Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw VPC 2.5 x 20mm 233225020 [3644767]

Facility

$2,938.40

Service Code	HCPCS C1713
Hospital Charge Code	3644767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.58
Max. Negotiated Rate	$2,850.25
Rate for Payer: Cash Price	$1,909.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,056.88
Rate for Payer: Health Management Network Commercial	$2,497.64
Rate for Payer: Kaiser Permanente Commercial	$1,851.19
Rate for Payer: Kaiser Permanente Medicaid	$1,498.58
Rate for Payer: MDX Hawaii PPO	$2,850.25
Rate for Payer: University Health Alliance Commercial	$1,645.50

Screw VPC 2.5 x 20mm 233225020 [3644767]

Facility

$2,938.40

Service Code	HCPCS C1713
Hospital Charge Code	3644767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,645.50
Max. Negotiated Rate	$2,850.25
Rate for Payer: Cash Price	$1,909.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,056.88
Rate for Payer: Health Management Network Commercial	$2,497.64
Rate for Payer: MDX Hawaii PPO	$2,850.25
Rate for Payer: University Health Alliance Commercial	$1,645.50

Screw VPC 3.4mm X 22mm 233230022 [3642222]

Facility

$1,894.20

Service Code	HCPCS C1713
Hospital Charge Code	3642222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.75
Max. Negotiated Rate	$1,837.37
Rate for Payer: Cash Price	$1,231.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,325.94
Rate for Payer: Health Management Network Commercial	$1,610.07
Rate for Payer: MDX Hawaii PPO	$1,837.37
Rate for Payer: University Health Alliance Commercial	$1,060.75

Screw VPC 3.4mm X 22mm 233230022 [3642222]

Facility

$1,894.20

Service Code	HCPCS C1713
Hospital Charge Code	3642222
Hospital Revenue Code	278
Min. Negotiated Rate	$966.04
Max. Negotiated Rate	$1,837.37
Rate for Payer: Cash Price	$1,231.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,325.94
Rate for Payer: Health Management Network Commercial	$1,610.07
Rate for Payer: Kaiser Permanente Commercial	$1,193.35
Rate for Payer: Kaiser Permanente Medicaid	$966.04
Rate for Payer: MDX Hawaii PPO	$1,837.37
Rate for Payer: University Health Alliance Commercial	$1,060.75

Screw VPC 3.4mm X 26mm 233230026 [3641860]

Facility

$1,894.20

Service Code	HCPCS C1713
Hospital Charge Code	3641860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.75
Max. Negotiated Rate	$1,837.37
Rate for Payer: Cash Price	$1,231.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,325.94
Rate for Payer: Health Management Network Commercial	$1,610.07
Rate for Payer: MDX Hawaii PPO	$1,837.37
Rate for Payer: University Health Alliance Commercial	$1,060.75

Screw VPC 3.4mm X 26mm 233230026 [3641860]

Facility

$1,894.20

Service Code	HCPCS C1713
Hospital Charge Code	3641860
Hospital Revenue Code	278
Min. Negotiated Rate	$966.04
Max. Negotiated Rate	$1,837.37
Rate for Payer: Cash Price	$1,231.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,325.94
Rate for Payer: Health Management Network Commercial	$1,610.07
Rate for Payer: Kaiser Permanente Commercial	$1,193.35
Rate for Payer: Kaiser Permanente Medicaid	$966.04
Rate for Payer: MDX Hawaii PPO	$1,837.37
Rate for Payer: University Health Alliance Commercial	$1,060.75

Screw Vpc 3.4mmx28mm 233230028 [3643670]

Facility

$1,894.20

Service Code	HCPCS C1713
Hospital Charge Code	3643670
Hospital Revenue Code	278
Min. Negotiated Rate	$966.04
Max. Negotiated Rate	$1,837.37
Rate for Payer: Cash Price	$1,231.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,325.94
Rate for Payer: Health Management Network Commercial	$1,610.07
Rate for Payer: Kaiser Permanente Commercial	$1,193.35
Rate for Payer: Kaiser Permanente Medicaid	$966.04
Rate for Payer: MDX Hawaii PPO	$1,837.37
Rate for Payer: University Health Alliance Commercial	$1,060.75

Screw Vpc 3.4mmx28mm 233230028 [3643670]

Facility

$1,894.20

Service Code	HCPCS C1713
Hospital Charge Code	3643670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.75
Max. Negotiated Rate	$1,837.37
Rate for Payer: Cash Price	$1,231.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,325.94
Rate for Payer: Health Management Network Commercial	$1,610.07
Rate for Payer: MDX Hawaii PPO	$1,837.37
Rate for Payer: University Health Alliance Commercial	$1,060.75

Screw VPC 3.4mm X 34mm 233230034 [3641861]

Facility

$2,938.40

Service Code	HCPCS C1713
Hospital Charge Code	3641861
Hospital Revenue Code	278
Min. Negotiated Rate	$1,645.50
Max. Negotiated Rate	$2,850.25
Rate for Payer: Cash Price	$1,909.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,056.88
Rate for Payer: Health Management Network Commercial	$2,497.64
Rate for Payer: MDX Hawaii PPO	$2,850.25
Rate for Payer: University Health Alliance Commercial	$1,645.50

Screw VPC 3.4mm X 34mm 233230034 [3641861]

Facility

$2,938.40

Service Code	HCPCS C1713
Hospital Charge Code	3641861
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.58
Max. Negotiated Rate	$2,850.25
Rate for Payer: Kaiser Permanente Medicaid	$1,498.58
Rate for Payer: Cash Price	$1,909.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,056.88
Rate for Payer: Health Management Network Commercial	$2,497.64
Rate for Payer: Kaiser Permanente Commercial	$1,851.19
Rate for Payer: MDX Hawaii PPO	$2,850.25
Rate for Payer: University Health Alliance Commercial	$1,645.50

Sealant Fibrin Patch 2x4in Evarrest EVT5024 [3640636]

Facility

$4,877.00

Hospital Charge Code	3640636
Hospital Revenue Code	272
Min. Negotiated Rate	$4,145.45
Max. Negotiated Rate	$4,730.69
Rate for Payer: Cash Price	$3,170.05
Rate for Payer: Health Management Network Commercial	$4,145.45
Rate for Payer: MDX Hawaii PPO	$4,730.69

Sealant Fibrin Patch 2x4in Evarrest EVT5024 [3640636]

Facility

$4,877.00

Hospital Charge Code	3640636
Hospital Revenue Code	272
Min. Negotiated Rate	$2,487.27
Max. Negotiated Rate	$4,730.69
Rate for Payer: Cash Price	$3,170.05
Rate for Payer: Hawaii Western Management Group Commercial	$4,633.15
Rate for Payer: Health Management Network Commercial	$4,145.45
Rate for Payer: Kaiser Permanente Commercial	$3,072.51
Rate for Payer: Kaiser Permanente Medicaid	$2,487.27
Rate for Payer: MDX Hawaii PPO	$4,730.69
Rate for Payer: University Health Alliance Commercial	$3,554.85

Sealer Aquamantys 2.3 Bipolar 231131 [3642669]

Facility

$2,838.50

Hospital Charge Code	3642669
Hospital Revenue Code	272
Min. Negotiated Rate	$1,447.63
Max. Negotiated Rate	$2,753.34
Rate for Payer: Cash Price	$1,845.02
Rate for Payer: Hawaii Western Management Group Commercial	$2,696.57
Rate for Payer: Health Management Network Commercial	$2,412.72
Rate for Payer: Kaiser Permanente Commercial	$1,788.26
Rate for Payer: Kaiser Permanente Medicaid	$1,447.63
Rate for Payer: MDX Hawaii PPO	$2,753.34
Rate for Payer: University Health Alliance Commercial	$2,068.98

Sealer Aquamantys 2.3 Bipolar 231131 [3642669]

Facility

$2,838.50

Hospital Charge Code	3642669
Hospital Revenue Code	272
Min. Negotiated Rate	$2,412.72
Max. Negotiated Rate	$2,753.34
Rate for Payer: Cash Price	$1,845.02
Rate for Payer: Health Management Network Commercial	$2,412.72
Rate for Payer: MDX Hawaii PPO	$2,753.34

Sealer Aquamantys 6.0 Bipolar 23-112-1 [3644021]

Facility

$2,724.62

Hospital Charge Code	3644021
Hospital Revenue Code	272
Min. Negotiated Rate	$1,389.56
Max. Negotiated Rate	$2,642.88
Rate for Payer: Cash Price	$1,771.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,588.39
Rate for Payer: Health Management Network Commercial	$2,315.93
Rate for Payer: Kaiser Permanente Commercial	$1,716.51
Rate for Payer: Kaiser Permanente Medicaid	$1,389.56
Rate for Payer: MDX Hawaii PPO	$2,642.88
Rate for Payer: University Health Alliance Commercial	$1,985.98

Sealer Aquamantys 6.0 Bipolar 23-112-1 [3644021]

Facility

$2,724.62

Hospital Charge Code	3644021
Hospital Revenue Code	272
Min. Negotiated Rate	$2,315.93
Max. Negotiated Rate	$2,642.88
Rate for Payer: Cash Price	$1,771.00
Rate for Payer: Health Management Network Commercial	$2,315.93
Rate for Payer: MDX Hawaii PPO	$2,642.88

Seamguard Bioabsorb Stapler Reinf 60 12BSGEC60A [3640196]

Facility

$766.72

Hospital Charge Code	3640196
Hospital Revenue Code	272
Min. Negotiated Rate	$651.71
Max. Negotiated Rate	$743.72
Rate for Payer: Cash Price	$498.37
Rate for Payer: Health Management Network Commercial	$651.71
Rate for Payer: MDX Hawaii PPO	$743.72

Seamguard Bioabsorb Stapler Reinf 60 12BSGEC60A [3640196]

Facility

$766.72

Hospital Charge Code	3640196
Hospital Revenue Code	272
Min. Negotiated Rate	$391.03
Max. Negotiated Rate	$743.72
Rate for Payer: Cash Price	$498.37
Rate for Payer: Hawaii Western Management Group Commercial	$728.38
Rate for Payer: Health Management Network Commercial	$651.71
Rate for Payer: Kaiser Permanente Commercial	$483.03
Rate for Payer: Kaiser Permanente Medicaid	$391.03
Rate for Payer: MDX Hawaii PPO	$743.72
Rate for Payer: University Health Alliance Commercial	$558.86

Secondary Fixation KitACL/PCL Repair AR1593 [3641466]

Facility

$3,003.00

Service Code	HCPCS C1713
Hospital Charge Code	3641466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,531.53
Max. Negotiated Rate	$2,912.91
Rate for Payer: Cash Price	$1,951.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,102.10
Rate for Payer: Health Management Network Commercial	$2,552.55
Rate for Payer: Kaiser Permanente Commercial	$1,891.89
Rate for Payer: Kaiser Permanente Medicaid	$1,531.53
Rate for Payer: MDX Hawaii PPO	$2,912.91
Rate for Payer: University Health Alliance Commercial	$1,681.68

Secondary Fixation KitACL/PCL Repair AR1593 [3641466]

Facility

$3,003.00

Service Code	HCPCS C1713
Hospital Charge Code	3641466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,681.68
Max. Negotiated Rate	$2,912.91
Rate for Payer: Cash Price	$1,951.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,102.10
Rate for Payer: Health Management Network Commercial	$2,552.55
Rate for Payer: MDX Hawaii PPO	$2,912.91
Rate for Payer: University Health Alliance Commercial	$1,681.68

Secondary Fixation Kit Bioswvlk 4.75X19.1 AR-1593-BC [3643211]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3643211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,924.59
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: Kaiser Permanente Commercial	$3,612.74
Rate for Payer: Kaiser Permanente Medicaid	$2,924.59
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Secondary Fixation Kit Bioswvlk 4.75X19.1 AR-1593-BC [3643211]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3643211
Hospital Revenue Code	278
Min. Negotiated Rate	$3,211.32
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Secondary Fixation Kit W/peek Swivelock AR-1593-P [3643908]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3643908
Hospital Revenue Code	278
Min. Negotiated Rate	$2,924.59
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: Kaiser Permanente Commercial	$3,612.74
Rate for Payer: Kaiser Permanente Medicaid	$2,924.59
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Secondary Fixation Kit W/peek Swivelock AR-1593-P [3643908]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3643908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,211.32
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

SEIZURE

Facility

$3,133.71

Service Code	APR-DRG 0532
Min. Negotiated Rate	$3,133.71
Max. Negotiated Rate	$3,133.71
Rate for Payer: AlohaCare Medicaid	$3,133.71
Rate for Payer: Hawaii Medical Service Association ABD	$3,133.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,133.71
Rate for Payer: Kaiser Permanente Medicaid	$3,133.71
Rate for Payer: Ohana Health Plan Medicaid	$3,133.71
Rate for Payer: UnitedHealthcare Medicaid	$3,133.71

Know your out-of-pocket cost for care.

All Charges