Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cann 4.0mm x 32mm Short Thd 207.632 [3640265D]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265D
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 32mm Short Thd 207.632 [3640265D]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265D
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 34mm Short Thd 207.634 [3640265E]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265E
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 34mm Short Thd 207.634 [3640265E]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265E
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 36mm Short Thd 207.636 [3640265F]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265F
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 36mm Short Thd 207.636 [3640265F]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265F
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 38mm Short Thd 207.638 [3640265G]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265G
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 38mm Short Thd 207.638 [3640265G]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265G
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 40mm Short Thd 207.640 [3640265H]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265H
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 40mm Short Thd 207.640 [3640265H]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265H
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 42mm Short Thd 207.642 [3640265I]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265I
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 42mm Short Thd 207.642 [3640265I]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265I
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 44mm Short Thd 207.644 [3640265J]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265J
Hospital Revenue Code	278
Min. Negotiated Rate	$694.17
Max. Negotiated Rate	$1,320.28
Rate for Payer: Kaiser Permanente Commercial	$857.50
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 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 44mm Short Thd 207.644 [3640265J]

Facility

$1,361.11

Service Code	HCPCS C1713
Hospital Charge Code	3640265J
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 46mm Short Thd 207.646 [3640265K]

Facility

$1,385.42

Service Code	HCPCS C1713
Hospital Charge Code	3640265K
Hospital Revenue Code	278
Min. Negotiated Rate	$706.56
Max. Negotiated Rate	$1,343.86
Rate for Payer: Cash Price	$900.52
Rate for Payer: Hawaii Western Management Group Commercial	$969.79
Rate for Payer: Health Management Network Commercial	$1,177.61
Rate for Payer: Kaiser Permanente Commercial	$872.81
Rate for Payer: Kaiser Permanente Medicaid	$706.56
Rate for Payer: MDX Hawaii PPO	$1,343.86
Rate for Payer: University Health Alliance Commercial	$775.84

Screw Cann 4.0mm x 46mm Short Thd 207.646 [3640265K]

Facility

$1,385.42

Service Code	HCPCS C1713
Hospital Charge Code	3640265K
Hospital Revenue Code	278
Min. Negotiated Rate	$775.84
Max. Negotiated Rate	$1,343.86
Rate for Payer: Cash Price	$900.52
Rate for Payer: Hawaii Western Management Group Commercial	$969.79
Rate for Payer: Health Management Network Commercial	$1,177.61
Rate for Payer: MDX Hawaii PPO	$1,343.86
Rate for Payer: University Health Alliance Commercial	$775.84

Screw Cann 4.0mm x 48mm Short Thd 207.648 [3640265L]

Facility

$1,361.12

Service Code	HCPCS C1713
Hospital Charge Code	3640265L
Hospital Revenue Code	278
Min. Negotiated Rate	$762.23
Max. Negotiated Rate	$1,320.29
Rate for Payer: Cash Price	$884.73
Rate for Payer: Hawaii Western Management Group Commercial	$952.78
Rate for Payer: Health Management Network Commercial	$1,156.95
Rate for Payer: MDX Hawaii PPO	$1,320.29
Rate for Payer: University Health Alliance Commercial	$762.23

Screw Cann 4.0mm x 48mm Short Thd 207.648 [3640265L]

Facility

$1,361.12

Service Code	HCPCS C1713
Hospital Charge Code	3640265L
Hospital Revenue Code	278
Min. Negotiated Rate	$694.17
Max. Negotiated Rate	$1,320.29
Rate for Payer: Cash Price	$884.73
Rate for Payer: Hawaii Western Management Group Commercial	$952.78
Rate for Payer: Health Management Network Commercial	$1,156.95
Rate for Payer: Kaiser Permanente Commercial	$857.51
Rate for Payer: Kaiser Permanente Medicaid	$694.17
Rate for Payer: MDX Hawaii PPO	$1,320.29
Rate for Payer: University Health Alliance Commercial	$762.23

Screw Cann 4.0mm x 50mm Short Thd 207.650 [3640265M]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3640265M
Hospital Revenue Code	278
Min. Negotiated Rate	$775.84
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Screw Cann 4.0mm x 50mm Short Thd 207.650 [3640265M]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3640265M
Hospital Revenue Code	278
Min. Negotiated Rate	$706.57
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: Kaiser Permanente Commercial	$872.82
Rate for Payer: Kaiser Permanente Medicaid	$706.57
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Screw Cann 4.5 x 34mm 214.534 [3607694]

Facility

$1,275.81

Service Code	HCPCS C1713
Hospital Charge Code	3607694
Hospital Revenue Code	278
Min. Negotiated Rate	$650.66
Max. Negotiated Rate	$1,237.54
Rate for Payer: Cash Price	$829.28
Rate for Payer: Hawaii Western Management Group Commercial	$893.07
Rate for Payer: Health Management Network Commercial	$1,084.44
Rate for Payer: Kaiser Permanente Commercial	$803.76
Rate for Payer: Kaiser Permanente Medicaid	$650.66
Rate for Payer: MDX Hawaii PPO	$1,237.54
Rate for Payer: University Health Alliance Commercial	$714.45

Screw Cann 4.5 x 34mm 214.534 [3607694]

Facility

$1,275.81

Service Code	HCPCS C1713
Hospital Charge Code	3607694
Hospital Revenue Code	278
Min. Negotiated Rate	$714.45
Max. Negotiated Rate	$1,237.54
Rate for Payer: Cash Price	$829.28
Rate for Payer: Hawaii Western Management Group Commercial	$893.07
Rate for Payer: Health Management Network Commercial	$1,084.44
Rate for Payer: MDX Hawaii PPO	$1,237.54
Rate for Payer: University Health Alliance Commercial	$714.45

Screw Cann 4.5 x 36mm 214.536 [3607695]

Facility

$1,383.28

Service Code	HCPCS C1713
Hospital Charge Code	3607695
Hospital Revenue Code	278
Min. Negotiated Rate	$705.47
Max. Negotiated Rate	$1,341.78
Rate for Payer: Cash Price	$899.13
Rate for Payer: Hawaii Western Management Group Commercial	$968.30
Rate for Payer: Health Management Network Commercial	$1,175.79
Rate for Payer: Kaiser Permanente Commercial	$871.47
Rate for Payer: Kaiser Permanente Medicaid	$705.47
Rate for Payer: MDX Hawaii PPO	$1,341.78
Rate for Payer: University Health Alliance Commercial	$774.64

Screw Cann 4.5 x 36mm 214.536 [3607695]

Facility

$1,383.28

Service Code	HCPCS C1713
Hospital Charge Code	3607695
Hospital Revenue Code	278
Min. Negotiated Rate	$774.64
Max. Negotiated Rate	$1,341.78
Rate for Payer: Cash Price	$899.13
Rate for Payer: Hawaii Western Management Group Commercial	$968.30
Rate for Payer: Health Management Network Commercial	$1,175.79
Rate for Payer: MDX Hawaii PPO	$1,341.78
Rate for Payer: University Health Alliance Commercial	$774.64

Screw Cann 4.5 x 38mm 214.538 [3607696]

Facility

$1,026.38

Service Code	HCPCS C1713
Hospital Charge Code	3607696
Hospital Revenue Code	278
Min. Negotiated Rate	$574.77
Max. Negotiated Rate	$995.59
Rate for Payer: Cash Price	$667.15
Rate for Payer: Hawaii Western Management Group Commercial	$718.47
Rate for Payer: Health Management Network Commercial	$872.42
Rate for Payer: MDX Hawaii PPO	$995.59
Rate for Payer: University Health Alliance Commercial	$574.77

Know your out-of-pocket cost for care.

All Charges