Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cann Conical 5.0x75mm 02.205.275 [3640159A]

Facility

$884.50

Service Code	HCPCS C1713
Hospital Charge Code	3640159A
Hospital Revenue Code	278
Min. Negotiated Rate	$451.10
Max. Negotiated Rate	$857.97
Rate for Payer: Cash Price	$574.93
Rate for Payer: Hawaii Western Management Group Commercial	$619.15
Rate for Payer: Health Management Network Commercial	$751.83
Rate for Payer: Kaiser Permanente Commercial	$557.24
Rate for Payer: Kaiser Permanente Medicaid	$451.10
Rate for Payer: MDX Hawaii PPO	$857.97
Rate for Payer: University Health Alliance Commercial	$495.32

Screw Cann Conical 5.0x75mm 02.205.275 [3640159A]

Facility

$884.50

Service Code	HCPCS C1713
Hospital Charge Code	3640159A
Hospital Revenue Code	278
Min. Negotiated Rate	$495.32
Max. Negotiated Rate	$857.97
Rate for Payer: Cash Price	$574.93
Rate for Payer: Hawaii Western Management Group Commercial	$619.15
Rate for Payer: Health Management Network Commercial	$751.83
Rate for Payer: MDX Hawaii PPO	$857.97
Rate for Payer: University Health Alliance Commercial	$495.32

Screw Cann Ti 6.5x100mm 16mm Thread 408.415 [3606394O]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394O
Hospital Revenue Code	278
Min. Negotiated Rate	$993.68
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: Kaiser Permanente Commercial	$1,227.49
Rate for Payer: Kaiser Permanente Medicaid	$993.68
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5x100mm 16mm Thread 408.415 [3606394O]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.10
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5 X 105mm 32mm Thread 408.443 [3606394G]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394G
Hospital Revenue Code	278
Min. Negotiated Rate	$771.45
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5 X 105mm 32mm Thread 408.443 [3606394G]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394G
Hospital Revenue Code	278
Min. Negotiated Rate	$702.57
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: Kaiser Permanente Commercial	$867.88
Rate for Payer: Kaiser Permanente Medicaid	$702.57
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5x130mm 32mm Thread 408.448 [3606394NN]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394NN
Hospital Revenue Code	278
Min. Negotiated Rate	$702.57
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: Kaiser Permanente Commercial	$867.88
Rate for Payer: Kaiser Permanente Medicaid	$702.57
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5x130mm 32mm Thread 408.448 [3606394NN]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394NN
Hospital Revenue Code	278
Min. Negotiated Rate	$771.45
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5x150mm 32mm Thread 408.452 [3606394RR]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394RR
Hospital Revenue Code	278
Min. Negotiated Rate	$702.57
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: Kaiser Permanente Commercial	$867.88
Rate for Payer: Kaiser Permanente Medicaid	$702.57
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5x150mm 32mm Thread 408.452 [3606394RR]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394RR
Hospital Revenue Code	278
Min. Negotiated Rate	$771.45
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5x60mm 32mm Thread 408.434 [3606394CC]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394CC
Hospital Revenue Code	278
Min. Negotiated Rate	$993.68
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: Kaiser Permanente Commercial	$1,227.49
Rate for Payer: Kaiser Permanente Medicaid	$993.68
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5x60mm 32mm Thread 408.434 [3606394CC]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394CC
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.10
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5 x 70mm 16mm Thread 408.409 [3606394A]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394A
Hospital Revenue Code	278
Min. Negotiated Rate	$702.57
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: Kaiser Permanente Commercial	$867.88
Rate for Payer: Kaiser Permanente Medicaid	$702.57
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5 x 70mm 16mm Thread 408.409 [3606394A]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394A
Hospital Revenue Code	278
Min. Negotiated Rate	$771.45
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5 x 75mm 16mm Thread 408.410 [3606394B]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394B
Hospital Revenue Code	278
Min. Negotiated Rate	$993.68
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: Kaiser Permanente Commercial	$1,227.49
Rate for Payer: Kaiser Permanente Medicaid	$993.68
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5 x 75mm 16mm Thread 408.410 [3606394B]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394B
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.10
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5x75mm 32mm Thread 408.437 [3606394DD]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394DD
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.10
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5x75mm 32mm Thread 408.437 [3606394DD]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394DD
Hospital Revenue Code	278
Min. Negotiated Rate	$993.68
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: Kaiser Permanente Commercial	$1,227.49
Rate for Payer: Kaiser Permanente Medicaid	$993.68
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5x80 32mm Thread 408.438 [3606394EE]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394EE
Hospital Revenue Code	278
Min. Negotiated Rate	$771.45
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5x80 32mm Thread 408.438 [3606394EE]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394EE
Hospital Revenue Code	278
Min. Negotiated Rate	$702.57
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: Kaiser Permanente Commercial	$867.88
Rate for Payer: Kaiser Permanente Medicaid	$702.57
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Screw Cann Ti 6.5 x 80mm 16mm Thread 408.411 [3606394C]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394C
Hospital Revenue Code	278
Min. Negotiated Rate	$993.68
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: Kaiser Permanente Commercial	$1,227.49
Rate for Payer: Kaiser Permanente Medicaid	$993.68
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5 x 80mm 16mm Thread 408.411 [3606394C]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.10
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5 x 85mm 16mm Thread 408.412 [3606394D]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394D
Hospital Revenue Code	278
Min. Negotiated Rate	$993.68
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: Kaiser Permanente Commercial	$1,227.49
Rate for Payer: Kaiser Permanente Medicaid	$993.68
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5 x 85mm 16mm Thread 408.412 [3606394D]

Facility

$1,948.39

Service Code	HCPCS C1713
Hospital Charge Code	3606394D
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.10
Max. Negotiated Rate	$1,889.94
Rate for Payer: Cash Price	$1,266.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,363.87
Rate for Payer: Health Management Network Commercial	$1,656.13
Rate for Payer: MDX Hawaii PPO	$1,889.94
Rate for Payer: University Health Alliance Commercial	$1,091.10

Screw Cann Ti 6.5x85mm 32mm Thread 408.439 [3606394FF]

Facility

$1,377.59

Service Code	HCPCS C1713
Hospital Charge Code	3606394FF
Hospital Revenue Code	278
Min. Negotiated Rate	$771.45
Max. Negotiated Rate	$1,336.26
Rate for Payer: Cash Price	$895.43
Rate for Payer: Hawaii Western Management Group Commercial	$964.31
Rate for Payer: Health Management Network Commercial	$1,170.95
Rate for Payer: MDX Hawaii PPO	$1,336.26
Rate for Payer: University Health Alliance Commercial	$771.45

Know your out-of-pocket cost for care.

All Charges