Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Wire K COCR 0.9mmX95mm 231209095 [3641862]

Facility

$716.05

Service Code	HCPCS C1713
Hospital Charge Code	3641862
Hospital Revenue Code	278
Min. Negotiated Rate	$400.99
Max. Negotiated Rate	$694.57
Rate for Payer: Cash Price	$465.43
Rate for Payer: Hawaii Western Management Group Commercial	$501.24
Rate for Payer: Health Management Network Commercial	$608.64
Rate for Payer: MDX Hawaii PPO	$694.57
Rate for Payer: University Health Alliance Commercial	$400.99

Wire K COCR 0.9mmX95mm 231209095 [3641862]

Facility

$716.05

Service Code	HCPCS C1713
Hospital Charge Code	3641862
Hospital Revenue Code	278
Min. Negotiated Rate	$365.19
Max. Negotiated Rate	$694.57
Rate for Payer: Cash Price	$465.43
Rate for Payer: Hawaii Western Management Group Commercial	$501.24
Rate for Payer: Health Management Network Commercial	$608.64
Rate for Payer: Kaiser Permanente Commercial	$451.11
Rate for Payer: Kaiser Permanente Medicaid	$365.19
Rate for Payer: MDX Hawaii PPO	$694.57
Rate for Payer: University Health Alliance Commercial	$400.99

Wire K COCR 1.1mmX105mm 231211105 [3641864]

Facility

$371.10

Service Code	HCPCS C1713
Hospital Charge Code	3641864
Hospital Revenue Code	278
Min. Negotiated Rate	$189.26
Max. Negotiated Rate	$359.97
Rate for Payer: Cash Price	$241.22
Rate for Payer: Hawaii Western Management Group Commercial	$259.77
Rate for Payer: Health Management Network Commercial	$315.44
Rate for Payer: Kaiser Permanente Commercial	$233.79
Rate for Payer: Kaiser Permanente Medicaid	$189.26
Rate for Payer: MDX Hawaii PPO	$359.97
Rate for Payer: University Health Alliance Commercial	$207.82

Wire K COCR 1.1mmX105mm 231211105 [3641864]

Facility

$371.10

Service Code	HCPCS C1713
Hospital Charge Code	3641864
Hospital Revenue Code	278
Min. Negotiated Rate	$207.82
Max. Negotiated Rate	$359.97
Rate for Payer: Cash Price	$241.22
Rate for Payer: Hawaii Western Management Group Commercial	$259.77
Rate for Payer: Health Management Network Commercial	$315.44
Rate for Payer: MDX Hawaii PPO	$359.97
Rate for Payer: University Health Alliance Commercial	$207.82

Wire K Double Trocar 1.4mmX165mm KWIRHCS14165 [3642785]

Facility

$214.50

Service Code	HCPCS C1713
Hospital Charge Code	3642785
Hospital Revenue Code	278
Min. Negotiated Rate	$109.39
Max. Negotiated Rate	$208.06
Rate for Payer: Cash Price	$139.43
Rate for Payer: Hawaii Western Management Group Commercial	$150.15
Rate for Payer: Health Management Network Commercial	$182.32
Rate for Payer: Kaiser Permanente Commercial	$135.13
Rate for Payer: Kaiser Permanente Medicaid	$109.39
Rate for Payer: MDX Hawaii PPO	$208.06
Rate for Payer: University Health Alliance Commercial	$120.12

Wire K Double Trocar 1.4mmX165mm KWIRHCS14165 [3642785]

Facility

$214.50

Service Code	HCPCS C1713
Hospital Charge Code	3642785
Hospital Revenue Code	278
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$208.06
Rate for Payer: Cash Price	$139.43
Rate for Payer: Hawaii Western Management Group Commercial	$150.15
Rate for Payer: Health Management Network Commercial	$182.32
Rate for Payer: MDX Hawaii PPO	$208.06
Rate for Payer: University Health Alliance Commercial	$120.12

Wire Kirschner 2.0mm 290.20.280 [3641301]

Facility

$405.25

Hospital Charge Code	3641301
Hospital Revenue Code	272
Min. Negotiated Rate	$206.68
Max. Negotiated Rate	$393.09
Rate for Payer: Cash Price	$263.41
Rate for Payer: Hawaii Western Management Group Commercial	$384.99
Rate for Payer: Health Management Network Commercial	$344.46
Rate for Payer: Kaiser Permanente Commercial	$255.31
Rate for Payer: Kaiser Permanente Medicaid	$206.68
Rate for Payer: MDX Hawaii PPO	$393.09
Rate for Payer: University Health Alliance Commercial	$295.39

Wire Kirschner 2.0mm 290.20.280 [3641301]

Facility

$405.25

Hospital Charge Code	3641301
Hospital Revenue Code	272
Min. Negotiated Rate	$344.46
Max. Negotiated Rate	$393.09
Rate for Payer: Cash Price	$263.41
Rate for Payer: Health Management Network Commercial	$344.46
Rate for Payer: MDX Hawaii PPO	$393.09

Wire Kirschner Trocar Point 2.5mm x 285mm 292.26 [3644552]

Facility

$118.32

Hospital Charge Code	3644552
Hospital Revenue Code	272
Min. Negotiated Rate	$100.57
Max. Negotiated Rate	$114.77
Rate for Payer: Cash Price	$76.91
Rate for Payer: Health Management Network Commercial	$100.57
Rate for Payer: MDX Hawaii PPO	$114.77

Wire Kirschner Trocar Point 2.5mm x 285mm 292.26 [3644552]

Facility

$118.32

Hospital Charge Code	3644552
Hospital Revenue Code	272
Min. Negotiated Rate	$60.34
Max. Negotiated Rate	$114.77
Rate for Payer: Cash Price	$76.91
Rate for Payer: Hawaii Western Management Group Commercial	$112.40
Rate for Payer: Health Management Network Commercial	$100.57
Rate for Payer: Kaiser Permanente Commercial	$74.54
Rate for Payer: Kaiser Permanente Medicaid	$60.34
Rate for Payer: MDX Hawaii PPO	$114.77
Rate for Payer: University Health Alliance Commercial	$86.24

Wire Kirschner w/Trocar Tip 2.5mm 290.25.280 [3641950]

Facility

$369.75

Hospital Charge Code	3641950
Hospital Revenue Code	272
Min. Negotiated Rate	$314.29
Max. Negotiated Rate	$358.66
Rate for Payer: Cash Price	$240.34
Rate for Payer: Health Management Network Commercial	$314.29
Rate for Payer: MDX Hawaii PPO	$358.66

Wire Kirschner w/Trocar Tip 2.5mm 290.25.280 [3641950]

Facility

$369.75

Hospital Charge Code	3641950
Hospital Revenue Code	272
Min. Negotiated Rate	$188.57
Max. Negotiated Rate	$358.66
Rate for Payer: Cash Price	$240.34
Rate for Payer: Hawaii Western Management Group Commercial	$351.26
Rate for Payer: Health Management Network Commercial	$314.29
Rate for Payer: Kaiser Permanente Commercial	$232.94
Rate for Payer: Kaiser Permanente Medicaid	$188.57
Rate for Payer: MDX Hawaii PPO	$358.66
Rate for Payer: University Health Alliance Commercial	$269.51

Wire K Single Diamond Trocar 1.5mmx229mm [3643293]

Facility

$318.25

Service Code	HCPCS C1713
Hospital Charge Code	3643293
Hospital Revenue Code	278
Min. Negotiated Rate	$162.31
Max. Negotiated Rate	$308.70
Rate for Payer: Cash Price	$206.86
Rate for Payer: Hawaii Western Management Group Commercial	$222.78
Rate for Payer: Health Management Network Commercial	$270.51
Rate for Payer: Kaiser Permanente Commercial	$200.50
Rate for Payer: Kaiser Permanente Medicaid	$162.31
Rate for Payer: MDX Hawaii PPO	$308.70
Rate for Payer: University Health Alliance Commercial	$178.22

Wire K Single Diamond Trocar 1.5mmx229mm [3643293]

Facility

$318.25

Service Code	HCPCS C1713
Hospital Charge Code	3643293
Hospital Revenue Code	278
Min. Negotiated Rate	$178.22
Max. Negotiated Rate	$308.70
Rate for Payer: Cash Price	$206.86
Rate for Payer: Hawaii Western Management Group Commercial	$222.78
Rate for Payer: Health Management Network Commercial	$270.51
Rate for Payer: MDX Hawaii PPO	$308.70
Rate for Payer: University Health Alliance Commercial	$178.22

Wire K Single Trocar 0.9mm x 203mm KWIR-ST-09203 [3645375]

Facility

$405.25

Hospital Charge Code	3645375
Hospital Revenue Code	272
Min. Negotiated Rate	$344.46
Max. Negotiated Rate	$393.09
Rate for Payer: Cash Price	$263.41
Rate for Payer: Health Management Network Commercial	$344.46
Rate for Payer: MDX Hawaii PPO	$393.09

Wire K Single Trocar 0.9mm x 203mm KWIR-ST-09203 [3645375]

Facility

$405.25

Hospital Charge Code	3645375
Hospital Revenue Code	272
Min. Negotiated Rate	$206.68
Max. Negotiated Rate	$393.09
Rate for Payer: Cash Price	$263.41
Rate for Payer: Hawaii Western Management Group Commercial	$384.99
Rate for Payer: Health Management Network Commercial	$344.46
Rate for Payer: Kaiser Permanente Commercial	$255.31
Rate for Payer: Kaiser Permanente Medicaid	$206.68
Rate for Payer: MDX Hawaii PPO	$393.09
Rate for Payer: University Health Alliance Commercial	$295.39

Wire K Single Trocar 1.4mm x 203mm KWIR-ST-14203 [3645376]

Facility

$369.75

Hospital Charge Code	3645376
Hospital Revenue Code	272
Min. Negotiated Rate	$314.29
Max. Negotiated Rate	$358.66
Rate for Payer: Cash Price	$240.34
Rate for Payer: Health Management Network Commercial	$314.29
Rate for Payer: MDX Hawaii PPO	$358.66

Wire K Single Trocar 1.4mm x 203mm KWIR-ST-14203 [3645376]

Facility

$369.75

Hospital Charge Code	3645376
Hospital Revenue Code	272
Min. Negotiated Rate	$188.57
Max. Negotiated Rate	$358.66
Rate for Payer: Cash Price	$240.34
Rate for Payer: Hawaii Western Management Group Commercial	$351.26
Rate for Payer: Health Management Network Commercial	$314.29
Rate for Payer: Kaiser Permanente Commercial	$232.94
Rate for Payer: Kaiser Permanente Medicaid	$188.57
Rate for Payer: MDX Hawaii PPO	$358.66
Rate for Payer: University Health Alliance Commercial	$269.51

Wire K Standard Tip 0.9mm x 152mm KWIR-STD-09152 [3642787]

Facility

$255.00

Service Code	HCPCS C1713
Hospital Charge Code	3642787
Hospital Revenue Code	278
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Hawaii Western Management Group Commercial	$178.50
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Kaiser Permanente Commercial	$160.65
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: University Health Alliance Commercial	$142.80

Wire K Standard Tip 0.9mm x 152mm KWIR-STD-09152 [3642787]

Facility

$255.00

Service Code	HCPCS C1713
Hospital Charge Code	3642787
Hospital Revenue Code	278
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Hawaii Western Management Group Commercial	$178.50
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: University Health Alliance Commercial	$142.80

Wire K Standard Tip 1.5mm x 127mm KWIR-STD-15127 [3642646]

Facility

$255.00

Service Code	HCPCS C1713
Hospital Charge Code	3642646
Hospital Revenue Code	278
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Hawaii Western Management Group Commercial	$178.50
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Kaiser Permanente Commercial	$160.65
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: University Health Alliance Commercial	$142.80

Wire K Standard Tip 1.5mm x 127mm KWIR-STD-15127 [3642646]

Facility

$255.00

Service Code	HCPCS C1713
Hospital Charge Code	3642646
Hospital Revenue Code	278
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Hawaii Western Management Group Commercial	$178.50
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: University Health Alliance Commercial	$142.80

Wire K Stnd Tip 1.5mmx127mm KWIR-DES-15127 [3645437]

Facility

$309.00

Hospital Charge Code	3645437
Hospital Revenue Code	272
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$194.67
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: University Health Alliance Commercial	$225.23

Wire K Stnd Tip 1.5mmx127mm KWIR-DES-15127 [3645437]

Facility

$309.00

Hospital Charge Code	3645437
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: MDX Hawaii PPO	$299.73

Wire K Stnd Tip Hps Pls 1.1mmx152mm [3643292]

Facility

$251.75

Service Code	HCPCS C1713
Hospital Charge Code	3643292
Hospital Revenue Code	278
Min. Negotiated Rate	$140.98
Max. Negotiated Rate	$244.20
Rate for Payer: Cash Price	$163.64
Rate for Payer: Hawaii Western Management Group Commercial	$176.22
Rate for Payer: Health Management Network Commercial	$213.99
Rate for Payer: MDX Hawaii PPO	$244.20
Rate for Payer: University Health Alliance Commercial	$140.98

Know your out-of-pocket cost for care.

All Charges