Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Comp Multi Thread Ti 3.5mmX24mm MTNL35240TS [3642738]

Facility

$726.25

Service Code	HCPCS C1713
Hospital Charge Code	3642738
Hospital Revenue Code	278
Min. Negotiated Rate	$406.70
Max. Negotiated Rate	$704.46
Rate for Payer: Cash Price	$472.06
Rate for Payer: Hawaii Western Management Group Commercial	$508.38
Rate for Payer: Health Management Network Commercial	$617.31
Rate for Payer: MDX Hawaii PPO	$704.46
Rate for Payer: University Health Alliance Commercial	$406.70

Screw Comp Multi Thread Ti 3.5mmx28mm MTNL-35280-TS [3643609]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3643609
Hospital Revenue Code	278
Min. Negotiated Rate	$539.97
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: Kaiser Permanente Commercial	$667.03
Rate for Payer: Kaiser Permanente Medicaid	$539.97
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Comp Multi Thread Ti 3.5mmx28mm MTNL-35280-TS [3643609]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3643609
Hospital Revenue Code	278
Min. Negotiated Rate	$592.91
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Comp Multi Thread Ti 3.5mmx32mm MTNL-35320-TS [3643610]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3643610
Hospital Revenue Code	278
Min. Negotiated Rate	$539.97
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: Kaiser Permanente Commercial	$667.03
Rate for Payer: Kaiser Permanente Medicaid	$539.97
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Comp Multi Thread Ti 3.5mmx32mm MTNL-35320-TS [3643610]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3643610
Hospital Revenue Code	278
Min. Negotiated Rate	$592.91
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Comp Multi Thread Ti 3.5mmx40mm MTNL-35400-TS [3643611]

Facility

$761.25

Service Code	HCPCS C1713
Hospital Charge Code	3643611
Hospital Revenue Code	278
Min. Negotiated Rate	$388.24
Max. Negotiated Rate	$738.41
Rate for Payer: Cash Price	$494.81
Rate for Payer: Hawaii Western Management Group Commercial	$532.88
Rate for Payer: Health Management Network Commercial	$647.06
Rate for Payer: Kaiser Permanente Commercial	$479.59
Rate for Payer: Kaiser Permanente Medicaid	$388.24
Rate for Payer: MDX Hawaii PPO	$738.41
Rate for Payer: University Health Alliance Commercial	$426.30

Screw Comp Multi Thread Ti 3.5mmx40mm MTNL-35400-TS [3643611]

Facility

$761.25

Service Code	HCPCS C1713
Hospital Charge Code	3643611
Hospital Revenue Code	278
Min. Negotiated Rate	$426.30
Max. Negotiated Rate	$738.41
Rate for Payer: Cash Price	$494.81
Rate for Payer: Hawaii Western Management Group Commercial	$532.88
Rate for Payer: Health Management Network Commercial	$647.06
Rate for Payer: MDX Hawaii PPO	$738.41
Rate for Payer: University Health Alliance Commercial	$426.30

Screw Comp Multi Thread Ti 3.5mmx50mm MTNL-35500-TS [3643659]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3643659
Hospital Revenue Code	278
Min. Negotiated Rate	$592.91
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Comp Multi Thread Ti 3.5mmx50mm MTNL-35500-TS [3643659]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3643659
Hospital Revenue Code	278
Min. Negotiated Rate	$539.97
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: Kaiser Permanente Commercial	$667.03
Rate for Payer: Kaiser Permanente Medicaid	$539.97
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Comp Multi Thread Ti 3.5mmx55mm MTNL-35550-TS [3643612]

Facility

$761.25

Service Code	HCPCS C1713
Hospital Charge Code	3643612
Hospital Revenue Code	278
Min. Negotiated Rate	$388.24
Max. Negotiated Rate	$738.41
Rate for Payer: Cash Price	$494.81
Rate for Payer: Hawaii Western Management Group Commercial	$532.88
Rate for Payer: Health Management Network Commercial	$647.06
Rate for Payer: Kaiser Permanente Commercial	$479.59
Rate for Payer: Kaiser Permanente Medicaid	$388.24
Rate for Payer: MDX Hawaii PPO	$738.41
Rate for Payer: University Health Alliance Commercial	$426.30

Screw Comp Multi Thread Ti 3.5mmx55mm MTNL-35550-TS [3643612]

Facility

$761.25

Service Code	HCPCS C1713
Hospital Charge Code	3643612
Hospital Revenue Code	278
Min. Negotiated Rate	$426.30
Max. Negotiated Rate	$738.41
Rate for Payer: Cash Price	$494.81
Rate for Payer: Hawaii Western Management Group Commercial	$532.88
Rate for Payer: Health Management Network Commercial	$647.06
Rate for Payer: MDX Hawaii PPO	$738.41
Rate for Payer: University Health Alliance Commercial	$426.30

Screw Compression DHS/DCS 36mm 280.990S [3641068]

Facility

$854.48

Service Code	HCPCS C1713
Hospital Charge Code	3641068
Hospital Revenue Code	278
Min. Negotiated Rate	$435.78
Max. Negotiated Rate	$828.85
Rate for Payer: Cash Price	$555.41
Rate for Payer: Hawaii Western Management Group Commercial	$598.14
Rate for Payer: Health Management Network Commercial	$726.31
Rate for Payer: Kaiser Permanente Commercial	$538.32
Rate for Payer: Kaiser Permanente Medicaid	$435.78
Rate for Payer: MDX Hawaii PPO	$828.85
Rate for Payer: University Health Alliance Commercial	$478.51

Screw Compression DHS/DCS 36mm 280.990S [3641068]

Facility

$854.48

Service Code	HCPCS C1713
Hospital Charge Code	3641068
Hospital Revenue Code	278
Min. Negotiated Rate	$478.51
Max. Negotiated Rate	$828.85
Rate for Payer: Cash Price	$555.41
Rate for Payer: Hawaii Western Management Group Commercial	$598.14
Rate for Payer: Health Management Network Commercial	$726.31
Rate for Payer: MDX Hawaii PPO	$828.85
Rate for Payer: University Health Alliance Commercial	$478.51

Screw Compr FT 4.0 x 36mm AR-8740-36H [3645008]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645008
Hospital Revenue Code	278
Min. Negotiated Rate	$1,753.36
Max. Negotiated Rate	$3,037.07
Rate for Payer: Cash Price	$2,035.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,191.70
Rate for Payer: Health Management Network Commercial	$2,661.35
Rate for Payer: MDX Hawaii PPO	$3,037.07
Rate for Payer: University Health Alliance Commercial	$1,753.36

Screw Compr FT 4.0 x 36mm AR-8740-36H [3645008]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645008
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.81
Max. Negotiated Rate	$3,037.07
Rate for Payer: Cash Price	$2,035.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,191.70
Rate for Payer: Health Management Network Commercial	$2,661.35
Rate for Payer: Kaiser Permanente Commercial	$1,972.53
Rate for Payer: Kaiser Permanente Medicaid	$1,596.81
Rate for Payer: MDX Hawaii PPO	$3,037.07
Rate for Payer: University Health Alliance Commercial	$1,753.36

Screw Compr FT 4.0 x 40mm AR-8740-40H [3644981]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,753.36
Max. Negotiated Rate	$3,037.07
Rate for Payer: Cash Price	$2,035.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,191.70
Rate for Payer: Health Management Network Commercial	$2,661.35
Rate for Payer: MDX Hawaii PPO	$3,037.07
Rate for Payer: University Health Alliance Commercial	$1,753.36

Screw Compr FT 4.0 x 40mm AR-8740-40H [3644981]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.81
Max. Negotiated Rate	$3,037.07
Rate for Payer: Cash Price	$2,035.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,191.70
Rate for Payer: Health Management Network Commercial	$2,661.35
Rate for Payer: Kaiser Permanente Commercial	$1,972.53
Rate for Payer: Kaiser Permanente Medicaid	$1,596.81
Rate for Payer: MDX Hawaii PPO	$3,037.07
Rate for Payer: University Health Alliance Commercial	$1,753.36

Screw Compr Ft 5.0 Lg 36mm Lgth AR-8750-36H [3645435]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3645435
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.17
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$2,562.21
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr Ft 5.0 Lg 36mm Lgth AR-8750-36H [3645435]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3645435
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr FT 5.0 LG 40mm Lgth AR-8750-40H [3644664]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3644664
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.17
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$2,562.21
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr FT 5.0 LG 40mm Lgth AR-8750-40H [3644664]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3644664
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr FT 5.0 LG 48mm Lgth AR-8750-48H [3644665]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3644665
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.17
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$2,562.21
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr FT 5.0 LG 48mm Lgth AR-8750-48H [3644665]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3644665
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr FT 5.0 LG 75mm Lgth AR-8750-75H [3644666]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3644666
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.17
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$2,562.21
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Screw Compr FT 5.0 LG 75mm Lgth AR-8750-75H [3644666]

Facility

$4,067.00

Service Code	HCPCS C1713
Hospital Charge Code	3644666
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,643.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

Know your out-of-pocket cost for care.

All Charges