Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Wire Compression Threaded 1.6 x 15 x 150mm 03.211.415 [3644378]

Facility

$422.96

Hospital Charge Code	3644378
Hospital Revenue Code	272
Min. Negotiated Rate	$359.52
Max. Negotiated Rate	$410.27
Rate for Payer: Cash Price	$274.92
Rate for Payer: Health Management Network Commercial	$359.52
Rate for Payer: MDX Hawaii PPO	$410.27

Wire K .045 Trocar Pt 164206045 [3640874]

Facility

$741.75

Service Code	HCPCS C1713
Hospital Charge Code	3640874
Hospital Revenue Code	278
Min. Negotiated Rate	$415.38
Max. Negotiated Rate	$719.50
Rate for Payer: Cash Price	$482.14
Rate for Payer: Hawaii Western Management Group Commercial	$519.23
Rate for Payer: Health Management Network Commercial	$630.49
Rate for Payer: MDX Hawaii PPO	$719.50
Rate for Payer: University Health Alliance Commercial	$415.38

Wire K .045 Trocar Pt 164206045 [3640874]

Facility

$741.75

Service Code	HCPCS C1713
Hospital Charge Code	3640874
Hospital Revenue Code	278
Min. Negotiated Rate	$378.29
Max. Negotiated Rate	$719.50
Rate for Payer: Cash Price	$482.14
Rate for Payer: Hawaii Western Management Group Commercial	$519.23
Rate for Payer: Health Management Network Commercial	$630.49
Rate for Payer: Kaiser Permanente Commercial	$467.30
Rate for Payer: Kaiser Permanente Medicaid	$378.29
Rate for Payer: MDX Hawaii PPO	$719.50
Rate for Payer: University Health Alliance Commercial	$415.38

Wire K .045X4" 316-0003 [3641883]

Facility

$342.75

Service Code	HCPCS C1713
Hospital Charge Code	3641883
Hospital Revenue Code	278
Min. Negotiated Rate	$191.94
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Hawaii Western Management Group Commercial	$239.93
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: MDX Hawaii PPO	$332.47
Rate for Payer: University Health Alliance Commercial	$191.94

Wire K .045X4" 316-0003 [3641883]

Facility

$342.75

Service Code	HCPCS C1713
Hospital Charge Code	3641883
Hospital Revenue Code	278
Min. Negotiated Rate	$174.80
Max. Negotiated Rate	$332.47
Rate for Payer: Cash Price	$222.79
Rate for Payer: Hawaii Western Management Group Commercial	$239.93
Rate for Payer: Health Management Network Commercial	$291.34
Rate for Payer: Kaiser Permanente Commercial	$215.93
Rate for Payer: Kaiser Permanente Medicaid	$174.80
Rate for Payer: MDX Hawaii PPO	$332.47
Rate for Payer: University Health Alliance Commercial	$191.94

Wire K .062mm 1.6mm x 229mm Smooth 186-78 [3609023]

Facility

$141.36

Service Code	HCPCS C1713
Hospital Charge Code	3609023
Hospital Revenue Code	278
Min. Negotiated Rate	$79.16
Max. Negotiated Rate	$137.12
Rate for Payer: Cash Price	$91.88
Rate for Payer: Hawaii Western Management Group Commercial	$98.95
Rate for Payer: Health Management Network Commercial	$120.16
Rate for Payer: MDX Hawaii PPO	$137.12
Rate for Payer: University Health Alliance Commercial	$79.16

Wire K .062mm 1.6mm x 229mm Smooth 186-78 [3609023]

Facility

$141.36

Service Code	HCPCS C1713
Hospital Charge Code	3609023
Hospital Revenue Code	278
Min. Negotiated Rate	$72.09
Max. Negotiated Rate	$137.12
Rate for Payer: Cash Price	$91.88
Rate for Payer: Hawaii Western Management Group Commercial	$98.95
Rate for Payer: Health Management Network Commercial	$120.16
Rate for Payer: Kaiser Permanente Commercial	$89.06
Rate for Payer: Kaiser Permanente Medicaid	$72.09
Rate for Payer: MDX Hawaii PPO	$137.12
Rate for Payer: University Health Alliance Commercial	$79.16

Wire K 0.8mm x 70mm 292.08 [3608919]

Facility

$83.73

Service Code	HCPCS C1713
Hospital Charge Code	3608919
Hospital Revenue Code	278
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$81.22
Rate for Payer: Cash Price	$54.42
Rate for Payer: Hawaii Western Management Group Commercial	$58.61
Rate for Payer: Health Management Network Commercial	$71.17
Rate for Payer: Kaiser Permanente Commercial	$52.75
Rate for Payer: Kaiser Permanente Medicaid	$42.70
Rate for Payer: MDX Hawaii PPO	$81.22
Rate for Payer: University Health Alliance Commercial	$46.89

Wire K 0.8mm x 70mm 292.08 [3608919]

Facility

$83.73

Service Code	HCPCS C1713
Hospital Charge Code	3608919
Hospital Revenue Code	278
Min. Negotiated Rate	$46.89
Max. Negotiated Rate	$81.22
Rate for Payer: Cash Price	$54.42
Rate for Payer: Hawaii Western Management Group Commercial	$58.61
Rate for Payer: Health Management Network Commercial	$71.17
Rate for Payer: MDX Hawaii PPO	$81.22
Rate for Payer: University Health Alliance Commercial	$46.89

Wire K 0.9mm .035mm x 229mm Smooth 186-46 [3609021]

Facility

$53.55

Service Code	HCPCS C1713
Hospital Charge Code	3609021
Hospital Revenue Code	278
Min. Negotiated Rate	$29.99
Max. Negotiated Rate	$51.94
Rate for Payer: Cash Price	$34.81
Rate for Payer: Hawaii Western Management Group Commercial	$37.48
Rate for Payer: Health Management Network Commercial	$45.52
Rate for Payer: MDX Hawaii PPO	$51.94
Rate for Payer: University Health Alliance Commercial	$29.99

Wire K 0.9mm .035mm x 229mm Smooth 186-46 [3609021]

Facility

$53.55

Service Code	HCPCS C1713
Hospital Charge Code	3609021
Hospital Revenue Code	278
Min. Negotiated Rate	$27.31
Max. Negotiated Rate	$51.94
Rate for Payer: Cash Price	$34.81
Rate for Payer: Hawaii Western Management Group Commercial	$37.48
Rate for Payer: Health Management Network Commercial	$45.52
Rate for Payer: Kaiser Permanente Commercial	$33.74
Rate for Payer: Kaiser Permanente Medicaid	$27.31
Rate for Payer: MDX Hawaii PPO	$51.94
Rate for Payer: University Health Alliance Commercial	$29.99

Wire K 1.0mm x 150mm 292.10 [3608917]

Facility

$791.02

Service Code	HCPCS C1713
Hospital Charge Code	3608917
Hospital Revenue Code	278
Min. Negotiated Rate	$442.97
Max. Negotiated Rate	$767.29
Rate for Payer: Cash Price	$514.16
Rate for Payer: Hawaii Western Management Group Commercial	$553.71
Rate for Payer: Health Management Network Commercial	$672.37
Rate for Payer: MDX Hawaii PPO	$767.29
Rate for Payer: University Health Alliance Commercial	$442.97

Wire K 1.0mm x 150mm 292.10 [3608917]

Facility

$791.02

Service Code	HCPCS C1713
Hospital Charge Code	3608917
Hospital Revenue Code	278
Min. Negotiated Rate	$403.42
Max. Negotiated Rate	$767.29
Rate for Payer: Cash Price	$514.16
Rate for Payer: Hawaii Western Management Group Commercial	$553.71
Rate for Payer: Health Management Network Commercial	$672.37
Rate for Payer: Kaiser Permanente Commercial	$498.34
Rate for Payer: Kaiser Permanente Medicaid	$403.42
Rate for Payer: MDX Hawaii PPO	$767.29
Rate for Payer: University Health Alliance Commercial	$442.97

Wire K 1.25 X 150mm 292.12 [3609042]

Facility

$90.95

Service Code	HCPCS C1713
Hospital Charge Code	3609042
Hospital Revenue Code	278
Min. Negotiated Rate	$50.93
Max. Negotiated Rate	$88.22
Rate for Payer: Cash Price	$59.12
Rate for Payer: Hawaii Western Management Group Commercial	$63.66
Rate for Payer: Health Management Network Commercial	$77.31
Rate for Payer: MDX Hawaii PPO	$88.22
Rate for Payer: University Health Alliance Commercial	$50.93

Wire K 1.25 X 150mm 292.12 [3609042]

Facility

$90.95

Service Code	HCPCS C1713
Hospital Charge Code	3609042
Hospital Revenue Code	278
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$88.22
Rate for Payer: Cash Price	$59.12
Rate for Payer: Hawaii Western Management Group Commercial	$63.66
Rate for Payer: Health Management Network Commercial	$77.31
Rate for Payer: Kaiser Permanente Commercial	$57.30
Rate for Payer: Kaiser Permanente Medicaid	$46.38
Rate for Payer: MDX Hawaii PPO	$88.22
Rate for Payer: University Health Alliance Commercial	$50.93

Wire K 1.6mm SS KW062SS [3620444]

Facility

$419.05

Service Code	HCPCS C1713
Hospital Charge Code	3620444
Hospital Revenue Code	278
Min. Negotiated Rate	$234.67
Max. Negotiated Rate	$406.48
Rate for Payer: Cash Price	$272.38
Rate for Payer: Hawaii Western Management Group Commercial	$293.33
Rate for Payer: Health Management Network Commercial	$356.19
Rate for Payer: MDX Hawaii PPO	$406.48
Rate for Payer: University Health Alliance Commercial	$234.67

Wire K 1.6mm SS KW062SS [3620444]

Facility

$419.05

Service Code	HCPCS C1713
Hospital Charge Code	3620444
Hospital Revenue Code	278
Min. Negotiated Rate	$213.72
Max. Negotiated Rate	$406.48
Rate for Payer: Cash Price	$272.38
Rate for Payer: Hawaii Western Management Group Commercial	$293.33
Rate for Payer: Health Management Network Commercial	$356.19
Rate for Payer: Kaiser Permanente Commercial	$264.00
Rate for Payer: Kaiser Permanente Medicaid	$213.72
Rate for Payer: MDX Hawaii PPO	$406.48
Rate for Payer: University Health Alliance Commercial	$234.67

Wire K 1.6mm x 150mm 292.16 [3609043]

Facility

$90.95

Service Code	HCPCS C1713
Hospital Charge Code	3609043
Hospital Revenue Code	278
Min. Negotiated Rate	$50.93
Max. Negotiated Rate	$88.22
Rate for Payer: Cash Price	$59.12
Rate for Payer: Hawaii Western Management Group Commercial	$63.66
Rate for Payer: Health Management Network Commercial	$77.31
Rate for Payer: MDX Hawaii PPO	$88.22
Rate for Payer: University Health Alliance Commercial	$50.93

Wire K 1.6mm x 150mm 292.16 [3609043]

Facility

$90.95

Service Code	HCPCS C1713
Hospital Charge Code	3609043
Hospital Revenue Code	278
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$88.22
Rate for Payer: Cash Price	$59.12
Rate for Payer: Hawaii Western Management Group Commercial	$63.66
Rate for Payer: Health Management Network Commercial	$77.31
Rate for Payer: Kaiser Permanente Commercial	$57.30
Rate for Payer: Kaiser Permanente Medicaid	$46.38
Rate for Payer: MDX Hawaii PPO	$88.22
Rate for Payer: University Health Alliance Commercial	$50.93

Wire K 2.0mm x 150mm 292.20 [3609044]

Facility

$90.95

Service Code	HCPCS C1713
Hospital Charge Code	3609044
Hospital Revenue Code	278
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$88.22
Rate for Payer: MDX Hawaii PPO	$88.22
Rate for Payer: Cash Price	$59.12
Rate for Payer: Hawaii Western Management Group Commercial	$63.66
Rate for Payer: Health Management Network Commercial	$77.31
Rate for Payer: Kaiser Permanente Commercial	$57.30
Rate for Payer: Kaiser Permanente Medicaid	$46.38
Rate for Payer: University Health Alliance Commercial	$50.93

Wire K 2.0mm x 150mm 292.20 [3609044]

Facility

$90.95

Service Code	HCPCS C1713
Hospital Charge Code	3609044
Hospital Revenue Code	278
Min. Negotiated Rate	$50.93
Max. Negotiated Rate	$88.22
Rate for Payer: Cash Price	$59.12
Rate for Payer: Hawaii Western Management Group Commercial	$63.66
Rate for Payer: Health Management Network Commercial	$77.31
Rate for Payer: MDX Hawaii PPO	$88.22
Rate for Payer: University Health Alliance Commercial	$50.93

Wire K 2.0mmX152mm KWIRSTD20152 [3642740]

Facility

$315.75

Service Code	HCPCS C1713
Hospital Charge Code	3642740
Hospital Revenue Code	278
Min. Negotiated Rate	$176.82
Max. Negotiated Rate	$306.28
Rate for Payer: Cash Price	$205.24
Rate for Payer: Hawaii Western Management Group Commercial	$221.03
Rate for Payer: Health Management Network Commercial	$268.39
Rate for Payer: MDX Hawaii PPO	$306.28
Rate for Payer: University Health Alliance Commercial	$176.82

Wire K 2.0mmX152mm KWIRSTD20152 [3642740]

Facility

$315.75

Service Code	HCPCS C1713
Hospital Charge Code	3642740
Hospital Revenue Code	278
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$306.28
Rate for Payer: Cash Price	$205.24
Rate for Payer: Hawaii Western Management Group Commercial	$221.03
Rate for Payer: Health Management Network Commercial	$268.39
Rate for Payer: Kaiser Permanente Commercial	$198.92
Rate for Payer: Kaiser Permanente Medicaid	$161.03
Rate for Payer: MDX Hawaii PPO	$306.28
Rate for Payer: University Health Alliance Commercial	$176.82

Wire K 2.0 x 152mm KW20SS [3626493]

Facility

$466.20

Service Code	HCPCS C1713
Hospital Charge Code	3626493
Hospital Revenue Code	278
Min. Negotiated Rate	$237.76
Max. Negotiated Rate	$452.21
Rate for Payer: Cash Price	$303.03
Rate for Payer: Hawaii Western Management Group Commercial	$326.34
Rate for Payer: Health Management Network Commercial	$396.27
Rate for Payer: Kaiser Permanente Commercial	$293.71
Rate for Payer: Kaiser Permanente Medicaid	$237.76
Rate for Payer: MDX Hawaii PPO	$452.21
Rate for Payer: University Health Alliance Commercial	$261.07

Wire K 2.0 x 152mm KW20SS [3626493]

Facility

$466.20

Service Code	HCPCS C1713
Hospital Charge Code	3626493
Hospital Revenue Code	278
Min. Negotiated Rate	$261.07
Max. Negotiated Rate	$452.21
Rate for Payer: Cash Price	$303.03
Rate for Payer: Hawaii Western Management Group Commercial	$326.34
Rate for Payer: Health Management Network Commercial	$396.27
Rate for Payer: MDX Hawaii PPO	$452.21
Rate for Payer: University Health Alliance Commercial	$261.07

Know your out-of-pocket cost for care.

All Charges