Kona Community Hospital

All Charges

Charge

Type

Setting

Price

2.5/3.0mm Cann Countersink Driver QC 03.333.201 [3644875]

Facility

$3,049.78

Hospital Charge Code	3644875
Hospital Revenue Code	272
Min. Negotiated Rate	$2,592.31
Max. Negotiated Rate	$2,958.29
Rate for Payer: Cash Price	$1,982.36
Rate for Payer: Health Management Network Commercial	$2,592.31
Rate for Payer: MDX Hawaii PPO	$2,958.29

25mm Central Screw, Modular AR-9561-25S [3645558]

Facility

$7,047.00

Service Code	HCPCS C1713
Hospital Charge Code	3645558
Hospital Revenue Code	278
Min. Negotiated Rate	$3,946.32
Max. Negotiated Rate	$6,835.59
Rate for Payer: Cash Price	$4,580.55
Rate for Payer: Hawaii Western Management Group Commercial	$4,932.90
Rate for Payer: Health Management Network Commercial	$5,989.95
Rate for Payer: MDX Hawaii PPO	$6,835.59
Rate for Payer: University Health Alliance Commercial	$3,946.32

25mm Central Screw, Modular AR-9561-25S [3645558]

Facility

$7,047.00

Service Code	HCPCS C1713
Hospital Charge Code	3645558
Hospital Revenue Code	278
Min. Negotiated Rate	$3,593.97
Max. Negotiated Rate	$6,835.59
Rate for Payer: Cash Price	$4,580.55
Rate for Payer: Hawaii Western Management Group Commercial	$4,932.90
Rate for Payer: Health Management Network Commercial	$5,989.95
Rate for Payer: Kaiser Permanente Commercial	$4,439.61
Rate for Payer: Kaiser Permanente Medicaid	$3,593.97
Rate for Payer: MDX Hawaii PPO	$6,835.59
Rate for Payer: University Health Alliance Commercial	$3,946.32

2.7/3.5mm Va Lcp Proximal Ulna Plate 02.107.506 [3645553]

Facility

$6,961.32

Service Code	HCPCS C1713
Hospital Charge Code	3645553
Hospital Revenue Code	278
Min. Negotiated Rate	$3,898.34
Max. Negotiated Rate	$6,752.48
Rate for Payer: Cash Price	$4,524.86
Rate for Payer: Hawaii Western Management Group Commercial	$4,872.92
Rate for Payer: Health Management Network Commercial	$5,917.12
Rate for Payer: MDX Hawaii PPO	$6,752.48
Rate for Payer: University Health Alliance Commercial	$3,898.34

2.7/3.5mm Va Lcp Proximal Ulna Plate 02.107.506 [3645553]

Facility

$6,961.32

Service Code	HCPCS C1713
Hospital Charge Code	3645553
Hospital Revenue Code	278
Min. Negotiated Rate	$3,550.27
Max. Negotiated Rate	$6,752.48
Rate for Payer: Cash Price	$4,524.86
Rate for Payer: Hawaii Western Management Group Commercial	$4,872.92
Rate for Payer: Health Management Network Commercial	$5,917.12
Rate for Payer: Kaiser Permanente Commercial	$4,385.63
Rate for Payer: Kaiser Permanente Medicaid	$3,550.27
Rate for Payer: MDX Hawaii PPO	$6,752.48
Rate for Payer: University Health Alliance Commercial	$3,898.34

2.7/3.5 Va Lat Ant Clavicle Plate, 10-Hole 02.112.047 [3645531]

Facility

$6,262.44

Service Code	HCPCS C1713
Hospital Charge Code	3645531
Hospital Revenue Code	278
Min. Negotiated Rate	$3,506.97
Max. Negotiated Rate	$6,074.57
Rate for Payer: Cash Price	$4,070.59
Rate for Payer: Hawaii Western Management Group Commercial	$4,383.71
Rate for Payer: Health Management Network Commercial	$5,323.07
Rate for Payer: MDX Hawaii PPO	$6,074.57
Rate for Payer: University Health Alliance Commercial	$3,506.97

2.7/3.5 Va Lat Ant Clavicle Plate, 10-Hole 02.112.047 [3645531]

Facility

$6,262.44

Service Code	HCPCS C1713
Hospital Charge Code	3645531
Hospital Revenue Code	278
Min. Negotiated Rate	$3,193.84
Max. Negotiated Rate	$6,074.57
Rate for Payer: Cash Price	$4,070.59
Rate for Payer: Hawaii Western Management Group Commercial	$4,383.71
Rate for Payer: Health Management Network Commercial	$5,323.07
Rate for Payer: Kaiser Permanente Commercial	$3,945.34
Rate for Payer: Kaiser Permanente Medicaid	$3,193.84
Rate for Payer: MDX Hawaii PPO	$6,074.57
Rate for Payer: University Health Alliance Commercial	$3,506.97

2.8mm Guidewire, 300mm Length 03.333.005 [3645550]

Facility

$830.91

Hospital Charge Code	3645550
Hospital Revenue Code	272
Min. Negotiated Rate	$706.27
Max. Negotiated Rate	$805.98
Rate for Payer: Cash Price	$540.09
Rate for Payer: Health Management Network Commercial	$706.27
Rate for Payer: MDX Hawaii PPO	$805.98

2.8mm Guidewire, 300mm Length 03.333.005 [3645550]

Facility

$830.91

Hospital Charge Code	3645550
Hospital Revenue Code	272
Min. Negotiated Rate	$423.76
Max. Negotiated Rate	$805.98
Rate for Payer: Cash Price	$540.09
Rate for Payer: Hawaii Western Management Group Commercial	$789.36
Rate for Payer: Health Management Network Commercial	$706.27
Rate for Payer: Kaiser Permanente Commercial	$523.47
Rate for Payer: Kaiser Permanente Medicaid	$423.76
Rate for Payer: MDX Hawaii PPO	$805.98
Rate for Payer: University Health Alliance Commercial	$605.65

2.8mm Threaded Guidewire 220mm Length 03.333.014 [3645564]

Facility

$1,048.86

Hospital Charge Code	3645564
Hospital Revenue Code	272
Min. Negotiated Rate	$534.92
Max. Negotiated Rate	$1,017.39
Rate for Payer: Cash Price	$681.76
Rate for Payer: Hawaii Western Management Group Commercial	$996.42
Rate for Payer: Health Management Network Commercial	$891.53
Rate for Payer: Kaiser Permanente Commercial	$660.78
Rate for Payer: Kaiser Permanente Medicaid	$534.92
Rate for Payer: MDX Hawaii PPO	$1,017.39
Rate for Payer: University Health Alliance Commercial	$764.51

2.8mm Threaded Guidewire 220mm Length 03.333.014 [3645564]

Facility

$1,048.86

Hospital Charge Code	3645564
Hospital Revenue Code	272
Min. Negotiated Rate	$891.53
Max. Negotiated Rate	$1,017.39
Rate for Payer: Cash Price	$681.76
Rate for Payer: Health Management Network Commercial	$891.53
Rate for Payer: MDX Hawaii PPO	$1,017.39

310.634 Drill Bit 310.634 4.3 mm Cann QC 200 mm [3600892]

Facility

$2,009.70

Hospital Charge Code	3600892
Hospital Revenue Code	272
Min. Negotiated Rate	$1,708.24
Max. Negotiated Rate	$1,949.41
Rate for Payer: Cash Price	$1,306.30
Rate for Payer: Health Management Network Commercial	$1,708.24
Rate for Payer: MDX Hawaii PPO	$1,949.41

310.634 Drill Bit 310.634 4.3 mm Cann QC 200 mm [3600892]

Facility

$2,009.70

Hospital Charge Code	3600892
Hospital Revenue Code	272
Min. Negotiated Rate	$1,024.95
Max. Negotiated Rate	$1,949.41
Rate for Payer: Cash Price	$1,306.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,909.21
Rate for Payer: Health Management Network Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Commercial	$1,266.11
Rate for Payer: Kaiser Permanente Medicaid	$1,024.95
Rate for Payer: MDX Hawaii PPO	$1,949.41
Rate for Payer: University Health Alliance Commercial	$1,464.87

351.27 Drill Bit 351.27 13mm Cann 300mm 351.27 [3640201]

Facility

$2,400.51

Hospital Charge Code	3640201
Hospital Revenue Code	272
Min. Negotiated Rate	$2,040.43
Max. Negotiated Rate	$2,328.49
Rate for Payer: Cash Price	$1,560.33
Rate for Payer: Health Management Network Commercial	$2,040.43
Rate for Payer: MDX Hawaii PPO	$2,328.49

351.27 Drill Bit 351.27 13mm Cann 300mm 351.27 [3640201]

Facility

$2,400.51

Hospital Charge Code	3640201
Hospital Revenue Code	272
Min. Negotiated Rate	$1,224.26
Max. Negotiated Rate	$2,328.49
Rate for Payer: Cash Price	$1,560.33
Rate for Payer: Hawaii Western Management Group Commercial	$2,280.48
Rate for Payer: Health Management Network Commercial	$2,040.43
Rate for Payer: Kaiser Permanente Commercial	$1,512.32
Rate for Payer: Kaiser Permanente Medicaid	$1,224.26
Rate for Payer: MDX Hawaii PPO	$2,328.49
Rate for Payer: University Health Alliance Commercial	$1,749.73

380544100 Arthroscopy Blade 4.0mm Agg Plus Angled [3640423]

Facility

$447.74

Hospital Charge Code	3640423
Hospital Revenue Code	272
Min. Negotiated Rate	$380.58
Max. Negotiated Rate	$434.31
Rate for Payer: Cash Price	$291.03
Rate for Payer: Health Management Network Commercial	$380.58
Rate for Payer: MDX Hawaii PPO	$434.31

380544100 Arthroscopy Blade 4.0mm Agg Plus Angled [3640423]

Facility

$447.74

Hospital Charge Code	3640423
Hospital Revenue Code	272
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$434.31
Rate for Payer: Cash Price	$291.03
Rate for Payer: Hawaii Western Management Group Commercial	$425.35
Rate for Payer: Health Management Network Commercial	$380.58
Rate for Payer: Kaiser Permanente Commercial	$282.08
Rate for Payer: Kaiser Permanente Medicaid	$228.35
Rate for Payer: MDX Hawaii PPO	$434.31
Rate for Payer: University Health Alliance Commercial	$326.36

3M Ranger Irrigation Set, Disp 24750 [3642069]

Facility

$321.49

Hospital Charge Code	3642069
Hospital Revenue Code	272
Min. Negotiated Rate	$273.27
Max. Negotiated Rate	$311.85
Rate for Payer: Cash Price	$208.97
Rate for Payer: Health Management Network Commercial	$273.27
Rate for Payer: MDX Hawaii PPO	$311.85

3M Ranger Irrigation Set, Disp 24750 [3642069]

Facility

$321.49

Hospital Charge Code	3642069
Hospital Revenue Code	272
Min. Negotiated Rate	$163.96
Max. Negotiated Rate	$311.85
Rate for Payer: Cash Price	$208.97
Rate for Payer: Hawaii Western Management Group Commercial	$305.42
Rate for Payer: Health Management Network Commercial	$273.27
Rate for Payer: Kaiser Permanente Commercial	$202.54
Rate for Payer: Kaiser Permanente Medicaid	$163.96
Rate for Payer: MDX Hawaii PPO	$311.85
Rate for Payer: University Health Alliance Commercial	$234.33

47248604640 Screw Affixus Blunt Tip 4.0mmX46mm [3642062]

Facility

$1,534.80

Service Code	HCPCS C1713
Hospital Charge Code	3642062
Hospital Revenue Code	278
Min. Negotiated Rate	$782.75
Max. Negotiated Rate	$1,488.76
Rate for Payer: Cash Price	$997.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.36
Rate for Payer: Health Management Network Commercial	$1,304.58
Rate for Payer: Kaiser Permanente Commercial	$966.92
Rate for Payer: Kaiser Permanente Medicaid	$782.75
Rate for Payer: MDX Hawaii PPO	$1,488.76
Rate for Payer: University Health Alliance Commercial	$859.49

47248604640 Screw Affixus Blunt Tip 4.0mmX46mm [3642062]

Facility

$1,534.80

Service Code	HCPCS C1713
Hospital Charge Code	3642062
Hospital Revenue Code	278
Min. Negotiated Rate	$859.49
Max. Negotiated Rate	$1,488.76
Rate for Payer: Cash Price	$997.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.36
Rate for Payer: Health Management Network Commercial	$1,304.58
Rate for Payer: MDX Hawaii PPO	$1,488.76
Rate for Payer: University Health Alliance Commercial	$859.49

47248613440 Screw Ann Cortical Bone 4.0mmX34mm [3641943]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3641943
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

47248613440 Screw Ann Cortical Bone 4.0mmX34mm [3641943]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3641943
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

47248614040 Screw Ann Cortical Bone 4.0mmX40mm [3641944]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3641944
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

47248614040 Screw Ann Cortical Bone 4.0mmX40mm [3641944]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3641944
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Know your out-of-pocket cost for care.

All Charges