Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$128.39
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: Kaiser Permanente Commercial	$158.60
Rate for Payer: Kaiser Permanente Medicaid	$128.39
Rate for Payer: MDX Hawaii PPO	$244.20
Rate for Payer: University Health Alliance Commercial	$140.98

Wire K Threaded 1.6mm x 150mm 292.71 [3609045]

Facility

$167.52

Service Code	HCPCS C1713
Hospital Charge Code	3609045
Hospital Revenue Code	278
Min. Negotiated Rate	$85.44
Max. Negotiated Rate	$162.49
Rate for Payer: Cash Price	$108.89
Rate for Payer: Hawaii Western Management Group Commercial	$117.26
Rate for Payer: Health Management Network Commercial	$142.39
Rate for Payer: Kaiser Permanente Commercial	$105.54
Rate for Payer: Kaiser Permanente Medicaid	$85.44
Rate for Payer: MDX Hawaii PPO	$162.49
Rate for Payer: University Health Alliance Commercial	$93.81

Wire K Threaded 1.6mm x 150mm 292.71 [3609045]

Facility

$167.52

Service Code	HCPCS C1713
Hospital Charge Code	3609045
Hospital Revenue Code	278
Min. Negotiated Rate	$93.81
Max. Negotiated Rate	$162.49
Rate for Payer: Cash Price	$108.89
Rate for Payer: Hawaii Western Management Group Commercial	$117.26
Rate for Payer: Health Management Network Commercial	$142.39
Rate for Payer: MDX Hawaii PPO	$162.49
Rate for Payer: University Health Alliance Commercial	$93.81

Wire K Trocar Tip 0.9mm x 152mm KWIR-ST-09152 [3644520]

Facility

$560.50

Hospital Charge Code	3644520
Hospital Revenue Code	272
Min. Negotiated Rate	$476.43
Max. Negotiated Rate	$543.68
Rate for Payer: Cash Price	$364.32
Rate for Payer: Health Management Network Commercial	$476.43
Rate for Payer: MDX Hawaii PPO	$543.68

Wire K Trocar Tip 0.9mm x 152mm KWIR-ST-09152 [3644520]

Facility

$560.50

Hospital Charge Code	3644520
Hospital Revenue Code	272
Min. Negotiated Rate	$285.86
Max. Negotiated Rate	$543.68
Rate for Payer: Cash Price	$364.32
Rate for Payer: Hawaii Western Management Group Commercial	$532.48
Rate for Payer: Health Management Network Commercial	$476.43
Rate for Payer: Kaiser Permanente Commercial	$353.12
Rate for Payer: Kaiser Permanente Medicaid	$285.86
Rate for Payer: MDX Hawaii PPO	$543.68
Rate for Payer: University Health Alliance Commercial	$408.55

Wire-K Trochar Tip 1.6mm 233500008 [3642971]

Facility

$235.75

Service Code	HCPCS C1713
Hospital Charge Code	3642971
Hospital Revenue Code	278
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$228.68
Rate for Payer: Cash Price	$153.24
Rate for Payer: Hawaii Western Management Group Commercial	$165.03
Rate for Payer: Health Management Network Commercial	$200.39
Rate for Payer: MDX Hawaii PPO	$228.68
Rate for Payer: University Health Alliance Commercial	$132.02

Wire-K Trochar Tip 1.6mm 233500008 [3642971]

Facility

$235.75

Service Code	HCPCS C1713
Hospital Charge Code	3642971
Hospital Revenue Code	278
Min. Negotiated Rate	$120.23
Max. Negotiated Rate	$228.68
Rate for Payer: Cash Price	$153.24
Rate for Payer: Hawaii Western Management Group Commercial	$165.03
Rate for Payer: Health Management Network Commercial	$200.39
Rate for Payer: Kaiser Permanente Commercial	$148.52
Rate for Payer: Kaiser Permanente Medicaid	$120.23
Rate for Payer: MDX Hawaii PPO	$228.68
Rate for Payer: University Health Alliance Commercial	$132.02

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$102,864.57

Service Code	MSDRG 464
Min. Negotiated Rate	$40,966.92
Max. Negotiated Rate	$102,864.57
Rate for Payer: AlohaCare Medicare	$40,966.92
Rate for Payer: Devoted Health Medicare	$45,063.61
Rate for Payer: Hawaii Medical Service Association Commercial	$102,864.57
Rate for Payer: Hawaii Medical Service Association Medicare	$40,966.92
Rate for Payer: Humana Medicare	$40,966.92
Rate for Payer: Kaiser Permanente Commercial	$53,728.57
Rate for Payer: Kaiser Permanente Medicare	$40,966.92
Rate for Payer: Ohana Health Plan Medicare	$40,966.92
Rate for Payer: UnitedHealthcare Medicare	$40,966.92

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$102,864.57

Service Code	MSDRG 463
Min. Negotiated Rate	$74,964.20
Max. Negotiated Rate	$102,864.57
Rate for Payer: AlohaCare Medicare	$74,964.20
Rate for Payer: Devoted Health Medicare	$82,460.62
Rate for Payer: Hawaii Medical Service Association Commercial	$102,864.57
Rate for Payer: Hawaii Medical Service Association Medicare	$74,964.20
Rate for Payer: Humana Medicare	$74,964.20
Rate for Payer: Kaiser Permanente Commercial	$98,316.38
Rate for Payer: Kaiser Permanente Medicare	$74,964.20
Rate for Payer: Ohana Health Plan Medicare	$74,964.20
Rate for Payer: UnitedHealthcare Medicare	$74,964.20

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$102,864.57

Service Code	MSDRG 465
Min. Negotiated Rate	$23,986.69
Max. Negotiated Rate	$102,864.57
Rate for Payer: AlohaCare Medicare	$23,986.69
Rate for Payer: Devoted Health Medicare	$26,385.36
Rate for Payer: Hawaii Medical Service Association Commercial	$102,864.57
Rate for Payer: Hawaii Medical Service Association Medicare	$23,986.69
Rate for Payer: Humana Medicare	$23,986.69
Rate for Payer: Kaiser Permanente Commercial	$31,458.83
Rate for Payer: Kaiser Permanente Medicare	$23,986.69
Rate for Payer: Ohana Health Plan Medicare	$23,986.69
Rate for Payer: UnitedHealthcare Medicare	$23,986.69

WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility

$33,025.12

Service Code	MSDRG 902
Min. Negotiated Rate	$25,180.98
Max. Negotiated Rate	$33,025.12
Rate for Payer: AlohaCare Medicare	$25,180.98
Rate for Payer: Devoted Health Medicare	$27,699.08
Rate for Payer: Hawaii Medical Service Association Commercial	$28,566.79
Rate for Payer: Hawaii Medical Service Association Medicare	$25,180.98
Rate for Payer: Humana Medicare	$25,180.98
Rate for Payer: Kaiser Permanente Commercial	$33,025.12
Rate for Payer: Kaiser Permanente Medicare	$25,180.98
Rate for Payer: Ohana Health Plan Medicare	$25,180.98
Rate for Payer: UnitedHealthcare Medicare	$25,180.98

WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility

$72,391.35

Service Code	MSDRG 901
Min. Negotiated Rate	$28,566.79
Max. Negotiated Rate	$72,391.35
Rate for Payer: AlohaCare Medicare	$55,196.90
Rate for Payer: Devoted Health Medicare	$60,716.59
Rate for Payer: Hawaii Medical Service Association Commercial	$28,566.79
Rate for Payer: Hawaii Medical Service Association Medicare	$55,196.90
Rate for Payer: Humana Medicare	$55,196.90
Rate for Payer: Kaiser Permanente Commercial	$72,391.35
Rate for Payer: Kaiser Permanente Medicare	$55,196.90
Rate for Payer: Ohana Health Plan Medicare	$55,196.90
Rate for Payer: UnitedHealthcare Medicare	$55,196.90

WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility

$28,566.79

Service Code	MSDRG 903
Min. Negotiated Rate	$15,383.47
Max. Negotiated Rate	$28,566.79
Rate for Payer: AlohaCare Medicare	$15,383.47
Rate for Payer: Devoted Health Medicare	$16,921.82
Rate for Payer: Hawaii Medical Service Association Commercial	$28,566.79
Rate for Payer: Hawaii Medical Service Association Medicare	$15,383.47
Rate for Payer: Humana Medicare	$15,383.47
Rate for Payer: Kaiser Permanente Commercial	$20,175.60
Rate for Payer: Kaiser Permanente Medicare	$15,383.47
Rate for Payer: Ohana Health Plan Medicare	$15,383.47
Rate for Payer: UnitedHealthcare Medicare	$15,383.47

WOUND VAC CANISTER VAC KCI M8275071 [2707600]

Facility

$234.21

Service Code	HCPCS A6154
Hospital Charge Code	2707600
Hospital Revenue Code	272
Min. Negotiated Rate	$199.08
Max. Negotiated Rate	$227.18
Rate for Payer: Cash Price	$152.24
Rate for Payer: Health Management Network Commercial	$199.08
Rate for Payer: MDX Hawaii PPO	$227.18

WOUND VAC CANISTER VAC KCI M8275071 [2707600]

Facility

$234.21

Service Code	HCPCS A6154
Hospital Charge Code	2707600
Hospital Revenue Code	272
Min. Negotiated Rate	$15.37
Max. Negotiated Rate	$227.18
Rate for Payer: Cash Price	$152.24
Rate for Payer: Cash Price	$152.24
Rate for Payer: Hawaii Western Management Group Commercial	$222.50
Rate for Payer: Health Management Network Commercial	$199.08
Rate for Payer: Kaiser Permanente Commercial	$147.55
Rate for Payer: Kaiser Permanente Medicaid	$119.45
Rate for Payer: MDX Hawaii PPO	$227.18
Rate for Payer: UnitedHealthcare Medicaid	$15.37
Rate for Payer: University Health Alliance Commercial	$170.72

WOUND VAC DRESSING SPONGE LARGE KCI M8275053 [2707602]

Facility

$424.28

Service Code	HCPCS A6550
Hospital Charge Code	2707602
Hospital Revenue Code	272
Min. Negotiated Rate	$360.64
Max. Negotiated Rate	$411.55
Rate for Payer: Cash Price	$275.78
Rate for Payer: Health Management Network Commercial	$360.64
Rate for Payer: MDX Hawaii PPO	$411.55

WOUND VAC DRESSING SPONGE LARGE KCI M8275053 [2707602]

Facility

$424.28

Service Code	HCPCS A6550
Hospital Charge Code	2707602
Hospital Revenue Code	272
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$411.55
Rate for Payer: Cash Price	$275.78
Rate for Payer: Cash Price	$275.78
Rate for Payer: Hawaii Western Management Group Commercial	$403.07
Rate for Payer: Health Management Network Commercial	$360.64
Rate for Payer: Kaiser Permanente Commercial	$267.30
Rate for Payer: Kaiser Permanente Medicaid	$216.38
Rate for Payer: MDX Hawaii PPO	$411.55
Rate for Payer: UnitedHealthcare Medicaid	$24.82
Rate for Payer: University Health Alliance Commercial	$309.26

WOUND VAC DRESSING SPONGE MED KCI M8275052 [2707601]

Facility

$324.39

Service Code	HCPCS A6550
Hospital Charge Code	2707601
Hospital Revenue Code	272
Min. Negotiated Rate	$275.73
Max. Negotiated Rate	$314.66
Rate for Payer: Cash Price	$210.85
Rate for Payer: Health Management Network Commercial	$275.73
Rate for Payer: MDX Hawaii PPO	$314.66

WOUND VAC DRESSING SPONGE MED KCI M8275052 [2707601]

Facility

$324.39

Service Code	HCPCS A6550
Hospital Charge Code	2707601
Hospital Revenue Code	272
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$314.66
Rate for Payer: Cash Price	$210.85
Rate for Payer: Cash Price	$210.85
Rate for Payer: Hawaii Western Management Group Commercial	$308.17
Rate for Payer: Health Management Network Commercial	$275.73
Rate for Payer: Kaiser Permanente Commercial	$204.37
Rate for Payer: Kaiser Permanente Medicaid	$165.44
Rate for Payer: MDX Hawaii PPO	$314.66
Rate for Payer: UnitedHealthcare Medicaid	$24.82
Rate for Payer: University Health Alliance Commercial	$236.45

WOUND VAC DRESSING SPONGE SMALL KCI M8275051 [2707642]

Facility

$269.92

Service Code	HCPCS A6550
Hospital Charge Code	2707642
Hospital Revenue Code	272
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$261.82
Rate for Payer: Cash Price	$175.45
Rate for Payer: Cash Price	$175.45
Rate for Payer: Hawaii Western Management Group Commercial	$256.42
Rate for Payer: Health Management Network Commercial	$229.43
Rate for Payer: Kaiser Permanente Commercial	$170.05
Rate for Payer: Kaiser Permanente Medicaid	$137.66
Rate for Payer: MDX Hawaii PPO	$261.82
Rate for Payer: UnitedHealthcare Medicaid	$24.82
Rate for Payer: University Health Alliance Commercial	$196.74

WOUND VAC DRESSING SPONGE SMALL KCI M8275051 [2707642]

Facility

$269.92

Service Code	HCPCS A6550
Hospital Charge Code	2707642
Hospital Revenue Code	272
Min. Negotiated Rate	$229.43
Max. Negotiated Rate	$261.82
Rate for Payer: Cash Price	$175.45
Rate for Payer: Health Management Network Commercial	$229.43
Rate for Payer: MDX Hawaii PPO	$261.82

WOUND VAC DRESSING VERAFLOW LARGE KCI ULTVFL05LG [2700151]

Facility

$1,283.68

Hospital Charge Code	2700151
Hospital Revenue Code	272
Min. Negotiated Rate	$1,091.13
Max. Negotiated Rate	$1,245.17
Rate for Payer: Cash Price	$834.39
Rate for Payer: Health Management Network Commercial	$1,091.13
Rate for Payer: MDX Hawaii PPO	$1,245.17

WOUND VAC DRESSING VERAFLOW LARGE KCI ULTVFL05LG [2700151]

Facility

$1,283.68

Hospital Charge Code	2700151
Hospital Revenue Code	272
Min. Negotiated Rate	$654.68
Max. Negotiated Rate	$1,245.17
Rate for Payer: Cash Price	$834.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,219.50
Rate for Payer: Health Management Network Commercial	$1,091.13
Rate for Payer: Kaiser Permanente Commercial	$808.72
Rate for Payer: Kaiser Permanente Medicaid	$654.68
Rate for Payer: MDX Hawaii PPO	$1,245.17
Rate for Payer: University Health Alliance Commercial	$935.67

WOUND VAC DRESSING VERAFLOW MEDIUM KCI ULTVFL05MD [2700575]

Facility

$742.83

Hospital Charge Code	2700575
Hospital Revenue Code	272
Min. Negotiated Rate	$378.84
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$705.69
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: Kaiser Permanente Commercial	$467.98
Rate for Payer: Kaiser Permanente Medicaid	$378.84
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$541.45

WOUND VAC DRESSING VERAFLOW MEDIUM KCI ULTVFL05MD [2700575]

Facility

$742.83

Hospital Charge Code	2700575
Hospital Revenue Code	272
Min. Negotiated Rate	$631.41
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: MDX Hawaii PPO	$720.55

Know your out-of-pocket cost for care.

All Charges