Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Plate Clav Superior Midshaft Dcrsd Lt 7h [3643622]

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643622
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$4,607.50
Rate for Payer: Cash Price	$3,087.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,325.00
Rate for Payer: Health Management Network Commercial	$4,037.50
Rate for Payer: Kaiser Permanente Commercial	$2,992.50
Rate for Payer: Kaiser Permanente Medicaid	$2,422.50
Rate for Payer: MDX Hawaii PPO	$4,607.50
Rate for Payer: University Health Alliance Commercial	$2,660.00

Plate Clav Superior Midshaft Dcrsd Lt 7h [3643622]

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643622
Hospital Revenue Code	278
Min. Negotiated Rate	$2,660.00
Max. Negotiated Rate	$4,607.50
Rate for Payer: Cash Price	$3,087.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,325.00
Rate for Payer: Health Management Network Commercial	$4,037.50
Rate for Payer: MDX Hawaii PPO	$4,607.50
Rate for Payer: University Health Alliance Commercial	$2,660.00

Plate Clav Sup Lat Lt 7h So-35-Slcl-007-L [3643694]

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643694
Hospital Revenue Code	278
Min. Negotiated Rate	$2,660.00
Max. Negotiated Rate	$4,607.50
Rate for Payer: Cash Price	$3,087.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,325.00
Rate for Payer: Health Management Network Commercial	$4,037.50
Rate for Payer: MDX Hawaii PPO	$4,607.50
Rate for Payer: University Health Alliance Commercial	$2,660.00

Plate Clav Sup Lat Lt 7h So-35-Slcl-007-L [3643694]

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643694
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$4,607.50
Rate for Payer: Cash Price	$3,087.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,325.00
Rate for Payer: Health Management Network Commercial	$4,037.50
Rate for Payer: Kaiser Permanente Commercial	$2,992.50
Rate for Payer: Kaiser Permanente Medicaid	$2,422.50
Rate for Payer: MDX Hawaii PPO	$4,607.50
Rate for Payer: University Health Alliance Commercial	$2,660.00

Plate DHS 135 deg Std Barrel 2 Hole 281.102S [3641035]

Facility

$4,665.95

Service Code	HCPCS C1713
Hospital Charge Code	3641035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,379.63
Max. Negotiated Rate	$4,525.97
Rate for Payer: Kaiser Permanente Medicaid	$2,379.63
Rate for Payer: Cash Price	$3,032.87
Rate for Payer: Hawaii Western Management Group Commercial	$3,266.16
Rate for Payer: Health Management Network Commercial	$3,966.06
Rate for Payer: Kaiser Permanente Commercial	$2,939.55
Rate for Payer: MDX Hawaii PPO	$4,525.97
Rate for Payer: University Health Alliance Commercial	$2,612.93

Plate DHS 135 deg Std Barrel 2 Hole 281.102S [3641035]

Facility

$4,665.95

Service Code	HCPCS C1713
Hospital Charge Code	3641035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,612.93
Max. Negotiated Rate	$4,525.97
Rate for Payer: Cash Price	$3,032.87
Rate for Payer: Hawaii Western Management Group Commercial	$3,266.16
Rate for Payer: Health Management Network Commercial	$3,966.06
Rate for Payer: MDX Hawaii PPO	$4,525.97
Rate for Payer: University Health Alliance Commercial	$2,612.93

Plate Dis Hum Lat Cap Freefix 70mm Rt [3643658]

Facility

$5,577.50

Service Code	HCPCS C1713
Hospital Charge Code	3643658
Hospital Revenue Code	278
Min. Negotiated Rate	$3,123.40
Max. Negotiated Rate	$5,410.18
Rate for Payer: Cash Price	$3,625.38
Rate for Payer: Hawaii Western Management Group Commercial	$3,904.25
Rate for Payer: Health Management Network Commercial	$4,740.88
Rate for Payer: MDX Hawaii PPO	$5,410.18
Rate for Payer: University Health Alliance Commercial	$3,123.40

Plate Dis Hum Lat Cap Freefix 70mm Rt [3643658]

Facility

$5,577.50

Service Code	HCPCS C1713
Hospital Charge Code	3643658
Hospital Revenue Code	278
Min. Negotiated Rate	$2,844.53
Max. Negotiated Rate	$5,410.18
Rate for Payer: Cash Price	$3,625.38
Rate for Payer: Hawaii Western Management Group Commercial	$3,904.25
Rate for Payer: Health Management Network Commercial	$4,740.88
Rate for Payer: Kaiser Permanente Commercial	$3,513.82
Rate for Payer: Kaiser Permanente Medicaid	$2,844.53
Rate for Payer: MDX Hawaii PPO	$5,410.18
Rate for Payer: University Health Alliance Commercial	$3,123.40

Plate Distal Fem NCB PP 9h 238mm Lt 02.02264.109 [3644827]

Facility

$8,448.40

Service Code	HCPCS C1713
Hospital Charge Code	3644827
Hospital Revenue Code	278
Min. Negotiated Rate	$4,308.68
Max. Negotiated Rate	$8,194.95
Rate for Payer: Cash Price	$5,491.46
Rate for Payer: Hawaii Western Management Group Commercial	$5,913.88
Rate for Payer: Health Management Network Commercial	$7,181.14
Rate for Payer: Kaiser Permanente Commercial	$5,322.49
Rate for Payer: Kaiser Permanente Medicaid	$4,308.68
Rate for Payer: MDX Hawaii PPO	$8,194.95
Rate for Payer: University Health Alliance Commercial	$4,731.10

Plate Distal Fem NCB PP 9h 238mm Lt 02.02264.109 [3644827]

Facility

$8,448.40

Service Code	HCPCS C1713
Hospital Charge Code	3644827
Hospital Revenue Code	278
Min. Negotiated Rate	$4,731.10
Max. Negotiated Rate	$8,194.95
Rate for Payer: Cash Price	$5,491.46
Rate for Payer: Hawaii Western Management Group Commercial	$5,913.88
Rate for Payer: Health Management Network Commercial	$7,181.14
Rate for Payer: MDX Hawaii PPO	$8,194.95
Rate for Payer: University Health Alliance Commercial	$4,731.10

Plate Dist Clavicle Ss 5h 70mm Rt AR-2656DR [3645450]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3645450
Hospital Revenue Code	278
Min. Negotiated Rate	$3,295.88
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: Kaiser Permanente Commercial	$4,071.38
Rate for Payer: Kaiser Permanente Medicaid	$3,295.88
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Plate Dist Clavicle Ss 5h 70mm Rt AR-2656DR [3645450]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3645450
Hospital Revenue Code	278
Min. Negotiated Rate	$3,619.00
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Plate Dist Hum Med Rt 9H 88mm 131218700 [3644232]

Facility

$6,726.40

Service Code	HCPCS C1713
Hospital Charge Code	3644232
Hospital Revenue Code	278
Min. Negotiated Rate	$3,766.78
Max. Negotiated Rate	$6,524.61
Rate for Payer: Cash Price	$4,372.16
Rate for Payer: Hawaii Western Management Group Commercial	$4,708.48
Rate for Payer: Health Management Network Commercial	$5,717.44
Rate for Payer: MDX Hawaii PPO	$6,524.61
Rate for Payer: University Health Alliance Commercial	$3,766.78

Plate Dist Hum Med Rt 9H 88mm 131218700 [3644232]

Facility

$6,726.40

Service Code	HCPCS C1713
Hospital Charge Code	3644232
Hospital Revenue Code	278
Min. Negotiated Rate	$3,430.46
Max. Negotiated Rate	$6,524.61
Rate for Payer: Cash Price	$4,372.16
Rate for Payer: Hawaii Western Management Group Commercial	$4,708.48
Rate for Payer: Health Management Network Commercial	$5,717.44
Rate for Payer: Kaiser Permanente Commercial	$4,237.63
Rate for Payer: Kaiser Permanente Medicaid	$3,430.46
Rate for Payer: MDX Hawaii PPO	$6,524.61
Rate for Payer: University Health Alliance Commercial	$3,766.78

Plate Dorsal Spanning Ti Long Gmn-Dsp-210 [3643663]

Facility

$6,273.50

Service Code	HCPCS C1713
Hospital Charge Code	3643663
Hospital Revenue Code	278
Min. Negotiated Rate	$3,513.16
Max. Negotiated Rate	$6,085.30
Rate for Payer: Cash Price	$4,077.78
Rate for Payer: Hawaii Western Management Group Commercial	$4,391.45
Rate for Payer: Health Management Network Commercial	$5,332.48
Rate for Payer: MDX Hawaii PPO	$6,085.30
Rate for Payer: University Health Alliance Commercial	$3,513.16

Plate Dorsal Spanning Ti Long Gmn-Dsp-210 [3643663]

Facility

$6,273.50

Service Code	HCPCS C1713
Hospital Charge Code	3643663
Hospital Revenue Code	278
Min. Negotiated Rate	$3,199.49
Max. Negotiated Rate	$6,085.30
Rate for Payer: Cash Price	$4,077.78
Rate for Payer: Hawaii Western Management Group Commercial	$4,391.45
Rate for Payer: Health Management Network Commercial	$5,332.48
Rate for Payer: Kaiser Permanente Commercial	$3,952.30
Rate for Payer: Kaiser Permanente Medicaid	$3,199.49
Rate for Payer: MDX Hawaii PPO	$6,085.30
Rate for Payer: University Health Alliance Commercial	$3,513.16

Plate Dorsal Spanning Ti Short GMN-DSP-160 [3642726]

Facility

$6,427.50

Service Code	HCPCS C1713
Hospital Charge Code	3642726
Hospital Revenue Code	278
Min. Negotiated Rate	$3,278.03
Max. Negotiated Rate	$6,234.68
Rate for Payer: Cash Price	$4,177.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.25
Rate for Payer: Health Management Network Commercial	$5,463.38
Rate for Payer: Kaiser Permanente Commercial	$4,049.32
Rate for Payer: Kaiser Permanente Medicaid	$3,278.03
Rate for Payer: MDX Hawaii PPO	$6,234.68
Rate for Payer: University Health Alliance Commercial	$3,599.40

Plate Dorsal Spanning Ti Short GMN-DSP-160 [3642726]

Facility

$6,427.50

Service Code	HCPCS C1713
Hospital Charge Code	3642726
Hospital Revenue Code	278
Min. Negotiated Rate	$3,599.40
Max. Negotiated Rate	$6,234.68
Rate for Payer: Cash Price	$4,177.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.25
Rate for Payer: Health Management Network Commercial	$5,463.38
Rate for Payer: MDX Hawaii PPO	$6,234.68
Rate for Payer: University Health Alliance Commercial	$3,599.40

Plate DVR Crosslock Narrow Left 131821050 [3626862]

Facility

$3,177.50

Service Code	HCPCS C1713
Hospital Charge Code	3626862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,779.40
Max. Negotiated Rate	$3,082.18
Rate for Payer: Cash Price	$2,065.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,224.25
Rate for Payer: Health Management Network Commercial	$2,700.88
Rate for Payer: MDX Hawaii PPO	$3,082.18
Rate for Payer: University Health Alliance Commercial	$1,779.40

Plate DVR Crosslock Narrow Left 131821050 [3626862]

Facility

$3,177.50

Service Code	HCPCS C1713
Hospital Charge Code	3626862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,620.53
Max. Negotiated Rate	$3,082.18
Rate for Payer: Cash Price	$2,065.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,224.25
Rate for Payer: Health Management Network Commercial	$2,700.88
Rate for Payer: Kaiser Permanente Commercial	$2,001.83
Rate for Payer: Kaiser Permanente Medicaid	$1,620.53
Rate for Payer: MDX Hawaii PPO	$3,082.18
Rate for Payer: University Health Alliance Commercial	$1,779.40

Plate DVR Crosslock Narrow Mini Left 131821040 [3641672]

Facility

$6,578.00

Service Code	HCPCS C1713
Hospital Charge Code	3641672
Hospital Revenue Code	278
Min. Negotiated Rate	$3,354.78
Max. Negotiated Rate	$6,380.66
Rate for Payer: Cash Price	$4,275.70
Rate for Payer: Hawaii Western Management Group Commercial	$4,604.60
Rate for Payer: Health Management Network Commercial	$5,591.30
Rate for Payer: Kaiser Permanente Commercial	$4,144.14
Rate for Payer: Kaiser Permanente Medicaid	$3,354.78
Rate for Payer: MDX Hawaii PPO	$6,380.66
Rate for Payer: University Health Alliance Commercial	$3,683.68

Plate DVR Crosslock Narrow Mini Left 131821040 [3641672]

Facility

$6,578.00

Service Code	HCPCS C1713
Hospital Charge Code	3641672
Hospital Revenue Code	278
Min. Negotiated Rate	$3,683.68
Max. Negotiated Rate	$6,380.66
Rate for Payer: Cash Price	$4,275.70
Rate for Payer: Hawaii Western Management Group Commercial	$4,604.60
Rate for Payer: Health Management Network Commercial	$5,591.30
Rate for Payer: MDX Hawaii PPO	$6,380.66
Rate for Payer: University Health Alliance Commercial	$3,683.68

Plate DVR Crosslock Narrow Right 131811050 [3643037]

Facility

$5,951.50

Service Code	HCPCS C1713
Hospital Charge Code	3643037
Hospital Revenue Code	278
Min. Negotiated Rate	$3,035.26
Max. Negotiated Rate	$5,772.95
Rate for Payer: Cash Price	$3,868.48
Rate for Payer: Hawaii Western Management Group Commercial	$4,166.05
Rate for Payer: Health Management Network Commercial	$5,058.77
Rate for Payer: Kaiser Permanente Commercial	$3,749.45
Rate for Payer: Kaiser Permanente Medicaid	$3,035.26
Rate for Payer: MDX Hawaii PPO	$5,772.95
Rate for Payer: University Health Alliance Commercial	$3,332.84

Plate DVR Crosslock Narrow Right 131811050 [3643037]

Facility

$5,951.50

Service Code	HCPCS C1713
Hospital Charge Code	3643037
Hospital Revenue Code	278
Min. Negotiated Rate	$3,332.84
Max. Negotiated Rate	$5,772.95
Rate for Payer: Cash Price	$3,868.48
Rate for Payer: Hawaii Western Management Group Commercial	$4,166.05
Rate for Payer: Health Management Network Commercial	$5,058.77
Rate for Payer: MDX Hawaii PPO	$5,772.95
Rate for Payer: University Health Alliance Commercial	$3,332.84

Plate Dvr Crosslock Nrw Mini Rt 131811040 [3643673]

Facility

$3,177.50

Service Code	HCPCS C1713
Hospital Charge Code	3643673
Hospital Revenue Code	278
Min. Negotiated Rate	$1,779.40
Max. Negotiated Rate	$3,082.18
Rate for Payer: Cash Price	$2,065.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,224.25
Rate for Payer: Health Management Network Commercial	$2,700.88
Rate for Payer: MDX Hawaii PPO	$3,082.18
Rate for Payer: University Health Alliance Commercial	$1,779.40

Know your out-of-pocket cost for care.

All Charges