Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 3.5 x12mm 204.812 [3606541]

Facility

$313.73

Service Code	HCPCS C1713
Hospital Charge Code	3606541
Hospital Revenue Code	278
Min. Negotiated Rate	$175.69
Max. Negotiated Rate	$304.32
Rate for Payer: Cash Price	$203.92
Rate for Payer: Hawaii Western Management Group Commercial	$219.61
Rate for Payer: Health Management Network Commercial	$266.67
Rate for Payer: MDX Hawaii PPO	$304.32
Rate for Payer: University Health Alliance Commercial	$175.69

Screw Cortex ST 3.5 x12mm 204.812 [3606541]

Facility

$313.73

Service Code	HCPCS C1713
Hospital Charge Code	3606541
Hospital Revenue Code	278
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$304.32
Rate for Payer: Cash Price	$203.92
Rate for Payer: Hawaii Western Management Group Commercial	$219.61
Rate for Payer: Health Management Network Commercial	$266.67
Rate for Payer: Kaiser Permanente Commercial	$197.65
Rate for Payer: Kaiser Permanente Medicaid	$160.00
Rate for Payer: MDX Hawaii PPO	$304.32
Rate for Payer: University Health Alliance Commercial	$175.69

Screw Cortex ST 3.5 x18mm 204.818 [3606544]

Facility

$220.65

Service Code	HCPCS C1713
Hospital Charge Code	3606544
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 3.5 x18mm 204.818 [3606544]

Facility

$220.65

Service Code	HCPCS C1713
Hospital Charge Code	3606544
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 3.5 x 20mm 204.820 [3606545]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606545
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 3.5 x 20mm 204.820 [3606545]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606545
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 3.5 x22mm 204.822 [3606546]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606546
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 3.5 x22mm 204.822 [3606546]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606546
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 3.5 x24mm 204.824 [3606547]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606547
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 3.5 x24mm 204.824 [3606547]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606547
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 3.5 x26mm 204.826 [3606548]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606548
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 3.5 x26mm 204.826 [3606548]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606548
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 3.5 x28mm 204.828 [3606549]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606549
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 3.5 x28mm 204.828 [3606549]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606549
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 3.5 x30mm 204.830 [3606530]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606530
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 3.5 x30mm 204.830 [3606530]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606530
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 3.5 x32mm 204.832 [3606550]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606550
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 3.5 x32mm 204.832 [3606550]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606550
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 3.5 x34mm 204.834 [3606539]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606539
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 3.5 x34mm 204.834 [3606539]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606539
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 3.5 x36mm 204.836 [3606551]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606551
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 3.5 x36mm 204.836 [3606551]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606551
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 3.5 x38mm 204.838 [3606538]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606538
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 3.5 x38mm 204.838 [3606538]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606538
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

Know your out-of-pocket cost for care.

All Charges