Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$523.45
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: Kaiser Permanente Commercial	$646.62
Rate for Payer: Kaiser Permanente Medicaid	$523.45
Rate for Payer: MDX Hawaii PPO	$995.59
Rate for Payer: University Health Alliance Commercial	$574.77

Screw Cann 4.5 x 40mm 214.540 [3607697]

Facility

$1,383.28

Service Code	HCPCS C1713
Hospital Charge Code	3607697
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 40mm 214.540 [3607697]

Facility

$1,383.28

Service Code	HCPCS C1713
Hospital Charge Code	3607697
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 42mm 214.542 [3606139]

Facility

$1,399.35

Service Code	HCPCS C1713
Hospital Charge Code	3606139
Hospital Revenue Code	278
Min. Negotiated Rate	$783.64
Max. Negotiated Rate	$1,357.37
Rate for Payer: Cash Price	$909.58
Rate for Payer: Hawaii Western Management Group Commercial	$979.54
Rate for Payer: Health Management Network Commercial	$1,189.45
Rate for Payer: MDX Hawaii PPO	$1,357.37
Rate for Payer: University Health Alliance Commercial	$783.64

Screw Cann 4.5 x 42mm 214.542 [3606139]

Facility

$1,399.35

Service Code	HCPCS C1713
Hospital Charge Code	3606139
Hospital Revenue Code	278
Min. Negotiated Rate	$713.67
Max. Negotiated Rate	$1,357.37
Rate for Payer: Cash Price	$909.58
Rate for Payer: Hawaii Western Management Group Commercial	$979.54
Rate for Payer: Health Management Network Commercial	$1,189.45
Rate for Payer: Kaiser Permanente Commercial	$881.59
Rate for Payer: Kaiser Permanente Medicaid	$713.67
Rate for Payer: MDX Hawaii PPO	$1,357.37
Rate for Payer: University Health Alliance Commercial	$783.64

Screw Cann 4.5 x 44mm 214.544 [3606143]

Facility

$638.75

Service Code	HCPCS C1713
Hospital Charge Code	3606143
Hospital Revenue Code	278
Min. Negotiated Rate	$325.76
Max. Negotiated Rate	$619.59
Rate for Payer: Cash Price	$415.19
Rate for Payer: Hawaii Western Management Group Commercial	$447.12
Rate for Payer: Health Management Network Commercial	$542.94
Rate for Payer: Kaiser Permanente Commercial	$402.41
Rate for Payer: Kaiser Permanente Medicaid	$325.76
Rate for Payer: MDX Hawaii PPO	$619.59
Rate for Payer: University Health Alliance Commercial	$357.70

Screw Cann 4.5 x 44mm 214.544 [3606143]

Facility

$638.75

Service Code	HCPCS C1713
Hospital Charge Code	3606143
Hospital Revenue Code	278
Min. Negotiated Rate	$357.70
Max. Negotiated Rate	$619.59
Rate for Payer: Cash Price	$415.19
Rate for Payer: Hawaii Western Management Group Commercial	$447.12
Rate for Payer: Health Management Network Commercial	$542.94
Rate for Payer: MDX Hawaii PPO	$619.59
Rate for Payer: University Health Alliance Commercial	$357.70

Screw Cann 4.5 x 46mm 214.546 [3607702]

Facility

$1,383.28

Service Code	HCPCS C1713
Hospital Charge Code	3607702
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 46mm 214.546 [3607702]

Facility

$1,383.28

Service Code	HCPCS C1713
Hospital Charge Code	3607702
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 Canc 36mm Thd 7.0mm x 75mm 8041-075 [3644660]

Facility

$3,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3644660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,942.36
Max. Negotiated Rate	$3,364.45
Rate for Payer: Cash Price	$2,254.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,427.95
Rate for Payer: Health Management Network Commercial	$2,948.22
Rate for Payer: MDX Hawaii PPO	$3,364.45
Rate for Payer: University Health Alliance Commercial	$1,942.36

Screw Cann Canc 36mm Thd 7.0mm x 75mm 8041-075 [3644660]

Facility

$3,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3644660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.93
Max. Negotiated Rate	$3,364.45
Rate for Payer: Cash Price	$2,254.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,427.95
Rate for Payer: Health Management Network Commercial	$2,948.22
Rate for Payer: Kaiser Permanente Commercial	$2,185.16
Rate for Payer: Kaiser Permanente Medicaid	$1,768.93
Rate for Payer: MDX Hawaii PPO	$3,364.45
Rate for Payer: University Health Alliance Commercial	$1,942.36

Screw Cann Canc 36mm Thd 7.0mm x 80mm 8041-080 [3644661]

Facility

$3,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3644661
Hospital Revenue Code	278
Min. Negotiated Rate	$1,942.36
Max. Negotiated Rate	$3,364.45
Rate for Payer: Cash Price	$2,254.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,427.95
Rate for Payer: Health Management Network Commercial	$2,948.22
Rate for Payer: MDX Hawaii PPO	$3,364.45
Rate for Payer: University Health Alliance Commercial	$1,942.36

Screw Cann Canc 36mm Thd 7.0mm x 80mm 8041-080 [3644661]

Facility

$3,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3644661
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.93
Max. Negotiated Rate	$3,364.45
Rate for Payer: Cash Price	$2,254.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,427.95
Rate for Payer: Health Management Network Commercial	$2,948.22
Rate for Payer: Kaiser Permanente Commercial	$2,185.16
Rate for Payer: Kaiser Permanente Medicaid	$1,768.93
Rate for Payer: MDX Hawaii PPO	$3,364.45
Rate for Payer: University Health Alliance Commercial	$1,942.36

Screw Cann Canc 36mm Thd 7.0mm x 85mm 8041-085 [3644662]

Facility

$3,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3644662
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.93
Max. Negotiated Rate	$3,364.45
Rate for Payer: Cash Price	$2,254.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,427.95
Rate for Payer: Health Management Network Commercial	$2,948.22
Rate for Payer: Kaiser Permanente Commercial	$2,185.16
Rate for Payer: Kaiser Permanente Medicaid	$1,768.93
Rate for Payer: MDX Hawaii PPO	$3,364.45
Rate for Payer: University Health Alliance Commercial	$1,942.36

Screw Cann Canc 36mm Thd 7.0mm x 85mm 8041-085 [3644662]

Facility

$3,468.50

Service Code	HCPCS C1713
Hospital Charge Code	3644662
Hospital Revenue Code	278
Min. Negotiated Rate	$1,942.36
Max. Negotiated Rate	$3,364.45
Rate for Payer: Cash Price	$2,254.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,427.95
Rate for Payer: Health Management Network Commercial	$2,948.22
Rate for Payer: MDX Hawaii PPO	$3,364.45
Rate for Payer: University Health Alliance Commercial	$1,942.36

Screw Cann Canc Lag 4.0mm x 30mm 1437630 [3644013]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3644013
Hospital Revenue Code	278
Min. Negotiated Rate	$569.28
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: Kaiser Permanente Commercial	$703.22
Rate for Payer: Kaiser Permanente Medicaid	$569.28
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mm x 30mm 1437630 [3644013]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3644013
Hospital Revenue Code	278
Min. Negotiated Rate	$625.09
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mmx34mm 1437634 [3644014]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3644014
Hospital Revenue Code	278
Min. Negotiated Rate	$569.28
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: Kaiser Permanente Commercial	$703.22
Rate for Payer: Kaiser Permanente Medicaid	$569.28
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mmx34mm 1437634 [3644014]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3644014
Hospital Revenue Code	278
Min. Negotiated Rate	$625.09
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mmx36mm 1437636 [3643952]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3643952
Hospital Revenue Code	278
Min. Negotiated Rate	$569.28
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: Kaiser Permanente Commercial	$703.22
Rate for Payer: Kaiser Permanente Medicaid	$569.28
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mmx36mm 1437636 [3643952]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3643952
Hospital Revenue Code	278
Min. Negotiated Rate	$625.09
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mmx38mm 1437638 [3643953]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3643953
Hospital Revenue Code	278
Min. Negotiated Rate	$625.09
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Canc Lag 4.0mmx38mm 1437638 [3643953]

Facility

$1,116.23

Service Code	HCPCS C1713
Hospital Charge Code	3643953
Hospital Revenue Code	278
Min. Negotiated Rate	$569.28
Max. Negotiated Rate	$1,082.74
Rate for Payer: Cash Price	$725.55
Rate for Payer: Hawaii Western Management Group Commercial	$781.36
Rate for Payer: Health Management Network Commercial	$948.80
Rate for Payer: Kaiser Permanente Commercial	$703.22
Rate for Payer: Kaiser Permanente Medicaid	$569.28
Rate for Payer: MDX Hawaii PPO	$1,082.74
Rate for Payer: University Health Alliance Commercial	$625.09

Screw Cann Conical 5.0x70mm 02.205.270 [3606393]

Facility

$884.49

Service Code	HCPCS C1713
Hospital Charge Code	3606393
Hospital Revenue Code	278
Min. Negotiated Rate	$495.31
Max. Negotiated Rate	$857.96
Rate for Payer: Cash Price	$574.92
Rate for Payer: Hawaii Western Management Group Commercial	$619.14
Rate for Payer: Health Management Network Commercial	$751.82
Rate for Payer: MDX Hawaii PPO	$857.96
Rate for Payer: University Health Alliance Commercial	$495.31

Screw Cann Conical 5.0x70mm 02.205.270 [3606393]

Facility

$884.49

Service Code	HCPCS C1713
Hospital Charge Code	3606393
Hospital Revenue Code	278
Min. Negotiated Rate	$451.09
Max. Negotiated Rate	$857.96
Rate for Payer: Cash Price	$574.92
Rate for Payer: Hawaii Western Management Group Commercial	$619.14
Rate for Payer: Health Management Network Commercial	$751.82
Rate for Payer: Kaiser Permanente Commercial	$557.23
Rate for Payer: Kaiser Permanente Medicaid	$451.09
Rate for Payer: MDX Hawaii PPO	$857.96
Rate for Payer: University Health Alliance Commercial	$495.31

Know your out-of-pocket cost for care.

All Charges