Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Nail Tibial Tna Ti 10mm 360mm 04.043.240s [3643751]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643751
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 10mm 390mm 04.043.250s [3643753]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643753
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 10mm 390mm 04.043.250s [3643753]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643753
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 11mm 315mm 04.043.325s [3643763]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643763
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 11mm 315mm 04.043.325s [3643763]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643763
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 12mm 330mm 04.043.430s [3643779]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643779
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 12mm 330mm 04.043.430s [3643779]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643779
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 8mm 285mm 04.043.015S [3644110]

Facility

$10,122.52

Service Code	HCPCS C1713
Hospital Charge Code	3644110
Hospital Revenue Code	278
Min. Negotiated Rate	$5,162.49
Max. Negotiated Rate	$9,818.84
Rate for Payer: Cash Price	$6,579.64
Rate for Payer: Hawaii Western Management Group Commercial	$7,085.76
Rate for Payer: Health Management Network Commercial	$8,604.14
Rate for Payer: Kaiser Permanente Commercial	$6,377.19
Rate for Payer: Kaiser Permanente Medicaid	$5,162.49
Rate for Payer: MDX Hawaii PPO	$9,818.84
Rate for Payer: University Health Alliance Commercial	$5,668.61

Nail Tibial Tna Ti 8mm 285mm 04.043.015S [3644110]

Facility

$10,122.52

Service Code	HCPCS C1713
Hospital Charge Code	3644110
Hospital Revenue Code	278
Min. Negotiated Rate	$5,668.61
Max. Negotiated Rate	$9,818.84
Rate for Payer: Cash Price	$6,579.64
Rate for Payer: Hawaii Western Management Group Commercial	$7,085.76
Rate for Payer: Health Management Network Commercial	$8,604.14
Rate for Payer: MDX Hawaii PPO	$9,818.84
Rate for Payer: University Health Alliance Commercial	$5,668.61

Nail Tibial Tna Ti 9mm 270mm 04.043.110s [3643730]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643730
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 270mm 04.043.110s [3643730]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643730
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 285mm 04.043.115s [3643731]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643731
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 285mm 04.043.115s [3643731]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643731
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 315mm 04.043.125s [3643733]

Facility

$9,903.00

Service Code	HCPCS C1713
Hospital Charge Code	3643733
Hospital Revenue Code	278
Min. Negotiated Rate	$5,050.53
Max. Negotiated Rate	$9,605.91
Rate for Payer: Cash Price	$6,436.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,932.10
Rate for Payer: Health Management Network Commercial	$8,417.55
Rate for Payer: Kaiser Permanente Commercial	$6,238.89
Rate for Payer: Kaiser Permanente Medicaid	$5,050.53
Rate for Payer: MDX Hawaii PPO	$9,605.91
Rate for Payer: University Health Alliance Commercial	$5,545.68

Nail Tibial Tna Ti 9mm 315mm 04.043.125s [3643733]

Facility

$9,903.00

Service Code	HCPCS C1713
Hospital Charge Code	3643733
Hospital Revenue Code	278
Min. Negotiated Rate	$5,545.68
Max. Negotiated Rate	$9,605.91
Rate for Payer: Cash Price	$6,436.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,932.10
Rate for Payer: Health Management Network Commercial	$8,417.55
Rate for Payer: MDX Hawaii PPO	$9,605.91
Rate for Payer: University Health Alliance Commercial	$5,545.68

Nail Tibial Tna Ti 9mm 330mm 04.043.130s [3643734]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643734
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 330mm 04.043.130s [3643734]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643734
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 345mm 04.043.135s [3643735]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643735
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 345mm 04.043.135s [3643735]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643735
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 360mm 04.043.140s [3643736]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643736
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 360mm 04.043.140s [3643736]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643736
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 375mm 04.043.145s [3643737]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643737
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.75
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: Kaiser Permanente Commercial	$6,124.27
Rate for Payer: Kaiser Permanente Medicaid	$4,957.75
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Tibial Tna Ti 9mm 375mm 04.043.145s [3643737]

Facility

$9,721.07

Service Code	HCPCS C1713
Hospital Charge Code	3643737
Hospital Revenue Code	278
Min. Negotiated Rate	$5,443.80
Max. Negotiated Rate	$9,429.44
Rate for Payer: Cash Price	$6,318.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.75
Rate for Payer: Health Management Network Commercial	$8,262.91
Rate for Payer: MDX Hawaii PPO	$9,429.44
Rate for Payer: University Health Alliance Commercial	$5,443.80

Nail Ti Elastic 1.5mm x 400mm 475.915 [3641465]

Facility

$1,798.99

Service Code	HCPCS C1713
Hospital Charge Code	3641465
Hospital Revenue Code	278
Min. Negotiated Rate	$917.48
Max. Negotiated Rate	$1,745.02
Rate for Payer: Cash Price	$1,169.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,259.29
Rate for Payer: Health Management Network Commercial	$1,529.14
Rate for Payer: Kaiser Permanente Commercial	$1,133.36
Rate for Payer: Kaiser Permanente Medicaid	$917.48
Rate for Payer: MDX Hawaii PPO	$1,745.02
Rate for Payer: University Health Alliance Commercial	$1,007.43

Nail Ti Elastic 1.5mm x 400mm 475.915 [3641465]

Facility

$1,798.99

Service Code	HCPCS C1713
Hospital Charge Code	3641465
Hospital Revenue Code	278
Min. Negotiated Rate	$1,007.43
Max. Negotiated Rate	$1,745.02
Rate for Payer: Cash Price	$1,169.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,259.29
Rate for Payer: Health Management Network Commercial	$1,529.14
Rate for Payer: MDX Hawaii PPO	$1,745.02
Rate for Payer: University Health Alliance Commercial	$1,007.43

Know your out-of-pocket cost for care.

All Charges