Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,518.44
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 Beveled Ft 3.5 x 42mm AR-8735BV-42 [3644508]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644508
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

Screw Beveled Ft 3.5 x 42mm AR-8735BV-42 [3644508]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644508
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

Screw Beveled Ft 3.5 x 48mm AR-8735BV-48 [3644509]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644509
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

Screw Beveled Ft 3.5 x 48mm AR-8735BV-48 [3644509]

Facility

$6,140.50

Service Code	HCPCS C1713
Hospital Charge Code	3644509
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

Screw Bone HGP II Acetabular Cup ST 6.5mmX20mm 662406520 [3642862]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3642862
Hospital Revenue Code	278
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: Kaiser Permanente Commercial	$194.51
Rate for Payer: Kaiser Permanente Medicaid	$157.46
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone HGP II Acetabular Cup ST 6.5mmX20mm 662406520 [3642862]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3642862
Hospital Revenue Code	278
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone HGP II Acetabular Cup ST 6.5mmX30mm 662406530 [3642328]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3642328
Hospital Revenue Code	278
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: Kaiser Permanente Commercial	$194.51
Rate for Payer: Kaiser Permanente Medicaid	$157.46
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone HGP II Acetabular Cup ST 6.5mmX30mm 662406530 [3642328]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3642328
Hospital Revenue Code	278
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone HGP II Acetabular Cup ST 6.5mmX40mm 662406540 [3642864]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3642864
Hospital Revenue Code	278
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: Kaiser Permanente Commercial	$194.51
Rate for Payer: Kaiser Permanente Medicaid	$157.46
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone HGP II Acetabular Cup ST 6.5mmX40mm 662406540 [3642864]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3642864
Hospital Revenue Code	278
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone Hgp II Acet Cup St 6.5x15mm 00-6624-065-15 [3643860]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3643860
Hospital Revenue Code	278
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone Hgp II Acet Cup St 6.5x15mm 00-6624-065-15 [3643860]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3643860
Hospital Revenue Code	278
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: Kaiser Permanente Commercial	$194.51
Rate for Payer: Kaiser Permanente Medicaid	$157.46
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone Hgp II Acet Cup St 6.5x50mm 00-6624-065-50 [3643861]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3643861
Hospital Revenue Code	278
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: Kaiser Permanente Commercial	$194.51
Rate for Payer: Kaiser Permanente Medicaid	$157.46
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Screw Bone Hgp II Acet Cup St 6.5x50mm 00-6624-065-50 [3643861]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3643861
Hospital Revenue Code	278
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

SCREW BONE LAG AFFIXUS HFN 10.5X90MM [00080859]

Facility

$3,762.00

Service Code	HCPCS C1713
Hospital Charge Code	00080859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,918.62
Max. Negotiated Rate	$3,649.14
Rate for Payer: Cash Price	$2,445.30
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$3,197.70
Rate for Payer: Kaiser Permanente Commercial	$2,370.06
Rate for Payer: Kaiser Permanente Medicaid	$1,918.62
Rate for Payer: MDX Hawaii PPO	$3,649.14
Rate for Payer: University Health Alliance Commercial	$2,106.72

SCREW BONE LAG AFFIXUS HFN 10.5X90MM [00080859]

Facility

$3,762.00

Service Code	HCPCS C1713
Hospital Charge Code	00080859
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.72
Max. Negotiated Rate	$3,649.14
Rate for Payer: Cash Price	$2,445.30
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$3,197.70
Rate for Payer: MDX Hawaii PPO	$3,649.14
Rate for Payer: University Health Alliance Commercial	$2,106.72

Screw Canc 4.0mm x 12mm 206.012 [3606536]

Facility

$184.64

Service Code	HCPCS C1713
Hospital Charge Code	3606536
Hospital Revenue Code	278
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$179.10
Rate for Payer: Cash Price	$120.02
Rate for Payer: Hawaii Western Management Group Commercial	$129.25
Rate for Payer: Health Management Network Commercial	$156.94
Rate for Payer: MDX Hawaii PPO	$179.10
Rate for Payer: University Health Alliance Commercial	$103.40

Screw Canc 4.0mm x 12mm 206.012 [3606536]

Facility

$184.64

Service Code	HCPCS C1713
Hospital Charge Code	3606536
Hospital Revenue Code	278
Min. Negotiated Rate	$94.17
Max. Negotiated Rate	$179.10
Rate for Payer: Cash Price	$120.02
Rate for Payer: Hawaii Western Management Group Commercial	$129.25
Rate for Payer: Health Management Network Commercial	$156.94
Rate for Payer: Kaiser Permanente Commercial	$116.32
Rate for Payer: Kaiser Permanente Medicaid	$94.17
Rate for Payer: MDX Hawaii PPO	$179.10
Rate for Payer: University Health Alliance Commercial	$103.40

Screw Canc 4.0mm x 14mm 206.014 [3606555]

Facility

$184.64

Service Code	HCPCS C1713
Hospital Charge Code	3606555
Hospital Revenue Code	278
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$179.10
Rate for Payer: Cash Price	$120.02
Rate for Payer: Hawaii Western Management Group Commercial	$129.25
Rate for Payer: Health Management Network Commercial	$156.94
Rate for Payer: MDX Hawaii PPO	$179.10
Rate for Payer: University Health Alliance Commercial	$103.40

Screw Canc 4.0mm x 14mm 206.014 [3606555]

Facility

$184.64

Service Code	HCPCS C1713
Hospital Charge Code	3606555
Hospital Revenue Code	278
Min. Negotiated Rate	$94.17
Max. Negotiated Rate	$179.10
Rate for Payer: Cash Price	$120.02
Rate for Payer: Hawaii Western Management Group Commercial	$129.25
Rate for Payer: Health Management Network Commercial	$156.94
Rate for Payer: Kaiser Permanente Commercial	$116.32
Rate for Payer: Kaiser Permanente Medicaid	$94.17
Rate for Payer: MDX Hawaii PPO	$179.10
Rate for Payer: University Health Alliance Commercial	$103.40

Screw Canc 4.0mm x 16mm 206.016 [3606556]

Facility

$184.64

Service Code	HCPCS C1713
Hospital Charge Code	3606556
Hospital Revenue Code	278
Min. Negotiated Rate	$94.17
Max. Negotiated Rate	$179.10
Rate for Payer: Cash Price	$120.02
Rate for Payer: Hawaii Western Management Group Commercial	$129.25
Rate for Payer: Health Management Network Commercial	$156.94
Rate for Payer: Kaiser Permanente Commercial	$116.32
Rate for Payer: Kaiser Permanente Medicaid	$94.17
Rate for Payer: MDX Hawaii PPO	$179.10
Rate for Payer: University Health Alliance Commercial	$103.40

Screw Canc 4.0mm x 16mm 206.016 [3606556]

Facility

$184.64

Service Code	HCPCS C1713
Hospital Charge Code	3606556
Hospital Revenue Code	278
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$179.10
Rate for Payer: Cash Price	$120.02
Rate for Payer: Hawaii Western Management Group Commercial	$129.25
Rate for Payer: Health Management Network Commercial	$156.94
Rate for Payer: MDX Hawaii PPO	$179.10
Rate for Payer: University Health Alliance Commercial	$103.40

Screw Canc 4.0mm x 18mm 206.018 [3606557]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3606557
Hospital Revenue Code	278
Min. Negotiated Rate	$241.49
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Canc 4.0mm x 18mm 206.018 [3606557]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3606557
Hospital Revenue Code	278
Min. Negotiated Rate	$219.93
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: Kaiser Permanente Commercial	$271.68
Rate for Payer: Kaiser Permanente Medicaid	$219.93
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Know your out-of-pocket cost for care.

All Charges