Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,620.53
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 Fem Neck Sys 2 Hole 04.268.000S [3641635]

Facility

$4,648.18

Service Code	HCPCS C1713
Hospital Charge Code	3641635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,602.98
Max. Negotiated Rate	$4,508.73
Rate for Payer: Cash Price	$3,021.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,253.73
Rate for Payer: Health Management Network Commercial	$3,950.95
Rate for Payer: MDX Hawaii PPO	$4,508.73
Rate for Payer: University Health Alliance Commercial	$2,602.98

Plate Fem Neck Sys 2 Hole 04.268.000S [3641635]

Facility

$4,648.18

Service Code	HCPCS C1713
Hospital Charge Code	3641635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,370.57
Max. Negotiated Rate	$4,508.73
Rate for Payer: Cash Price	$3,021.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,253.73
Rate for Payer: Health Management Network Commercial	$3,950.95
Rate for Payer: Kaiser Permanente Commercial	$2,928.35
Rate for Payer: Kaiser Permanente Medicaid	$2,370.57
Rate for Payer: MDX Hawaii PPO	$4,508.73
Rate for Payer: University Health Alliance Commercial	$2,602.98

Plate Fibular Cluster 9 Hole Anat RT P53-203-R009 [3644939]

Facility

$8,489.00

Service Code	HCPCS C1713
Hospital Charge Code	3644939
Hospital Revenue Code	278
Min. Negotiated Rate	$4,753.84
Max. Negotiated Rate	$8,234.33
Rate for Payer: Cash Price	$5,517.85
Rate for Payer: Hawaii Western Management Group Commercial	$5,942.30
Rate for Payer: Health Management Network Commercial	$7,215.65
Rate for Payer: MDX Hawaii PPO	$8,234.33
Rate for Payer: University Health Alliance Commercial	$4,753.84

Plate Fibular Cluster 9 Hole Anat RT P53-203-R009 [3644939]

Facility

$8,489.00

Service Code	HCPCS C1713
Hospital Charge Code	3644939
Hospital Revenue Code	278
Min. Negotiated Rate	$4,329.39
Max. Negotiated Rate	$8,234.33
Rate for Payer: Cash Price	$5,517.85
Rate for Payer: Hawaii Western Management Group Commercial	$5,942.30
Rate for Payer: Health Management Network Commercial	$7,215.65
Rate for Payer: Kaiser Permanente Commercial	$5,348.07
Rate for Payer: Kaiser Permanente Medicaid	$4,329.39
Rate for Payer: MDX Hawaii PPO	$8,234.33
Rate for Payer: University Health Alliance Commercial	$4,753.84

Plate For Femoral Neck Sys 1 Hole 04.168.000S [3641727]

Facility

$4,648.18

Service Code	HCPCS C1713
Hospital Charge Code	3641727
Hospital Revenue Code	278
Min. Negotiated Rate	$2,370.57
Max. Negotiated Rate	$4,508.73
Rate for Payer: Cash Price	$3,021.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,253.73
Rate for Payer: Health Management Network Commercial	$3,950.95
Rate for Payer: Kaiser Permanente Commercial	$2,928.35
Rate for Payer: Kaiser Permanente Medicaid	$2,370.57
Rate for Payer: MDX Hawaii PPO	$4,508.73
Rate for Payer: University Health Alliance Commercial	$2,602.98

Plate For Femoral Neck Sys 1 Hole 04.168.000S [3641727]

Facility

$4,648.18

Service Code	HCPCS C1713
Hospital Charge Code	3641727
Hospital Revenue Code	278
Min. Negotiated Rate	$2,602.98
Max. Negotiated Rate	$4,508.73
Rate for Payer: Cash Price	$3,021.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,253.73
Rate for Payer: Health Management Network Commercial	$3,950.95
Rate for Payer: MDX Hawaii PPO	$4,508.73
Rate for Payer: University Health Alliance Commercial	$2,602.98

Plate Grid Offset Left Locking 1.6mm 333-1608 [3644895]

Facility

$3,059.00

Service Code	HCPCS C1713
Hospital Charge Code	3644895
Hospital Revenue Code	278
Min. Negotiated Rate	$1,560.09
Max. Negotiated Rate	$2,967.23
Rate for Payer: Cash Price	$1,988.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,141.30
Rate for Payer: Health Management Network Commercial	$2,600.15
Rate for Payer: Kaiser Permanente Commercial	$1,927.17
Rate for Payer: Kaiser Permanente Medicaid	$1,560.09
Rate for Payer: MDX Hawaii PPO	$2,967.23
Rate for Payer: University Health Alliance Commercial	$1,713.04

Plate Grid Offset Left Locking 1.6mm 333-1608 [3644895]

Facility

$3,059.00

Service Code	HCPCS C1713
Hospital Charge Code	3644895
Hospital Revenue Code	278
Min. Negotiated Rate	$1,713.04
Max. Negotiated Rate	$2,967.23
Rate for Payer: Cash Price	$1,988.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,141.30
Rate for Payer: Health Management Network Commercial	$2,600.15
Rate for Payer: MDX Hawaii PPO	$2,967.23
Rate for Payer: University Health Alliance Commercial	$1,713.04

Plate Lat Cap Dis Hum 100mm Lt Dhpflcl5hl [3643493]

Facility

$5,842.50

Service Code	HCPCS C1713
Hospital Charge Code	3643493
Hospital Revenue Code	278
Min. Negotiated Rate	$2,979.68
Max. Negotiated Rate	$5,667.23
Rate for Payer: Cash Price	$3,797.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,089.75
Rate for Payer: Health Management Network Commercial	$4,966.12
Rate for Payer: Kaiser Permanente Commercial	$3,680.78
Rate for Payer: Kaiser Permanente Medicaid	$2,979.68
Rate for Payer: MDX Hawaii PPO	$5,667.23
Rate for Payer: University Health Alliance Commercial	$3,271.80

Plate Lat Cap Dis Hum 100mm Lt Dhpflcl5hl [3643493]

Facility

$5,842.50

Service Code	HCPCS C1713
Hospital Charge Code	3643493
Hospital Revenue Code	278
Min. Negotiated Rate	$3,271.80
Max. Negotiated Rate	$5,667.23
Rate for Payer: Cash Price	$3,797.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,089.75
Rate for Payer: Health Management Network Commercial	$4,966.12
Rate for Payer: MDX Hawaii PPO	$5,667.23
Rate for Payer: University Health Alliance Commercial	$3,271.80

Plate LCP 1/3 Tubular 10H 117mm 241.401 [3606453]

Facility

$1,268.74

Service Code	HCPCS C1713
Hospital Charge Code	3606453
Hospital Revenue Code	278
Min. Negotiated Rate	$710.49
Max. Negotiated Rate	$1,230.68
Rate for Payer: Cash Price	$824.68
Rate for Payer: Hawaii Western Management Group Commercial	$888.12
Rate for Payer: Health Management Network Commercial	$1,078.43
Rate for Payer: MDX Hawaii PPO	$1,230.68
Rate for Payer: University Health Alliance Commercial	$710.49

Plate LCP 1/3 Tubular 10H 117mm 241.401 [3606453]

Facility

$1,268.74

Service Code	HCPCS C1713
Hospital Charge Code	3606453
Hospital Revenue Code	278
Min. Negotiated Rate	$647.06
Max. Negotiated Rate	$1,230.68
Rate for Payer: Cash Price	$824.68
Rate for Payer: Hawaii Western Management Group Commercial	$888.12
Rate for Payer: Health Management Network Commercial	$1,078.43
Rate for Payer: Kaiser Permanente Commercial	$799.31
Rate for Payer: Kaiser Permanente Medicaid	$647.06
Rate for Payer: MDX Hawaii PPO	$1,230.68
Rate for Payer: University Health Alliance Commercial	$710.49

Plate Lcp 1/3 Tubular 5H 241.351 [3606448]

Facility

$1,187.45

Service Code	HCPCS C1713
Hospital Charge Code	3606448
Hospital Revenue Code	278
Min. Negotiated Rate	$605.60
Max. Negotiated Rate	$1,151.83
Rate for Payer: Cash Price	$771.84
Rate for Payer: Hawaii Western Management Group Commercial	$831.22
Rate for Payer: Health Management Network Commercial	$1,009.33
Rate for Payer: Kaiser Permanente Commercial	$748.09
Rate for Payer: Kaiser Permanente Medicaid	$605.60
Rate for Payer: MDX Hawaii PPO	$1,151.83
Rate for Payer: University Health Alliance Commercial	$664.97

Plate Lcp 1/3 Tubular 5H 241.351 [3606448]

Facility

$1,187.45

Service Code	HCPCS C1713
Hospital Charge Code	3606448
Hospital Revenue Code	278
Min. Negotiated Rate	$664.97
Max. Negotiated Rate	$1,151.83
Rate for Payer: Cash Price	$771.84
Rate for Payer: Hawaii Western Management Group Commercial	$831.22
Rate for Payer: Health Management Network Commercial	$1,009.33
Rate for Payer: MDX Hawaii PPO	$1,151.83
Rate for Payer: University Health Alliance Commercial	$664.97

Plate Lcp 1/3 Tubular 6H 241.361 [3606449]

Facility

$1,187.45

Service Code	HCPCS C1713
Hospital Charge Code	3606449
Hospital Revenue Code	278
Min. Negotiated Rate	$664.97
Max. Negotiated Rate	$1,151.83
Rate for Payer: Cash Price	$771.84
Rate for Payer: Hawaii Western Management Group Commercial	$831.22
Rate for Payer: Health Management Network Commercial	$1,009.33
Rate for Payer: MDX Hawaii PPO	$1,151.83
Rate for Payer: University Health Alliance Commercial	$664.97

Plate Lcp 1/3 Tubular 6H 241.361 [3606449]

Facility

$1,187.45

Service Code	HCPCS C1713
Hospital Charge Code	3606449
Hospital Revenue Code	278
Min. Negotiated Rate	$605.60
Max. Negotiated Rate	$1,151.83
Rate for Payer: Cash Price	$771.84
Rate for Payer: Hawaii Western Management Group Commercial	$831.22
Rate for Payer: Health Management Network Commercial	$1,009.33
Rate for Payer: Kaiser Permanente Commercial	$748.09
Rate for Payer: Kaiser Permanente Medicaid	$605.60
Rate for Payer: MDX Hawaii PPO	$1,151.83
Rate for Payer: University Health Alliance Commercial	$664.97

Plate Lcp 1/3 Tubular 7H 241.371 [3606450]

Facility

$1,205.93

Service Code	HCPCS C1713
Hospital Charge Code	3606450
Hospital Revenue Code	278
Min. Negotiated Rate	$615.02
Max. Negotiated Rate	$1,169.75
Rate for Payer: Cash Price	$783.85
Rate for Payer: Hawaii Western Management Group Commercial	$844.15
Rate for Payer: Health Management Network Commercial	$1,025.04
Rate for Payer: Kaiser Permanente Commercial	$759.74
Rate for Payer: Kaiser Permanente Medicaid	$615.02
Rate for Payer: MDX Hawaii PPO	$1,169.75
Rate for Payer: University Health Alliance Commercial	$675.32

Plate Lcp 1/3 Tubular 7H 241.371 [3606450]

Facility

$1,205.93

Service Code	HCPCS C1713
Hospital Charge Code	3606450
Hospital Revenue Code	278
Min. Negotiated Rate	$675.32
Max. Negotiated Rate	$1,169.75
Rate for Payer: Cash Price	$783.85
Rate for Payer: Hawaii Western Management Group Commercial	$844.15
Rate for Payer: Health Management Network Commercial	$1,025.04
Rate for Payer: MDX Hawaii PPO	$1,169.75
Rate for Payer: University Health Alliance Commercial	$675.32

Plate Lcp 1/3 Tubular 8H 241.381 [3606451]

Facility

$1,268.74

Service Code	HCPCS C1713
Hospital Charge Code	3606451
Hospital Revenue Code	278
Min. Negotiated Rate	$647.06
Max. Negotiated Rate	$1,230.68
Rate for Payer: Cash Price	$824.68
Rate for Payer: Hawaii Western Management Group Commercial	$888.12
Rate for Payer: Health Management Network Commercial	$1,078.43
Rate for Payer: Kaiser Permanente Commercial	$799.31
Rate for Payer: Kaiser Permanente Medicaid	$647.06
Rate for Payer: MDX Hawaii PPO	$1,230.68
Rate for Payer: University Health Alliance Commercial	$710.49

Plate Lcp 1/3 Tubular 8H 241.381 [3606451]

Facility

$1,268.74

Service Code	HCPCS C1713
Hospital Charge Code	3606451
Hospital Revenue Code	278
Min. Negotiated Rate	$710.49
Max. Negotiated Rate	$1,230.68
Rate for Payer: Cash Price	$824.68
Rate for Payer: Hawaii Western Management Group Commercial	$888.12
Rate for Payer: Health Management Network Commercial	$1,078.43
Rate for Payer: MDX Hawaii PPO	$1,230.68
Rate for Payer: University Health Alliance Commercial	$710.49

Plate LCP 2.7mm 40mm 4H 249.680 [3643144]

Facility

$1,995.22

Service Code	HCPCS C1713
Hospital Charge Code	3643144
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.32
Max. Negotiated Rate	$1,935.36
Rate for Payer: Cash Price	$1,296.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.65
Rate for Payer: Health Management Network Commercial	$1,695.94
Rate for Payer: MDX Hawaii PPO	$1,935.36
Rate for Payer: University Health Alliance Commercial	$1,117.32

Plate LCP 2.7mm 40mm 4H 249.680 [3643144]

Facility

$1,995.22

Service Code	HCPCS C1713
Hospital Charge Code	3643144
Hospital Revenue Code	278
Min. Negotiated Rate	$1,017.56
Max. Negotiated Rate	$1,935.36
Rate for Payer: Cash Price	$1,296.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.65
Rate for Payer: Health Management Network Commercial	$1,695.94
Rate for Payer: Kaiser Permanente Commercial	$1,256.99
Rate for Payer: Kaiser Permanente Medicaid	$1,017.56
Rate for Payer: MDX Hawaii PPO	$1,935.36
Rate for Payer: University Health Alliance Commercial	$1,117.32

Plate LCP 2.7mm 58mm 6H 249.682 [3643124]

Facility

$2,668.91

Service Code	HCPCS C1713
Hospital Charge Code	3643124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.14
Max. Negotiated Rate	$2,588.84
Rate for Payer: Cash Price	$1,734.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,868.24
Rate for Payer: Health Management Network Commercial	$2,268.57
Rate for Payer: Kaiser Permanente Commercial	$1,681.41
Rate for Payer: Kaiser Permanente Medicaid	$1,361.14
Rate for Payer: MDX Hawaii PPO	$2,588.84
Rate for Payer: University Health Alliance Commercial	$1,494.59

Plate LCP 2.7mm 58mm 6H 249.682 [3643124]

Facility

$2,668.91

Service Code	HCPCS C1713
Hospital Charge Code	3643124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,494.59
Max. Negotiated Rate	$2,588.84
Rate for Payer: Cash Price	$1,734.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,868.24
Rate for Payer: Health Management Network Commercial	$2,268.57
Rate for Payer: MDX Hawaii PPO	$2,588.84
Rate for Payer: University Health Alliance Commercial	$1,494.59

Know your out-of-pocket cost for care.

All Charges