Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Mini-Monster Cann Full Thrd Screw 2.0 x 15mm P20-120-015F [3644486]

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	3644486
Hospital Revenue Code	278
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: University Health Alliance Commercial	$910.00

Mini-Monster Cann Full Thrd Screw 2.0 x 15mm P20-120-015F [3644486]

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	3644486
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: Kaiser Permanente Commercial	$1,023.75
Rate for Payer: Kaiser Permanente Medicaid	$828.75
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: University Health Alliance Commercial	$910.00

Mini-Monster Cann Full Thrd Screw Hd 3.0 x 22mm P20-130-022F [3644901]

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	3644901
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: Kaiser Permanente Commercial	$1,023.75
Rate for Payer: Kaiser Permanente Medicaid	$828.75
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: University Health Alliance Commercial	$910.00

Mini-Monster Cann Full Thrd Screw Hd 3.0 x 22mm P20-130-022F [3644901]

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	3644901
Hospital Revenue Code	278
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: University Health Alliance Commercial	$910.00

Mini-Monster Cann Full Thrd Screw Hd 3.0 x 24mm P20-130-024F [3644902]

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	3644902
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: Kaiser Permanente Commercial	$1,023.75
Rate for Payer: Kaiser Permanente Medicaid	$828.75
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: University Health Alliance Commercial	$910.00

Mini-Monster Cann Full Thrd Screw Hd 3.0 x 24mm P20-130-024F [3644902]

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	3644902
Hospital Revenue Code	278
Min. Negotiated Rate	$910.00
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,137.50
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: University Health Alliance Commercial	$910.00

Mini-Monster Cann Long Thrd Screw 4.0 x 60mm P20-140-060L [3644531]

Facility

$1,809.50

Service Code	HCPCS C1713
Hospital Charge Code	3644531
Hospital Revenue Code	278
Min. Negotiated Rate	$922.85
Max. Negotiated Rate	$1,755.21
Rate for Payer: Cash Price	$1,176.18
Rate for Payer: Hawaii Western Management Group Commercial	$1,266.65
Rate for Payer: Health Management Network Commercial	$1,538.08
Rate for Payer: Kaiser Permanente Commercial	$1,139.98
Rate for Payer: Kaiser Permanente Medicaid	$922.85
Rate for Payer: MDX Hawaii PPO	$1,755.21
Rate for Payer: University Health Alliance Commercial	$1,013.32

Mini-Monster Cann Long Thrd Screw 4.0 x 60mm P20-140-060L [3644531]

Facility

$1,809.50

Service Code	HCPCS C1713
Hospital Charge Code	3644531
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.32
Max. Negotiated Rate	$1,755.21
Rate for Payer: Cash Price	$1,176.18
Rate for Payer: Hawaii Western Management Group Commercial	$1,266.65
Rate for Payer: Health Management Network Commercial	$1,538.08
Rate for Payer: MDX Hawaii PPO	$1,755.21
Rate for Payer: University Health Alliance Commercial	$1,013.32

Mini-Monster Cann Short Thrd Screw 2.0 x 26mm P20-520-026S [3644504]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644504
Hospital Revenue Code	278
Min. Negotiated Rate	$964.66
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: Kaiser Permanente Commercial	$1,191.64
Rate for Payer: Kaiser Permanente Medicaid	$964.66
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 2.0 x 26mm P20-520-026S [3644504]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644504
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.24
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 2.0 x 34mm P20-520-034S [3644505]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644505
Hospital Revenue Code	278
Min. Negotiated Rate	$964.66
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: Kaiser Permanente Commercial	$1,191.64
Rate for Payer: Kaiser Permanente Medicaid	$964.66
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 2.0 x 34mm P20-520-034S [3644505]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644505
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.24
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 24mm P20-535-024S [3644903]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644903
Hospital Revenue Code	278
Min. Negotiated Rate	$964.66
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: Kaiser Permanente Commercial	$1,191.64
Rate for Payer: Kaiser Permanente Medicaid	$964.66
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 24mm P20-535-024S [3644903]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644903
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.24
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 26mm P20-535-026S [3644748]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644748
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.24
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 26mm P20-535-026S [3644748]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644748
Hospital Revenue Code	278
Min. Negotiated Rate	$964.66
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: Kaiser Permanente Commercial	$1,191.64
Rate for Payer: Kaiser Permanente Medicaid	$964.66
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 36mm P20-535-036S [3644749]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644749
Hospital Revenue Code	278
Min. Negotiated Rate	$964.66
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: Kaiser Permanente Commercial	$1,191.64
Rate for Payer: Kaiser Permanente Medicaid	$964.66
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 36mm P20-535-036S [3644749]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644749
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.24
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 38mm P20-535-038S [3644750]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644750
Hospital Revenue Code	278
Min. Negotiated Rate	$964.66
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: Kaiser Permanente Commercial	$1,191.64
Rate for Payer: Kaiser Permanente Medicaid	$964.66
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 3.5mm x 38mm P20-535-038S [3644750]

Facility

$1,891.50

Service Code	HCPCS C1713
Hospital Charge Code	3644750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,059.24
Max. Negotiated Rate	$1,834.76
Rate for Payer: Cash Price	$1,229.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.05
Rate for Payer: Health Management Network Commercial	$1,607.78
Rate for Payer: MDX Hawaii PPO	$1,834.76
Rate for Payer: University Health Alliance Commercial	$1,059.24

Mini-Monster Cann Short Thrd Screw 4.0mm x 26mm P20-540-026S [3644324]

Facility

$2,055.50

Service Code	HCPCS C1713
Hospital Charge Code	3644324
Hospital Revenue Code	278
Min. Negotiated Rate	$1,048.31
Max. Negotiated Rate	$1,993.84
Rate for Payer: Cash Price	$1,336.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,438.85
Rate for Payer: Health Management Network Commercial	$1,747.17
Rate for Payer: Kaiser Permanente Commercial	$1,294.96
Rate for Payer: Kaiser Permanente Medicaid	$1,048.31
Rate for Payer: MDX Hawaii PPO	$1,993.84
Rate for Payer: University Health Alliance Commercial	$1,151.08

Mini-Monster Cann Short Thrd Screw 4.0mm x 26mm P20-540-026S [3644324]

Facility

$2,055.50

Service Code	HCPCS C1713
Hospital Charge Code	3644324
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.08
Max. Negotiated Rate	$1,993.84
Rate for Payer: Cash Price	$1,336.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,438.85
Rate for Payer: Health Management Network Commercial	$1,747.17
Rate for Payer: MDX Hawaii PPO	$1,993.84
Rate for Payer: University Health Alliance Commercial	$1,151.08

Mini-Monster Cann Short Thrd Screw 4.0mm x 30mm P20-540-030S [3644325]

Facility

$2,055.50

Service Code	HCPCS C1713
Hospital Charge Code	3644325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.08
Max. Negotiated Rate	$1,993.84
Rate for Payer: Cash Price	$1,336.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,438.85
Rate for Payer: Health Management Network Commercial	$1,747.17
Rate for Payer: MDX Hawaii PPO	$1,993.84
Rate for Payer: University Health Alliance Commercial	$1,151.08

Mini-Monster Cann Short Thrd Screw 4.0mm x 30mm P20-540-030S [3644325]

Facility

$2,055.50

Service Code	HCPCS C1713
Hospital Charge Code	3644325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,048.31
Max. Negotiated Rate	$1,993.84
Rate for Payer: Cash Price	$1,336.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,438.85
Rate for Payer: Health Management Network Commercial	$1,747.17
Rate for Payer: Kaiser Permanente Commercial	$1,294.96
Rate for Payer: Kaiser Permanente Medicaid	$1,048.31
Rate for Payer: MDX Hawaii PPO	$1,993.84
Rate for Payer: University Health Alliance Commercial	$1,151.08

Mini-Monster Cann Short Thrd Screw 4.0mm x 36mm P20-540-036S [3644326]

Facility

$2,055.50

Service Code	HCPCS C1713
Hospital Charge Code	3644326
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.08
Max. Negotiated Rate	$1,993.84
Rate for Payer: Cash Price	$1,336.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,438.85
Rate for Payer: Health Management Network Commercial	$1,747.17
Rate for Payer: MDX Hawaii PPO	$1,993.84
Rate for Payer: University Health Alliance Commercial	$1,151.08

Know your out-of-pocket cost for care.

All Charges