Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cann Ti 7.3 x95mm 16mm Thread 408.895 [3606396H]

Facility

$1,371.89

Service Code	HCPCS C1713
Hospital Charge Code	3606396H
Hospital Revenue Code	278
Min. Negotiated Rate	$768.26
Max. Negotiated Rate	$1,330.73
Rate for Payer: Cash Price	$891.73
Rate for Payer: Hawaii Western Management Group Commercial	$960.32
Rate for Payer: Health Management Network Commercial	$1,166.11
Rate for Payer: MDX Hawaii PPO	$1,330.73
Rate for Payer: University Health Alliance Commercial	$768.26

Screw Cann Ti 7.3 x95mm 16mm Thread 408.895 [3606396H]

Facility

$1,371.89

Service Code	HCPCS C1713
Hospital Charge Code	3606396H
Hospital Revenue Code	278
Min. Negotiated Rate	$699.66
Max. Negotiated Rate	$1,330.73
Rate for Payer: Cash Price	$891.73
Rate for Payer: Hawaii Western Management Group Commercial	$960.32
Rate for Payer: Health Management Network Commercial	$1,166.11
Rate for Payer: Kaiser Permanente Commercial	$864.29
Rate for Payer: Kaiser Permanente Medicaid	$699.66
Rate for Payer: MDX Hawaii PPO	$1,330.73
Rate for Payer: University Health Alliance Commercial	$768.26

Screw Cann Ti 7.3 x 95mm 32mm thread 409.895 [3606397E]

Facility

$1,936.34

Service Code	HCPCS C1713
Hospital Charge Code	3606397E
Hospital Revenue Code	278
Min. Negotiated Rate	$1,084.35
Max. Negotiated Rate	$1,878.25
Rate for Payer: Cash Price	$1,258.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,355.44
Rate for Payer: Health Management Network Commercial	$1,645.89
Rate for Payer: MDX Hawaii PPO	$1,878.25
Rate for Payer: University Health Alliance Commercial	$1,084.35

Screw Cann Ti 7.3 x 95mm 32mm thread 409.895 [3606397E]

Facility

$1,936.34

Service Code	HCPCS C1713
Hospital Charge Code	3606397E
Hospital Revenue Code	278
Min. Negotiated Rate	$987.53
Max. Negotiated Rate	$1,878.25
Rate for Payer: Cash Price	$1,258.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,355.44
Rate for Payer: Health Management Network Commercial	$1,645.89
Rate for Payer: Kaiser Permanente Commercial	$1,219.89
Rate for Payer: Kaiser Permanente Medicaid	$987.53
Rate for Payer: MDX Hawaii PPO	$1,878.25
Rate for Payer: University Health Alliance Commercial	$1,084.35

Screw Cap NCB Locking 02.03150.300 [3641305]

Facility

$1,495.49

Service Code	HCPCS C1713
Hospital Charge Code	3641305
Hospital Revenue Code	278
Min. Negotiated Rate	$762.70
Max. Negotiated Rate	$1,450.63
Rate for Payer: Cash Price	$972.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,046.84
Rate for Payer: Health Management Network Commercial	$1,271.17
Rate for Payer: Kaiser Permanente Commercial	$942.16
Rate for Payer: Kaiser Permanente Medicaid	$762.70
Rate for Payer: MDX Hawaii PPO	$1,450.63
Rate for Payer: University Health Alliance Commercial	$837.47

Screw Cap NCB Locking 02.03150.300 [3641305]

Facility

$1,495.49

Service Code	HCPCS C1713
Hospital Charge Code	3641305
Hospital Revenue Code	278
Min. Negotiated Rate	$837.47
Max. Negotiated Rate	$1,450.63
Rate for Payer: Cash Price	$972.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,046.84
Rate for Payer: Health Management Network Commercial	$1,271.17
Rate for Payer: MDX Hawaii PPO	$1,450.63
Rate for Payer: University Health Alliance Commercial	$837.47

Screw Cephalic 5x37.5mm Dt750375 [3643934]

Facility

$1,487.07

Service Code	HCPCS C1713
Hospital Charge Code	3643934
Hospital Revenue Code	278
Min. Negotiated Rate	$832.76
Max. Negotiated Rate	$1,442.46
Rate for Payer: Cash Price	$966.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.95
Rate for Payer: Health Management Network Commercial	$1,264.01
Rate for Payer: MDX Hawaii PPO	$1,442.46
Rate for Payer: University Health Alliance Commercial	$832.76

Screw Cephalic 5x37.5mm Dt750375 [3643934]

Facility

$1,487.07

Service Code	HCPCS C1713
Hospital Charge Code	3643934
Hospital Revenue Code	278
Min. Negotiated Rate	$758.41
Max. Negotiated Rate	$1,442.46
Rate for Payer: Cash Price	$966.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.95
Rate for Payer: Health Management Network Commercial	$1,264.01
Rate for Payer: Kaiser Permanente Commercial	$936.85
Rate for Payer: Kaiser Permanente Medicaid	$758.41
Rate for Payer: MDX Hawaii PPO	$1,442.46
Rate for Payer: University Health Alliance Commercial	$832.76

Screw Cephalic 5x45mm Dt750450 [3643935]

Facility

$1,487.06

Service Code	HCPCS C1713
Hospital Charge Code	3643935
Hospital Revenue Code	278
Min. Negotiated Rate	$758.40
Max. Negotiated Rate	$1,442.45
Rate for Payer: Cash Price	$966.59
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.94
Rate for Payer: Health Management Network Commercial	$1,264.00
Rate for Payer: Kaiser Permanente Commercial	$936.85
Rate for Payer: Kaiser Permanente Medicaid	$758.40
Rate for Payer: MDX Hawaii PPO	$1,442.45
Rate for Payer: University Health Alliance Commercial	$832.75

Screw Cephalic 5x45mm Dt750450 [3643935]

Facility

$1,487.06

Service Code	HCPCS C1713
Hospital Charge Code	3643935
Hospital Revenue Code	278
Min. Negotiated Rate	$832.75
Max. Negotiated Rate	$1,442.45
Rate for Payer: Cash Price	$966.59
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.94
Rate for Payer: Health Management Network Commercial	$1,264.00
Rate for Payer: MDX Hawaii PPO	$1,442.45
Rate for Payer: University Health Alliance Commercial	$832.75

Screw Comp 3.5mmx14mm Ti Ffc-35140-Ts [3643501]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643501
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp 3.5mmx14mm Ti Ffc-35140-Ts [3643501]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643501
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp 3.5mmx16mm Ti Ffc35160ts [3643502]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643502
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp 3.5mmx16mm Ti Ffc35160ts [3643502]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643502
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp 3.5mmx18mm Ti Ffc35180ts [3643503]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643503
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp 3.5mmx18mm Ti Ffc35180ts [3643503]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643503
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx22mm [3643283]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643283
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx22mm [3643283]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643283
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx24mm [3643284]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643284
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx24mm [3643284]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643284
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx28mm Ffc-35280-Ts [3643660]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643660
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx28mm Ffc-35280-Ts [3643660]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643660
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx38mm Ffc-35380-Ts [3643661]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643661
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx38mm Ffc-35380-Ts [3643661]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643661
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Screw Comp Freefix Ti 3.5mmx40mm Ffc-35400-Ts [3643662]

Facility

$866.25

Service Code	HCPCS C1713
Hospital Charge Code	3643662
Hospital Revenue Code	278
Min. Negotiated Rate	$441.79
Max. Negotiated Rate	$840.26
Rate for Payer: Cash Price	$563.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.38
Rate for Payer: Health Management Network Commercial	$736.31
Rate for Payer: Kaiser Permanente Commercial	$545.74
Rate for Payer: Kaiser Permanente Medicaid	$441.79
Rate for Payer: MDX Hawaii PPO	$840.26
Rate for Payer: University Health Alliance Commercial	$485.10

Know your out-of-pocket cost for care.

All Charges