Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Guidewire Threaded 1.25mm x 150mm 900.722 [3605144]

Facility

$281.19

Service Code	HCPCS C1769
Hospital Charge Code	3605144
Hospital Revenue Code	272
Min. Negotiated Rate	$143.41
Max. Negotiated Rate	$272.75
Rate for Payer: Cash Price	$182.77
Rate for Payer: Hawaii Western Management Group Commercial	$267.13
Rate for Payer: Health Management Network Commercial	$239.01
Rate for Payer: Kaiser Permanente Commercial	$177.15
Rate for Payer: Kaiser Permanente Medicaid	$143.41
Rate for Payer: MDX Hawaii PPO	$272.75
Rate for Payer: University Health Alliance Commercial	$204.96

Guidewire Threaded 1.25mm x 150mm 900.722 [3605144]

Facility

$281.19

Service Code	HCPCS C1769
Hospital Charge Code	3605144
Hospital Revenue Code	272
Min. Negotiated Rate	$239.01
Max. Negotiated Rate	$272.75
Rate for Payer: Cash Price	$182.77
Rate for Payer: Health Management Network Commercial	$239.01
Rate for Payer: MDX Hawaii PPO	$272.75

Guidewire Threaded 1.6mm x 150mm 292.72 [3601783]

Facility

$313.79

Service Code	HCPCS C1769
Hospital Charge Code	3601783
Hospital Revenue Code	272
Min. Negotiated Rate	$160.03
Max. Negotiated Rate	$304.38
Rate for Payer: Cash Price	$203.96
Rate for Payer: Hawaii Western Management Group Commercial	$298.10
Rate for Payer: Health Management Network Commercial	$266.72
Rate for Payer: Kaiser Permanente Commercial	$197.69
Rate for Payer: Kaiser Permanente Medicaid	$160.03
Rate for Payer: MDX Hawaii PPO	$304.38
Rate for Payer: University Health Alliance Commercial	$228.72

Guidewire Threaded 1.6mm x 150mm 292.72 [3601783]

Facility

$313.79

Service Code	HCPCS C1769
Hospital Charge Code	3601783
Hospital Revenue Code	272
Min. Negotiated Rate	$266.72
Max. Negotiated Rate	$304.38
Rate for Payer: Cash Price	$203.96
Rate for Payer: Health Management Network Commercial	$266.72
Rate for Payer: MDX Hawaii PPO	$304.38

Guidewire Threaded 2.0mm x 230mm 292.65 [3608925]

Facility

$369.68

Service Code	HCPCS C1769
Hospital Charge Code	3608925
Hospital Revenue Code	272
Min. Negotiated Rate	$188.54
Max. Negotiated Rate	$358.59
Rate for Payer: Cash Price	$240.29
Rate for Payer: Hawaii Western Management Group Commercial	$351.20
Rate for Payer: Health Management Network Commercial	$314.23
Rate for Payer: Kaiser Permanente Commercial	$232.90
Rate for Payer: Kaiser Permanente Medicaid	$188.54
Rate for Payer: MDX Hawaii PPO	$358.59
Rate for Payer: University Health Alliance Commercial	$269.46

Guidewire Threaded 2.0mm x 230mm 292.65 [3608925]

Facility

$369.68

Service Code	HCPCS C1769
Hospital Charge Code	3608925
Hospital Revenue Code	272
Min. Negotiated Rate	$314.23
Max. Negotiated Rate	$358.59
Rate for Payer: Cash Price	$240.29
Rate for Payer: Health Management Network Commercial	$314.23
Rate for Payer: MDX Hawaii PPO	$358.59

Guidewire Threaded 2.8mm x 300mm 292.68 [3601776]

Facility

$416.01

Service Code	HCPCS C1769
Hospital Charge Code	3601776
Hospital Revenue Code	272
Min. Negotiated Rate	$212.17
Max. Negotiated Rate	$403.53
Rate for Payer: Cash Price	$270.41
Rate for Payer: Hawaii Western Management Group Commercial	$395.21
Rate for Payer: Health Management Network Commercial	$353.61
Rate for Payer: Kaiser Permanente Commercial	$262.09
Rate for Payer: Kaiser Permanente Medicaid	$212.17
Rate for Payer: MDX Hawaii PPO	$403.53
Rate for Payer: University Health Alliance Commercial	$303.23

Guidewire Threaded 2.8mm x 300mm 292.68 [3601776]

Facility

$416.01

Service Code	HCPCS C1769
Hospital Charge Code	3601776
Hospital Revenue Code	272
Min. Negotiated Rate	$353.61
Max. Negotiated Rate	$403.53
Rate for Payer: Cash Price	$270.41
Rate for Payer: Health Management Network Commercial	$353.61
Rate for Payer: MDX Hawaii PPO	$403.53

Guidewire Threaded w/Trocar Tip 1.35mm AR-8943-38 [3643232]

Facility

$265.13

Hospital Charge Code	3643232
Hospital Revenue Code	272
Min. Negotiated Rate	$225.36
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: MDX Hawaii PPO	$257.18

Guidewire Threaded w/Trocar Tip 1.35mm AR-8943-38 [3643232]

Facility

$265.13

Hospital Charge Code	3643232
Hospital Revenue Code	272
Min. Negotiated Rate	$135.22
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Hawaii Western Management Group Commercial	$251.87
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: Kaiser Permanente Commercial	$167.03
Rate for Payer: Kaiser Permanente Medicaid	$135.22
Rate for Payer: MDX Hawaii PPO	$257.18
Rate for Payer: University Health Alliance Commercial	$193.25

Guidewire Trocar .062" AR-18700-71 [3644582]

Facility

$265.13

Hospital Charge Code	3644582
Hospital Revenue Code	272
Min. Negotiated Rate	$135.22
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Hawaii Western Management Group Commercial	$251.87
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: Kaiser Permanente Commercial	$167.03
Rate for Payer: Kaiser Permanente Medicaid	$135.22
Rate for Payer: MDX Hawaii PPO	$257.18
Rate for Payer: University Health Alliance Commercial	$193.25

Guidewire Trocar .062" AR-18700-71 [3644582]

Facility

$265.13

Hospital Charge Code	3644582
Hospital Revenue Code	272
Min. Negotiated Rate	$225.36
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: MDX Hawaii PPO	$257.18

Guidewire Trocar 1.1mm AR-18700-30 [3644467]

Facility

$265.13

Hospital Charge Code	3644467
Hospital Revenue Code	272
Min. Negotiated Rate	$225.36
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: MDX Hawaii PPO	$257.18

Guidewire Trocar 1.1mm AR-18700-30 [3644467]

Facility

$265.13

Hospital Charge Code	3644467
Hospital Revenue Code	272
Min. Negotiated Rate	$135.22
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Hawaii Western Management Group Commercial	$251.87
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: Kaiser Permanente Commercial	$167.03
Rate for Payer: Kaiser Permanente Medicaid	$135.22
Rate for Payer: MDX Hawaii PPO	$257.18
Rate for Payer: University Health Alliance Commercial	$193.25

Guidewire Trocar Pt 2.8mm x 450mm 900.726 [3601771]

Facility

$648.42

Service Code	HCPCS C1769
Hospital Charge Code	3601771
Hospital Revenue Code	272
Min. Negotiated Rate	$330.69
Max. Negotiated Rate	$628.97
Rate for Payer: Cash Price	$421.47
Rate for Payer: Hawaii Western Management Group Commercial	$616.00
Rate for Payer: Health Management Network Commercial	$551.16
Rate for Payer: Kaiser Permanente Commercial	$408.50
Rate for Payer: Kaiser Permanente Medicaid	$330.69
Rate for Payer: MDX Hawaii PPO	$628.97
Rate for Payer: University Health Alliance Commercial	$472.63

Guidewire Trocar Pt 2.8mm x 450mm 900.726 [3601771]

Facility

$648.42

Service Code	HCPCS C1769
Hospital Charge Code	3601771
Hospital Revenue Code	272
Min. Negotiated Rate	$551.16
Max. Negotiated Rate	$628.97
Rate for Payer: Cash Price	$421.47
Rate for Payer: Health Management Network Commercial	$551.16
Rate for Payer: MDX Hawaii PPO	$628.97

Guide Wire Trocar Tip .045in AR-8737-41 [3644979]

Facility

$288.75

Hospital Charge Code	3644979
Hospital Revenue Code	272
Min. Negotiated Rate	$147.26
Max. Negotiated Rate	$280.09
Rate for Payer: Cash Price	$187.69
Rate for Payer: Hawaii Western Management Group Commercial	$274.31
Rate for Payer: Health Management Network Commercial	$245.44
Rate for Payer: Kaiser Permanente Commercial	$181.91
Rate for Payer: Kaiser Permanente Medicaid	$147.26
Rate for Payer: MDX Hawaii PPO	$280.09
Rate for Payer: University Health Alliance Commercial	$210.47

Guide Wire Trocar Tip .045in AR-8737-41 [3644979]

Facility

$288.75

Hospital Charge Code	3644979
Hospital Revenue Code	272
Min. Negotiated Rate	$245.44
Max. Negotiated Rate	$280.09
Rate for Payer: Cash Price	$187.69
Rate for Payer: Health Management Network Commercial	$245.44
Rate for Payer: MDX Hawaii PPO	$280.09

Guidewire Trocar Tip 0.86mm AR-8737-39 [3644734]

Facility

$288.75

Hospital Charge Code	3644734
Hospital Revenue Code	272
Min. Negotiated Rate	$147.26
Max. Negotiated Rate	$280.09
Rate for Payer: Cash Price	$187.69
Rate for Payer: Hawaii Western Management Group Commercial	$274.31
Rate for Payer: Health Management Network Commercial	$245.44
Rate for Payer: Kaiser Permanente Commercial	$181.91
Rate for Payer: Kaiser Permanente Medicaid	$147.26
Rate for Payer: MDX Hawaii PPO	$280.09
Rate for Payer: University Health Alliance Commercial	$210.47

Guidewire Trocar Tip 0.86mm AR-8737-39 [3644734]

Facility

$288.75

Hospital Charge Code	3644734
Hospital Revenue Code	272
Min. Negotiated Rate	$245.44
Max. Negotiated Rate	$280.09
Rate for Payer: Cash Price	$187.69
Rate for Payer: Health Management Network Commercial	$245.44
Rate for Payer: MDX Hawaii PPO	$280.09

Guidewire Trocar Tip 1.35mm AR-8943-01 [3643231]

Facility

$265.13

Hospital Charge Code	3643231
Hospital Revenue Code	272
Min. Negotiated Rate	$135.22
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Hawaii Western Management Group Commercial	$251.87
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: Kaiser Permanente Commercial	$167.03
Rate for Payer: Kaiser Permanente Medicaid	$135.22
Rate for Payer: MDX Hawaii PPO	$257.18
Rate for Payer: University Health Alliance Commercial	$193.25

Guidewire Trocar Tip 1.35mm AR-8943-01 [3643231]

Facility

$265.13

Hospital Charge Code	3643231
Hospital Revenue Code	272
Min. Negotiated Rate	$225.36
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: MDX Hawaii PPO	$257.18

Guidewire Trocar Tip 2.4mm x 200mm AR-8967K [3644900]

Facility

$207.75

Hospital Charge Code	3644900
Hospital Revenue Code	272
Min. Negotiated Rate	$176.59
Max. Negotiated Rate	$201.52
Rate for Payer: Cash Price	$135.04
Rate for Payer: Health Management Network Commercial	$176.59
Rate for Payer: MDX Hawaii PPO	$201.52

Guidewire Trocar Tip 2.4mm x 200mm AR-8967K [3644900]

Facility

$207.75

Hospital Charge Code	3644900
Hospital Revenue Code	272
Min. Negotiated Rate	$105.95
Max. Negotiated Rate	$201.52
Rate for Payer: Cash Price	$135.04
Rate for Payer: Hawaii Western Management Group Commercial	$197.36
Rate for Payer: Health Management Network Commercial	$176.59
Rate for Payer: Kaiser Permanente Commercial	$130.88
Rate for Payer: Kaiser Permanente Medicaid	$105.95
Rate for Payer: MDX Hawaii PPO	$201.52
Rate for Payer: University Health Alliance Commercial	$151.43

Guidewire Trocar Tip 2mmX150mm AR-8945K [3643233]

Facility

$144.00

Hospital Charge Code	3643233
Hospital Revenue Code	272
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Hawaii Western Management Group Commercial	$136.80
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$90.72
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: University Health Alliance Commercial	$104.96

Know your out-of-pocket cost for care.

All Charges