Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Anti-Rotation 5.0mm x 80mm AR-9094AR-080 [3644738]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644738
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 5.0mm x 80mm AR-9094AR-080 [3644738]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644738
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 85mm AR-9094AR-085 [3644622]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644622
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 5.0mm x 85mm AR-9094AR-085 [3644622]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644622
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 90mm AR-9094AR-090 [3644656]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644656
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 5.0mm x 90mm AR-9094AR-090 [3644656]

Facility

$3,765.50

Service Code	HCPCS C1713
Hospital Charge Code	3644656
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 Antirotation for Fem Neck Sys 100mm 04.168.500S [3642036]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3642036
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 100mm 04.168.500S [3642036]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3642036
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 105mm 04.168.505S [3642277]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3642277
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 105mm 04.168.505S [3642277]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3642277
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 75mm 04.168.475S [3641730]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641730
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 75mm 04.168.475S [3641730]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641730
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 80mm 04.168.480S [3642038]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3642038
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 80mm 04.168.480S [3642038]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3642038
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 85mm 04.168.485S [3641743]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641743
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 85mm 04.168.485S [3641743]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641743
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 90mm 04.168.490S [3641983]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641983
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 90mm 04.168.490S [3641983]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641983
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 95mm 04.168.495S [3641729]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641729
Hospital Revenue Code	278
Min. Negotiated Rate	$899.45
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: Kaiser Permanente Commercial	$1,111.09
Rate for Payer: Kaiser Permanente Medicaid	$899.45
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Antirotation for Fem Neck Sys 95mm 04.168.495S [3641729]

Facility

$1,763.63

Service Code	HCPCS C1713
Hospital Charge Code	3641729
Hospital Revenue Code	278
Min. Negotiated Rate	$987.63
Max. Negotiated Rate	$1,710.72
Rate for Payer: Cash Price	$1,146.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.54
Rate for Payer: Health Management Network Commercial	$1,499.09
Rate for Payer: MDX Hawaii PPO	$1,710.72
Rate for Payer: University Health Alliance Commercial	$987.63

Screw Bc If Vented 10x20mm AR-4020C-10 [3643958]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3643958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Bc If Vented 10x20mm AR-4020C-10 [3643958]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3643958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw BC IF Vented 8 X 20mm AR4020C08 [3641850]

Facility

$1,740.75

Service Code	HCPCS C1713
Hospital Charge Code	3641850
Hospital Revenue Code	278
Min. Negotiated Rate	$887.78
Max. Negotiated Rate	$1,688.53
Rate for Payer: Cash Price	$1,131.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,218.53
Rate for Payer: Health Management Network Commercial	$1,479.64
Rate for Payer: Kaiser Permanente Commercial	$1,096.67
Rate for Payer: Kaiser Permanente Medicaid	$887.78
Rate for Payer: MDX Hawaii PPO	$1,688.53
Rate for Payer: University Health Alliance Commercial	$974.82

Screw BC IF Vented 8 X 20mm AR4020C08 [3641850]

Facility

$1,740.75

Service Code	HCPCS C1713
Hospital Charge Code	3641850
Hospital Revenue Code	278
Min. Negotiated Rate	$974.82
Max. Negotiated Rate	$1,688.53
Rate for Payer: Cash Price	$1,131.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,218.53
Rate for Payer: Health Management Network Commercial	$1,479.64
Rate for Payer: MDX Hawaii PPO	$1,688.53
Rate for Payer: University Health Alliance Commercial	$974.82

Screw Bc If Vented 9 X 20mm Ar-4020c-09 [3643410]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3643410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Know your out-of-pocket cost for care.

All Charges