Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$4,648.10
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: MDX Hawaii PPO	$8,051.17
Rate for Payer: University Health Alliance Commercial	$4,648.10

Plate Lisfranc Small Ti RT AR-8951SR [3644989]

Facility

$6,172.00

Service Code	HCPCS C1713
Hospital Charge Code	3644989
Hospital Revenue Code	278
Min. Negotiated Rate	$3,147.72
Max. Negotiated Rate	$5,986.84
Rate for Payer: Cash Price	$4,011.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.40
Rate for Payer: Health Management Network Commercial	$5,246.20
Rate for Payer: Kaiser Permanente Commercial	$3,888.36
Rate for Payer: Kaiser Permanente Medicaid	$3,147.72
Rate for Payer: MDX Hawaii PPO	$5,986.84
Rate for Payer: University Health Alliance Commercial	$3,456.32

Plate Lisfranc Small Ti RT AR-8951SR [3644989]

Facility

$6,172.00

Service Code	HCPCS C1713
Hospital Charge Code	3644989
Hospital Revenue Code	278
Min. Negotiated Rate	$3,456.32
Max. Negotiated Rate	$5,986.84
Rate for Payer: Cash Price	$4,011.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.40
Rate for Payer: Health Management Network Commercial	$5,246.20
Rate for Payer: MDX Hawaii PPO	$5,986.84
Rate for Payer: University Health Alliance Commercial	$3,456.32

Plate L LCP 2.7mm 32mm 2H HD x 3H 249.688 [3644565]

Facility

$2,713.96

Service Code	HCPCS C1713
Hospital Charge Code	3644565
Hospital Revenue Code	278
Min. Negotiated Rate	$1,384.12
Max. Negotiated Rate	$2,632.54
Rate for Payer: Cash Price	$1,764.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,899.77
Rate for Payer: Health Management Network Commercial	$2,306.87
Rate for Payer: Kaiser Permanente Commercial	$1,709.79
Rate for Payer: Kaiser Permanente Medicaid	$1,384.12
Rate for Payer: MDX Hawaii PPO	$2,632.54
Rate for Payer: University Health Alliance Commercial	$1,519.82

Plate L LCP 2.7mm 32mm 2H HD x 3H 249.688 [3644565]

Facility

$2,713.96

Service Code	HCPCS C1713
Hospital Charge Code	3644565
Hospital Revenue Code	278
Min. Negotiated Rate	$1,519.82
Max. Negotiated Rate	$2,632.54
Rate for Payer: Cash Price	$1,764.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,899.77
Rate for Payer: Health Management Network Commercial	$2,306.87
Rate for Payer: MDX Hawaii PPO	$2,632.54
Rate for Payer: University Health Alliance Commercial	$1,519.82

Plate Lock Distal Fib Ss Lt 5h AR-8943DL-05 [3645478]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3645478
Hospital Revenue Code	278
Min. Negotiated Rate	$3,211.32
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Plate Lock Distal Fib Ss Lt 5h AR-8943DL-05 [3645478]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3645478
Hospital Revenue Code	278
Min. Negotiated Rate	$2,924.59
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: Kaiser Permanente Commercial	$3,612.74
Rate for Payer: Kaiser Permanente Medicaid	$2,924.59
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Plate Lock Distal Fib SS Rt 4H AR-8943DR-04 [3644229]

Facility

$5,090.50

Service Code	HCPCS C1713
Hospital Charge Code	3644229
Hospital Revenue Code	278
Min. Negotiated Rate	$2,596.16
Max. Negotiated Rate	$4,937.78
Rate for Payer: Cash Price	$3,308.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,563.35
Rate for Payer: Health Management Network Commercial	$4,326.93
Rate for Payer: Kaiser Permanente Commercial	$3,207.01
Rate for Payer: Kaiser Permanente Medicaid	$2,596.16
Rate for Payer: MDX Hawaii PPO	$4,937.78
Rate for Payer: University Health Alliance Commercial	$2,850.68

Plate Lock Distal Fib SS Rt 4H AR-8943DR-04 [3644229]

Facility

$5,090.50

Service Code	HCPCS C1713
Hospital Charge Code	3644229
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.68
Max. Negotiated Rate	$4,937.78
Rate for Payer: Cash Price	$3,308.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,563.35
Rate for Payer: Health Management Network Commercial	$4,326.93
Rate for Payer: MDX Hawaii PPO	$4,937.78
Rate for Payer: University Health Alliance Commercial	$2,850.68

Plate Lock Distal Fib SS Rt 5H AR-8943DR-05 [3644838]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3644838
Hospital Revenue Code	278
Min. Negotiated Rate	$3,211.32
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Plate Lock Distal Fib SS Rt 5H AR-8943DR-05 [3644838]

Facility

$5,734.50

Service Code	HCPCS C1713
Hospital Charge Code	3644838
Hospital Revenue Code	278
Min. Negotiated Rate	$2,924.59
Max. Negotiated Rate	$5,562.47
Rate for Payer: Cash Price	$3,727.42
Rate for Payer: Hawaii Western Management Group Commercial	$4,014.15
Rate for Payer: Health Management Network Commercial	$4,874.32
Rate for Payer: Kaiser Permanente Commercial	$3,612.74
Rate for Payer: Kaiser Permanente Medicaid	$2,924.59
Rate for Payer: MDX Hawaii PPO	$5,562.47
Rate for Payer: University Health Alliance Commercial	$3,211.32

Plate Lock Distal Fibula SS LT 6H AR-8943DL-06 [3644741]

Facility

$6,172.00

Service Code	HCPCS C1713
Hospital Charge Code	3644741
Hospital Revenue Code	278
Min. Negotiated Rate	$3,147.72
Max. Negotiated Rate	$5,986.84
Rate for Payer: Cash Price	$4,011.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.40
Rate for Payer: Health Management Network Commercial	$5,246.20
Rate for Payer: Kaiser Permanente Commercial	$3,888.36
Rate for Payer: Kaiser Permanente Medicaid	$3,147.72
Rate for Payer: MDX Hawaii PPO	$5,986.84
Rate for Payer: University Health Alliance Commercial	$3,456.32

Plate Lock Distal Fibula SS LT 6H AR-8943DL-06 [3644741]

Facility

$6,172.00

Service Code	HCPCS C1713
Hospital Charge Code	3644741
Hospital Revenue Code	278
Min. Negotiated Rate	$3,456.32
Max. Negotiated Rate	$5,986.84
Rate for Payer: Cash Price	$4,011.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.40
Rate for Payer: Health Management Network Commercial	$5,246.20
Rate for Payer: MDX Hawaii PPO	$5,986.84
Rate for Payer: University Health Alliance Commercial	$3,456.32

Plate Lock Distal Fibula SS RT 6H AR-8943DR-06 [3644268]

Facility

$6,172.00

Service Code	HCPCS C1713
Hospital Charge Code	3644268
Hospital Revenue Code	278
Min. Negotiated Rate	$3,456.32
Max. Negotiated Rate	$5,986.84
Rate for Payer: Cash Price	$4,011.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.40
Rate for Payer: Health Management Network Commercial	$5,246.20
Rate for Payer: MDX Hawaii PPO	$5,986.84
Rate for Payer: University Health Alliance Commercial	$3,456.32

Plate Lock Distal Fibula SS RT 6H AR-8943DR-06 [3644268]

Facility

$6,172.00

Service Code	HCPCS C1713
Hospital Charge Code	3644268
Hospital Revenue Code	278
Min. Negotiated Rate	$3,147.72
Max. Negotiated Rate	$5,986.84
Rate for Payer: Cash Price	$4,011.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,320.40
Rate for Payer: Health Management Network Commercial	$5,246.20
Rate for Payer: Kaiser Permanente Commercial	$3,888.36
Rate for Payer: Kaiser Permanente Medicaid	$3,147.72
Rate for Payer: MDX Hawaii PPO	$5,986.84
Rate for Payer: University Health Alliance Commercial	$3,456.32

Plate Lock Distall Fib SS LT 4H AR-8943DL-04 [3644415]

Facility

$5,090.50

Service Code	HCPCS C1713
Hospital Charge Code	3644415
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.68
Max. Negotiated Rate	$4,937.78
Rate for Payer: Cash Price	$3,308.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,563.35
Rate for Payer: Health Management Network Commercial	$4,326.93
Rate for Payer: MDX Hawaii PPO	$4,937.78
Rate for Payer: University Health Alliance Commercial	$2,850.68

Plate Lock Distall Fib SS LT 4H AR-8943DL-04 [3644415]

Facility

$5,090.50

Service Code	HCPCS C1713
Hospital Charge Code	3644415
Hospital Revenue Code	278
Min. Negotiated Rate	$2,596.16
Max. Negotiated Rate	$4,937.78
Rate for Payer: Cash Price	$3,308.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,563.35
Rate for Payer: Health Management Network Commercial	$4,326.93
Rate for Payer: Kaiser Permanente Commercial	$3,207.01
Rate for Payer: Kaiser Permanente Medicaid	$2,596.16
Rate for Payer: MDX Hawaii PPO	$4,937.78
Rate for Payer: University Health Alliance Commercial	$2,850.68

Plate Locking Third Tubular SS 6h AR-8943T-06 [3644442]

Facility

$2,240.00

Service Code	HCPCS C1713
Hospital Charge Code	3644442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.40
Max. Negotiated Rate	$2,172.80
Rate for Payer: Cash Price	$1,456.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.00
Rate for Payer: Health Management Network Commercial	$1,904.00
Rate for Payer: MDX Hawaii PPO	$2,172.80
Rate for Payer: University Health Alliance Commercial	$1,254.40

Plate Locking Third Tubular SS 6h AR-8943T-06 [3644442]

Facility

$2,240.00

Service Code	HCPCS C1713
Hospital Charge Code	3644442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,142.40
Max. Negotiated Rate	$2,172.80
Rate for Payer: Cash Price	$1,456.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.00
Rate for Payer: Health Management Network Commercial	$1,904.00
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Medicaid	$1,142.40
Rate for Payer: MDX Hawaii PPO	$2,172.80
Rate for Payer: University Health Alliance Commercial	$1,254.40

Plate Lock Straight SS 7H AR-8943C-07 [3644450]

Facility

$4,440.50

Service Code	HCPCS C1713
Hospital Charge Code	3644450
Hospital Revenue Code	278
Min. Negotiated Rate	$2,264.66
Max. Negotiated Rate	$4,307.28
Rate for Payer: Cash Price	$2,886.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,108.35
Rate for Payer: Health Management Network Commercial	$3,774.43
Rate for Payer: Kaiser Permanente Commercial	$2,797.51
Rate for Payer: Kaiser Permanente Medicaid	$2,264.66
Rate for Payer: MDX Hawaii PPO	$4,307.28
Rate for Payer: University Health Alliance Commercial	$2,486.68

Plate Lock Straight SS 7H AR-8943C-07 [3644450]

Facility

$4,440.50

Service Code	HCPCS C1713
Hospital Charge Code	3644450
Hospital Revenue Code	278
Min. Negotiated Rate	$2,486.68
Max. Negotiated Rate	$4,307.28
Rate for Payer: Cash Price	$2,886.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,108.35
Rate for Payer: Health Management Network Commercial	$3,774.43
Rate for Payer: MDX Hawaii PPO	$4,307.28
Rate for Payer: University Health Alliance Commercial	$2,486.68

Plate Low Pro Recon 3.5mm 9H 245.029 [3645373]

Facility

$3,689.00

Service Code	HCPCS C1713
Hospital Charge Code	3645373
Hospital Revenue Code	278
Min. Negotiated Rate	$2,065.84
Max. Negotiated Rate	$3,578.33
Rate for Payer: Cash Price	$2,397.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,582.30
Rate for Payer: Health Management Network Commercial	$3,135.65
Rate for Payer: MDX Hawaii PPO	$3,578.33
Rate for Payer: University Health Alliance Commercial	$2,065.84

Plate Low Pro Recon 3.5mm 9H 245.029 [3645373]

Facility

$3,689.00

Service Code	HCPCS C1713
Hospital Charge Code	3645373
Hospital Revenue Code	278
Min. Negotiated Rate	$1,881.39
Max. Negotiated Rate	$3,578.33
Rate for Payer: Cash Price	$2,397.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,582.30
Rate for Payer: Health Management Network Commercial	$3,135.65
Rate for Payer: Kaiser Permanente Commercial	$2,324.07
Rate for Payer: Kaiser Permanente Medicaid	$1,881.39
Rate for Payer: MDX Hawaii PPO	$3,578.33
Rate for Payer: University Health Alliance Commercial	$2,065.84

Plate Medial Hook Lock SS 3H AR-8943H-03 [3644679]

Facility

$6,315.50

Service Code	HCPCS C1713
Hospital Charge Code	3644679
Hospital Revenue Code	278
Min. Negotiated Rate	$3,220.91
Max. Negotiated Rate	$6,126.03
Rate for Payer: Cash Price	$4,105.08
Rate for Payer: Hawaii Western Management Group Commercial	$4,420.85
Rate for Payer: Health Management Network Commercial	$5,368.18
Rate for Payer: Kaiser Permanente Commercial	$3,978.76
Rate for Payer: Kaiser Permanente Medicaid	$3,220.91
Rate for Payer: MDX Hawaii PPO	$6,126.03
Rate for Payer: University Health Alliance Commercial	$3,536.68

Plate Medial Hook Lock SS 3H AR-8943H-03 [3644679]

Facility

$6,315.50

Service Code	HCPCS C1713
Hospital Charge Code	3644679
Hospital Revenue Code	278
Min. Negotiated Rate	$3,536.68
Max. Negotiated Rate	$6,126.03
Rate for Payer: Cash Price	$4,105.08
Rate for Payer: Hawaii Western Management Group Commercial	$4,420.85
Rate for Payer: Health Management Network Commercial	$5,368.18
Rate for Payer: MDX Hawaii PPO	$6,126.03
Rate for Payer: University Health Alliance Commercial	$3,536.68

Know your out-of-pocket cost for care.

All Charges