Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Plate T 2.0mm 8 Hole AR-18720P-19 [3644476]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644476
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 T 2.0mm 8 Hole AR-18720P-19 [3644476]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644476
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 2.7mm 3 Hole HD 6 Hole AR-18827P-19 [3644813]

Facility

$8,475.00

Service Code	HCPCS C1713
Hospital Charge Code	3644813
Hospital Revenue Code	278
Min. Negotiated Rate	$4,322.25
Max. Negotiated Rate	$8,220.75
Rate for Payer: Cash Price	$5,508.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,932.50
Rate for Payer: Health Management Network Commercial	$7,203.75
Rate for Payer: Kaiser Permanente Commercial	$5,339.25
Rate for Payer: Kaiser Permanente Medicaid	$4,322.25
Rate for Payer: MDX Hawaii PPO	$8,220.75
Rate for Payer: University Health Alliance Commercial	$4,746.00

Plate T 2.7mm 3 Hole HD 6 Hole AR-18827P-19 [3644813]

Facility

$8,475.00

Service Code	HCPCS C1713
Hospital Charge Code	3644813
Hospital Revenue Code	278
Min. Negotiated Rate	$4,746.00
Max. Negotiated Rate	$8,220.75
Rate for Payer: Cash Price	$5,508.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,932.50
Rate for Payer: Health Management Network Commercial	$7,203.75
Rate for Payer: MDX Hawaii PPO	$8,220.75
Rate for Payer: University Health Alliance Commercial	$4,746.00

Plate T Compression 4 Hole P53-152-0001 [3644541]

Facility

$7,089.00

Service Code	HCPCS C1713
Hospital Charge Code	3644541
Hospital Revenue Code	278
Min. Negotiated Rate	$3,615.39
Max. Negotiated Rate	$6,876.33
Rate for Payer: Cash Price	$4,607.85
Rate for Payer: Hawaii Western Management Group Commercial	$4,962.30
Rate for Payer: Health Management Network Commercial	$6,025.65
Rate for Payer: Kaiser Permanente Commercial	$4,466.07
Rate for Payer: Kaiser Permanente Medicaid	$3,615.39
Rate for Payer: MDX Hawaii PPO	$6,876.33
Rate for Payer: University Health Alliance Commercial	$3,969.84

Plate T Compression 4 Hole P53-152-0001 [3644541]

Facility

$7,089.00

Service Code	HCPCS C1713
Hospital Charge Code	3644541
Hospital Revenue Code	278
Min. Negotiated Rate	$3,969.84
Max. Negotiated Rate	$6,876.33
Rate for Payer: Cash Price	$4,607.85
Rate for Payer: Hawaii Western Management Group Commercial	$4,962.30
Rate for Payer: Health Management Network Commercial	$6,025.65
Rate for Payer: MDX Hawaii PPO	$6,876.33
Rate for Payer: University Health Alliance Commercial	$3,969.84

Plate Tibial A/p Sloped Osteotomy 11mm AR-13200ST-11.0 [3644005]

Facility

$4,167.50

Service Code	HCPCS C1713
Hospital Charge Code	3644005
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.43
Max. Negotiated Rate	$4,042.47
Rate for Payer: Cash Price	$2,708.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,917.25
Rate for Payer: Health Management Network Commercial	$3,542.38
Rate for Payer: Kaiser Permanente Commercial	$2,625.53
Rate for Payer: Kaiser Permanente Medicaid	$2,125.43
Rate for Payer: MDX Hawaii PPO	$4,042.47
Rate for Payer: University Health Alliance Commercial	$2,333.80

Plate Tibial A/p Sloped Osteotomy 11mm AR-13200ST-11.0 [3644005]

Facility

$4,167.50

Service Code	HCPCS C1713
Hospital Charge Code	3644005
Hospital Revenue Code	278
Min. Negotiated Rate	$2,333.80
Max. Negotiated Rate	$4,042.47
Rate for Payer: Cash Price	$2,708.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,917.25
Rate for Payer: Health Management Network Commercial	$3,542.38
Rate for Payer: MDX Hawaii PPO	$4,042.47
Rate for Payer: University Health Alliance Commercial	$2,333.80

Plate T Locking 1.6mm 4X8 333-1607 [3642103]

Facility

$2,041.88

Service Code	HCPCS C1713
Hospital Charge Code	3642103
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.45
Max. Negotiated Rate	$1,980.62
Rate for Payer: Cash Price	$1,327.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,429.32
Rate for Payer: Health Management Network Commercial	$1,735.60
Rate for Payer: MDX Hawaii PPO	$1,980.62
Rate for Payer: University Health Alliance Commercial	$1,143.45

Plate T Locking 1.6mm 4X8 333-1607 [3642103]

Facility

$2,041.88

Service Code	HCPCS C1713
Hospital Charge Code	3642103
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.36
Max. Negotiated Rate	$1,980.62
Rate for Payer: Cash Price	$1,327.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,429.32
Rate for Payer: Health Management Network Commercial	$1,735.60
Rate for Payer: Kaiser Permanente Commercial	$1,286.38
Rate for Payer: Kaiser Permanente Medicaid	$1,041.36
Rate for Payer: MDX Hawaii PPO	$1,980.62
Rate for Payer: University Health Alliance Commercial	$1,143.45

Plate VA LCP Clavicle Lat Rt CS1 2.7mm 02.112.611 [3644377]

Facility

$6,735.15

Service Code	HCPCS C1713
Hospital Charge Code	3644377
Hospital Revenue Code	278
Min. Negotiated Rate	$3,771.68
Max. Negotiated Rate	$6,533.10
Rate for Payer: Cash Price	$4,377.85
Rate for Payer: Hawaii Western Management Group Commercial	$4,714.60
Rate for Payer: Health Management Network Commercial	$5,724.88
Rate for Payer: MDX Hawaii PPO	$6,533.10
Rate for Payer: University Health Alliance Commercial	$3,771.68

Plate VA LCP Clavicle Lat Rt CS1 2.7mm 02.112.611 [3644377]

Facility

$6,735.15

Service Code	HCPCS C1713
Hospital Charge Code	3644377
Hospital Revenue Code	278
Min. Negotiated Rate	$3,434.93
Max. Negotiated Rate	$6,533.10
Rate for Payer: Cash Price	$4,377.85
Rate for Payer: Hawaii Western Management Group Commercial	$4,714.60
Rate for Payer: Health Management Network Commercial	$5,724.88
Rate for Payer: Kaiser Permanente Commercial	$4,243.14
Rate for Payer: Kaiser Permanente Medicaid	$3,434.93
Rate for Payer: MDX Hawaii PPO	$6,533.10
Rate for Payer: University Health Alliance Commercial	$3,771.68

Plate VA LCP Clavicle Shaft Rt CS1 2.7mm 02.112.621 [3644359]

Facility

$6,479.13

Service Code	HCPCS C1713
Hospital Charge Code	3644359
Hospital Revenue Code	278
Min. Negotiated Rate	$3,304.36
Max. Negotiated Rate	$6,284.76
Rate for Payer: Cash Price	$4,211.43
Rate for Payer: Hawaii Western Management Group Commercial	$4,535.39
Rate for Payer: Health Management Network Commercial	$5,507.26
Rate for Payer: Kaiser Permanente Commercial	$4,081.85
Rate for Payer: Kaiser Permanente Medicaid	$3,304.36
Rate for Payer: MDX Hawaii PPO	$6,284.76
Rate for Payer: University Health Alliance Commercial	$3,628.31

Plate VA LCP Clavicle Shaft Rt CS1 2.7mm 02.112.621 [3644359]

Facility

$6,479.13

Service Code	HCPCS C1713
Hospital Charge Code	3644359
Hospital Revenue Code	278
Min. Negotiated Rate	$3,628.31
Max. Negotiated Rate	$6,284.76
Rate for Payer: Cash Price	$4,211.43
Rate for Payer: Hawaii Western Management Group Commercial	$4,535.39
Rate for Payer: Health Management Network Commercial	$5,507.26
Rate for Payer: MDX Hawaii PPO	$6,284.76
Rate for Payer: University Health Alliance Commercial	$3,628.31

Plate Valcp Cvd Condylar 4.5mm 10h Lt 02.124.411 [3640717]

Facility

$5,411.33

Service Code	HCPCS C1713
Hospital Charge Code	3640717
Hospital Revenue Code	278
Min. Negotiated Rate	$2,759.78
Max. Negotiated Rate	$5,248.99
Rate for Payer: Cash Price	$3,517.36
Rate for Payer: Hawaii Western Management Group Commercial	$3,787.93
Rate for Payer: Health Management Network Commercial	$4,599.63
Rate for Payer: Kaiser Permanente Commercial	$3,409.14
Rate for Payer: Kaiser Permanente Medicaid	$2,759.78
Rate for Payer: MDX Hawaii PPO	$5,248.99
Rate for Payer: University Health Alliance Commercial	$3,030.34

Plate Valcp Cvd Condylar 4.5mm 10h Lt 02.124.411 [3640717]

Facility

$5,411.33

Service Code	HCPCS C1713
Hospital Charge Code	3640717
Hospital Revenue Code	278
Min. Negotiated Rate	$3,030.34
Max. Negotiated Rate	$5,248.99
Rate for Payer: Cash Price	$3,517.36
Rate for Payer: Hawaii Western Management Group Commercial	$3,787.93
Rate for Payer: Health Management Network Commercial	$4,599.63
Rate for Payer: MDX Hawaii PPO	$5,248.99
Rate for Payer: University Health Alliance Commercial	$3,030.34

Plate VALCP CVD Condylar 4.5mm 10h Rt 02.124.410 [3645417]

Facility

$11,441.78

Service Code	HCPCS C1713
Hospital Charge Code	3645417
Hospital Revenue Code	278
Min. Negotiated Rate	$5,835.31
Max. Negotiated Rate	$11,098.53
Rate for Payer: Cash Price	$7,437.16
Rate for Payer: Hawaii Western Management Group Commercial	$8,009.25
Rate for Payer: Health Management Network Commercial	$9,725.51
Rate for Payer: Kaiser Permanente Commercial	$7,208.32
Rate for Payer: Kaiser Permanente Medicaid	$5,835.31
Rate for Payer: MDX Hawaii PPO	$11,098.53
Rate for Payer: University Health Alliance Commercial	$6,407.40

Plate VALCP CVD Condylar 4.5mm 10h Rt 02.124.410 [3645417]

Facility

$11,441.78

Service Code	HCPCS C1713
Hospital Charge Code	3645417
Hospital Revenue Code	278
Min. Negotiated Rate	$6,407.40
Max. Negotiated Rate	$11,098.53
Rate for Payer: Cash Price	$7,437.16
Rate for Payer: Hawaii Western Management Group Commercial	$8,009.25
Rate for Payer: Health Management Network Commercial	$9,725.51
Rate for Payer: MDX Hawaii PPO	$11,098.53
Rate for Payer: University Health Alliance Commercial	$6,407.40

Plate Valcp Cvd Condylar 4.5mm 8h Lt 02.124.409 [3640481]

Facility

$8,740.76

Service Code	HCPCS C1713
Hospital Charge Code	3640481
Hospital Revenue Code	278
Min. Negotiated Rate	$4,894.83
Max. Negotiated Rate	$8,478.54
Rate for Payer: Cash Price	$5,681.49
Rate for Payer: Hawaii Western Management Group Commercial	$6,118.53
Rate for Payer: Health Management Network Commercial	$7,429.65
Rate for Payer: MDX Hawaii PPO	$8,478.54
Rate for Payer: University Health Alliance Commercial	$4,894.83

Plate Valcp Cvd Condylar 4.5mm 8h Lt 02.124.409 [3640481]

Facility

$8,740.76

Service Code	HCPCS C1713
Hospital Charge Code	3640481
Hospital Revenue Code	278
Min. Negotiated Rate	$4,457.79
Max. Negotiated Rate	$8,478.54
Rate for Payer: Cash Price	$5,681.49
Rate for Payer: Hawaii Western Management Group Commercial	$6,118.53
Rate for Payer: Health Management Network Commercial	$7,429.65
Rate for Payer: Kaiser Permanente Commercial	$5,506.68
Rate for Payer: Kaiser Permanente Medicaid	$4,457.79
Rate for Payer: MDX Hawaii PPO	$8,478.54
Rate for Payer: University Health Alliance Commercial	$4,894.83

Plate Valcp Cvd Condylar 4.5mm 8h Rt 02.124.408S [3643873]

Facility

$9,465.26

Service Code	HCPCS C1713
Hospital Charge Code	3643873
Hospital Revenue Code	278
Min. Negotiated Rate	$5,300.55
Max. Negotiated Rate	$9,181.30
Rate for Payer: Cash Price	$6,152.42
Rate for Payer: Hawaii Western Management Group Commercial	$6,625.68
Rate for Payer: Health Management Network Commercial	$8,045.47
Rate for Payer: MDX Hawaii PPO	$9,181.30
Rate for Payer: University Health Alliance Commercial	$5,300.55

Plate Valcp Cvd Condylar 4.5mm 8h Rt 02.124.408S [3643873]

Facility

$9,465.26

Service Code	HCPCS C1713
Hospital Charge Code	3643873
Hospital Revenue Code	278
Min. Negotiated Rate	$4,827.28
Max. Negotiated Rate	$9,181.30
Rate for Payer: Cash Price	$6,152.42
Rate for Payer: Hawaii Western Management Group Commercial	$6,625.68
Rate for Payer: Health Management Network Commercial	$8,045.47
Rate for Payer: Kaiser Permanente Commercial	$5,963.11
Rate for Payer: Kaiser Permanente Medicaid	$4,827.28
Rate for Payer: MDX Hawaii PPO	$9,181.30
Rate for Payer: University Health Alliance Commercial	$5,300.55

Plate Valcp Ext Med Dist Hum X-Long 6h Rt [3643840]

Facility

$3,546.60

Service Code	HCPCS C1713
Hospital Charge Code	3643840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,986.10
Max. Negotiated Rate	$3,440.20
Rate for Payer: Cash Price	$2,305.29
Rate for Payer: Hawaii Western Management Group Commercial	$2,482.62
Rate for Payer: Health Management Network Commercial	$3,014.61
Rate for Payer: MDX Hawaii PPO	$3,440.20
Rate for Payer: University Health Alliance Commercial	$1,986.10

Plate Valcp Ext Med Dist Hum X-Long 6h Rt [3643840]

Facility

$3,546.60

Service Code	HCPCS C1713
Hospital Charge Code	3643840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.77
Max. Negotiated Rate	$3,440.20
Rate for Payer: Cash Price	$2,305.29
Rate for Payer: Hawaii Western Management Group Commercial	$2,482.62
Rate for Payer: Health Management Network Commercial	$3,014.61
Rate for Payer: Kaiser Permanente Commercial	$2,234.36
Rate for Payer: Kaiser Permanente Medicaid	$1,808.77
Rate for Payer: MDX Hawaii PPO	$3,440.20
Rate for Payer: University Health Alliance Commercial	$1,986.10

Plate VALCP Lat Dist Fib 2.7mm 4H LT 02.118.403 [3640505]

Facility

$3,204.71

Service Code	HCPCS C1713
Hospital Charge Code	3640505
Hospital Revenue Code	278
Min. Negotiated Rate	$1,634.40
Max. Negotiated Rate	$3,108.57
Rate for Payer: Cash Price	$2,083.06
Rate for Payer: Hawaii Western Management Group Commercial	$2,243.30
Rate for Payer: Health Management Network Commercial	$2,724.00
Rate for Payer: Kaiser Permanente Commercial	$2,018.97
Rate for Payer: Kaiser Permanente Medicaid	$1,634.40
Rate for Payer: MDX Hawaii PPO	$3,108.57
Rate for Payer: University Health Alliance Commercial	$1,794.64

Know your out-of-pocket cost for care.

All Charges