Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Mesh 3Dmax Light Wt XLrg Left 0117312 [3642993]

Facility

$2,320.98

Service Code	HCPCS C1781
Hospital Charge Code	3642993
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.70
Max. Negotiated Rate	$2,251.35
Rate for Payer: Cash Price	$1,508.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,624.69
Rate for Payer: Health Management Network Commercial	$1,972.83
Rate for Payer: Kaiser Permanente Commercial	$1,462.22
Rate for Payer: Kaiser Permanente Medicaid	$1,183.70
Rate for Payer: MDX Hawaii PPO	$2,251.35
Rate for Payer: University Health Alliance Commercial	$1,299.75

Mesh 3Dmax Light Wt XLrg Left 0117312 [3642993]

Facility

$2,320.98

Service Code	HCPCS C1781
Hospital Charge Code	3642993
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.75
Max. Negotiated Rate	$2,251.35
Rate for Payer: Cash Price	$1,508.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,624.69
Rate for Payer: Health Management Network Commercial	$1,972.83
Rate for Payer: MDX Hawaii PPO	$2,251.35
Rate for Payer: University Health Alliance Commercial	$1,299.75

Mesh 3Dmax Light Wt Xlrg Right 0117322 [3642994]

Facility

$2,224.11

Service Code	HCPCS C1781
Hospital Charge Code	3642994
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.30
Max. Negotiated Rate	$2,157.39
Rate for Payer: Cash Price	$1,445.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,556.88
Rate for Payer: Health Management Network Commercial	$1,890.49
Rate for Payer: Kaiser Permanente Commercial	$1,401.19
Rate for Payer: Kaiser Permanente Medicaid	$1,134.30
Rate for Payer: MDX Hawaii PPO	$2,157.39
Rate for Payer: University Health Alliance Commercial	$1,245.50

Mesh 3Dmax Light Wt Xlrg Right 0117322 [3642994]

Facility

$2,224.11

Service Code	HCPCS C1781
Hospital Charge Code	3642994
Hospital Revenue Code	278
Min. Negotiated Rate	$1,245.50
Max. Negotiated Rate	$2,157.39
Rate for Payer: Cash Price	$1,445.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,556.88
Rate for Payer: Health Management Network Commercial	$1,890.49
Rate for Payer: MDX Hawaii PPO	$2,157.39
Rate for Payer: University Health Alliance Commercial	$1,245.50

Mesh 3Dmax Right 0115321 [3603335]

Facility

$1,661.90

Service Code	HCPCS C1781
Hospital Charge Code	3603335
Hospital Revenue Code	278
Min. Negotiated Rate	$847.57
Max. Negotiated Rate	$1,612.04
Rate for Payer: Cash Price	$1,080.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.33
Rate for Payer: Health Management Network Commercial	$1,412.62
Rate for Payer: Kaiser Permanente Commercial	$1,047.00
Rate for Payer: Kaiser Permanente Medicaid	$847.57
Rate for Payer: MDX Hawaii PPO	$1,612.04
Rate for Payer: University Health Alliance Commercial	$930.66

Mesh 3Dmax Right 0115321 [3603335]

Facility

$1,661.90

Service Code	HCPCS C1781
Hospital Charge Code	3603335
Hospital Revenue Code	278
Min. Negotiated Rate	$930.66
Max. Negotiated Rate	$1,612.04
Rate for Payer: Cash Price	$1,080.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.33
Rate for Payer: Health Management Network Commercial	$1,412.62
Rate for Payer: MDX Hawaii PPO	$1,612.04
Rate for Payer: University Health Alliance Commercial	$930.66

Mesh 3DMax Xlrg Left 0115312 [3644800]

Facility

$1,977.09

Service Code	HCPCS C1781
Hospital Charge Code	3644800
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.32
Max. Negotiated Rate	$1,917.78
Rate for Payer: Cash Price	$1,285.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.96
Rate for Payer: Health Management Network Commercial	$1,680.53
Rate for Payer: Kaiser Permanente Commercial	$1,245.57
Rate for Payer: Kaiser Permanente Medicaid	$1,008.32
Rate for Payer: MDX Hawaii PPO	$1,917.78
Rate for Payer: University Health Alliance Commercial	$1,107.17

Mesh 3DMax Xlrg Left 0115312 [3644800]

Facility

$1,977.09

Service Code	HCPCS C1781
Hospital Charge Code	3644800
Hospital Revenue Code	278
Min. Negotiated Rate	$1,107.17
Max. Negotiated Rate	$1,917.78
Rate for Payer: Cash Price	$1,285.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.96
Rate for Payer: Health Management Network Commercial	$1,680.53
Rate for Payer: MDX Hawaii PPO	$1,917.78
Rate for Payer: University Health Alliance Commercial	$1,107.17

Mesh 3DMax Xlrg Right 0115322 [3644801]

Facility

$1,977.09

Service Code	HCPCS C1781
Hospital Charge Code	3644801
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.32
Max. Negotiated Rate	$1,917.78
Rate for Payer: Cash Price	$1,285.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.96
Rate for Payer: Health Management Network Commercial	$1,680.53
Rate for Payer: Kaiser Permanente Commercial	$1,245.57
Rate for Payer: Kaiser Permanente Medicaid	$1,008.32
Rate for Payer: MDX Hawaii PPO	$1,917.78
Rate for Payer: University Health Alliance Commercial	$1,107.17

Mesh 3DMax Xlrg Right 0115322 [3644801]

Facility

$1,977.09

Service Code	HCPCS C1781
Hospital Charge Code	3644801
Hospital Revenue Code	278
Min. Negotiated Rate	$1,107.17
Max. Negotiated Rate	$1,917.78
Rate for Payer: Cash Price	$1,285.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.96
Rate for Payer: Health Management Network Commercial	$1,680.53
Rate for Payer: MDX Hawaii PPO	$1,917.78
Rate for Payer: University Health Alliance Commercial	$1,107.17

Mesh Parietex Compos Ventral Patch 6in PCO6VP [3640345]

Facility

$3,271.94

Service Code	HCPCS C1781
Hospital Charge Code	3640345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.29
Max. Negotiated Rate	$3,173.78
Rate for Payer: Cash Price	$2,126.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,290.36
Rate for Payer: Health Management Network Commercial	$2,781.15
Rate for Payer: MDX Hawaii PPO	$3,173.78
Rate for Payer: University Health Alliance Commercial	$1,832.29

Mesh Parietex Compos Ventral Patch 6in PCO6VP [3640345]

Facility

$3,271.94

Service Code	HCPCS C1781
Hospital Charge Code	3640345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,668.69
Max. Negotiated Rate	$3,173.78
Rate for Payer: Cash Price	$2,126.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,290.36
Rate for Payer: Health Management Network Commercial	$2,781.15
Rate for Payer: Kaiser Permanente Commercial	$2,061.32
Rate for Payer: Kaiser Permanente Medicaid	$1,668.69
Rate for Payer: MDX Hawaii PPO	$3,173.78
Rate for Payer: University Health Alliance Commercial	$1,832.29

Mesh Perfix Lg 0112770 [3603325]

Facility

$1,230.49

Service Code	HCPCS C1781
Hospital Charge Code	3603325
Hospital Revenue Code	278
Min. Negotiated Rate	$689.07
Max. Negotiated Rate	$1,193.58
Rate for Payer: Cash Price	$799.82
Rate for Payer: Hawaii Western Management Group Commercial	$861.34
Rate for Payer: Health Management Network Commercial	$1,045.92
Rate for Payer: MDX Hawaii PPO	$1,193.58
Rate for Payer: University Health Alliance Commercial	$689.07

Mesh Perfix Lg 0112770 [3603325]

Facility

$1,230.49

Service Code	HCPCS C1781
Hospital Charge Code	3603325
Hospital Revenue Code	278
Min. Negotiated Rate	$627.55
Max. Negotiated Rate	$1,193.58
Rate for Payer: Cash Price	$799.82
Rate for Payer: Hawaii Western Management Group Commercial	$861.34
Rate for Payer: Health Management Network Commercial	$1,045.92
Rate for Payer: Kaiser Permanente Commercial	$775.21
Rate for Payer: Kaiser Permanente Medicaid	$627.55
Rate for Payer: MDX Hawaii PPO	$1,193.58
Rate for Payer: University Health Alliance Commercial	$689.07

Mesh Perfix Plug Light Exlg 0117080 [3603337]

Facility

$2,561.85

Service Code	HCPCS C1781
Hospital Charge Code	3603337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,306.54
Max. Negotiated Rate	$2,484.99
Rate for Payer: Cash Price	$1,665.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,793.30
Rate for Payer: Health Management Network Commercial	$2,177.57
Rate for Payer: Kaiser Permanente Commercial	$1,613.97
Rate for Payer: Kaiser Permanente Medicaid	$1,306.54
Rate for Payer: MDX Hawaii PPO	$2,484.99
Rate for Payer: University Health Alliance Commercial	$1,434.64

Mesh Perfix Plug Light Exlg 0117080 [3603337]

Facility

$2,561.85

Service Code	HCPCS C1781
Hospital Charge Code	3603337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,434.64
Max. Negotiated Rate	$2,484.99
Rate for Payer: Cash Price	$1,665.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,793.30
Rate for Payer: Health Management Network Commercial	$2,177.57
Rate for Payer: MDX Hawaii PPO	$2,484.99
Rate for Payer: University Health Alliance Commercial	$1,434.64

Mesh Perfix Plug Light Lg 0117070 [3603338]

Facility

$2,214.89

Service Code	HCPCS C1781
Hospital Charge Code	3603338
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.59
Max. Negotiated Rate	$2,148.44
Rate for Payer: Cash Price	$1,439.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,550.42
Rate for Payer: Health Management Network Commercial	$1,882.66
Rate for Payer: Kaiser Permanente Commercial	$1,395.38
Rate for Payer: Kaiser Permanente Medicaid	$1,129.59
Rate for Payer: MDX Hawaii PPO	$2,148.44
Rate for Payer: University Health Alliance Commercial	$1,240.34

Mesh Perfix Plug Light Lg 0117070 [3603338]

Facility

$2,214.89

Service Code	HCPCS C1781
Hospital Charge Code	3603338
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.34
Max. Negotiated Rate	$2,148.44
Rate for Payer: Cash Price	$1,439.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,550.42
Rate for Payer: Health Management Network Commercial	$1,882.66
Rate for Payer: MDX Hawaii PPO	$2,148.44
Rate for Payer: University Health Alliance Commercial	$1,240.34

Mesh Phasix Plug Lg 1190602 [3640182]

Facility

$3,333.05

Service Code	HCPCS C1781
Hospital Charge Code	3640182
Hospital Revenue Code	278
Min. Negotiated Rate	$1,699.86
Max. Negotiated Rate	$3,233.06
Rate for Payer: Cash Price	$2,166.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,333.14
Rate for Payer: Health Management Network Commercial	$2,833.09
Rate for Payer: Kaiser Permanente Commercial	$2,099.82
Rate for Payer: Kaiser Permanente Medicaid	$1,699.86
Rate for Payer: MDX Hawaii PPO	$3,233.06
Rate for Payer: University Health Alliance Commercial	$1,866.51

Mesh Phasix Plug Lg 1190602 [3640182]

Facility

$3,333.05

Service Code	HCPCS C1781
Hospital Charge Code	3640182
Hospital Revenue Code	278
Min. Negotiated Rate	$1,866.51
Max. Negotiated Rate	$3,233.06
Rate for Payer: Cash Price	$2,166.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,333.14
Rate for Payer: Health Management Network Commercial	$2,833.09
Rate for Payer: MDX Hawaii PPO	$3,233.06
Rate for Payer: University Health Alliance Commercial	$1,866.51

Mesh Phasix Plug XLG 1190603 [3640183]

Facility

$3,357.35

Service Code	HCPCS C1781
Hospital Charge Code	3640183
Hospital Revenue Code	278
Min. Negotiated Rate	$1,712.25
Max. Negotiated Rate	$3,256.63
Rate for Payer: Cash Price	$2,182.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,350.14
Rate for Payer: Health Management Network Commercial	$2,853.75
Rate for Payer: Kaiser Permanente Commercial	$2,115.13
Rate for Payer: Kaiser Permanente Medicaid	$1,712.25
Rate for Payer: MDX Hawaii PPO	$3,256.63
Rate for Payer: University Health Alliance Commercial	$1,880.12

Mesh Phasix Plug XLG 1190603 [3640183]

Facility

$3,357.35

Service Code	HCPCS C1781
Hospital Charge Code	3640183
Hospital Revenue Code	278
Min. Negotiated Rate	$1,880.12
Max. Negotiated Rate	$3,256.63
Rate for Payer: Cash Price	$2,182.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,350.14
Rate for Payer: Health Management Network Commercial	$2,853.75
Rate for Payer: MDX Hawaii PPO	$3,256.63
Rate for Payer: University Health Alliance Commercial	$1,880.12

Mesh Phasix ST 15 x 20cm 1201520 [3640958]

Facility

$28,189.80

Service Code	HCPCS C1781
Hospital Charge Code	3640958
Hospital Revenue Code	278
Min. Negotiated Rate	$15,786.29
Max. Negotiated Rate	$27,344.11
Rate for Payer: Cash Price	$18,323.37
Rate for Payer: Hawaii Western Management Group Commercial	$19,732.86
Rate for Payer: Health Management Network Commercial	$23,961.33
Rate for Payer: MDX Hawaii PPO	$27,344.11
Rate for Payer: University Health Alliance Commercial	$15,786.29

Mesh Phasix ST 15 x 20cm 1201520 [3640958]

Facility

$28,189.80

Service Code	HCPCS C1781
Hospital Charge Code	3640958
Hospital Revenue Code	278
Min. Negotiated Rate	$14,376.80
Max. Negotiated Rate	$27,344.11
Rate for Payer: Cash Price	$18,323.37
Rate for Payer: Hawaii Western Management Group Commercial	$19,732.86
Rate for Payer: Health Management Network Commercial	$23,961.33
Rate for Payer: Kaiser Permanente Commercial	$17,759.57
Rate for Payer: Kaiser Permanente Medicaid	$14,376.80
Rate for Payer: MDX Hawaii PPO	$27,344.11
Rate for Payer: University Health Alliance Commercial	$15,786.29

Mesh Phasix ST 7 x 10cm 1200710 [3640926]

Facility

$5,052.50

Service Code	HCPCS C1781
Hospital Charge Code	3640926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,576.78
Max. Negotiated Rate	$4,900.93
Rate for Payer: Cash Price	$3,284.12
Rate for Payer: Hawaii Western Management Group Commercial	$3,536.75
Rate for Payer: Health Management Network Commercial	$4,294.62
Rate for Payer: Kaiser Permanente Commercial	$3,183.07
Rate for Payer: Kaiser Permanente Medicaid	$2,576.78
Rate for Payer: MDX Hawaii PPO	$4,900.93
Rate for Payer: University Health Alliance Commercial	$2,829.40

Know your out-of-pocket cost for care.

All Charges