Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw 1.5 Cortex Slf-Tpng T4 Sd Rec 15 02.214.115 [3645542]

Facility

$540.95

Service Code	HCPCS C1713
Hospital Charge Code	3645542
Hospital Revenue Code	278
Min. Negotiated Rate	$302.93
Max. Negotiated Rate	$524.72
Rate for Payer: Cash Price	$351.62
Rate for Payer: Hawaii Western Management Group Commercial	$378.67
Rate for Payer: Health Management Network Commercial	$459.81
Rate for Payer: MDX Hawaii PPO	$524.72
Rate for Payer: University Health Alliance Commercial	$302.93

Screw 1.5 VA-Lcking Scr Slf-Tpng T4 SD Rec 11 02.130.210 [3645544]

Facility

$1,013.79

Service Code	HCPCS C1713
Hospital Charge Code	3645544
Hospital Revenue Code	278
Min. Negotiated Rate	$517.03
Max. Negotiated Rate	$983.38
Rate for Payer: Cash Price	$658.96
Rate for Payer: Hawaii Western Management Group Commercial	$709.65
Rate for Payer: Health Management Network Commercial	$861.72
Rate for Payer: Kaiser Permanente Commercial	$638.69
Rate for Payer: Kaiser Permanente Medicaid	$517.03
Rate for Payer: MDX Hawaii PPO	$983.38
Rate for Payer: University Health Alliance Commercial	$567.72

Screw 1.5 VA-Lcking Scr Slf-Tpng T4 SD Rec 11 02.130.210 [3645544]

Facility

$1,013.79

Service Code	HCPCS C1713
Hospital Charge Code	3645544
Hospital Revenue Code	278
Min. Negotiated Rate	$567.72
Max. Negotiated Rate	$983.38
Rate for Payer: Cash Price	$658.96
Rate for Payer: Hawaii Western Management Group Commercial	$709.65
Rate for Payer: Health Management Network Commercial	$861.72
Rate for Payer: MDX Hawaii PPO	$983.38
Rate for Payer: University Health Alliance Commercial	$567.72

Screw 5.0mm Canc NCB 65mm 02.03152.065 [3642027]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3642027
Hospital Revenue Code	278
Min. Negotiated Rate	$658.23
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: Kaiser Permanente Commercial	$813.10
Rate for Payer: Kaiser Permanente Medicaid	$658.23
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 65mm 02.03152.065 [3642027]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3642027
Hospital Revenue Code	278
Min. Negotiated Rate	$722.76
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 80mm 02.03152.080 [3641295]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3641295
Hospital Revenue Code	278
Min. Negotiated Rate	$658.23
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: Kaiser Permanente Commercial	$813.10
Rate for Payer: Kaiser Permanente Medicaid	$658.23
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 80mm 02.03152.080 [3641295]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3641295
Hospital Revenue Code	278
Min. Negotiated Rate	$722.76
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 85mm 02.03152.085 [3641296]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3641296
Hospital Revenue Code	278
Min. Negotiated Rate	$658.23
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: Kaiser Permanente Commercial	$813.10
Rate for Payer: Kaiser Permanente Medicaid	$658.23
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 85mm 02.03152.085 [3641296]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3641296
Hospital Revenue Code	278
Min. Negotiated Rate	$722.76
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 90mm 02.03152.090 [3644822]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3644822
Hospital Revenue Code	278
Min. Negotiated Rate	$658.23
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: Kaiser Permanente Commercial	$813.10
Rate for Payer: Kaiser Permanente Medicaid	$658.23
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Canc NCB 90mm 02.03152.090 [3644822]

Facility

$1,290.64

Service Code	HCPCS C1713
Hospital Charge Code	3644822
Hospital Revenue Code	278
Min. Negotiated Rate	$722.76
Max. Negotiated Rate	$1,251.92
Rate for Payer: Cash Price	$838.92
Rate for Payer: Hawaii Western Management Group Commercial	$903.45
Rate for Payer: Health Management Network Commercial	$1,097.04
Rate for Payer: MDX Hawaii PPO	$1,251.92
Rate for Payer: University Health Alliance Commercial	$722.76

Screw 5.0mm Cort NCB 28mm Self Tap 02.03150.028 [3644824]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3644824
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw 5.0mm Cort NCB 28mm Self Tap 02.03150.028 [3644824]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3644824
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw Affixus Blunt Tip 4.0mmX40mm 47-2486-040-40 [3642061]

Facility

$1,534.80

Service Code	HCPCS C1713
Hospital Charge Code	3642061
Hospital Revenue Code	278
Min. Negotiated Rate	$782.75
Max. Negotiated Rate	$1,488.76
Rate for Payer: Cash Price	$997.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.36
Rate for Payer: Health Management Network Commercial	$1,304.58
Rate for Payer: Kaiser Permanente Commercial	$966.92
Rate for Payer: Kaiser Permanente Medicaid	$782.75
Rate for Payer: MDX Hawaii PPO	$1,488.76
Rate for Payer: University Health Alliance Commercial	$859.49

Screw Affixus Blunt Tip 4.0mmX40mm 47-2486-040-40 [3642061]

Facility

$1,534.80

Service Code	HCPCS C1713
Hospital Charge Code	3642061
Hospital Revenue Code	278
Min. Negotiated Rate	$859.49
Max. Negotiated Rate	$1,488.76
Rate for Payer: Cash Price	$997.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.36
Rate for Payer: Health Management Network Commercial	$1,304.58
Rate for Payer: MDX Hawaii PPO	$1,488.76
Rate for Payer: University Health Alliance Commercial	$859.49

Screw Affixus Blunt Tip 4.0mm x 44mm 47-2486-044-40 [3644355]

Facility

$1,534.80

Service Code	HCPCS C1713
Hospital Charge Code	3644355
Hospital Revenue Code	278
Min. Negotiated Rate	$782.75
Max. Negotiated Rate	$1,488.76
Rate for Payer: Cash Price	$997.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.36
Rate for Payer: Health Management Network Commercial	$1,304.58
Rate for Payer: Kaiser Permanente Commercial	$966.92
Rate for Payer: Kaiser Permanente Medicaid	$782.75
Rate for Payer: MDX Hawaii PPO	$1,488.76
Rate for Payer: University Health Alliance Commercial	$859.49

Screw Affixus Blunt Tip 4.0mm x 44mm 47-2486-044-40 [3644355]

Facility

$1,534.80

Service Code	HCPCS C1713
Hospital Charge Code	3644355
Hospital Revenue Code	278
Min. Negotiated Rate	$859.49
Max. Negotiated Rate	$1,488.76
Rate for Payer: Cash Price	$997.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.36
Rate for Payer: Health Management Network Commercial	$1,304.58
Rate for Payer: MDX Hawaii PPO	$1,488.76
Rate for Payer: University Health Alliance Commercial	$859.49

Screw Ann Cortical Bone 4.0mmX26mm 47-2486-126-40 [3643248]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3643248
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw Ann Cortical Bone 4.0mmX26mm 47-2486-126-40 [3643248]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3643248
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw Ann Cortical Bone 4.0mm x 30mm 47-2486-130-40 [3644357]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3644357
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw Ann Cortical Bone 4.0mm x 30mm 47-2486-130-40 [3644357]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3644357
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw Anti-Rotation 5.0mm x 70mm AR-9094AR-070 [3644737]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644737
Hospital Revenue Code	278
Min. Negotiated Rate	$2,108.68
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Screw Anti-Rotation 5.0mm x 70mm AR-9094AR-070 [3644737]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.40
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: Kaiser Permanente Commercial	$2,372.26
Rate for Payer: Kaiser Permanente Medicaid	$1,920.40
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Screw Anti-Rotation 5.0mmx75mm AR-9094AR-075 [3645423]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3645423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.40
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: Kaiser Permanente Commercial	$2,372.26
Rate for Payer: Kaiser Permanente Medicaid	$1,920.40
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Screw Anti-Rotation 5.0mmx75mm AR-9094AR-075 [3645423]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3645423
Hospital Revenue Code	278
Min. Negotiated Rate	$2,108.68
Max. Negotiated Rate	$3,652.53
Rate for Payer: Cash Price	$2,447.58
Rate for Payer: Hawaii Western Management Group Commercial	$2,635.85
Rate for Payer: Health Management Network Commercial	$3,200.68
Rate for Payer: MDX Hawaii PPO	$3,652.53
Rate for Payer: University Health Alliance Commercial	$2,108.68

Know your out-of-pocket cost for care.

All Charges