Kona Community Hospital

All Charges

Charge

Type

Setting

Price

00249005443 Drill Tib/Hum Cali 4.3mm [3640906]

Facility

$1,353.00

Hospital Charge Code	3640906
Hospital Revenue Code	272
Min. Negotiated Rate	$690.03
Max. Negotiated Rate	$1,312.41
Rate for Payer: Cash Price	$879.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,285.35
Rate for Payer: Health Management Network Commercial	$1,150.05
Rate for Payer: Kaiser Permanente Commercial	$852.39
Rate for Payer: Kaiser Permanente Medicaid	$690.03
Rate for Payer: MDX Hawaii PPO	$1,312.41
Rate for Payer: University Health Alliance Commercial	$986.20

00249005443 Drill Tib/Hum Cali 4.3mm [3640906]

Facility

$1,353.00

Hospital Charge Code	3640906
Hospital Revenue Code	272
Min. Negotiated Rate	$1,150.05
Max. Negotiated Rate	$1,312.41
Rate for Payer: Cash Price	$879.45
Rate for Payer: Health Management Network Commercial	$1,150.05
Rate for Payer: MDX Hawaii PPO	$1,312.41

00-9986-021-20 Blade Osteotome MRI Short 8mm [3642341]

Facility

$774.96

Hospital Charge Code	3642341
Hospital Revenue Code	272
Min. Negotiated Rate	$395.23
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$736.21
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: Kaiser Permanente Commercial	$488.22
Rate for Payer: Kaiser Permanente Medicaid	$395.23
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$564.87

00-9986-021-20 Blade Osteotome MRI Short 8mm [3642341]

Facility

$774.96

Hospital Charge Code	3642341
Hospital Revenue Code	272
Min. Negotiated Rate	$658.72
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: MDX Hawaii PPO	$751.71

00-9986-021-21 Blade Osteotome MRI NonSt Short 10mm [3642748]

Facility

$774.96

Hospital Charge Code	3642748
Hospital Revenue Code	272
Min. Negotiated Rate	$658.72
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: MDX Hawaii PPO	$751.71

00-9986-021-21 Blade Osteotome MRI NonSt Short 10mm [3642748]

Facility

$774.96

Hospital Charge Code	3642748
Hospital Revenue Code	272
Min. Negotiated Rate	$395.23
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$736.21
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: Kaiser Permanente Commercial	$488.22
Rate for Payer: Kaiser Permanente Medicaid	$395.23
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$564.87

00-9986-021-23 Blade Osteotome MRI NonSt Short 20mm [3643129]

Facility

$774.96

Service Code	HCPCS C1776
Hospital Charge Code	3643129
Hospital Revenue Code	278
Min. Negotiated Rate	$395.23
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$542.47
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: Kaiser Permanente Commercial	$488.22
Rate for Payer: Kaiser Permanente Medicaid	$395.23
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$433.98

00-9986-021-23 Blade Osteotome MRI NonSt Short 20mm [3643129]

Facility

$774.96

Service Code	HCPCS C1776
Hospital Charge Code	3643129
Hospital Revenue Code	278
Min. Negotiated Rate	$433.98
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$542.47
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$433.98

00-9986-021-24 Blade Osteotome MRI NonSt Short Curved 12mm [3642445]

Facility

$774.96

Hospital Charge Code	3642445
Hospital Revenue Code	272
Min. Negotiated Rate	$395.23
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$736.21
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: Kaiser Permanente Commercial	$488.22
Rate for Payer: Kaiser Permanente Medicaid	$395.23
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$564.87

00-9986-021-24 Blade Osteotome MRI NonSt Short Curved 12mm [3642445]

Facility

$774.96

Hospital Charge Code	3642445
Hospital Revenue Code	272
Min. Negotiated Rate	$658.72
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: MDX Hawaii PPO	$751.71

00-9986-021-25 Blade Osteotome MRI NonSt Long Curved 20mm [3642747]

Facility

$774.96

Hospital Charge Code	3642747
Hospital Revenue Code	272
Min. Negotiated Rate	$658.72
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: MDX Hawaii PPO	$751.71

00-9986-021-25 Blade Osteotome MRI NonSt Long Curved 20mm [3642747]

Facility

$774.96

Hospital Charge Code	3642747
Hospital Revenue Code	272
Min. Negotiated Rate	$395.23
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$736.21
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: Kaiser Permanente Commercial	$488.22
Rate for Payer: Kaiser Permanente Medicaid	$395.23
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$564.87

00-9986-021-27 Blade Osteotome MRI NonSt Long 8mm [3642446]

Facility

$774.96

Hospital Charge Code	3642446
Hospital Revenue Code	272
Min. Negotiated Rate	$658.72
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: MDX Hawaii PPO	$751.71

00-9986-021-27 Blade Osteotome MRI NonSt Long 8mm [3642446]

Facility

$774.96

Hospital Charge Code	3642446
Hospital Revenue Code	272
Min. Negotiated Rate	$395.23
Max. Negotiated Rate	$751.71
Rate for Payer: Cash Price	$503.72
Rate for Payer: Hawaii Western Management Group Commercial	$736.21
Rate for Payer: Health Management Network Commercial	$658.72
Rate for Payer: Kaiser Permanente Commercial	$488.22
Rate for Payer: Kaiser Permanente Medicaid	$395.23
Rate for Payer: MDX Hawaii PPO	$751.71
Rate for Payer: University Health Alliance Commercial	$564.87

02.03150.030 Screw 5.0mm Cort NCB 30mm Self Tap [3642389]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3642389
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

02.03150.030 Screw 5.0mm Cort NCB 30mm Self Tap [3642389]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3642389
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

02.03150.032 Screw 5.0mm Cort NCB 32mm Self Tap [3642390]

Facility

$1,610.04

Service Code	HCPCS C1713
Hospital Charge Code	3642390
Hospital Revenue Code	278
Min. Negotiated Rate	$821.12
Max. Negotiated Rate	$1,561.74
Rate for Payer: Cash Price	$1,046.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.03
Rate for Payer: Health Management Network Commercial	$1,368.53
Rate for Payer: Kaiser Permanente Commercial	$1,014.33
Rate for Payer: Kaiser Permanente Medicaid	$821.12
Rate for Payer: MDX Hawaii PPO	$1,561.74
Rate for Payer: University Health Alliance Commercial	$901.62

02.03150.032 Screw 5.0mm Cort NCB 32mm Self Tap [3642390]

Facility

$1,610.04

Service Code	HCPCS C1713
Hospital Charge Code	3642390
Hospital Revenue Code	278
Min. Negotiated Rate	$901.62
Max. Negotiated Rate	$1,561.74
Rate for Payer: Cash Price	$1,046.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.03
Rate for Payer: Health Management Network Commercial	$1,368.53
Rate for Payer: MDX Hawaii PPO	$1,561.74
Rate for Payer: University Health Alliance Commercial	$901.62

02.03150.036 Screw 5.0mm Cort NCB 36mm Self Tap [3641298]

Facility

$1,610.04

Service Code	HCPCS C1713
Hospital Charge Code	3641298
Hospital Revenue Code	278
Min. Negotiated Rate	$901.62
Max. Negotiated Rate	$1,561.74
Rate for Payer: Cash Price	$1,046.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.03
Rate for Payer: Health Management Network Commercial	$1,368.53
Rate for Payer: MDX Hawaii PPO	$1,561.74
Rate for Payer: University Health Alliance Commercial	$901.62

02.03150.036 Screw 5.0mm Cort NCB 36mm Self Tap [3641298]

Facility

$1,610.04

Service Code	HCPCS C1713
Hospital Charge Code	3641298
Hospital Revenue Code	278
Min. Negotiated Rate	$821.12
Max. Negotiated Rate	$1,561.74
Rate for Payer: Cash Price	$1,046.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.03
Rate for Payer: Health Management Network Commercial	$1,368.53
Rate for Payer: Kaiser Permanente Commercial	$1,014.33
Rate for Payer: Kaiser Permanente Medicaid	$821.12
Rate for Payer: MDX Hawaii PPO	$1,561.74
Rate for Payer: University Health Alliance Commercial	$901.62

02.03150.038 Screw 5.0mm Cort NCB 38mm Self Tap [3641299]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3641299
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

02.03150.038 Screw 5.0mm Cort NCB 38mm Self Tap [3641299]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3641299
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

02.03150.040 Screw 5.0mm Cort NCB 40mm Self Tap [3642024]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3642024
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

02.03150.040 Screw 5.0mm Cort NCB 40mm Self Tap [3642024]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3642024
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

02.03150.042 Screw 5.0mm Cort NCB 42mm Self Tap [3642164]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3642164
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Know your out-of-pocket cost for care.

All Charges