Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 24mm 202.884 [3643143]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643143
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 24mm 202.884 [3643143]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643143
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 26mm 202.886 [3623740A]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3623740A
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 26mm 202.886 [3623740A]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3623740A
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 28mm 202.888 [3623740C]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3623740C
Hospital Revenue Code	278
Min. Negotiated Rate	$144.42
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Cortex 2.7mm ST T8 SD 28mm 202.888 [3623740C]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3623740C
Hospital Revenue Code	278
Min. Negotiated Rate	$131.52
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: Kaiser Permanente Commercial	$162.47
Rate for Payer: Kaiser Permanente Medicaid	$131.52
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Cortex 2.7mm ST T8 SD 30mm 202.890 [3643119]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3643119
Hospital Revenue Code	278
Min. Negotiated Rate	$131.52
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: Kaiser Permanente Commercial	$162.47
Rate for Payer: Kaiser Permanente Medicaid	$131.52
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Cortex 2.7mm ST T8 SD 30mm 202.890 [3643119]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3643119
Hospital Revenue Code	278
Min. Negotiated Rate	$144.42
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Cortex 2.7mm ST T8 SD 32mm 202.892 [3623740B]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3623740B
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 32mm 202.892 [3623740B]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3623740B
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 36mm 202.896 [3643120]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643120
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 36mm 202.896 [3643120]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643120
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 38mm 202.898 [3623740D]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3623740D
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 38mm 202.898 [3623740D]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3623740D
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 40mm 202.900 [3643121]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643121
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 40mm 202.900 [3643121]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3643121
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 42mm 202.962 [3644158]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3644158
Hospital Revenue Code	278
Min. Negotiated Rate	$487.02
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Cortex 2.7mm St T8 Sd 42mm 202.962 [3644158]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3644158
Hospital Revenue Code	278
Min. Negotiated Rate	$443.54
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: Kaiser Permanente Commercial	$547.90
Rate for Payer: Kaiser Permanente Medicaid	$443.54
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Cortex 2.7mm St T8 Sd 44mm 202.963 [3644159]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3644159
Hospital Revenue Code	278
Min. Negotiated Rate	$487.02
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Cortex 2.7mm St T8 Sd 44mm 202.963 [3644159]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3644159
Hospital Revenue Code	278
Min. Negotiated Rate	$443.54
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: Kaiser Permanente Commercial	$547.90
Rate for Payer: Kaiser Permanente Medicaid	$443.54
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Cortex 2.7mm St T8 Sd 50mm 202.967 [3644162]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3644162
Hospital Revenue Code	278
Min. Negotiated Rate	$487.02
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Cortex 2.7mm St T8 Sd 50mm 202.967 [3644162]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3644162
Hospital Revenue Code	278
Min. Negotiated Rate	$443.54
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: Kaiser Permanente Commercial	$547.90
Rate for Payer: Kaiser Permanente Medicaid	$443.54
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Cortex ST 2.7 x 12mm 202.812 [3606401]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606401
Hospital Revenue Code	278
Min. Negotiated Rate	$179.04
Max. Negotiated Rate	$340.52
Rate for Payer: Cash Price	$228.18
Rate for Payer: Hawaii Western Management Group Commercial	$245.74
Rate for Payer: Health Management Network Commercial	$298.39
Rate for Payer: Kaiser Permanente Commercial	$221.16
Rate for Payer: Kaiser Permanente Medicaid	$179.04
Rate for Payer: MDX Hawaii PPO	$340.52
Rate for Payer: University Health Alliance Commercial	$196.59

Screw Cortex ST 2.7 x 12mm 202.812 [3606401]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606401
Hospital Revenue Code	278
Min. Negotiated Rate	$196.59
Max. Negotiated Rate	$340.52
Rate for Payer: Cash Price	$228.18
Rate for Payer: Hawaii Western Management Group Commercial	$245.74
Rate for Payer: Health Management Network Commercial	$298.39
Rate for Payer: MDX Hawaii PPO	$340.52
Rate for Payer: University Health Alliance Commercial	$196.59

Know your out-of-pocket cost for care.

All Charges