Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$144.00

Hospital Charge Code	3643233
Hospital Revenue Code	272
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$139.68

Guide Wire Trocar Tip Thrd .062in AR-8941KT [3644982]

Facility

$288.75

Hospital Charge Code	3644982
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 Thrd .062in AR-8941KT [3644982]

Facility

$288.75

Hospital Charge Code	3644982
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 w/Trocar Tip .062" AR-8941K [3644678]

Facility

$207.75

Hospital Charge Code	3644678
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 w/Trocar Tip .062" AR-8941K [3644678]

Facility

$207.75

Hospital Charge Code	3644678
Hospital Revenue Code	272
Min. Negotiated Rate	$176.59
Max. Negotiated Rate	$201.52
Rate for Payer: MDX Hawaii PPO	$201.52
Rate for Payer: Cash Price	$135.04
Rate for Payer: Health Management Network Commercial	$176.59

Guidewire w/Trocar Tip.062" x 9.25" AR-8750K [3644667]

Facility

$207.75

Hospital Charge Code	3644667
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 w/Trocar Tip.062" x 9.25" AR-8750K [3644667]

Facility

$207.75

Hospital Charge Code	3644667
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 w/Trocar Tip Thrd 2.4mm x 9.25" AR-8770K [3644668]

Facility

$376.50

Hospital Charge Code	3644668
Hospital Revenue Code	272
Min. Negotiated Rate	$320.02
Max. Negotiated Rate	$365.20
Rate for Payer: Cash Price	$244.72
Rate for Payer: Health Management Network Commercial	$320.02
Rate for Payer: MDX Hawaii PPO	$365.20

Guidewire w/Trocar Tip Thrd 2.4mm x 9.25" AR-8770K [3644668]

Facility

$376.50

Hospital Charge Code	3644668
Hospital Revenue Code	272
Min. Negotiated Rate	$192.01
Max. Negotiated Rate	$365.20
Rate for Payer: Cash Price	$244.72
Rate for Payer: Hawaii Western Management Group Commercial	$357.68
Rate for Payer: Health Management Network Commercial	$320.02
Rate for Payer: Kaiser Permanente Commercial	$237.19
Rate for Payer: Kaiser Permanente Medicaid	$192.01
Rate for Payer: MDX Hawaii PPO	$365.20
Rate for Payer: University Health Alliance Commercial	$274.43

Guidewire Zipwire Std .018 x 180 cm Straight M00146236B1 [3643392]

Facility

$95.54

Service Code	HCPCS C1769
Hospital Charge Code	3643392
Hospital Revenue Code	272
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$92.67
Rate for Payer: Cash Price	$62.10
Rate for Payer: Hawaii Western Management Group Commercial	$90.76
Rate for Payer: Health Management Network Commercial	$81.21
Rate for Payer: Kaiser Permanente Commercial	$60.19
Rate for Payer: Kaiser Permanente Medicaid	$48.73
Rate for Payer: MDX Hawaii PPO	$92.67
Rate for Payer: University Health Alliance Commercial	$69.64

Guidewire Zipwire Std .018 x 180 cm Straight M00146236B1 [3643392]

Facility

$95.54

Service Code	HCPCS C1769
Hospital Charge Code	3643392
Hospital Revenue Code	272
Min. Negotiated Rate	$81.21
Max. Negotiated Rate	$92.67
Rate for Payer: Cash Price	$62.10
Rate for Payer: Health Management Network Commercial	$81.21
Rate for Payer: MDX Hawaii PPO	$92.67

Guidewire Zipwire Std .035 x 150cm Straight M0066802051 [3643922]

Facility

$288.48

Service Code	HCPCS C1769
Hospital Charge Code	3643922
Hospital Revenue Code	272
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$279.83
Rate for Payer: Cash Price	$187.51
Rate for Payer: Health Management Network Commercial	$245.21
Rate for Payer: MDX Hawaii PPO	$279.83

Guidewire Zipwire Std .035 x 150cm Straight M0066802051 [3643922]

Facility

$288.48

Service Code	HCPCS C1769
Hospital Charge Code	3643922
Hospital Revenue Code	272
Min. Negotiated Rate	$147.12
Max. Negotiated Rate	$279.83
Rate for Payer: Cash Price	$187.51
Rate for Payer: Hawaii Western Management Group Commercial	$274.06
Rate for Payer: Health Management Network Commercial	$245.21
Rate for Payer: Kaiser Permanente Commercial	$181.74
Rate for Payer: Kaiser Permanente Medicaid	$147.12
Rate for Payer: MDX Hawaii PPO	$279.83
Rate for Payer: University Health Alliance Commercial	$210.27

Guidwire .035 x 150cm Angled Zipwire M00146151B1 [3641014]

Facility

$189.75

Service Code	HCPCS C1769
Hospital Charge Code	3641014
Hospital Revenue Code	272
Min. Negotiated Rate	$96.77
Max. Negotiated Rate	$184.06
Rate for Payer: Cash Price	$123.34
Rate for Payer: Hawaii Western Management Group Commercial	$180.26
Rate for Payer: Health Management Network Commercial	$161.29
Rate for Payer: Kaiser Permanente Commercial	$119.54
Rate for Payer: Kaiser Permanente Medicaid	$96.77
Rate for Payer: MDX Hawaii PPO	$184.06
Rate for Payer: University Health Alliance Commercial	$138.31

Guidwire .035 x 150cm Angled Zipwire M00146151B1 [3641014]

Facility

$189.75

Service Code	HCPCS C1769
Hospital Charge Code	3641014
Hospital Revenue Code	272
Min. Negotiated Rate	$161.29
Max. Negotiated Rate	$184.06
Rate for Payer: Cash Price	$123.34
Rate for Payer: Health Management Network Commercial	$161.29
Rate for Payer: MDX Hawaii PPO	$184.06

Guidwire Bentson .035X180cm Str 15cm Floppy Tip M001491471 [3641962]

Facility

$136.00

Service Code	HCPCS C1769
Hospital Charge Code	3641962
Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: MDX Hawaii PPO	$131.92

Guidwire Bentson .035X180cm Str 15cm Floppy Tip M001491471 [3641962]

Facility

$136.00

Service Code	HCPCS C1769
Hospital Charge Code	3641962
Hospital Revenue Code	272
Min. Negotiated Rate	$69.36
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$85.68
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$99.13

Guidwire V-18 Control Wire 0.018inX2000cm Straight M001468520 [3641977]

Facility

$460.75

Service Code	HCPCS C1769
Hospital Charge Code	3641977
Hospital Revenue Code	272
Min. Negotiated Rate	$234.98
Max. Negotiated Rate	$446.93
Rate for Payer: Cash Price	$299.49
Rate for Payer: Hawaii Western Management Group Commercial	$437.71
Rate for Payer: Health Management Network Commercial	$391.64
Rate for Payer: Kaiser Permanente Commercial	$290.27
Rate for Payer: Kaiser Permanente Medicaid	$234.98
Rate for Payer: MDX Hawaii PPO	$446.93
Rate for Payer: University Health Alliance Commercial	$335.84

Guidwire V-18 Control Wire 0.018inX2000cm Straight M001468520 [3641977]

Facility

$460.75

Service Code	HCPCS C1769
Hospital Charge Code	3641977
Hospital Revenue Code	272
Min. Negotiated Rate	$391.64
Max. Negotiated Rate	$446.93
Rate for Payer: Cash Price	$299.49
Rate for Payer: Health Management Network Commercial	$391.64
Rate for Payer: MDX Hawaii PPO	$446.93

Guidwire Zipwire Std .018 x 180cm Angled M00146232B1 [3643393]

Facility

$95.54

Service Code	HCPCS C1769
Hospital Charge Code	3643393
Hospital Revenue Code	272
Min. Negotiated Rate	$81.21
Max. Negotiated Rate	$92.67
Rate for Payer: Cash Price	$62.10
Rate for Payer: Health Management Network Commercial	$81.21
Rate for Payer: MDX Hawaii PPO	$92.67

Guidwire Zipwire Std .018 x 180cm Angled M00146232B1 [3643393]

Facility

$95.54

Service Code	HCPCS C1769
Hospital Charge Code	3643393
Hospital Revenue Code	272
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$92.67
Rate for Payer: Cash Price	$62.10
Rate for Payer: Hawaii Western Management Group Commercial	$90.76
Rate for Payer: Health Management Network Commercial	$81.21
Rate for Payer: Kaiser Permanente Commercial	$60.19
Rate for Payer: Kaiser Permanente Medicaid	$48.73
Rate for Payer: MDX Hawaii PPO	$92.67
Rate for Payer: University Health Alliance Commercial	$69.64

Guidwire Zipwire Std .035X180cm Angled M00146152B1 [3641964]

Facility

$336.00

Service Code	HCPCS C1769
Hospital Charge Code	3641964
Hospital Revenue Code	272
Min. Negotiated Rate	$171.36
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$211.68
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: University Health Alliance Commercial	$244.91

Guidwire Zipwire Std .035X180cm Angled M00146152B1 [3641964]

Facility

$336.00

Service Code	HCPCS C1769
Hospital Charge Code	3641964
Hospital Revenue Code	272
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: MDX Hawaii PPO	$325.92

Guidwire Zipwire Std .035X180cm Straight M00146156B1 [3641965]

Facility

$336.00

Service Code	HCPCS C1769
Hospital Charge Code	3641965
Hospital Revenue Code	272
Min. Negotiated Rate	$171.36
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$211.68
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: University Health Alliance Commercial	$244.91

Guidwire Zipwire Std .035X180cm Straight M00146156B1 [3641965]

Facility

$336.00

Service Code	HCPCS C1769
Hospital Charge Code	3641965
Hospital Revenue Code	272
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: MDX Hawaii PPO	$325.92

Know your out-of-pocket cost for care.

All Charges