Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$3,176.04
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: MDX Hawaii PPO	$5,501.35
Rate for Payer: University Health Alliance Commercial	$3,176.04

Plate Prox Tib Locking 5H Std LT 816235705 [3642048]

Facility

$4,817.50

Service Code	HCPCS C1713
Hospital Charge Code	3642048
Hospital Revenue Code	278
Min. Negotiated Rate	$2,697.80
Max. Negotiated Rate	$4,672.98
Rate for Payer: Cash Price	$3,131.38
Rate for Payer: Hawaii Western Management Group Commercial	$3,372.25
Rate for Payer: Health Management Network Commercial	$4,094.88
Rate for Payer: MDX Hawaii PPO	$4,672.98
Rate for Payer: University Health Alliance Commercial	$2,697.80

Plate Prox Tib Locking 5H Std LT 816235705 [3642048]

Facility

$4,817.50

Service Code	HCPCS C1713
Hospital Charge Code	3642048
Hospital Revenue Code	278
Min. Negotiated Rate	$2,456.93
Max. Negotiated Rate	$4,672.98
Rate for Payer: Cash Price	$3,131.38
Rate for Payer: Hawaii Western Management Group Commercial	$3,372.25
Rate for Payer: Health Management Network Commercial	$4,094.88
Rate for Payer: Kaiser Permanente Commercial	$3,035.03
Rate for Payer: Kaiser Permanente Medicaid	$2,456.93
Rate for Payer: MDX Hawaii PPO	$4,672.98
Rate for Payer: University Health Alliance Commercial	$2,697.80

Plate Prx Hum Lo Rt 7h 133mm 110030202 [3644103]

Facility

$10,916.60

Service Code	HCPCS C1713
Hospital Charge Code	3644103
Hospital Revenue Code	278
Min. Negotiated Rate	$6,113.30
Max. Negotiated Rate	$10,589.10
Rate for Payer: Cash Price	$7,095.79
Rate for Payer: Hawaii Western Management Group Commercial	$7,641.62
Rate for Payer: Health Management Network Commercial	$9,279.11
Rate for Payer: MDX Hawaii PPO	$10,589.10
Rate for Payer: University Health Alliance Commercial	$6,113.30

Plate Prx Hum Lo Rt 7h 133mm 110030202 [3644103]

Facility

$10,916.60

Service Code	HCPCS C1713
Hospital Charge Code	3644103
Hospital Revenue Code	278
Min. Negotiated Rate	$5,567.47
Max. Negotiated Rate	$10,589.10
Rate for Payer: Cash Price	$7,095.79
Rate for Payer: Hawaii Western Management Group Commercial	$7,641.62
Rate for Payer: Health Management Network Commercial	$9,279.11
Rate for Payer: Kaiser Permanente Commercial	$6,877.46
Rate for Payer: Kaiser Permanente Medicaid	$5,567.47
Rate for Payer: MDX Hawaii PPO	$10,589.10
Rate for Payer: University Health Alliance Commercial	$6,113.30

Plate Sinus Tarsi Right Small P53-102-R201 [3644783]

Facility

$7,593.00

Service Code	HCPCS C1713
Hospital Charge Code	3644783
Hospital Revenue Code	278
Min. Negotiated Rate	$3,872.43
Max. Negotiated Rate	$7,365.21
Rate for Payer: Cash Price	$4,935.45
Rate for Payer: Hawaii Western Management Group Commercial	$5,315.10
Rate for Payer: Health Management Network Commercial	$6,454.05
Rate for Payer: Kaiser Permanente Commercial	$4,783.59
Rate for Payer: Kaiser Permanente Medicaid	$3,872.43
Rate for Payer: MDX Hawaii PPO	$7,365.21
Rate for Payer: University Health Alliance Commercial	$4,252.08

Plate Sinus Tarsi Right Small P53-102-R201 [3644783]

Facility

$7,593.00

Service Code	HCPCS C1713
Hospital Charge Code	3644783
Hospital Revenue Code	278
Min. Negotiated Rate	$4,252.08
Max. Negotiated Rate	$7,365.21
Rate for Payer: Cash Price	$4,935.45
Rate for Payer: Hawaii Western Management Group Commercial	$5,315.10
Rate for Payer: Health Management Network Commercial	$6,454.05
Rate for Payer: MDX Hawaii PPO	$7,365.21
Rate for Payer: University Health Alliance Commercial	$4,252.08

Plate Sinus Tarsi Support Left Small P53-102-L101 [3644908]

Facility

$7,593.00

Service Code	HCPCS C1713
Hospital Charge Code	3644908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,872.43
Max. Negotiated Rate	$7,365.21
Rate for Payer: Cash Price	$4,935.45
Rate for Payer: Hawaii Western Management Group Commercial	$5,315.10
Rate for Payer: Health Management Network Commercial	$6,454.05
Rate for Payer: Kaiser Permanente Commercial	$4,783.59
Rate for Payer: Kaiser Permanente Medicaid	$3,872.43
Rate for Payer: MDX Hawaii PPO	$7,365.21
Rate for Payer: University Health Alliance Commercial	$4,252.08

Plate Sinus Tarsi Support Left Small P53-102-L101 [3644908]

Facility

$7,593.00

Service Code	HCPCS C1713
Hospital Charge Code	3644908
Hospital Revenue Code	278
Min. Negotiated Rate	$4,252.08
Max. Negotiated Rate	$7,365.21
Rate for Payer: Cash Price	$4,935.45
Rate for Payer: Hawaii Western Management Group Commercial	$5,315.10
Rate for Payer: Health Management Network Commercial	$6,454.05
Rate for Payer: MDX Hawaii PPO	$7,365.21
Rate for Payer: University Health Alliance Commercial	$4,252.08

Plate Straight 2.4mm 10 Hole AR-18724P-07 [3644884]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644884
Hospital Revenue Code	278
Min. Negotiated Rate	$3,438.68
Max. Negotiated Rate	$5,956.28
Rate for Payer: Cash Price	$3,991.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.35
Rate for Payer: Health Management Network Commercial	$5,219.43
Rate for Payer: MDX Hawaii PPO	$5,956.28
Rate for Payer: University Health Alliance Commercial	$3,438.68

Plate Straight 2.4mm 10 Hole AR-18724P-07 [3644884]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644884
Hospital Revenue Code	278
Min. Negotiated Rate	$3,131.66
Max. Negotiated Rate	$5,956.28
Rate for Payer: Cash Price	$3,991.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.35
Rate for Payer: Health Management Network Commercial	$5,219.43
Rate for Payer: Kaiser Permanente Commercial	$3,868.51
Rate for Payer: Kaiser Permanente Medicaid	$3,131.66
Rate for Payer: MDX Hawaii PPO	$5,956.28
Rate for Payer: University Health Alliance Commercial	$3,438.68

Plate Sup Clavicle 8h 90mm Lt 133525090 [3643591]

Facility

$9,079.80

Service Code	HCPCS C1713
Hospital Charge Code	3643591
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.70
Max. Negotiated Rate	$8,807.41
Rate for Payer: Cash Price	$5,901.87
Rate for Payer: Hawaii Western Management Group Commercial	$6,355.86
Rate for Payer: Health Management Network Commercial	$7,717.83
Rate for Payer: Kaiser Permanente Commercial	$5,720.27
Rate for Payer: Kaiser Permanente Medicaid	$4,630.70
Rate for Payer: MDX Hawaii PPO	$8,807.41
Rate for Payer: University Health Alliance Commercial	$5,084.69

Plate Sup Clavicle 8h 90mm Lt 133525090 [3643591]

Facility

$9,079.80

Service Code	HCPCS C1713
Hospital Charge Code	3643591
Hospital Revenue Code	278
Min. Negotiated Rate	$5,084.69
Max. Negotiated Rate	$8,807.41
Rate for Payer: Cash Price	$5,901.87
Rate for Payer: Hawaii Western Management Group Commercial	$6,355.86
Rate for Payer: Health Management Network Commercial	$7,717.83
Rate for Payer: MDX Hawaii PPO	$8,807.41
Rate for Payer: University Health Alliance Commercial	$5,084.69

Plate Sup Clavicle 8H 90mm Rt 133515090 [3643195]

Facility

$9,079.80

Service Code	HCPCS C1713
Hospital Charge Code	3643195
Hospital Revenue Code	278
Min. Negotiated Rate	$5,084.69
Max. Negotiated Rate	$8,807.41
Rate for Payer: Cash Price	$5,901.87
Rate for Payer: Hawaii Western Management Group Commercial	$6,355.86
Rate for Payer: Health Management Network Commercial	$7,717.83
Rate for Payer: MDX Hawaii PPO	$8,807.41
Rate for Payer: University Health Alliance Commercial	$5,084.69

Plate Sup Clavicle 8H 90mm Rt 133515090 [3643195]

Facility

$9,079.80

Service Code	HCPCS C1713
Hospital Charge Code	3643195
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.70
Max. Negotiated Rate	$8,807.41
Rate for Payer: Cash Price	$5,901.87
Rate for Payer: Hawaii Western Management Group Commercial	$6,355.86
Rate for Payer: Health Management Network Commercial	$7,717.83
Rate for Payer: Kaiser Permanente Commercial	$5,720.27
Rate for Payer: Kaiser Permanente Medicaid	$4,630.70
Rate for Payer: MDX Hawaii PPO	$8,807.41
Rate for Payer: University Health Alliance Commercial	$5,084.69

Plate Sup Clavicle Nrw 10h 100mm Lt 133522100 [3644105]

Facility

$8,850.20

Service Code	HCPCS C1713
Hospital Charge Code	3644105
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 Sup Clavicle Nrw 10h 100mm Lt 133522100 [3644105]

Facility

$8,850.20

Service Code	HCPCS C1713
Hospital Charge Code	3644105
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 Sup Clavicle Nrw 10h 100mm Rt 133512100 [3643940]

Facility

$5,248.00

Service Code	HCPCS C1713
Hospital Charge Code	3643940
Hospital Revenue Code	278
Min. Negotiated Rate	$2,938.88
Max. Negotiated Rate	$5,090.56
Rate for Payer: Cash Price	$3,411.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,673.60
Rate for Payer: Health Management Network Commercial	$4,460.80
Rate for Payer: MDX Hawaii PPO	$5,090.56
Rate for Payer: University Health Alliance Commercial	$2,938.88

Plate Sup Clavicle Nrw 10h 100mm Rt 133512100 [3643940]

Facility

$5,248.00

Service Code	HCPCS C1713
Hospital Charge Code	3643940
Hospital Revenue Code	278
Min. Negotiated Rate	$2,676.48
Max. Negotiated Rate	$5,090.56
Rate for Payer: Cash Price	$3,411.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,673.60
Rate for Payer: Health Management Network Commercial	$4,460.80
Rate for Payer: Kaiser Permanente Commercial	$3,306.24
Rate for Payer: Kaiser Permanente Medicaid	$2,676.48
Rate for Payer: MDX Hawaii PPO	$5,090.56
Rate for Payer: University Health Alliance Commercial	$2,938.88

Plate Suture Patella Star Pole Fracture Small AR-13070S-P-S [3645402]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3645402
Hospital Revenue Code	278
Min. Negotiated Rate	$9,677.25
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: Kaiser Permanente Commercial	$11,954.25
Rate for Payer: Kaiser Permanente Medicaid	$9,677.25
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Plate Suture Patella Star Pole Fracture Small AR-13070S-P-S [3645402]

Facility

$18,975.00

Service Code	HCPCS C1713
Hospital Charge Code	3645402
Hospital Revenue Code	278
Min. Negotiated Rate	$10,626.00
Max. Negotiated Rate	$18,405.75
Rate for Payer: Cash Price	$12,333.75
Rate for Payer: Hawaii Western Management Group Commercial	$13,282.50
Rate for Payer: Health Management Network Commercial	$16,128.75
Rate for Payer: MDX Hawaii PPO	$18,405.75
Rate for Payer: University Health Alliance Commercial	$10,626.00

Plate T 10 Hole T2 P53-005-0010 [3644493]

Facility

$5,689.00

Service Code	HCPCS C1713
Hospital Charge Code	3644493
Hospital Revenue Code	278
Min. Negotiated Rate	$3,185.84
Max. Negotiated Rate	$5,518.33
Rate for Payer: Cash Price	$3,697.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,982.30
Rate for Payer: Health Management Network Commercial	$4,835.65
Rate for Payer: MDX Hawaii PPO	$5,518.33
Rate for Payer: University Health Alliance Commercial	$3,185.84

Plate T 10 Hole T2 P53-005-0010 [3644493]

Facility

$5,689.00

Service Code	HCPCS C1713
Hospital Charge Code	3644493
Hospital Revenue Code	278
Min. Negotiated Rate	$2,901.39
Max. Negotiated Rate	$5,518.33
Rate for Payer: Cash Price	$3,697.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,982.30
Rate for Payer: Health Management Network Commercial	$4,835.65
Rate for Payer: Kaiser Permanente Commercial	$3,584.07
Rate for Payer: Kaiser Permanente Medicaid	$2,901.39
Rate for Payer: MDX Hawaii PPO	$5,518.33
Rate for Payer: University Health Alliance Commercial	$3,185.84

Plate T 2.0mm 6 Hole AR-18720P-17 [3644790]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644790
Hospital Revenue Code	278
Min. Negotiated Rate	$3,131.66
Max. Negotiated Rate	$5,956.28
Rate for Payer: Cash Price	$3,991.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.35
Rate for Payer: Health Management Network Commercial	$5,219.43
Rate for Payer: Kaiser Permanente Commercial	$3,868.51
Rate for Payer: Kaiser Permanente Medicaid	$3,131.66
Rate for Payer: MDX Hawaii PPO	$5,956.28
Rate for Payer: University Health Alliance Commercial	$3,438.68

Plate T 2.0mm 6 Hole AR-18720P-17 [3644790]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644790
Hospital Revenue Code	278
Min. Negotiated Rate	$3,438.68
Max. Negotiated Rate	$5,956.28
Rate for Payer: Cash Price	$3,991.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.35
Rate for Payer: Health Management Network Commercial	$5,219.43
Rate for Payer: MDX Hawaii PPO	$5,956.28
Rate for Payer: University Health Alliance Commercial	$3,438.68

Know your out-of-pocket cost for care.

All Charges