Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cortex ST 2.7 x 14mm 202.814 [3606402]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606402
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 14mm 202.814 [3606402]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606402
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

Screw Cortex ST 2.7 x 16mm 202.816 [3606403]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606403
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 16mm 202.816 [3606403]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606403
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

Screw Cortex ST 2.7 x 18mm 202.818 [3606404]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606404
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 18mm 202.818 [3606404]

Facility

$351.05

Service Code	HCPCS C1713
Hospital Charge Code	3606404
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

Screw Cortex ST 2.7 x 24mm 202.824 [3606407]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606407
Hospital Revenue Code	278
Min. Negotiated Rate	$135.57
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: Kaiser Permanente Commercial	$167.47
Rate for Payer: Kaiser Permanente Medicaid	$135.57
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex ST 2.7 x 24mm 202.824 [3606407]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606407
Hospital Revenue Code	278
Min. Negotiated Rate	$148.86
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex ST 2.7 x 30mm 202.830 [3606410]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606410
Hospital Revenue Code	278
Min. Negotiated Rate	$148.86
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex ST 2.7 x 30mm 202.830 [3606410]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606410
Hospital Revenue Code	278
Min. Negotiated Rate	$135.57
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: Kaiser Permanente Commercial	$167.47
Rate for Payer: Kaiser Permanente Medicaid	$135.57
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex St 2.7x34mm 202.834 [3606412]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606412
Hospital Revenue Code	278
Min. Negotiated Rate	$148.86
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex St 2.7x34mm 202.834 [3606412]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606412
Hospital Revenue Code	278
Min. Negotiated Rate	$135.57
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: Kaiser Permanente Commercial	$167.47
Rate for Payer: Kaiser Permanente Medicaid	$135.57
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex ST 2.7 x 38mm 202.838 [3606414]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606414
Hospital Revenue Code	278
Min. Negotiated Rate	$148.86
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex ST 2.7 x 38mm 202.838 [3606414]

Facility

$265.82

Service Code	HCPCS C1713
Hospital Charge Code	3606414
Hospital Revenue Code	278
Min. Negotiated Rate	$135.57
Max. Negotiated Rate	$257.85
Rate for Payer: Cash Price	$172.78
Rate for Payer: Hawaii Western Management Group Commercial	$186.07
Rate for Payer: Health Management Network Commercial	$225.95
Rate for Payer: Kaiser Permanente Commercial	$167.47
Rate for Payer: Kaiser Permanente Medicaid	$135.57
Rate for Payer: MDX Hawaii PPO	$257.85
Rate for Payer: University Health Alliance Commercial	$148.86

Screw Cortex ST 3.5mmX14mm 204.814 [3606542]

Facility

$220.65

Service Code	HCPCS C1713
Hospital Charge Code	3606542
Hospital Revenue Code	278
Min. Negotiated Rate	$123.56
Max. Negotiated Rate	$214.03
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.46
Rate for Payer: Health Management Network Commercial	$187.55
Rate for Payer: MDX Hawaii PPO	$214.03
Rate for Payer: University Health Alliance Commercial	$123.56

Screw Cortex ST 3.5mmX14mm 204.814 [3606542]

Facility

$220.65

Service Code	HCPCS C1713
Hospital Charge Code	3606542
Hospital Revenue Code	278
Min. Negotiated Rate	$112.53
Max. Negotiated Rate	$214.03
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.46
Rate for Payer: Health Management Network Commercial	$187.55
Rate for Payer: Kaiser Permanente Commercial	$139.01
Rate for Payer: Kaiser Permanente Medicaid	$112.53
Rate for Payer: MDX Hawaii PPO	$214.03
Rate for Payer: University Health Alliance Commercial	$123.56

Screw Cortex ST 3.5mmX16mm 204.816 [3606543]

Facility

$220.65

Service Code	HCPCS C1713
Hospital Charge Code	3606543
Hospital Revenue Code	278
Min. Negotiated Rate	$112.53
Max. Negotiated Rate	$214.03
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.46
Rate for Payer: Health Management Network Commercial	$187.55
Rate for Payer: Kaiser Permanente Commercial	$139.01
Rate for Payer: Kaiser Permanente Medicaid	$112.53
Rate for Payer: MDX Hawaii PPO	$214.03
Rate for Payer: University Health Alliance Commercial	$123.56

Screw Cortex ST 3.5mmX16mm 204.816 [3606543]

Facility

$220.65

Service Code	HCPCS C1713
Hospital Charge Code	3606543
Hospital Revenue Code	278
Min. Negotiated Rate	$123.56
Max. Negotiated Rate	$214.03
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.46
Rate for Payer: Health Management Network Commercial	$187.55
Rate for Payer: MDX Hawaii PPO	$214.03
Rate for Payer: University Health Alliance Commercial	$123.56

Screw Cortex ST 3.5mm x 60mm 204.860 [3606201]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606201
Hospital Revenue Code	278
Min. Negotiated Rate	$123.56
Max. Negotiated Rate	$214.02
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.45
Rate for Payer: Health Management Network Commercial	$187.54
Rate for Payer: MDX Hawaii PPO	$214.02
Rate for Payer: University Health Alliance Commercial	$123.56

Screw Cortex ST 3.5mm x 60mm 204.860 [3606201]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606201
Hospital Revenue Code	278
Min. Negotiated Rate	$112.53
Max. Negotiated Rate	$214.02
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.45
Rate for Payer: Health Management Network Commercial	$187.54
Rate for Payer: Kaiser Permanente Commercial	$139.00
Rate for Payer: Kaiser Permanente Medicaid	$112.53
Rate for Payer: MDX Hawaii PPO	$214.02
Rate for Payer: University Health Alliance Commercial	$123.56

Screw Cortex St 3.5mm x 65mm 204.865 [3645364]

Facility

$381.56

Service Code	HCPCS C1713
Hospital Charge Code	3645364
Hospital Revenue Code	278
Min. Negotiated Rate	$213.67
Max. Negotiated Rate	$370.11
Rate for Payer: Cash Price	$248.01
Rate for Payer: Hawaii Western Management Group Commercial	$267.09
Rate for Payer: Health Management Network Commercial	$324.33
Rate for Payer: MDX Hawaii PPO	$370.11
Rate for Payer: University Health Alliance Commercial	$213.67

Screw Cortex St 3.5mm x 65mm 204.865 [3645364]

Facility

$381.56

Service Code	HCPCS C1713
Hospital Charge Code	3645364
Hospital Revenue Code	278
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$370.11
Rate for Payer: Cash Price	$248.01
Rate for Payer: Hawaii Western Management Group Commercial	$267.09
Rate for Payer: Health Management Network Commercial	$324.33
Rate for Payer: Kaiser Permanente Commercial	$240.38
Rate for Payer: Kaiser Permanente Medicaid	$194.60
Rate for Payer: MDX Hawaii PPO	$370.11
Rate for Payer: University Health Alliance Commercial	$213.67

Screw Cortex St 3.5mm x 75mm 204.875 [3645366]

Facility

$381.56

Service Code	HCPCS C1713
Hospital Charge Code	3645366
Hospital Revenue Code	278
Min. Negotiated Rate	$213.67
Max. Negotiated Rate	$370.11
Rate for Payer: Cash Price	$248.01
Rate for Payer: Hawaii Western Management Group Commercial	$267.09
Rate for Payer: Health Management Network Commercial	$324.33
Rate for Payer: MDX Hawaii PPO	$370.11
Rate for Payer: University Health Alliance Commercial	$213.67

Screw Cortex St 3.5mm x 75mm 204.875 [3645366]

Facility

$381.56

Service Code	HCPCS C1713
Hospital Charge Code	3645366
Hospital Revenue Code	278
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$370.11
Rate for Payer: Cash Price	$248.01
Rate for Payer: Hawaii Western Management Group Commercial	$267.09
Rate for Payer: Health Management Network Commercial	$324.33
Rate for Payer: Kaiser Permanente Commercial	$240.38
Rate for Payer: Kaiser Permanente Medicaid	$194.60
Rate for Payer: MDX Hawaii PPO	$370.11
Rate for Payer: University Health Alliance Commercial	$213.67

Screw Cortex ST 3.5 x10mm 204.810 [3606540]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606540
Hospital Revenue Code	278
Min. Negotiated Rate	$112.53
Max. Negotiated Rate	$214.02
Rate for Payer: Cash Price	$143.42
Rate for Payer: Hawaii Western Management Group Commercial	$154.45
Rate for Payer: Health Management Network Commercial	$187.54
Rate for Payer: Kaiser Permanente Commercial	$139.00
Rate for Payer: Kaiser Permanente Medicaid	$112.53
Rate for Payer: MDX Hawaii PPO	$214.02
Rate for Payer: University Health Alliance Commercial	$123.56

Know your out-of-pocket cost for care.

All Charges