Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Plate Medl Drct Dis Hum 75mm Lt Dhpfmdl3hl [3643494]

Facility

$5,842.50

Service Code	HCPCS C1713
Hospital Charge Code	3643494
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 Medl Drct Dis Hum 75mm Lt Dhpfmdl3hl [3643494]

Facility

$5,842.50

Service Code	HCPCS C1713
Hospital Charge Code	3643494
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 Ncb Pp Pr Fem 12h 285mm 02.03263.112 [3645485]

Facility

$9,511.46

Service Code	HCPCS C1713
Hospital Charge Code	3645485
Hospital Revenue Code	278
Min. Negotiated Rate	$4,850.84
Max. Negotiated Rate	$9,226.12
Rate for Payer: Cash Price	$6,182.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,658.02
Rate for Payer: Health Management Network Commercial	$8,084.74
Rate for Payer: Kaiser Permanente Commercial	$5,992.22
Rate for Payer: Kaiser Permanente Medicaid	$4,850.84
Rate for Payer: MDX Hawaii PPO	$9,226.12
Rate for Payer: University Health Alliance Commercial	$5,326.42

Plate Ncb Pp Pr Fem 12h 285mm 02.03263.112 [3645485]

Facility

$9,511.46

Service Code	HCPCS C1713
Hospital Charge Code	3645485
Hospital Revenue Code	278
Min. Negotiated Rate	$5,326.42
Max. Negotiated Rate	$9,226.12
Rate for Payer: Cash Price	$6,182.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,658.02
Rate for Payer: Health Management Network Commercial	$8,084.74
Rate for Payer: MDX Hawaii PPO	$9,226.12
Rate for Payer: University Health Alliance Commercial	$5,326.42

Plate Ncb Pp Pr Fem Rt 115mm 02.02263.000 [3645479]

Facility

$8,853.00

Service Code	HCPCS C1713
Hospital Charge Code	3645479
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Plate Ncb Pp Pr Fem Rt 115mm 02.02263.000 [3645479]

Facility

$8,853.00

Service Code	HCPCS C1713
Hospital Charge Code	3645479
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Plate NCB PP PR Fem Rt 12H 285mm 02.03263.012 [3645386]

Facility

$8,850.20

Service Code	HCPCS C1713
Hospital Charge Code	3645386
Hospital Revenue Code	278
Min. Negotiated Rate	$4,956.11
Max. Negotiated Rate	$8,584.69
Rate for Payer: Cash Price	$5,752.63
Rate for Payer: Hawaii Western Management Group Commercial	$6,195.14
Rate for Payer: Health Management Network Commercial	$7,522.67
Rate for Payer: MDX Hawaii PPO	$8,584.69
Rate for Payer: University Health Alliance Commercial	$4,956.11

Plate NCB PP PR Fem Rt 12H 285mm 02.03263.012 [3645386]

Facility

$8,850.20

Service Code	HCPCS C1713
Hospital Charge Code	3645386
Hospital Revenue Code	278
Min. Negotiated Rate	$4,513.60
Max. Negotiated Rate	$8,584.69
Rate for Payer: Cash Price	$5,752.63
Rate for Payer: Hawaii Western Management Group Commercial	$6,195.14
Rate for Payer: Health Management Network Commercial	$7,522.67
Rate for Payer: Kaiser Permanente Commercial	$5,575.63
Rate for Payer: Kaiser Permanente Medicaid	$4,513.60
Rate for Payer: MDX Hawaii PPO	$8,584.69
Rate for Payer: University Health Alliance Commercial	$4,956.11

Plate NCB PP Troch Rt Wide 02.02263.202 [3645387]

Facility

$7,070.80

Service Code	HCPCS C1713
Hospital Charge Code	3645387
Hospital Revenue Code	278
Min. Negotiated Rate	$3,606.11
Max. Negotiated Rate	$6,858.68
Rate for Payer: Cash Price	$4,596.02
Rate for Payer: Hawaii Western Management Group Commercial	$4,949.56
Rate for Payer: Health Management Network Commercial	$6,010.18
Rate for Payer: Kaiser Permanente Commercial	$4,454.60
Rate for Payer: Kaiser Permanente Medicaid	$3,606.11
Rate for Payer: MDX Hawaii PPO	$6,858.68
Rate for Payer: University Health Alliance Commercial	$3,959.65

Plate NCB PP Troch Rt Wide 02.02263.202 [3645387]

Facility

$7,070.80

Service Code	HCPCS C1713
Hospital Charge Code	3645387
Hospital Revenue Code	278
Min. Negotiated Rate	$3,959.65
Max. Negotiated Rate	$6,858.68
Rate for Payer: Cash Price	$4,596.02
Rate for Payer: Hawaii Western Management Group Commercial	$4,949.56
Rate for Payer: Health Management Network Commercial	$6,010.18
Rate for Payer: MDX Hawaii PPO	$6,858.68
Rate for Payer: University Health Alliance Commercial	$3,959.65

Plate Non Lock Third Tubular Ss 8h AR-8943TNL-08 [3644136]

Facility

$1,246.20

Service Code	HCPCS C1713
Hospital Charge Code	3644136
Hospital Revenue Code	278
Min. Negotiated Rate	$635.56
Max. Negotiated Rate	$1,208.81
Rate for Payer: Cash Price	$810.03
Rate for Payer: Hawaii Western Management Group Commercial	$872.34
Rate for Payer: Health Management Network Commercial	$1,059.27
Rate for Payer: Kaiser Permanente Commercial	$785.11
Rate for Payer: Kaiser Permanente Medicaid	$635.56
Rate for Payer: MDX Hawaii PPO	$1,208.81
Rate for Payer: University Health Alliance Commercial	$697.87

Plate Non Lock Third Tubular Ss 8h AR-8943TNL-08 [3644136]

Facility

$1,246.20

Service Code	HCPCS C1713
Hospital Charge Code	3644136
Hospital Revenue Code	278
Min. Negotiated Rate	$697.87
Max. Negotiated Rate	$1,208.81
Rate for Payer: Cash Price	$810.03
Rate for Payer: Hawaii Western Management Group Commercial	$872.34
Rate for Payer: Health Management Network Commercial	$1,059.27
Rate for Payer: MDX Hawaii PPO	$1,208.81
Rate for Payer: University Health Alliance Commercial	$697.87

Plate Olecranon 10H 79mm 131218600 [3640877]

Facility

$6,439.40

Service Code	HCPCS C1713
Hospital Charge Code	3640877
Hospital Revenue Code	278
Min. Negotiated Rate	$3,284.09
Max. Negotiated Rate	$6,246.22
Rate for Payer: Cash Price	$4,185.61
Rate for Payer: Hawaii Western Management Group Commercial	$4,507.58
Rate for Payer: Health Management Network Commercial	$5,473.49
Rate for Payer: Kaiser Permanente Commercial	$4,056.82
Rate for Payer: Kaiser Permanente Medicaid	$3,284.09
Rate for Payer: MDX Hawaii PPO	$6,246.22
Rate for Payer: University Health Alliance Commercial	$3,606.06

Plate Olecranon 10H 79mm 131218600 [3640877]

Facility

$6,439.40

Service Code	HCPCS C1713
Hospital Charge Code	3640877
Hospital Revenue Code	278
Min. Negotiated Rate	$3,606.06
Max. Negotiated Rate	$6,246.22
Rate for Payer: Cash Price	$4,185.61
Rate for Payer: Hawaii Western Management Group Commercial	$4,507.58
Rate for Payer: Health Management Network Commercial	$5,473.49
Rate for Payer: MDX Hawaii PPO	$6,246.22
Rate for Payer: University Health Alliance Commercial	$3,606.06

Plate Post Dist Fib SS 8H AR-8963PLL-08 [3644680]

Facility

$6,522.00

Service Code	HCPCS C1713
Hospital Charge Code	3644680
Hospital Revenue Code	278
Min. Negotiated Rate	$3,652.32
Max. Negotiated Rate	$6,326.34
Rate for Payer: Cash Price	$4,239.30
Rate for Payer: Hawaii Western Management Group Commercial	$4,565.40
Rate for Payer: Health Management Network Commercial	$5,543.70
Rate for Payer: MDX Hawaii PPO	$6,326.34
Rate for Payer: University Health Alliance Commercial	$3,652.32

Plate Post Dist Fib SS 8H AR-8963PLL-08 [3644680]

Facility

$6,522.00

Service Code	HCPCS C1713
Hospital Charge Code	3644680
Hospital Revenue Code	278
Min. Negotiated Rate	$3,326.22
Max. Negotiated Rate	$6,326.34
Rate for Payer: Cash Price	$4,239.30
Rate for Payer: Hawaii Western Management Group Commercial	$4,565.40
Rate for Payer: Health Management Network Commercial	$5,543.70
Rate for Payer: Kaiser Permanente Commercial	$4,108.86
Rate for Payer: Kaiser Permanente Medicaid	$3,326.22
Rate for Payer: MDX Hawaii PPO	$6,326.34
Rate for Payer: University Health Alliance Commercial	$3,652.32

Plate Posterior Dist Tibia SS 3H AR-8963P-03 [3643234]

Facility

$7,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3643234
Hospital Revenue Code	278
Min. Negotiated Rate	$3,727.84
Max. Negotiated Rate	$7,090.22
Rate for Payer: Cash Price	$4,751.18
Rate for Payer: Hawaii Western Management Group Commercial	$5,116.65
Rate for Payer: Health Management Network Commercial	$6,213.07
Rate for Payer: Kaiser Permanente Commercial	$4,604.98
Rate for Payer: Kaiser Permanente Medicaid	$3,727.84
Rate for Payer: MDX Hawaii PPO	$7,090.22
Rate for Payer: University Health Alliance Commercial	$4,093.32

Plate Posterior Dist Tibia SS 3H AR-8963P-03 [3643234]

Facility

$7,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3643234
Hospital Revenue Code	278
Min. Negotiated Rate	$4,093.32
Max. Negotiated Rate	$7,090.22
Rate for Payer: Cash Price	$4,751.18
Rate for Payer: Hawaii Western Management Group Commercial	$5,116.65
Rate for Payer: Health Management Network Commercial	$6,213.07
Rate for Payer: MDX Hawaii PPO	$7,090.22
Rate for Payer: University Health Alliance Commercial	$4,093.32

Plate Posterolateral Fib 11 Hole Anat w/Comp P53-208-0011 [3644542]

Facility

$8,489.00

Service Code	HCPCS C1713
Hospital Charge Code	3644542
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 Posterolateral Fib 11 Hole Anat w/Comp P53-208-0011 [3644542]

Facility

$8,489.00

Service Code	HCPCS C1713
Hospital Charge Code	3644542
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 Protean Coronoid Assembled Right PRT-CRD-RT [3644289]

Facility

$5,524.50

Service Code	HCPCS C1713
Hospital Charge Code	3644289
Hospital Revenue Code	278
Min. Negotiated Rate	$2,817.49
Max. Negotiated Rate	$5,358.77
Rate for Payer: Cash Price	$3,590.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,867.15
Rate for Payer: Health Management Network Commercial	$4,695.82
Rate for Payer: Kaiser Permanente Commercial	$3,480.43
Rate for Payer: Kaiser Permanente Medicaid	$2,817.49
Rate for Payer: MDX Hawaii PPO	$5,358.77
Rate for Payer: University Health Alliance Commercial	$3,093.72

Plate Protean Coronoid Assembled Right PRT-CRD-RT [3644289]

Facility

$5,524.50

Service Code	HCPCS C1713
Hospital Charge Code	3644289
Hospital Revenue Code	278
Min. Negotiated Rate	$3,093.72
Max. Negotiated Rate	$5,358.77
Rate for Payer: Cash Price	$3,590.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,867.15
Rate for Payer: Health Management Network Commercial	$4,695.82
Rate for Payer: MDX Hawaii PPO	$5,358.77
Rate for Payer: University Health Alliance Commercial	$3,093.72

Plate Protean Rad Col Assembled Rt Prt-Rcp-Rt [3643901]

Facility

$2,567.50

Service Code	HCPCS C1713
Hospital Charge Code	3643901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,309.42
Max. Negotiated Rate	$2,490.47
Rate for Payer: Cash Price	$1,668.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,797.25
Rate for Payer: Health Management Network Commercial	$2,182.38
Rate for Payer: Kaiser Permanente Commercial	$1,617.53
Rate for Payer: Kaiser Permanente Medicaid	$1,309.42
Rate for Payer: MDX Hawaii PPO	$2,490.47
Rate for Payer: University Health Alliance Commercial	$1,437.80

Plate Protean Rad Col Assembled Rt Prt-Rcp-Rt [3643901]

Facility

$2,567.50

Service Code	HCPCS C1713
Hospital Charge Code	3643901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,437.80
Max. Negotiated Rate	$2,490.47
Rate for Payer: Cash Price	$1,668.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,797.25
Rate for Payer: Health Management Network Commercial	$2,182.38
Rate for Payer: MDX Hawaii PPO	$2,490.47
Rate for Payer: University Health Alliance Commercial	$1,437.80

Plate Proximal Ulna 73mm Right APL-PUP-3HR [3643607]

Facility

$5,671.50

Service Code	HCPCS C1713
Hospital Charge Code	3643607
Hospital Revenue Code	278
Min. Negotiated Rate	$2,892.47
Max. Negotiated Rate	$5,501.35
Rate for Payer: Cash Price	$3,686.48
Rate for Payer: Hawaii Western Management Group Commercial	$3,970.05
Rate for Payer: Health Management Network Commercial	$4,820.77
Rate for Payer: Kaiser Permanente Commercial	$3,573.05
Rate for Payer: Kaiser Permanente Medicaid	$2,892.47
Rate for Payer: MDX Hawaii PPO	$5,501.35
Rate for Payer: University Health Alliance Commercial	$3,176.04

Know your out-of-pocket cost for care.

All Charges