Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Anchor Biocomp Swivlock 4.75 x 19.1mm AR-2324-BCC [3623603]

Facility

$3,077.00

Service Code	HCPCS C1713
Hospital Charge Code	3623603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,723.12
Max. Negotiated Rate	$2,984.69
Rate for Payer: Cash Price	$2,000.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,153.90
Rate for Payer: Health Management Network Commercial	$2,615.45
Rate for Payer: MDX Hawaii PPO	$2,984.69
Rate for Payer: University Health Alliance Commercial	$1,723.12

Anchor Biocomp Swivlock 4.75 x 19.1mm AR-2324-BCC [3623603]

Facility

$3,077.00

Service Code	HCPCS C1713
Hospital Charge Code	3623603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.27
Max. Negotiated Rate	$2,984.69
Rate for Payer: Cash Price	$2,000.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,153.90
Rate for Payer: Health Management Network Commercial	$2,615.45
Rate for Payer: Kaiser Permanente Commercial	$1,938.51
Rate for Payer: Kaiser Permanente Medicaid	$1,569.27
Rate for Payer: MDX Hawaii PPO	$2,984.69
Rate for Payer: University Health Alliance Commercial	$1,723.12

Anchor Biocomp Swvlk 4.75 x 22mm AR-2324BCC-2 [3645413]

Facility

$3,630.50

Service Code	HCPCS C1713
Hospital Charge Code	3645413
Hospital Revenue Code	278
Min. Negotiated Rate	$2,033.08
Max. Negotiated Rate	$3,521.59
Rate for Payer: Cash Price	$2,359.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,541.35
Rate for Payer: Health Management Network Commercial	$3,085.93
Rate for Payer: MDX Hawaii PPO	$3,521.59
Rate for Payer: University Health Alliance Commercial	$2,033.08

Anchor Biocomp Swvlk 4.75 x 22mm AR-2324BCC-2 [3645413]

Facility

$3,630.50

Service Code	HCPCS C1713
Hospital Charge Code	3645413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,851.56
Max. Negotiated Rate	$3,521.59
Rate for Payer: Cash Price	$2,359.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,541.35
Rate for Payer: Health Management Network Commercial	$3,085.93
Rate for Payer: Kaiser Permanente Commercial	$2,287.22
Rate for Payer: Kaiser Permanente Medicaid	$1,851.56
Rate for Payer: MDX Hawaii PPO	$3,521.59
Rate for Payer: University Health Alliance Commercial	$2,033.08

Anchor Bone (3) Smith & Nephew 4403 [3642461]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3642461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.78
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: Kaiser Permanente Commercial	$2,443.14
Rate for Payer: Kaiser Permanente Medicaid	$1,977.78
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

Anchor Bone (3) Smith & Nephew 4403 [3642461]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3642461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,171.68
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

Anchor Fast Guard Endotrach Tube Fastener [2709851]

Facility

$84.32

Hospital Charge Code	2709851
Hospital Revenue Code	272
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$81.79
Rate for Payer: Cash Price	$54.81
Rate for Payer: Hawaii Western Management Group Commercial	$80.10
Rate for Payer: Health Management Network Commercial	$71.67
Rate for Payer: Kaiser Permanente Commercial	$53.12
Rate for Payer: Kaiser Permanente Medicaid	$43.00
Rate for Payer: MDX Hawaii PPO	$81.79
Rate for Payer: University Health Alliance Commercial	$61.46

Anchor Fast Guard Endotrach Tube Fastener [2709851]

Facility

$84.32

Hospital Charge Code	2709851
Hospital Revenue Code	272
Min. Negotiated Rate	$71.67
Max. Negotiated Rate	$81.79
Rate for Payer: Cash Price	$54.81
Rate for Payer: Health Management Network Commercial	$71.67
Rate for Payer: MDX Hawaii PPO	$81.79

Anchor Iconix 2 2.3mm w/Ndle Force Fiber 3910-500-422 [3640702]

Facility

$2,488.15

Service Code	HCPCS C1713
Hospital Charge Code	3640702
Hospital Revenue Code	278
Min. Negotiated Rate	$1,393.36
Max. Negotiated Rate	$2,413.51
Rate for Payer: Cash Price	$1,617.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,741.70
Rate for Payer: Health Management Network Commercial	$2,114.93
Rate for Payer: MDX Hawaii PPO	$2,413.51
Rate for Payer: University Health Alliance Commercial	$1,393.36

Anchor Iconix 2 2.3mm w/Ndle Force Fiber 3910-500-422 [3640702]

Facility

$2,488.15

Service Code	HCPCS C1713
Hospital Charge Code	3640702
Hospital Revenue Code	278
Min. Negotiated Rate	$1,268.96
Max. Negotiated Rate	$2,413.51
Rate for Payer: Cash Price	$1,617.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,741.70
Rate for Payer: Health Management Network Commercial	$2,114.93
Rate for Payer: Kaiser Permanente Commercial	$1,567.53
Rate for Payer: Kaiser Permanente Medicaid	$1,268.96
Rate for Payer: MDX Hawaii PPO	$2,413.51
Rate for Payer: University Health Alliance Commercial	$1,393.36

Anchor Iconix 2.3mm SP W/2Strnds 2.0 FF Suture 3910-500-922 [3644270]

Facility

$3,823.24

Service Code	HCPCS C1713
Hospital Charge Code	3644270
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.01
Max. Negotiated Rate	$3,708.54
Rate for Payer: Cash Price	$2,485.11
Rate for Payer: Hawaii Western Management Group Commercial	$2,676.27
Rate for Payer: Health Management Network Commercial	$3,249.75
Rate for Payer: MDX Hawaii PPO	$3,708.54
Rate for Payer: University Health Alliance Commercial	$2,141.01

Anchor Iconix 2.3mm SP W/2Strnds 2.0 FF Suture 3910-500-922 [3644270]

Facility

$3,823.24

Service Code	HCPCS C1713
Hospital Charge Code	3644270
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.85
Max. Negotiated Rate	$3,708.54
Rate for Payer: Cash Price	$2,485.11
Rate for Payer: Hawaii Western Management Group Commercial	$2,676.27
Rate for Payer: Health Management Network Commercial	$3,249.75
Rate for Payer: Kaiser Permanente Commercial	$2,408.64
Rate for Payer: Kaiser Permanente Medicaid	$1,949.85
Rate for Payer: MDX Hawaii PPO	$3,708.54
Rate for Payer: University Health Alliance Commercial	$2,141.01

Anchor Suture Biocomp S-Tak AR1934BCFT2 [3641172]

Facility

$2,680.75

Service Code	HCPCS C1713
Hospital Charge Code	3641172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,367.18
Max. Negotiated Rate	$2,600.33
Rate for Payer: Cash Price	$1,742.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,876.53
Rate for Payer: Health Management Network Commercial	$2,278.64
Rate for Payer: Kaiser Permanente Commercial	$1,688.87
Rate for Payer: Kaiser Permanente Medicaid	$1,367.18
Rate for Payer: MDX Hawaii PPO	$2,600.33
Rate for Payer: University Health Alliance Commercial	$1,501.22

Anchor Suture Biocomp S-Tak AR1934BCFT2 [3641172]

Facility

$2,680.75

Service Code	HCPCS C1713
Hospital Charge Code	3641172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,501.22
Max. Negotiated Rate	$2,600.33
Rate for Payer: Cash Price	$1,742.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,876.53
Rate for Payer: Health Management Network Commercial	$2,278.64
Rate for Payer: MDX Hawaii PPO	$2,600.33
Rate for Payer: University Health Alliance Commercial	$1,501.22

Anchor Suture Biocomp S-Tak Knotless AR1938BC [3641247]

Facility

$3,239.00

Service Code	HCPCS C1713
Hospital Charge Code	3641247
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.89
Max. Negotiated Rate	$3,141.83
Rate for Payer: Cash Price	$2,105.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,267.30
Rate for Payer: Health Management Network Commercial	$2,753.15
Rate for Payer: Kaiser Permanente Commercial	$2,040.57
Rate for Payer: Kaiser Permanente Medicaid	$1,651.89
Rate for Payer: MDX Hawaii PPO	$3,141.83
Rate for Payer: University Health Alliance Commercial	$1,813.84

Anchor Suture Biocomp S-Tak Knotless AR1938BC [3641247]

Facility

$3,239.00

Service Code	HCPCS C1713
Hospital Charge Code	3641247
Hospital Revenue Code	278
Min. Negotiated Rate	$1,813.84
Max. Negotiated Rate	$3,141.83
Rate for Payer: Cash Price	$2,105.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,267.30
Rate for Payer: Health Management Network Commercial	$2,753.15
Rate for Payer: MDX Hawaii PPO	$3,141.83
Rate for Payer: University Health Alliance Commercial	$1,813.84

Anchor Swivelock Bc Sp Kl 4.75mm Ar-2324kbcsp [3644548]

Facility

$4,215.50

Service Code	HCPCS C1713
Hospital Charge Code	3644548
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.68
Max. Negotiated Rate	$4,089.03
Rate for Payer: Cash Price	$2,740.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,950.85
Rate for Payer: Health Management Network Commercial	$3,583.18
Rate for Payer: MDX Hawaii PPO	$4,089.03
Rate for Payer: University Health Alliance Commercial	$2,360.68

Anchor Swivelock Bc Sp Kl 4.75mm Ar-2324kbcsp [3644548]

Facility

$4,215.50

Service Code	HCPCS C1713
Hospital Charge Code	3644548
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.91
Max. Negotiated Rate	$4,089.03
Rate for Payer: Cash Price	$2,740.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,950.85
Rate for Payer: Health Management Network Commercial	$3,583.18
Rate for Payer: Kaiser Permanente Commercial	$2,655.76
Rate for Payer: Kaiser Permanente Medicaid	$2,149.91
Rate for Payer: MDX Hawaii PPO	$4,089.03
Rate for Payer: University Health Alliance Commercial	$2,360.68

Anchor Swivelock Tenod Biocomp 8 X 19.5mm AR-1662BCC-8 [3641132]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3641132
Hospital Revenue Code	278
Min. Negotiated Rate	$2,108.68
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Anchor Swivelock Tenod Biocomp 8 X 19.5mm AR-1662BCC-8 [3641132]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3641132
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.40
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: Kaiser Permanente Commercial	$2,372.26
Rate for Payer: Kaiser Permanente Medicaid	$1,920.40
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Anchor Swivelock Tenod Biocomp 9 X 19.1mm AR-1662BCC-9 [3642363]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3642363
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.40
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: Kaiser Permanente Commercial	$2,372.26
Rate for Payer: Kaiser Permanente Medicaid	$1,920.40
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Anchor Swivelock Tenod Biocomp 9 X 19.1mm AR-1662BCC-9 [3642363]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3642363
Hospital Revenue Code	278
Min. Negotiated Rate	$2,108.68
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Anchor Tendon (8) Smith & Nephew 25041 [3642462]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3642462
Hospital Revenue Code	278
Min. Negotiated Rate	$2,171.68
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

Anchor Tendon (8) Smith & Nephew 25041 [3642462]

Facility

$3,878.00

Service Code	HCPCS C1713
Hospital Charge Code	3642462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.78
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: Kaiser Permanente Commercial	$2,443.14
Rate for Payer: Kaiser Permanente Medicaid	$1,977.78
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

Angel Sys w/Aspiration Kit w/ACDA ABS-10062T [3644645]

Facility

$7,222.00

Hospital Charge Code	3644645
Hospital Revenue Code	272
Min. Negotiated Rate	$6,138.70
Max. Negotiated Rate	$7,005.34
Rate for Payer: Cash Price	$4,694.30
Rate for Payer: Health Management Network Commercial	$6,138.70
Rate for Payer: MDX Hawaii PPO	$7,005.34

Know your out-of-pocket cost for care.

All Charges