Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Compr Mini FT 3.5 x 16mm AR-8730-16H [3645004]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645004
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 Mini FT 3.5 x 16mm AR-8730-16H [3645004]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645004
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 Mini FT 3.5 x 18mm AR-8730-18H [3645005]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645005
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 Mini FT 3.5 x 18mm AR-8730-18H [3645005]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645005
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 Mini FT 3.5 x 20mm AR-8730-20H [3645006]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645006
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 Mini FT 3.5 x 20mm AR-8730-20H [3645006]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645006
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 Mini FT 3.5 x 24mm AR-8730-24H [3644976]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644976
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 Mini FT 3.5 x 24mm AR-8730-24H [3644976]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644976
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 Mini FT 3.5 x 34mm AR-8730-34H [3645007]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645007
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 Mini FT 3.5 x 34mm AR-8730-34H [3645007]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3645007
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 Mini FT 3.5 x 36mm AR-8730-36H [3644977]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644977
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 Mini FT 3.5 x 36mm AR-8730-36H [3644977]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644977
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 Cortex 2.7mm ST T8 SD 10mm 202.870 [3643139]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3643139
Hospital Revenue Code	278
Min. Negotiated Rate	$219.93
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: Kaiser Permanente Commercial	$271.68
Rate for Payer: Kaiser Permanente Medicaid	$219.93
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 10mm 202.870 [3643139]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3643139
Hospital Revenue Code	278
Min. Negotiated Rate	$241.49
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 12mm 202.872 [3643115]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643115
Hospital Revenue Code	278
Min. Negotiated Rate	$191.37
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Screw Cortex 2.7mm ST T8 SD 12mm 202.872 [3643115]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643115
Hospital Revenue Code	278
Min. Negotiated Rate	$174.29
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: Kaiser Permanente Commercial	$215.30
Rate for Payer: Kaiser Permanente Medicaid	$174.29
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Screw Cortex 2.7mm ST T8 SD 14mm 202.874 [3641577]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3641577
Hospital Revenue Code	278
Min. Negotiated Rate	$219.93
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: Kaiser Permanente Commercial	$271.68
Rate for Payer: Kaiser Permanente Medicaid	$219.93
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 14mm 202.874 [3641577]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3641577
Hospital Revenue Code	278
Min. Negotiated Rate	$241.49
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 16mm 202.876 [3641690]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3641690
Hospital Revenue Code	278
Min. Negotiated Rate	$219.93
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: Kaiser Permanente Commercial	$271.68
Rate for Payer: Kaiser Permanente Medicaid	$219.93
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 16mm 202.876 [3641690]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3641690
Hospital Revenue Code	278
Min. Negotiated Rate	$241.49
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 18mm 202.878 [3642618]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3642618
Hospital Revenue Code	278
Min. Negotiated Rate	$219.93
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: Kaiser Permanente Commercial	$271.68
Rate for Payer: Kaiser Permanente Medicaid	$219.93
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 18mm 202.878 [3642618]

Facility

$431.24

Service Code	HCPCS C1713
Hospital Charge Code	3642618
Hospital Revenue Code	278
Min. Negotiated Rate	$241.49
Max. Negotiated Rate	$418.30
Rate for Payer: Cash Price	$280.31
Rate for Payer: Hawaii Western Management Group Commercial	$301.87
Rate for Payer: Health Management Network Commercial	$366.55
Rate for Payer: MDX Hawaii PPO	$418.30
Rate for Payer: University Health Alliance Commercial	$241.49

Screw Cortex 2.7mm ST T8 SD 20mm 202.880 [3623740]

Facility

$342.42

Service Code	HCPCS C1713
Hospital Charge Code	3623740
Hospital Revenue Code	278
Min. Negotiated Rate	$174.63
Max. Negotiated Rate	$332.15
Rate for Payer: Cash Price	$222.57
Rate for Payer: Hawaii Western Management Group Commercial	$239.69
Rate for Payer: Health Management Network Commercial	$291.06
Rate for Payer: Kaiser Permanente Commercial	$215.72
Rate for Payer: Kaiser Permanente Medicaid	$174.63
Rate for Payer: MDX Hawaii PPO	$332.15
Rate for Payer: University Health Alliance Commercial	$191.76

Screw Cortex 2.7mm ST T8 SD 20mm 202.880 [3623740]

Facility

$342.42

Service Code	HCPCS C1713
Hospital Charge Code	3623740
Hospital Revenue Code	278
Min. Negotiated Rate	$191.76
Max. Negotiated Rate	$332.15
Rate for Payer: Cash Price	$222.57
Rate for Payer: Hawaii Western Management Group Commercial	$239.69
Rate for Payer: Health Management Network Commercial	$291.06
Rate for Payer: MDX Hawaii PPO	$332.15
Rate for Payer: University Health Alliance Commercial	$191.76

Screw Cortex 2.7mm ST T8 SD 22mm 202.882 [3643140]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643140
Hospital Revenue Code	278
Min. Negotiated Rate	$174.29
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: Kaiser Permanente Commercial	$215.30
Rate for Payer: Kaiser Permanente Medicaid	$174.29
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Know your out-of-pocket cost for care.

All Charges