Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,794.64
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: MDX Hawaii PPO	$3,108.57
Rate for Payer: University Health Alliance Commercial	$1,794.64

Plate VALCP Lat Dist Fib 2.7mm 4H Rt 02.118.402 [3640676]

Facility

$3,204.71

Service Code	HCPCS C1713
Hospital Charge Code	3640676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,794.64
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: MDX Hawaii PPO	$3,108.57
Rate for Payer: University Health Alliance Commercial	$1,794.64

Plate VALCP Lat Dist Fib 2.7mm 4H Rt 02.118.402 [3640676]

Facility

$3,204.71

Service Code	HCPCS C1713
Hospital Charge Code	3640676
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

Plate VA LCP Lat Dist Fib 2.7mm 5H Lt 02.118.405 [3640767]

Facility

$4,831.37

Service Code	HCPCS C1713
Hospital Charge Code	3640767
Hospital Revenue Code	278
Min. Negotiated Rate	$2,464.00
Max. Negotiated Rate	$4,686.43
Rate for Payer: Cash Price	$3,140.39
Rate for Payer: Hawaii Western Management Group Commercial	$3,381.96
Rate for Payer: Health Management Network Commercial	$4,106.66
Rate for Payer: Kaiser Permanente Commercial	$3,043.76
Rate for Payer: Kaiser Permanente Medicaid	$2,464.00
Rate for Payer: MDX Hawaii PPO	$4,686.43
Rate for Payer: University Health Alliance Commercial	$2,705.57

Plate VA LCP Lat Dist Fib 2.7mm 5H Lt 02.118.405 [3640767]

Facility

$4,831.37

Service Code	HCPCS C1713
Hospital Charge Code	3640767
Hospital Revenue Code	278
Min. Negotiated Rate	$2,705.57
Max. Negotiated Rate	$4,686.43
Rate for Payer: Cash Price	$3,140.39
Rate for Payer: Hawaii Western Management Group Commercial	$3,381.96
Rate for Payer: Health Management Network Commercial	$4,106.66
Rate for Payer: MDX Hawaii PPO	$4,686.43
Rate for Payer: University Health Alliance Commercial	$2,705.57

Plate VA LCP Lat Dist Fib 2.7mm 7H Rt 02.118.408 [3640591]

Facility

$5,038.56

Service Code	HCPCS C1713
Hospital Charge Code	3640591
Hospital Revenue Code	278
Min. Negotiated Rate	$2,569.67
Max. Negotiated Rate	$4,887.40
Rate for Payer: Cash Price	$3,275.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,526.99
Rate for Payer: Health Management Network Commercial	$4,282.78
Rate for Payer: Kaiser Permanente Commercial	$3,174.29
Rate for Payer: Kaiser Permanente Medicaid	$2,569.67
Rate for Payer: MDX Hawaii PPO	$4,887.40
Rate for Payer: University Health Alliance Commercial	$2,821.59

Plate VA LCP Lat Dist Fib 2.7mm 7H Rt 02.118.408 [3640591]

Facility

$5,038.56

Service Code	HCPCS C1713
Hospital Charge Code	3640591
Hospital Revenue Code	278
Min. Negotiated Rate	$2,821.59
Max. Negotiated Rate	$4,887.40
Rate for Payer: Cash Price	$3,275.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,526.99
Rate for Payer: Health Management Network Commercial	$4,282.78
Rate for Payer: MDX Hawaii PPO	$4,887.40
Rate for Payer: University Health Alliance Commercial	$2,821.59

Plate Valcp Pl Dist Hum W/lat Support 7h Rt [3643839]

Facility

$3,546.60

Service Code	HCPCS C1713
Hospital Charge Code	3643839
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 Pl Dist Hum W/lat Support 7h Rt [3643839]

Facility

$3,546.60

Service Code	HCPCS C1713
Hospital Charge Code	3643839
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 Prox Tibia 3.5mm 4H 87mm Rt 02.127.210 [3644629]

Facility

$9,407.05

Service Code	HCPCS C1713
Hospital Charge Code	3644629
Hospital Revenue Code	278
Min. Negotiated Rate	$4,797.60
Max. Negotiated Rate	$9,124.84
Rate for Payer: Cash Price	$6,114.58
Rate for Payer: Hawaii Western Management Group Commercial	$6,584.94
Rate for Payer: Health Management Network Commercial	$7,995.99
Rate for Payer: Kaiser Permanente Commercial	$5,926.44
Rate for Payer: Kaiser Permanente Medicaid	$4,797.60
Rate for Payer: MDX Hawaii PPO	$9,124.84
Rate for Payer: University Health Alliance Commercial	$5,267.95

Plate VALCP Prox Tibia 3.5mm 4H 87mm Rt 02.127.210 [3644629]

Facility

$9,407.05

Service Code	HCPCS C1713
Hospital Charge Code	3644629
Hospital Revenue Code	278
Min. Negotiated Rate	$5,267.95
Max. Negotiated Rate	$9,124.84
Rate for Payer: Cash Price	$6,114.58
Rate for Payer: Hawaii Western Management Group Commercial	$6,584.94
Rate for Payer: Health Management Network Commercial	$7,995.99
Rate for Payer: MDX Hawaii PPO	$9,124.84
Rate for Payer: University Health Alliance Commercial	$5,267.95

Plate VALCP Prox Tibia 3.5mm 6H Rt 02.127.220 [3640592]

Facility

$7,984.86

Service Code	HCPCS C1713
Hospital Charge Code	3640592
Hospital Revenue Code	278
Min. Negotiated Rate	$4,471.52
Max. Negotiated Rate	$7,745.31
Rate for Payer: Cash Price	$5,190.16
Rate for Payer: Hawaii Western Management Group Commercial	$5,589.40
Rate for Payer: Health Management Network Commercial	$6,787.13
Rate for Payer: MDX Hawaii PPO	$7,745.31
Rate for Payer: University Health Alliance Commercial	$4,471.52

Plate VALCP Prox Tibia 3.5mm 6H Rt 02.127.220 [3640592]

Facility

$7,984.86

Service Code	HCPCS C1713
Hospital Charge Code	3640592
Hospital Revenue Code	278
Min. Negotiated Rate	$4,072.28
Max. Negotiated Rate	$7,745.31
Rate for Payer: Cash Price	$5,190.16
Rate for Payer: Hawaii Western Management Group Commercial	$5,589.40
Rate for Payer: Health Management Network Commercial	$6,787.13
Rate for Payer: Kaiser Permanente Commercial	$5,030.46
Rate for Payer: Kaiser Permanente Medicaid	$4,072.28
Rate for Payer: MDX Hawaii PPO	$7,745.31
Rate for Payer: University Health Alliance Commercial	$4,471.52

Plate VALCP Prox Tibia 3.5mm 8H 147mm L 02.127.231 [3644608]

Facility

$11,024.05

Service Code	HCPCS C1713
Hospital Charge Code	3644608
Hospital Revenue Code	278
Min. Negotiated Rate	$5,622.27
Max. Negotiated Rate	$10,693.33
Rate for Payer: Cash Price	$7,165.63
Rate for Payer: Hawaii Western Management Group Commercial	$7,716.84
Rate for Payer: Health Management Network Commercial	$9,370.44
Rate for Payer: Kaiser Permanente Commercial	$6,945.15
Rate for Payer: Kaiser Permanente Medicaid	$5,622.27
Rate for Payer: MDX Hawaii PPO	$10,693.33
Rate for Payer: University Health Alliance Commercial	$6,173.47

Plate VALCP Prox Tibia 3.5mm 8H 147mm L 02.127.231 [3644608]

Facility

$11,024.05

Service Code	HCPCS C1713
Hospital Charge Code	3644608
Hospital Revenue Code	278
Min. Negotiated Rate	$6,173.47
Max. Negotiated Rate	$10,693.33
Rate for Payer: Cash Price	$7,165.63
Rate for Payer: Hawaii Western Management Group Commercial	$7,716.84
Rate for Payer: Health Management Network Commercial	$9,370.44
Rate for Payer: MDX Hawaii PPO	$10,693.33
Rate for Payer: University Health Alliance Commercial	$6,173.47

Plate Valcp Prox Tibia 3.5mm 8h Rt 02.127.230 [3640596]

Facility

$8,878.41

Service Code	HCPCS C1713
Hospital Charge Code	3640596
Hospital Revenue Code	278
Min. Negotiated Rate	$4,971.91
Max. Negotiated Rate	$8,612.06
Rate for Payer: Cash Price	$5,770.97
Rate for Payer: Hawaii Western Management Group Commercial	$6,214.89
Rate for Payer: Health Management Network Commercial	$7,546.65
Rate for Payer: MDX Hawaii PPO	$8,612.06
Rate for Payer: University Health Alliance Commercial	$4,971.91

Plate Valcp Prox Tibia 3.5mm 8h Rt 02.127.230 [3640596]

Facility

$8,878.41

Service Code	HCPCS C1713
Hospital Charge Code	3640596
Hospital Revenue Code	278
Min. Negotiated Rate	$4,527.99
Max. Negotiated Rate	$8,612.06
Rate for Payer: Cash Price	$5,770.97
Rate for Payer: Hawaii Western Management Group Commercial	$6,214.89
Rate for Payer: Health Management Network Commercial	$7,546.65
Rate for Payer: Kaiser Permanente Commercial	$5,593.40
Rate for Payer: Kaiser Permanente Medicaid	$4,527.99
Rate for Payer: MDX Hawaii PPO	$8,612.06
Rate for Payer: University Health Alliance Commercial	$4,971.91

Plate Va Lock 2.7mm Ant Pat 3 Hole 02.137.001S [3644177]

Facility

$10,653.44

Service Code	HCPCS C1713
Hospital Charge Code	3644177
Hospital Revenue Code	278
Min. Negotiated Rate	$5,965.93
Max. Negotiated Rate	$10,333.84
Rate for Payer: Cash Price	$6,924.74
Rate for Payer: Hawaii Western Management Group Commercial	$7,457.41
Rate for Payer: Health Management Network Commercial	$9,055.42
Rate for Payer: MDX Hawaii PPO	$10,333.84
Rate for Payer: University Health Alliance Commercial	$5,965.93

Plate Va Lock 2.7mm Ant Pat 3 Hole 02.137.001S [3644177]

Facility

$10,653.44

Service Code	HCPCS C1713
Hospital Charge Code	3644177
Hospital Revenue Code	278
Min. Negotiated Rate	$5,433.25
Max. Negotiated Rate	$10,333.84
Rate for Payer: Cash Price	$6,924.74
Rate for Payer: Hawaii Western Management Group Commercial	$7,457.41
Rate for Payer: Health Management Network Commercial	$9,055.42
Rate for Payer: Kaiser Permanente Commercial	$6,711.67
Rate for Payer: Kaiser Permanente Medicaid	$5,433.25
Rate for Payer: MDX Hawaii PPO	$10,333.84
Rate for Payer: University Health Alliance Commercial	$5,965.93

Plate VA Lock 2.7mm Ant Pat 6 Hole 02.137.005S [3644973]

Facility

$11,534.18

Service Code	HCPCS C1713
Hospital Charge Code	3644973
Hospital Revenue Code	278
Min. Negotiated Rate	$5,882.43
Max. Negotiated Rate	$11,188.15
Rate for Payer: Cash Price	$7,497.22
Rate for Payer: Hawaii Western Management Group Commercial	$8,073.93
Rate for Payer: Health Management Network Commercial	$9,804.05
Rate for Payer: Kaiser Permanente Commercial	$7,266.53
Rate for Payer: Kaiser Permanente Medicaid	$5,882.43
Rate for Payer: MDX Hawaii PPO	$11,188.15
Rate for Payer: University Health Alliance Commercial	$6,459.14

Plate VA Lock 2.7mm Ant Pat 6 Hole 02.137.005S [3644973]

Facility

$11,534.18

Service Code	HCPCS C1713
Hospital Charge Code	3644973
Hospital Revenue Code	278
Min. Negotiated Rate	$6,459.14
Max. Negotiated Rate	$11,188.15
Rate for Payer: Cash Price	$7,497.22
Rate for Payer: Hawaii Western Management Group Commercial	$8,073.93
Rate for Payer: Health Management Network Commercial	$9,804.05
Rate for Payer: MDX Hawaii PPO	$11,188.15
Rate for Payer: University Health Alliance Commercial	$6,459.14

Plate VA Prox Tibia Small Bend LT 3.5 6H 117mm 02.127.221 [3644983]

Facility

$9,639.98

Service Code	HCPCS C1713
Hospital Charge Code	3644983
Hospital Revenue Code	278
Min. Negotiated Rate	$4,916.39
Max. Negotiated Rate	$9,350.78
Rate for Payer: Cash Price	$6,265.99
Rate for Payer: Hawaii Western Management Group Commercial	$6,747.99
Rate for Payer: Health Management Network Commercial	$8,193.98
Rate for Payer: Kaiser Permanente Commercial	$6,073.19
Rate for Payer: Kaiser Permanente Medicaid	$4,916.39
Rate for Payer: MDX Hawaii PPO	$9,350.78
Rate for Payer: University Health Alliance Commercial	$5,398.39

Plate VA Prox Tibia Small Bend LT 3.5 6H 117mm 02.127.221 [3644983]

Facility

$9,639.98

Service Code	HCPCS C1713
Hospital Charge Code	3644983
Hospital Revenue Code	278
Min. Negotiated Rate	$5,398.39
Max. Negotiated Rate	$9,350.78
Rate for Payer: Cash Price	$6,265.99
Rate for Payer: Hawaii Western Management Group Commercial	$6,747.99
Rate for Payer: Health Management Network Commercial	$8,193.98
Rate for Payer: MDX Hawaii PPO	$9,350.78
Rate for Payer: University Health Alliance Commercial	$5,398.39

Plate VDR Ti Narrow Rt 3 Hole AR-8916VNR-03 [3644604]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644604
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 VDR Ti Narrow Rt 3 Hole AR-8916VNR-03 [3644604]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644604
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