Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Canc Lock 4.0mm X 44mm 816140044 [3642122]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3642122
Hospital Revenue Code	278
Min. Negotiated Rate	$710.47
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Canc Lock 4.0mmx46mm 816140046 [3644104]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3644104
Hospital Revenue Code	278
Min. Negotiated Rate	$647.03
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: Kaiser Permanente Commercial	$799.27
Rate for Payer: Kaiser Permanente Medicaid	$647.03
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Canc Lock 4.0mmx46mm 816140046 [3644104]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3644104
Hospital Revenue Code	278
Min. Negotiated Rate	$710.47
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Canc Lock 4.0mm X 55mm 816140055 [3641531]

Facility

$984.38

Service Code	HCPCS C1713
Hospital Charge Code	3641531
Hospital Revenue Code	278
Min. Negotiated Rate	$502.03
Max. Negotiated Rate	$954.85
Rate for Payer: Kaiser Permanente Commercial	$620.16
Rate for Payer: Cash Price	$639.85
Rate for Payer: Hawaii Western Management Group Commercial	$689.07
Rate for Payer: Health Management Network Commercial	$836.72
Rate for Payer: Kaiser Permanente Medicaid	$502.03
Rate for Payer: MDX Hawaii PPO	$954.85
Rate for Payer: University Health Alliance Commercial	$551.25

Screw Canc Lock 4.0mm X 55mm 816140055 [3641531]

Facility

$984.38

Service Code	HCPCS C1713
Hospital Charge Code	3641531
Hospital Revenue Code	278
Min. Negotiated Rate	$551.25
Max. Negotiated Rate	$954.85
Rate for Payer: Cash Price	$639.85
Rate for Payer: Hawaii Western Management Group Commercial	$689.07
Rate for Payer: Health Management Network Commercial	$836.72
Rate for Payer: MDX Hawaii PPO	$954.85
Rate for Payer: University Health Alliance Commercial	$551.25

Screw Canc Lock 4.0mm X 70mm 816140070 [3641529]

Facility

$984.38

Service Code	HCPCS C1713
Hospital Charge Code	3641529
Hospital Revenue Code	278
Min. Negotiated Rate	$502.03
Max. Negotiated Rate	$954.85
Rate for Payer: Cash Price	$639.85
Rate for Payer: Hawaii Western Management Group Commercial	$689.07
Rate for Payer: Health Management Network Commercial	$836.72
Rate for Payer: Kaiser Permanente Commercial	$620.16
Rate for Payer: Kaiser Permanente Medicaid	$502.03
Rate for Payer: MDX Hawaii PPO	$954.85
Rate for Payer: University Health Alliance Commercial	$551.25

Screw Canc Lock 4.0mm X 70mm 816140070 [3641529]

Facility

$984.38

Service Code	HCPCS C1713
Hospital Charge Code	3641529
Hospital Revenue Code	278
Min. Negotiated Rate	$551.25
Max. Negotiated Rate	$954.85
Rate for Payer: Cash Price	$639.85
Rate for Payer: Hawaii Western Management Group Commercial	$689.07
Rate for Payer: Health Management Network Commercial	$836.72
Rate for Payer: MDX Hawaii PPO	$954.85
Rate for Payer: University Health Alliance Commercial	$551.25

Screw Canc Lock 4.0mm X 75mm 816140075 [3641099A]

Facility

$932.75

Service Code	HCPCS C1713
Hospital Charge Code	3641099A
Hospital Revenue Code	278
Min. Negotiated Rate	$475.70
Max. Negotiated Rate	$904.77
Rate for Payer: Cash Price	$606.29
Rate for Payer: Hawaii Western Management Group Commercial	$652.92
Rate for Payer: Health Management Network Commercial	$792.84
Rate for Payer: Kaiser Permanente Commercial	$587.63
Rate for Payer: Kaiser Permanente Medicaid	$475.70
Rate for Payer: MDX Hawaii PPO	$904.77
Rate for Payer: University Health Alliance Commercial	$522.34

Screw Canc Lock 4.0mm X 75mm 816140075 [3641099A]

Facility

$932.75

Service Code	HCPCS C1713
Hospital Charge Code	3641099A
Hospital Revenue Code	278
Min. Negotiated Rate	$522.34
Max. Negotiated Rate	$904.77
Rate for Payer: Cash Price	$606.29
Rate for Payer: Hawaii Western Management Group Commercial	$652.92
Rate for Payer: Health Management Network Commercial	$792.84
Rate for Payer: MDX Hawaii PPO	$904.77
Rate for Payer: University Health Alliance Commercial	$522.34

Screw Canclus FT SS 3mm x 20mm Ar-8830-20 [3644847]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3644847
Hospital Revenue Code	278
Min. Negotiated Rate	$238.21
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3mm x 20mm Ar-8830-20 [3644847]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3644847
Hospital Revenue Code	278
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: Kaiser Permanente Commercial	$267.99
Rate for Payer: Kaiser Permanente Medicaid	$216.94
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3mm x 26mm AR-8830-26 [3644808]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3644808
Hospital Revenue Code	278
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: Kaiser Permanente Commercial	$267.99
Rate for Payer: Kaiser Permanente Medicaid	$216.94
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3mm x 26mm AR-8830-26 [3644808]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3644808
Hospital Revenue Code	278
Min. Negotiated Rate	$238.21
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3 x14mm AR-8830-14 [3641598]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3641598
Hospital Revenue Code	278
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: Kaiser Permanente Commercial	$267.99
Rate for Payer: Kaiser Permanente Medicaid	$216.94
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3 x14mm AR-8830-14 [3641598]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3641598
Hospital Revenue Code	278
Min. Negotiated Rate	$238.21
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3 x18mm AR-8830-18 [3641600]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3641600
Hospital Revenue Code	278
Min. Negotiated Rate	$238.21
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Canclus FT SS 3 x18mm AR-8830-18 [3641600]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3641600
Hospital Revenue Code	278
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: Kaiser Permanente Commercial	$267.99
Rate for Payer: Kaiser Permanente Medicaid	$216.94
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Cann 3.75mm Fully Thread 32mm AR-7000-32FT [3642520]

Facility

$1,901.75

Service Code	HCPCS C1713
Hospital Charge Code	3642520
Hospital Revenue Code	278
Min. Negotiated Rate	$969.89
Max. Negotiated Rate	$1,844.70
Rate for Payer: Cash Price	$1,236.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.22
Rate for Payer: Health Management Network Commercial	$1,616.49
Rate for Payer: Kaiser Permanente Commercial	$1,198.10
Rate for Payer: Kaiser Permanente Medicaid	$969.89
Rate for Payer: MDX Hawaii PPO	$1,844.70
Rate for Payer: University Health Alliance Commercial	$1,064.98

Screw Cann 3.75mm Fully Thread 32mm AR-7000-32FT [3642520]

Facility

$1,901.75

Service Code	HCPCS C1713
Hospital Charge Code	3642520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.98
Max. Negotiated Rate	$1,844.70
Rate for Payer: Cash Price	$1,236.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.22
Rate for Payer: Health Management Network Commercial	$1,616.49
Rate for Payer: MDX Hawaii PPO	$1,844.70
Rate for Payer: University Health Alliance Commercial	$1,064.98

Screw Cann 3.75mm Fully Thread 34mm AR-7000-34FT [3644899]

Facility

$1,901.75

Service Code	HCPCS C1713
Hospital Charge Code	3644899
Hospital Revenue Code	278
Min. Negotiated Rate	$969.89
Max. Negotiated Rate	$1,844.70
Rate for Payer: Cash Price	$1,236.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.22
Rate for Payer: Health Management Network Commercial	$1,616.49
Rate for Payer: Kaiser Permanente Commercial	$1,198.10
Rate for Payer: Kaiser Permanente Medicaid	$969.89
Rate for Payer: MDX Hawaii PPO	$1,844.70
Rate for Payer: University Health Alliance Commercial	$1,064.98

Screw Cann 3.75mm Fully Thread 34mm AR-7000-34FT [3644899]

Facility

$1,901.75

Service Code	HCPCS C1713
Hospital Charge Code	3644899
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.98
Max. Negotiated Rate	$1,844.70
Rate for Payer: Cash Price	$1,236.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,331.22
Rate for Payer: Health Management Network Commercial	$1,616.49
Rate for Payer: MDX Hawaii PPO	$1,844.70
Rate for Payer: University Health Alliance Commercial	$1,064.98

Screw Cann 4.0mm x 28mm Short Thd 207.628 [3640265B]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265B
Hospital Revenue Code	278
Min. Negotiated Rate	$694.17
Max. Negotiated Rate	$1,320.28
Rate for Payer: Cash Price	$884.72
Rate for Payer: Hawaii Western Management Group Commercial	$952.78
Rate for Payer: Health Management Network Commercial	$1,156.94
Rate for Payer: Kaiser Permanente Commercial	$857.50
Rate for Payer: Kaiser Permanente Medicaid	$694.17
Rate for Payer: MDX Hawaii PPO	$1,320.28
Rate for Payer: University Health Alliance Commercial	$762.22

Screw Cann 4.0mm x 28mm Short Thd 207.628 [3640265B]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265B
Hospital Revenue Code	278
Min. Negotiated Rate	$762.22
Max. Negotiated Rate	$1,320.28
Rate for Payer: Cash Price	$884.72
Rate for Payer: Hawaii Western Management Group Commercial	$952.78
Rate for Payer: Health Management Network Commercial	$1,156.94
Rate for Payer: MDX Hawaii PPO	$1,320.28
Rate for Payer: University Health Alliance Commercial	$762.22

Screw Cann 4.0mm x 30mm Short Thd 207.630 [3640265C]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265C
Hospital Revenue Code	278
Min. Negotiated Rate	$694.17
Max. Negotiated Rate	$1,320.28
Rate for Payer: Cash Price	$884.72
Rate for Payer: Hawaii Western Management Group Commercial	$952.78
Rate for Payer: Health Management Network Commercial	$1,156.94
Rate for Payer: Kaiser Permanente Commercial	$857.50
Rate for Payer: Kaiser Permanente Medicaid	$694.17
Rate for Payer: MDX Hawaii PPO	$1,320.28
Rate for Payer: University Health Alliance Commercial	$762.22

Screw Cann 4.0mm x 30mm Short Thd 207.630 [3640265C]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265C
Hospital Revenue Code	278
Min. Negotiated Rate	$762.22
Max. Negotiated Rate	$1,320.28
Rate for Payer: Cash Price	$884.72
Rate for Payer: Hawaii Western Management Group Commercial	$952.78
Rate for Payer: Health Management Network Commercial	$1,156.94
Rate for Payer: MDX Hawaii PPO	$1,320.28
Rate for Payer: University Health Alliance Commercial	$762.22

Know your out-of-pocket cost for care.

All Charges