Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Chimaera Hfs Lag Screw Fixed 90mm 99-T93690 [3643473]

Facility

$5,955.00

Service Code	HCPCS C1713
Hospital Charge Code	3643473
Hospital Revenue Code	278
Min. Negotiated Rate	$3,334.80
Max. Negotiated Rate	$5,776.35
Rate for Payer: Cash Price	$3,870.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,168.50
Rate for Payer: Health Management Network Commercial	$5,061.75
Rate for Payer: MDX Hawaii PPO	$5,776.35
Rate for Payer: University Health Alliance Commercial	$3,334.80

Hip Chimaera Hfs Lag Screw Fixed 90mm 99-T93690 [3643473]

Facility

$5,955.00

Service Code	HCPCS C1713
Hospital Charge Code	3643473
Hospital Revenue Code	278
Min. Negotiated Rate	$3,037.05
Max. Negotiated Rate	$5,776.35
Rate for Payer: Cash Price	$3,870.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,168.50
Rate for Payer: Health Management Network Commercial	$5,061.75
Rate for Payer: Kaiser Permanente Commercial	$3,751.65
Rate for Payer: Kaiser Permanente Medicaid	$3,037.05
Rate for Payer: MDX Hawaii PPO	$5,776.35
Rate for Payer: University Health Alliance Commercial	$3,334.80

Hip Chimaera Hfs Lag Screw Fixed 95mm 99-T93695 [3643474]

Facility

$5,955.00

Service Code	HCPCS C1713
Hospital Charge Code	3643474
Hospital Revenue Code	278
Min. Negotiated Rate	$3,334.80
Max. Negotiated Rate	$5,776.35
Rate for Payer: Cash Price	$3,870.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,168.50
Rate for Payer: Health Management Network Commercial	$5,061.75
Rate for Payer: MDX Hawaii PPO	$5,776.35
Rate for Payer: University Health Alliance Commercial	$3,334.80

Hip Chimaera Hfs Lag Screw Fixed 95mm 99-T93695 [3643474]

Facility

$5,955.00

Service Code	HCPCS C1713
Hospital Charge Code	3643474
Hospital Revenue Code	278
Min. Negotiated Rate	$3,037.05
Max. Negotiated Rate	$5,776.35
Rate for Payer: Cash Price	$3,870.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,168.50
Rate for Payer: Health Management Network Commercial	$5,061.75
Rate for Payer: Kaiser Permanente Commercial	$3,751.65
Rate for Payer: Kaiser Permanente Medicaid	$3,037.05
Rate for Payer: MDX Hawaii PPO	$5,776.35
Rate for Payer: University Health Alliance Commercial	$3,334.80

Hip Chimaera Hfs Lag Screw Sliding 105mm 99-T93705 [3643384]

Facility

$6,781.00

Service Code	HCPCS C1713
Hospital Charge Code	3643384
Hospital Revenue Code	278
Min. Negotiated Rate	$3,458.31
Max. Negotiated Rate	$6,577.57
Rate for Payer: Cash Price	$4,407.65
Rate for Payer: Hawaii Western Management Group Commercial	$4,746.70
Rate for Payer: Health Management Network Commercial	$5,763.85
Rate for Payer: Kaiser Permanente Commercial	$4,272.03
Rate for Payer: Kaiser Permanente Medicaid	$3,458.31
Rate for Payer: MDX Hawaii PPO	$6,577.57
Rate for Payer: University Health Alliance Commercial	$3,797.36

Hip Chimaera Hfs Lag Screw Sliding 105mm 99-T93705 [3643384]

Facility

$6,781.00

Service Code	HCPCS C1713
Hospital Charge Code	3643384
Hospital Revenue Code	278
Min. Negotiated Rate	$3,797.36
Max. Negotiated Rate	$6,577.57
Rate for Payer: Cash Price	$4,407.65
Rate for Payer: Hawaii Western Management Group Commercial	$4,746.70
Rate for Payer: Health Management Network Commercial	$5,763.85
Rate for Payer: MDX Hawaii PPO	$6,577.57
Rate for Payer: University Health Alliance Commercial	$3,797.36

Hip Chimaera Hfs Lag Screw Supple 90mm 99-T93590 [3643461]

Facility

$4,517.00

Service Code	HCPCS C1713
Hospital Charge Code	3643461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,303.67
Max. Negotiated Rate	$4,381.49
Rate for Payer: Cash Price	$2,936.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,161.90
Rate for Payer: Health Management Network Commercial	$3,839.45
Rate for Payer: Kaiser Permanente Commercial	$2,845.71
Rate for Payer: Kaiser Permanente Medicaid	$2,303.67
Rate for Payer: MDX Hawaii PPO	$4,381.49
Rate for Payer: University Health Alliance Commercial	$2,529.52

Hip Chimaera Hfs Lag Screw Supple 90mm 99-T93590 [3643461]

Facility

$4,517.00

Service Code	HCPCS C1713
Hospital Charge Code	3643461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,529.52
Max. Negotiated Rate	$4,381.49
Rate for Payer: Cash Price	$2,936.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,161.90
Rate for Payer: Health Management Network Commercial	$3,839.45
Rate for Payer: MDX Hawaii PPO	$4,381.49
Rate for Payer: University Health Alliance Commercial	$2,529.52

Hip Chimaera HFS Lag Screw Supplementary 75mm 99-T93575 [3644305]

Facility

$4,517.00

Service Code	HCPCS C1713
Hospital Charge Code	3644305
Hospital Revenue Code	278
Min. Negotiated Rate	$2,303.67
Max. Negotiated Rate	$4,381.49
Rate for Payer: Cash Price	$2,936.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,161.90
Rate for Payer: Health Management Network Commercial	$3,839.45
Rate for Payer: Kaiser Permanente Commercial	$2,845.71
Rate for Payer: Kaiser Permanente Medicaid	$2,303.67
Rate for Payer: MDX Hawaii PPO	$4,381.49
Rate for Payer: University Health Alliance Commercial	$2,529.52

Hip Chimaera HFS Lag Screw Supplementary 75mm 99-T93575 [3644305]

Facility

$4,517.00

Service Code	HCPCS C1713
Hospital Charge Code	3644305
Hospital Revenue Code	278
Min. Negotiated Rate	$2,529.52
Max. Negotiated Rate	$4,381.49
Rate for Payer: Cash Price	$2,936.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,161.90
Rate for Payer: Health Management Network Commercial	$3,839.45
Rate for Payer: MDX Hawaii PPO	$4,381.49
Rate for Payer: University Health Alliance Commercial	$2,529.52

Hip Chimaera HFS Lag Screw Supplementary 85mm 99-T93585 [3644306]

Facility

$4,517.00

Service Code	HCPCS C1713
Hospital Charge Code	3644306
Hospital Revenue Code	278
Min. Negotiated Rate	$2,303.67
Max. Negotiated Rate	$4,381.49
Rate for Payer: Cash Price	$2,936.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,161.90
Rate for Payer: Health Management Network Commercial	$3,839.45
Rate for Payer: Kaiser Permanente Commercial	$2,845.71
Rate for Payer: Kaiser Permanente Medicaid	$2,303.67
Rate for Payer: MDX Hawaii PPO	$4,381.49
Rate for Payer: University Health Alliance Commercial	$2,529.52

Hip Chimaera HFS Lag Screw Supplementary 85mm 99-T93585 [3644306]

Facility

$4,517.00

Service Code	HCPCS C1713
Hospital Charge Code	3644306
Hospital Revenue Code	278
Min. Negotiated Rate	$2,529.52
Max. Negotiated Rate	$4,381.49
Rate for Payer: Cash Price	$2,936.05
Rate for Payer: Hawaii Western Management Group Commercial	$3,161.90
Rate for Payer: Health Management Network Commercial	$3,839.45
Rate for Payer: MDX Hawaii PPO	$4,381.49
Rate for Payer: University Health Alliance Commercial	$2,529.52

Hip Chimaera Hfs Long Nail Rt 130 Deg 11x440m [3643489]

Facility

$8,770.00

Service Code	HCPCS C1713
Hospital Charge Code	3643489
Hospital Revenue Code	278
Min. Negotiated Rate	$4,472.70
Max. Negotiated Rate	$8,506.90
Rate for Payer: Cash Price	$5,700.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,139.00
Rate for Payer: Health Management Network Commercial	$7,454.50
Rate for Payer: Kaiser Permanente Commercial	$5,525.10
Rate for Payer: Kaiser Permanente Medicaid	$4,472.70
Rate for Payer: MDX Hawaii PPO	$8,506.90
Rate for Payer: University Health Alliance Commercial	$4,911.20

Hip Chimaera Hfs Long Nail Rt 130 Deg 11x440m [3643489]

Facility

$8,770.00

Service Code	HCPCS C1713
Hospital Charge Code	3643489
Hospital Revenue Code	278
Min. Negotiated Rate	$4,911.20
Max. Negotiated Rate	$8,506.90
Rate for Payer: Cash Price	$5,700.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,139.00
Rate for Payer: Health Management Network Commercial	$7,454.50
Rate for Payer: MDX Hawaii PPO	$8,506.90
Rate for Payer: University Health Alliance Commercial	$4,911.20

Hip Chimaera Hfs Short Nail 125deg 11x180mm 99-T93125 [3643906]

Facility

$10,701.00

Service Code	HCPCS C1713
Hospital Charge Code	3643906
Hospital Revenue Code	278
Min. Negotiated Rate	$5,992.56
Max. Negotiated Rate	$10,379.97
Rate for Payer: Cash Price	$6,955.65
Rate for Payer: Hawaii Western Management Group Commercial	$7,490.70
Rate for Payer: Health Management Network Commercial	$9,095.85
Rate for Payer: MDX Hawaii PPO	$10,379.97
Rate for Payer: University Health Alliance Commercial	$5,992.56

Hip Chimaera Hfs Short Nail 125deg 11x180mm 99-T93125 [3643906]

Facility

$10,701.00

Service Code	HCPCS C1713
Hospital Charge Code	3643906
Hospital Revenue Code	278
Min. Negotiated Rate	$5,457.51
Max. Negotiated Rate	$10,379.97
Rate for Payer: Cash Price	$6,955.65
Rate for Payer: Hawaii Western Management Group Commercial	$7,490.70
Rate for Payer: Health Management Network Commercial	$9,095.85
Rate for Payer: Kaiser Permanente Commercial	$6,741.63
Rate for Payer: Kaiser Permanente Medicaid	$5,457.51
Rate for Payer: MDX Hawaii PPO	$10,379.97
Rate for Payer: University Health Alliance Commercial	$5,992.56

Hip Chimaera Hfs Short Nail 130 Deg 11x180mm 99-T93130 [3644117]

Facility

$10,701.00

Service Code	HCPCS C1713
Hospital Charge Code	3644117
Hospital Revenue Code	278
Min. Negotiated Rate	$5,992.56
Max. Negotiated Rate	$10,379.97
Rate for Payer: Cash Price	$6,955.65
Rate for Payer: Hawaii Western Management Group Commercial	$7,490.70
Rate for Payer: Health Management Network Commercial	$9,095.85
Rate for Payer: MDX Hawaii PPO	$10,379.97
Rate for Payer: University Health Alliance Commercial	$5,992.56

Hip Chimaera Hfs Short Nail 130 Deg 11x180mm 99-T93130 [3644117]

Facility

$10,701.00

Service Code	HCPCS C1713
Hospital Charge Code	3644117
Hospital Revenue Code	278
Min. Negotiated Rate	$5,457.51
Max. Negotiated Rate	$10,379.97
Rate for Payer: Cash Price	$6,955.65
Rate for Payer: Hawaii Western Management Group Commercial	$7,490.70
Rate for Payer: Health Management Network Commercial	$9,095.85
Rate for Payer: Kaiser Permanente Commercial	$6,741.63
Rate for Payer: Kaiser Permanente Medicaid	$5,457.51
Rate for Payer: MDX Hawaii PPO	$10,379.97
Rate for Payer: University Health Alliance Commercial	$5,992.56

Hip Chimaera Hfs Supple Lag Screw 105mm [3643491]

Facility

$3,122.00

Service Code	HCPCS C1713
Hospital Charge Code	3643491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,592.22
Max. Negotiated Rate	$3,028.34
Rate for Payer: Cash Price	$2,029.30
Rate for Payer: Hawaii Western Management Group Commercial	$2,185.40
Rate for Payer: Health Management Network Commercial	$2,653.70
Rate for Payer: Kaiser Permanente Commercial	$1,966.86
Rate for Payer: Kaiser Permanente Medicaid	$1,592.22
Rate for Payer: MDX Hawaii PPO	$3,028.34
Rate for Payer: University Health Alliance Commercial	$1,748.32

Hip Chimaera Hfs Supple Lag Screw 105mm [3643491]

Facility

$3,122.00

Service Code	HCPCS C1713
Hospital Charge Code	3643491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,748.32
Max. Negotiated Rate	$3,028.34
Rate for Payer: Cash Price	$2,029.30
Rate for Payer: Hawaii Western Management Group Commercial	$2,185.40
Rate for Payer: Health Management Network Commercial	$2,653.70
Rate for Payer: MDX Hawaii PPO	$3,028.34
Rate for Payer: University Health Alliance Commercial	$1,748.32

Hip Chimaera Hfs Thrd Lock Screw 5x35mm 99-T931035 [3643390]

Facility

$2,014.50

Service Code	HCPCS C1713
Hospital Charge Code	3643390
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.12
Max. Negotiated Rate	$1,954.07
Rate for Payer: Cash Price	$1,309.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,410.15
Rate for Payer: Health Management Network Commercial	$1,712.33
Rate for Payer: MDX Hawaii PPO	$1,954.07
Rate for Payer: University Health Alliance Commercial	$1,128.12

Hip Chimaera Hfs Thrd Lock Screw 5x35mm 99-T931035 [3643390]

Facility

$2,014.50

Service Code	HCPCS C1713
Hospital Charge Code	3643390
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.39
Max. Negotiated Rate	$1,954.07
Rate for Payer: Cash Price	$1,309.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,410.15
Rate for Payer: Health Management Network Commercial	$1,712.33
Rate for Payer: Kaiser Permanente Commercial	$1,269.13
Rate for Payer: Kaiser Permanente Medicaid	$1,027.39
Rate for Payer: MDX Hawaii PPO	$1,954.07
Rate for Payer: University Health Alliance Commercial	$1,128.12

Hip Chimaera Hfs Thrd Lock Screw 5x60mm [3643492]

Facility

$1,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3643492
Hospital Revenue Code	278
Min. Negotiated Rate	$748.93
Max. Negotiated Rate	$1,424.44
Rate for Payer: Cash Price	$954.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,027.95
Rate for Payer: Health Management Network Commercial	$1,248.22
Rate for Payer: Kaiser Permanente Commercial	$925.15
Rate for Payer: Kaiser Permanente Medicaid	$748.93
Rate for Payer: MDX Hawaii PPO	$1,424.44
Rate for Payer: University Health Alliance Commercial	$822.36

Hip Chimaera Hfs Thrd Lock Screw 5x60mm [3643492]

Facility

$1,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3643492
Hospital Revenue Code	278
Min. Negotiated Rate	$822.36
Max. Negotiated Rate	$1,424.44
Rate for Payer: Cash Price	$954.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,027.95
Rate for Payer: Health Management Network Commercial	$1,248.22
Rate for Payer: MDX Hawaii PPO	$1,424.44
Rate for Payer: University Health Alliance Commercial	$822.36

Hip Chimaera Lag Screw Gradual Reamer 193970 [3643387]

Facility

$6,910.50

Service Code	HCPCS C1713
Hospital Charge Code	3643387
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.36
Max. Negotiated Rate	$6,703.19
Rate for Payer: Cash Price	$4,491.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,837.35
Rate for Payer: Health Management Network Commercial	$5,873.93
Rate for Payer: Kaiser Permanente Commercial	$4,353.61
Rate for Payer: Kaiser Permanente Medicaid	$3,524.36
Rate for Payer: MDX Hawaii PPO	$6,703.19
Rate for Payer: University Health Alliance Commercial	$3,869.88

Know your out-of-pocket cost for care.

All Charges