Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Affixus Screw Cortical Bone 5.0mm X 36mm 8145-50-036 [3627532]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3627532
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 38mm 8145-50-038 [3640869]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640869
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 38mm 8145-50-038 [3640869]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640869
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 40mm 8145-50-040 [3640869B]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640869B
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 40mm 8145-50-040 [3640869B]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3640869B
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 42mm 8145-50-042 [3640869C]

Facility

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	3640869C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,484.00
Max. Negotiated Rate	$2,570.50
Rate for Payer: Cash Price	$1,722.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,855.00
Rate for Payer: Health Management Network Commercial	$2,252.50
Rate for Payer: MDX Hawaii PPO	$2,570.50
Rate for Payer: University Health Alliance Commercial	$1,484.00

Affixus Screw Cortical Bone 5.0mm x 42mm 8145-50-042 [3640869C]

Facility

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	3640869C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,570.50
Rate for Payer: Cash Price	$1,722.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,855.00
Rate for Payer: Health Management Network Commercial	$2,252.50
Rate for Payer: Kaiser Permanente Commercial	$1,669.50
Rate for Payer: Kaiser Permanente Medicaid	$1,351.50
Rate for Payer: MDX Hawaii PPO	$2,570.50
Rate for Payer: University Health Alliance Commercial	$1,484.00

Affixus Screw Cortical Bone 5.0mm x 44mm 8145-50-044 [3640869A]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3640869A
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 44mm 8145-50-044 [3640869A]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3640869A
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 46mm 8145-50-046 [3642056]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3642056
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 46mm 8145-50-046 [3642056]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3642056
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 48mm 8145-50-048 [3641457]

Facility

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	3641457
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,570.50
Rate for Payer: Cash Price	$1,722.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,855.00
Rate for Payer: Health Management Network Commercial	$2,252.50
Rate for Payer: Kaiser Permanente Commercial	$1,669.50
Rate for Payer: Kaiser Permanente Medicaid	$1,351.50
Rate for Payer: MDX Hawaii PPO	$2,570.50
Rate for Payer: University Health Alliance Commercial	$1,484.00

Affixus Screw Cortical Bone 5.0mm x 48mm 8145-50-048 [3641457]

Facility

$2,650.00

Service Code	HCPCS C1713
Hospital Charge Code	3641457
Hospital Revenue Code	278
Min. Negotiated Rate	$1,484.00
Max. Negotiated Rate	$2,570.50
Rate for Payer: Cash Price	$1,722.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,855.00
Rate for Payer: Health Management Network Commercial	$2,252.50
Rate for Payer: MDX Hawaii PPO	$2,570.50
Rate for Payer: University Health Alliance Commercial	$1,484.00

Affixus Screw Cortical Bone 5.0mm x 50mm 8145-50-050 [3640869E]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3640869E
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 50mm 8145-50-050 [3640869E]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3640869E
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 54mm 8145-50-054 [3641605]

Facility

$1,299.38

Service Code	HCPCS C1713
Hospital Charge Code	3641605
Hospital Revenue Code	278
Min. Negotiated Rate	$662.68
Max. Negotiated Rate	$1,260.40
Rate for Payer: Cash Price	$844.60
Rate for Payer: Hawaii Western Management Group Commercial	$909.57
Rate for Payer: Health Management Network Commercial	$1,104.47
Rate for Payer: Kaiser Permanente Commercial	$818.61
Rate for Payer: Kaiser Permanente Medicaid	$662.68
Rate for Payer: MDX Hawaii PPO	$1,260.40
Rate for Payer: University Health Alliance Commercial	$727.65

Affixus Screw Cortical Bone 5.0mm x 54mm 8145-50-054 [3641605]

Facility

$1,299.38

Service Code	HCPCS C1713
Hospital Charge Code	3641605
Hospital Revenue Code	278
Min. Negotiated Rate	$727.65
Max. Negotiated Rate	$1,260.40
Rate for Payer: Cash Price	$844.60
Rate for Payer: Hawaii Western Management Group Commercial	$909.57
Rate for Payer: Health Management Network Commercial	$1,104.47
Rate for Payer: MDX Hawaii PPO	$1,260.40
Rate for Payer: University Health Alliance Commercial	$727.65

Affixus Screw Cortical Bone 5.0mm x 58mm 8145-50-058 [3642717]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3642717
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 58mm 8145-50-058 [3642717]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3642717
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw HFN A/R 100mm 8145-01-100 [3641603]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3641603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Affixus Screw HFN A/R 100mm 8145-01-100 [3641603]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3641603
Hospital Revenue Code	278
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Affixus Screw HFN A/R 110mm 8145-01-110 [3642616]

Facility

$1,657.43

Service Code	HCPCS C1713
Hospital Charge Code	3642616
Hospital Revenue Code	278
Min. Negotiated Rate	$845.29
Max. Negotiated Rate	$1,607.71
Rate for Payer: Cash Price	$1,077.33
Rate for Payer: Hawaii Western Management Group Commercial	$1,160.20
Rate for Payer: Health Management Network Commercial	$1,408.82
Rate for Payer: Kaiser Permanente Commercial	$1,044.18
Rate for Payer: Kaiser Permanente Medicaid	$845.29
Rate for Payer: MDX Hawaii PPO	$1,607.71
Rate for Payer: University Health Alliance Commercial	$928.16

Affixus Screw HFN A/R 110mm 8145-01-110 [3642616]

Facility

$1,657.43

Service Code	HCPCS C1713
Hospital Charge Code	3642616
Hospital Revenue Code	278
Min. Negotiated Rate	$928.16
Max. Negotiated Rate	$1,607.71
Rate for Payer: Cash Price	$1,077.33
Rate for Payer: Hawaii Western Management Group Commercial	$1,160.20
Rate for Payer: Health Management Network Commercial	$1,408.82
Rate for Payer: MDX Hawaii PPO	$1,607.71
Rate for Payer: University Health Alliance Commercial	$928.16

Affixus Screw HFN A/R 70mm 8145-01-070 [3641617]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3641617
Hospital Revenue Code	278
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Affixus Screw HFN A/R 70mm 8145-01-070 [3641617]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3641617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Know your out-of-pocket cost for care.

All Charges