Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PICC NEEDLE GUIDE KIT [2702964]

Facility

$136.00

Hospital Charge Code	2702964
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

PICC NEEDLE GUIDE KIT [2702964]

Facility

$136.00

Hospital Charge Code	2702964
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

PICC SAFETY INTRODUCER NEEDLE [2702966]

Facility

$241.43

Hospital Charge Code	2702966
Hospital Revenue Code	272
Min. Negotiated Rate	$205.22
Max. Negotiated Rate	$234.19
Rate for Payer: Cash Price	$156.93
Rate for Payer: Health Management Network Commercial	$205.22
Rate for Payer: MDX Hawaii PPO	$234.19

PICC SAFETY INTRODUCER NEEDLE [2702966]

Facility

$241.43

Hospital Charge Code	2702966
Hospital Revenue Code	272
Min. Negotiated Rate	$123.13
Max. Negotiated Rate	$234.19
Rate for Payer: Cash Price	$156.93
Rate for Payer: Hawaii Western Management Group Commercial	$229.36
Rate for Payer: Health Management Network Commercial	$205.22
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: Kaiser Permanente Medicaid	$123.13
Rate for Payer: MDX Hawaii PPO	$234.19
Rate for Payer: University Health Alliance Commercial	$175.98

PICC SINGLE LUMEN 3FR [2702978]

Facility

$1,794.13

Service Code	HCPCS C1751
Hospital Charge Code	2702978
Hospital Revenue Code	272
Min. Negotiated Rate	$915.01
Max. Negotiated Rate	$1,740.31
Rate for Payer: Cash Price	$1,166.18
Rate for Payer: Hawaii Western Management Group Commercial	$1,704.42
Rate for Payer: Health Management Network Commercial	$1,525.01
Rate for Payer: Kaiser Permanente Commercial	$1,130.30
Rate for Payer: Kaiser Permanente Medicaid	$915.01
Rate for Payer: MDX Hawaii PPO	$1,740.31
Rate for Payer: University Health Alliance Commercial	$1,307.74

PICC SINGLE LUMEN 3FR [2702978]

Facility

$1,794.13

Service Code	HCPCS C1751
Hospital Charge Code	2702978
Hospital Revenue Code	272
Min. Negotiated Rate	$1,525.01
Max. Negotiated Rate	$1,740.31
Rate for Payer: Cash Price	$1,166.18
Rate for Payer: Health Management Network Commercial	$1,525.01
Rate for Payer: MDX Hawaii PPO	$1,740.31

PICC TRIPLE LUMEN 5FR [2702963]

Facility

$1,655.75

Service Code	HCPCS C1751
Hospital Charge Code	2702963
Hospital Revenue Code	272
Min. Negotiated Rate	$844.43
Max. Negotiated Rate	$1,606.08
Rate for Payer: Cash Price	$1,076.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,572.96
Rate for Payer: Health Management Network Commercial	$1,407.39
Rate for Payer: Kaiser Permanente Commercial	$1,043.12
Rate for Payer: Kaiser Permanente Medicaid	$844.43
Rate for Payer: MDX Hawaii PPO	$1,606.08
Rate for Payer: University Health Alliance Commercial	$1,206.88

PICC TRIPLE LUMEN 5FR [2702963]

Facility

$1,655.75

Service Code	HCPCS C1751
Hospital Charge Code	2702963
Hospital Revenue Code	272
Min. Negotiated Rate	$1,407.39
Max. Negotiated Rate	$1,606.08
Rate for Payer: Cash Price	$1,076.24
Rate for Payer: Health Management Network Commercial	$1,407.39
Rate for Payer: MDX Hawaii PPO	$1,606.08

PIFLUFOLASTAT F-18 DIAGNOSTIC 1 MCI

Professional

Both

$1,750.00

Service Code	HCPCS A9595
Min. Negotiated Rate	$1,487.50
Max. Negotiated Rate	$1,487.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,487.50

PILOCARPINE HCL 1 % OPHT DROP

Facility

$420.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$214.24
Max. Negotiated Rate	$407.48
Rate for Payer: Cash Price	$273.05
Rate for Payer: Hawaii Western Management Group Commercial	$399.08
Rate for Payer: Health Management Network Commercial	$357.07
Rate for Payer: Kaiser Permanente Commercial	$264.65
Rate for Payer: Kaiser Permanente Medicaid	$214.24
Rate for Payer: MDX Hawaii PPO	$407.48
Rate for Payer: UnitedHealthcare Medicaid	$252.05
Rate for Payer: University Health Alliance Commercial	$306.20

PILOCARPINE HCL 1 % OPHT DROP

Facility

$420.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$357.07
Max. Negotiated Rate	$407.48
Rate for Payer: Cash Price	$273.05
Rate for Payer: Health Management Network Commercial	$357.07
Rate for Payer: MDX Hawaii PPO	$407.48

Pin Bending Threaded For 2.4mm Lock Plates 329.922 [3644566]

Facility

$1,962.99

Hospital Charge Code	3644566
Hospital Revenue Code	272
Min. Negotiated Rate	$1,001.12
Max. Negotiated Rate	$1,904.10
Rate for Payer: Cash Price	$1,275.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.84
Rate for Payer: Health Management Network Commercial	$1,668.54
Rate for Payer: Kaiser Permanente Commercial	$1,236.68
Rate for Payer: Kaiser Permanente Medicaid	$1,001.12
Rate for Payer: MDX Hawaii PPO	$1,904.10
Rate for Payer: University Health Alliance Commercial	$1,430.82

Pin Bending Threaded For 2.4mm Lock Plates 329.922 [3644566]

Facility

$1,962.99

Hospital Charge Code	3644566
Hospital Revenue Code	272
Min. Negotiated Rate	$1,668.54
Max. Negotiated Rate	$1,904.10
Rate for Payer: Cash Price	$1,275.94
Rate for Payer: Health Management Network Commercial	$1,668.54
Rate for Payer: MDX Hawaii PPO	$1,904.10

Pin, Bone Quick Release 2 Pack 800-01-338 [3642107]

Facility

$823.15

Service Code	HCPCS C1776
Hospital Charge Code	3642107
Hospital Revenue Code	278
Min. Negotiated Rate	$419.81
Max. Negotiated Rate	$798.46
Rate for Payer: Cash Price	$535.05
Rate for Payer: Hawaii Western Management Group Commercial	$576.21
Rate for Payer: Health Management Network Commercial	$699.68
Rate for Payer: Kaiser Permanente Commercial	$518.58
Rate for Payer: Kaiser Permanente Medicaid	$419.81
Rate for Payer: MDX Hawaii PPO	$798.46
Rate for Payer: University Health Alliance Commercial	$460.96

Pin, Bone Quick Release 2 Pack 800-01-338 [3642107]

Facility

$823.15

Service Code	HCPCS C1776
Hospital Charge Code	3642107
Hospital Revenue Code	278
Min. Negotiated Rate	$460.96
Max. Negotiated Rate	$798.46
Rate for Payer: Cash Price	$535.05
Rate for Payer: Hawaii Western Management Group Commercial	$576.21
Rate for Payer: Health Management Network Commercial	$699.68
Rate for Payer: MDX Hawaii PPO	$798.46
Rate for Payer: University Health Alliance Commercial	$460.96

Pin Fix Fluted 3.2mmX150mm Sterile 20800000010 [3642789]

Facility

$796.38

Service Code	HCPCS C1713
Hospital Charge Code	3642789
Hospital Revenue Code	278
Min. Negotiated Rate	$445.97
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Pin Fix Fluted 3.2mmX150mm Sterile 20800000010 [3642789]

Facility

$796.38

Service Code	HCPCS C1713
Hospital Charge Code	3642789
Hospital Revenue Code	278
Min. Negotiated Rate	$406.15
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: Kaiser Permanente Commercial	$501.72
Rate for Payer: Kaiser Permanente Medicaid	$406.15
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Pin Fix Fluted 3.2mmX80mm Sterile 20800000011 [3642791]

Facility

$796.38

Service Code	HCPCS C1713
Hospital Charge Code	3642791
Hospital Revenue Code	278
Min. Negotiated Rate	$406.15
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: Kaiser Permanente Commercial	$501.72
Rate for Payer: Kaiser Permanente Medicaid	$406.15
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Pin Fix Fluted 3.2mmX80mm Sterile 20800000011 [3642791]

Facility

$796.38

Service Code	HCPCS C1713
Hospital Charge Code	3642791
Hospital Revenue Code	278
Min. Negotiated Rate	$445.97
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Pin Guide Osteotomy 2.4mm Ar-13303-2.4 [3644009]

Facility

$294.50

Hospital Charge Code	3644009
Hospital Revenue Code	272
Min. Negotiated Rate	$250.32
Max. Negotiated Rate	$285.67
Rate for Payer: Cash Price	$191.42
Rate for Payer: Health Management Network Commercial	$250.32
Rate for Payer: MDX Hawaii PPO	$285.67

Pin Guide Osteotomy 2.4mm Ar-13303-2.4 [3644009]

Facility

$294.50

Hospital Charge Code	3644009
Hospital Revenue Code	272
Min. Negotiated Rate	$150.19
Max. Negotiated Rate	$285.67
Rate for Payer: Cash Price	$191.42
Rate for Payer: Hawaii Western Management Group Commercial	$279.77
Rate for Payer: Health Management Network Commercial	$250.32
Rate for Payer: Kaiser Permanente Commercial	$185.53
Rate for Payer: Kaiser Permanente Medicaid	$150.19
Rate for Payer: MDX Hawaii PPO	$285.67
Rate for Payer: University Health Alliance Commercial	$214.66

Pin Schanz 4.0mm AO P99-300-4013 [3644784]

Facility

$962.38

Hospital Charge Code	3644784
Hospital Revenue Code	272
Min. Negotiated Rate	$818.02
Max. Negotiated Rate	$933.51
Rate for Payer: Cash Price	$625.55
Rate for Payer: Health Management Network Commercial	$818.02
Rate for Payer: MDX Hawaii PPO	$933.51

Pin Schanz 4.0mm AO P99-300-4013 [3644784]

Facility

$962.38

Hospital Charge Code	3644784
Hospital Revenue Code	272
Min. Negotiated Rate	$490.81
Max. Negotiated Rate	$933.51
Rate for Payer: Cash Price	$625.55
Rate for Payer: Hawaii Western Management Group Commercial	$914.26
Rate for Payer: Health Management Network Commercial	$818.02
Rate for Payer: Kaiser Permanente Commercial	$606.30
Rate for Payer: Kaiser Permanente Medicaid	$490.81
Rate for Payer: MDX Hawaii PPO	$933.51
Rate for Payer: University Health Alliance Commercial	$701.48

Pin Threaded 2.0mm 00-2490-046-20 [3644439]

Facility

$917.40

Hospital Charge Code	3644439
Hospital Revenue Code	272
Min. Negotiated Rate	$467.87
Max. Negotiated Rate	$889.88
Rate for Payer: Cash Price	$596.31
Rate for Payer: Hawaii Western Management Group Commercial	$871.53
Rate for Payer: Health Management Network Commercial	$779.79
Rate for Payer: Kaiser Permanente Commercial	$577.96
Rate for Payer: Kaiser Permanente Medicaid	$467.87
Rate for Payer: MDX Hawaii PPO	$889.88
Rate for Payer: University Health Alliance Commercial	$668.69

Pin Threaded 2.0mm 00-2490-046-20 [3644439]

Facility

$917.40

Hospital Charge Code	3644439
Hospital Revenue Code	272
Min. Negotiated Rate	$779.79
Max. Negotiated Rate	$889.88
Rate for Payer: Cash Price	$596.31
Rate for Payer: Health Management Network Commercial	$779.79
Rate for Payer: MDX Hawaii PPO	$889.88

Know your out-of-pocket cost for care.

All Charges