
Hospital Charge Code	3641512
Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.36
Max. Negotiated Rate	$1,358.41
Rate for Payer: Cash Price	$910.27
Rate for Payer: Health Management Network Commercial	$1,190.36
Rate for Payer: MDX Hawaii PPO	$1,358.41

Know your out-of-pocket cost for care.

All Charges