Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Plate LCP 2.7mm 67mm 7H 249.683 [3643145]

Facility

$1,995.22

Service Code	HCPCS C1713
Hospital Charge Code	3643145
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 67mm 7H 249.683 [3643145]

Facility

$1,995.22

Service Code	HCPCS C1713
Hospital Charge Code	3643145
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 8H 76mm 247.372 [3640817]

Facility

$2,668.91

Service Code	HCPCS C1713
Hospital Charge Code	3640817
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

Plate LCP 2.7mm 8H 76mm 247.372 [3640817]

Facility

$2,668.91

Service Code	HCPCS C1713
Hospital Charge Code	3640817
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 3.5mm 6 Hole 85mm 223.561 [3606440]

Facility

$2,064.21

Service Code	HCPCS C1713
Hospital Charge Code	3606440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.96
Max. Negotiated Rate	$2,002.28
Rate for Payer: Cash Price	$1,341.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.95
Rate for Payer: Health Management Network Commercial	$1,754.58
Rate for Payer: MDX Hawaii PPO	$2,002.28
Rate for Payer: University Health Alliance Commercial	$1,155.96

Plate LCP 3.5mm 6 Hole 85mm 223.561 [3606440]

Facility

$2,064.21

Service Code	HCPCS C1713
Hospital Charge Code	3606440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,052.75
Max. Negotiated Rate	$2,002.28
Rate for Payer: Cash Price	$1,341.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.95
Rate for Payer: Health Management Network Commercial	$1,754.58
Rate for Payer: Kaiser Permanente Commercial	$1,300.45
Rate for Payer: Kaiser Permanente Medicaid	$1,052.75
Rate for Payer: MDX Hawaii PPO	$2,002.28
Rate for Payer: University Health Alliance Commercial	$1,155.96

Plate LCP 3.5mm 7 Hole 98mm 223.571 [3604952]

Facility

$2,134.94

Service Code	HCPCS C1713
Hospital Charge Code	3604952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.82
Max. Negotiated Rate	$2,070.89
Rate for Payer: Cash Price	$1,387.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,494.46
Rate for Payer: Health Management Network Commercial	$1,814.70
Rate for Payer: Kaiser Permanente Commercial	$1,345.01
Rate for Payer: Kaiser Permanente Medicaid	$1,088.82
Rate for Payer: MDX Hawaii PPO	$2,070.89
Rate for Payer: University Health Alliance Commercial	$1,195.57

Plate LCP 3.5mm 7 Hole 98mm 223.571 [3604952]

Facility

$2,134.94

Service Code	HCPCS C1713
Hospital Charge Code	3604952
Hospital Revenue Code	278
Min. Negotiated Rate	$1,195.57
Max. Negotiated Rate	$2,070.89
Rate for Payer: Cash Price	$1,387.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,494.46
Rate for Payer: Health Management Network Commercial	$1,814.70
Rate for Payer: MDX Hawaii PPO	$2,070.89
Rate for Payer: University Health Alliance Commercial	$1,195.57

Plate LCP 3.5mm 8 Hole 111mm 223.581 [3606441]

Facility

$2,233.95

Service Code	HCPCS C1713
Hospital Charge Code	3606441
Hospital Revenue Code	278
Min. Negotiated Rate	$1,139.31
Max. Negotiated Rate	$2,166.93
Rate for Payer: Cash Price	$1,452.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,563.77
Rate for Payer: Health Management Network Commercial	$1,898.86
Rate for Payer: Kaiser Permanente Commercial	$1,407.39
Rate for Payer: Kaiser Permanente Medicaid	$1,139.31
Rate for Payer: MDX Hawaii PPO	$2,166.93
Rate for Payer: University Health Alliance Commercial	$1,251.01

Plate LCP 3.5mm 8 Hole 111mm 223.581 [3606441]

Facility

$2,233.95

Service Code	HCPCS C1713
Hospital Charge Code	3606441
Hospital Revenue Code	278
Min. Negotiated Rate	$1,251.01
Max. Negotiated Rate	$2,166.93
Rate for Payer: Cash Price	$1,452.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,563.77
Rate for Payer: Health Management Network Commercial	$1,898.86
Rate for Payer: MDX Hawaii PPO	$2,166.93
Rate for Payer: University Health Alliance Commercial	$1,251.01

Plate Lcp Metaphyseal 3.5mm 7h 223.407 [3640555]

Facility

$2,654.78

Service Code	HCPCS C1713
Hospital Charge Code	3640555
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.94
Max. Negotiated Rate	$2,575.14
Rate for Payer: Cash Price	$1,725.61
Rate for Payer: Hawaii Western Management Group Commercial	$1,858.35
Rate for Payer: Health Management Network Commercial	$2,256.56
Rate for Payer: Kaiser Permanente Commercial	$1,672.51
Rate for Payer: Kaiser Permanente Medicaid	$1,353.94
Rate for Payer: MDX Hawaii PPO	$2,575.14
Rate for Payer: University Health Alliance Commercial	$1,486.68

Plate Lcp Metaphyseal 3.5mm 7h 223.407 [3640555]

Facility

$2,654.78

Service Code	HCPCS C1713
Hospital Charge Code	3640555
Hospital Revenue Code	278
Min. Negotiated Rate	$1,486.68
Max. Negotiated Rate	$2,575.14
Rate for Payer: Cash Price	$1,725.61
Rate for Payer: Hawaii Western Management Group Commercial	$1,858.35
Rate for Payer: Health Management Network Commercial	$2,256.56
Rate for Payer: MDX Hawaii PPO	$2,575.14
Rate for Payer: University Health Alliance Commercial	$1,486.68

Plate LCP PostLateral Distal Fibula 4H Lt 02.112.109 [3641171]

Facility

$2,690.31

Service Code	HCPCS C1713
Hospital Charge Code	3641171
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.06
Max. Negotiated Rate	$2,609.60
Rate for Payer: Cash Price	$1,748.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,883.22
Rate for Payer: Health Management Network Commercial	$2,286.76
Rate for Payer: Kaiser Permanente Commercial	$1,694.90
Rate for Payer: Kaiser Permanente Medicaid	$1,372.06
Rate for Payer: MDX Hawaii PPO	$2,609.60
Rate for Payer: University Health Alliance Commercial	$1,506.57

Plate LCP PostLateral Distal Fibula 4H Lt 02.112.109 [3641171]

Facility

$2,690.31

Service Code	HCPCS C1713
Hospital Charge Code	3641171
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.57
Max. Negotiated Rate	$2,609.60
Rate for Payer: Cash Price	$1,748.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,883.22
Rate for Payer: Health Management Network Commercial	$2,286.76
Rate for Payer: MDX Hawaii PPO	$2,609.60
Rate for Payer: University Health Alliance Commercial	$1,506.57

Plate LCP Post Med Prox Tibia 3.5mm 2H 79mm 02.120.702S [3644607]

Facility

$7,085.64

Service Code	HCPCS C1713
Hospital Charge Code	3644607
Hospital Revenue Code	278
Min. Negotiated Rate	$3,967.96
Max. Negotiated Rate	$6,873.07
Rate for Payer: Cash Price	$4,605.67
Rate for Payer: Hawaii Western Management Group Commercial	$4,959.95
Rate for Payer: Health Management Network Commercial	$6,022.79
Rate for Payer: MDX Hawaii PPO	$6,873.07
Rate for Payer: University Health Alliance Commercial	$3,967.96

Plate LCP Post Med Prox Tibia 3.5mm 2H 79mm 02.120.702S [3644607]

Facility

$7,085.64

Service Code	HCPCS C1713
Hospital Charge Code	3644607
Hospital Revenue Code	278
Min. Negotiated Rate	$3,613.68
Max. Negotiated Rate	$6,873.07
Rate for Payer: Cash Price	$4,605.67
Rate for Payer: Hawaii Western Management Group Commercial	$4,959.95
Rate for Payer: Health Management Network Commercial	$6,022.79
Rate for Payer: Kaiser Permanente Commercial	$4,463.95
Rate for Payer: Kaiser Permanente Medicaid	$3,613.68
Rate for Payer: MDX Hawaii PPO	$6,873.07
Rate for Payer: University Health Alliance Commercial	$3,967.96

Plate Lcp Recon 3.5mm 7H 245.071 [3606465]

Facility

$2,142.11

Service Code	HCPCS C1713
Hospital Charge Code	3606465
Hospital Revenue Code	278
Min. Negotiated Rate	$1,092.48
Max. Negotiated Rate	$2,077.85
Rate for Payer: Cash Price	$1,392.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,499.48
Rate for Payer: Health Management Network Commercial	$1,820.79
Rate for Payer: Kaiser Permanente Commercial	$1,349.53
Rate for Payer: Kaiser Permanente Medicaid	$1,092.48
Rate for Payer: MDX Hawaii PPO	$2,077.85
Rate for Payer: University Health Alliance Commercial	$1,199.58

Plate Lcp Recon 3.5mm 7H 245.071 [3606465]

Facility

$2,142.11

Service Code	HCPCS C1713
Hospital Charge Code	3606465
Hospital Revenue Code	278
Min. Negotiated Rate	$1,199.58
Max. Negotiated Rate	$2,077.85
Rate for Payer: Cash Price	$1,392.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,499.48
Rate for Payer: Health Management Network Commercial	$1,820.79
Rate for Payer: MDX Hawaii PPO	$2,077.85
Rate for Payer: University Health Alliance Commercial	$1,199.58

Plate LCP T 2.7mm 2H HD x 4H 249.697 [3643147]

Facility

$4,291.10

Service Code	HCPCS C1713
Hospital Charge Code	3643147
Hospital Revenue Code	278
Min. Negotiated Rate	$2,188.46
Max. Negotiated Rate	$4,162.37
Rate for Payer: Cash Price	$2,789.22
Rate for Payer: Hawaii Western Management Group Commercial	$3,003.77
Rate for Payer: Health Management Network Commercial	$3,647.43
Rate for Payer: Kaiser Permanente Commercial	$2,703.39
Rate for Payer: Kaiser Permanente Medicaid	$2,188.46
Rate for Payer: MDX Hawaii PPO	$4,162.37
Rate for Payer: University Health Alliance Commercial	$2,403.02

Plate LCP T 2.7mm 2H HD x 4H 249.697 [3643147]

Facility

$4,291.10

Service Code	HCPCS C1713
Hospital Charge Code	3643147
Hospital Revenue Code	278
Min. Negotiated Rate	$2,403.02
Max. Negotiated Rate	$4,162.37
Rate for Payer: Cash Price	$2,789.22
Rate for Payer: Hawaii Western Management Group Commercial	$3,003.77
Rate for Payer: Health Management Network Commercial	$3,647.43
Rate for Payer: MDX Hawaii PPO	$4,162.37
Rate for Payer: University Health Alliance Commercial	$2,403.02

Plate Lcp T Obl Rt 3.5mm 3h 241.031 [3606475]

Facility

$1,707.75

Service Code	HCPCS C1713
Hospital Charge Code	3606475
Hospital Revenue Code	278
Min. Negotiated Rate	$870.95
Max. Negotiated Rate	$1,656.52
Rate for Payer: Cash Price	$1,110.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,195.42
Rate for Payer: Health Management Network Commercial	$1,451.59
Rate for Payer: Kaiser Permanente Commercial	$1,075.88
Rate for Payer: Kaiser Permanente Medicaid	$870.95
Rate for Payer: MDX Hawaii PPO	$1,656.52
Rate for Payer: University Health Alliance Commercial	$956.34

Plate Lcp T Obl Rt 3.5mm 3h 241.031 [3606475]

Facility

$1,707.75

Service Code	HCPCS C1713
Hospital Charge Code	3606475
Hospital Revenue Code	278
Min. Negotiated Rate	$956.34
Max. Negotiated Rate	$1,656.52
Rate for Payer: Cash Price	$1,110.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,195.42
Rate for Payer: Health Management Network Commercial	$1,451.59
Rate for Payer: MDX Hawaii PPO	$1,656.52
Rate for Payer: University Health Alliance Commercial	$956.34

Plate Lcp T Rt Ang 3.5mm 3x7h 241.171 [3606459]

Facility

$3,254.03

Service Code	HCPCS C1713
Hospital Charge Code	3606459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,659.56
Max. Negotiated Rate	$3,156.41
Rate for Payer: Cash Price	$2,115.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,277.82
Rate for Payer: Health Management Network Commercial	$2,765.93
Rate for Payer: Kaiser Permanente Commercial	$2,050.04
Rate for Payer: Kaiser Permanente Medicaid	$1,659.56
Rate for Payer: MDX Hawaii PPO	$3,156.41
Rate for Payer: University Health Alliance Commercial	$1,822.26

Plate Lcp T Rt Ang 3.5mm 3x7h 241.171 [3606459]

Facility

$3,254.03

Service Code	HCPCS C1713
Hospital Charge Code	3606459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,822.26
Max. Negotiated Rate	$3,156.41
Rate for Payer: Cash Price	$2,115.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,277.82
Rate for Payer: Health Management Network Commercial	$2,765.93
Rate for Payer: MDX Hawaii PPO	$3,156.41
Rate for Payer: University Health Alliance Commercial	$1,822.26

Plate LCP Xartc Dist Hum 3.5mm 6H 158mm LG Lt 02.104.026 [3644843]

Facility

$8,300.18

Service Code	HCPCS C1713
Hospital Charge Code	3644843
Hospital Revenue Code	278
Min. Negotiated Rate	$4,233.09
Max. Negotiated Rate	$8,051.17
Rate for Payer: Cash Price	$5,395.12
Rate for Payer: Hawaii Western Management Group Commercial	$5,810.13
Rate for Payer: Health Management Network Commercial	$7,055.15
Rate for Payer: Kaiser Permanente Commercial	$5,229.11
Rate for Payer: Kaiser Permanente Medicaid	$4,233.09
Rate for Payer: MDX Hawaii PPO	$8,051.17
Rate for Payer: University Health Alliance Commercial	$4,648.10

Know your out-of-pocket cost for care.

All Charges