Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cortex ST 3.5 x40mm 204.840 [3606552]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606552
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 x40mm 204.840 [3606552]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606552
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 x45mm 204.845 [3606553]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606553
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 x45mm 204.845 [3606553]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606553
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 x55mm 204.855 [3606200]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606200
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 x55mm 204.855 [3606200]

Facility

$220.64

Service Code	HCPCS C1713
Hospital Charge Code	3606200
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 LP SD 3.5mmX12mm 02.206.212 [3640125]

Facility

$242.02

Service Code	HCPCS C1713
Hospital Charge Code	3640125
Hospital Revenue Code	278
Min. Negotiated Rate	$123.43
Max. Negotiated Rate	$234.76
Rate for Payer: Cash Price	$157.31
Rate for Payer: Hawaii Western Management Group Commercial	$169.41
Rate for Payer: Health Management Network Commercial	$205.72
Rate for Payer: Kaiser Permanente Commercial	$152.47
Rate for Payer: Kaiser Permanente Medicaid	$123.43
Rate for Payer: MDX Hawaii PPO	$234.76
Rate for Payer: University Health Alliance Commercial	$135.53

Screw Cortex ST LP SD 3.5mmX12mm 02.206.212 [3640125]

Facility

$242.02

Service Code	HCPCS C1713
Hospital Charge Code	3640125
Hospital Revenue Code	278
Min. Negotiated Rate	$135.53
Max. Negotiated Rate	$234.76
Rate for Payer: Cash Price	$157.31
Rate for Payer: Hawaii Western Management Group Commercial	$169.41
Rate for Payer: Health Management Network Commercial	$205.72
Rate for Payer: MDX Hawaii PPO	$234.76
Rate for Payer: University Health Alliance Commercial	$135.53

Screw Cortex ST LP SD 3.5 x 14mm 02.206.214 [3640125I]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125I
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: Kaiser Permanente Commercial	$203.56
Rate for Payer: Kaiser Permanente Medicaid	$164.79
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 14mm 02.206.214 [3640125I]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125I
Hospital Revenue Code	278
Min. Negotiated Rate	$180.94
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 16mm 02.206.216 [3640125E]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125E
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: Kaiser Permanente Commercial	$203.56
Rate for Payer: Kaiser Permanente Medicaid	$164.79
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 16mm 02.206.216 [3640125E]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125E
Hospital Revenue Code	278
Min. Negotiated Rate	$180.94
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 20mm 02.206.220 [3640125A]

Facility

$242.02

Service Code	HCPCS C1713
Hospital Charge Code	3640125A
Hospital Revenue Code	278
Min. Negotiated Rate	$123.43
Max. Negotiated Rate	$234.76
Rate for Payer: Cash Price	$157.31
Rate for Payer: Hawaii Western Management Group Commercial	$169.41
Rate for Payer: Health Management Network Commercial	$205.72
Rate for Payer: Kaiser Permanente Commercial	$152.47
Rate for Payer: Kaiser Permanente Medicaid	$123.43
Rate for Payer: MDX Hawaii PPO	$234.76
Rate for Payer: University Health Alliance Commercial	$135.53

Screw Cortex ST LP SD 3.5 x 20mm 02.206.220 [3640125A]

Facility

$242.02

Service Code	HCPCS C1713
Hospital Charge Code	3640125A
Hospital Revenue Code	278
Min. Negotiated Rate	$135.53
Max. Negotiated Rate	$234.76
Rate for Payer: Cash Price	$157.31
Rate for Payer: Hawaii Western Management Group Commercial	$169.41
Rate for Payer: Health Management Network Commercial	$205.72
Rate for Payer: MDX Hawaii PPO	$234.76
Rate for Payer: University Health Alliance Commercial	$135.53

Screw Cortex ST LP SD 3.5 x 22mm 02.206.222 [3640125C]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125C
Hospital Revenue Code	278
Min. Negotiated Rate	$180.94
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 22mm 02.206.222 [3640125C]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125C
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: Kaiser Permanente Commercial	$203.56
Rate for Payer: Kaiser Permanente Medicaid	$164.79
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 26mm 02.206.226 [3640125H]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125H
Hospital Revenue Code	278
Min. Negotiated Rate	$180.94
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 26mm 02.206.226 [3640125H]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125H
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: Kaiser Permanente Commercial	$203.56
Rate for Payer: Kaiser Permanente Medicaid	$164.79
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 28mm 02.206.228 [3640125J]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125J
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: Kaiser Permanente Commercial	$203.56
Rate for Payer: Kaiser Permanente Medicaid	$164.79
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST LP SD 3.5 x 28mm 02.206.228 [3640125J]

Facility

$323.11

Service Code	HCPCS C1713
Hospital Charge Code	3640125J
Hospital Revenue Code	278
Min. Negotiated Rate	$180.94
Max. Negotiated Rate	$313.42
Rate for Payer: Cash Price	$210.02
Rate for Payer: Hawaii Western Management Group Commercial	$226.18
Rate for Payer: Health Management Network Commercial	$274.64
Rate for Payer: MDX Hawaii PPO	$313.42
Rate for Payer: University Health Alliance Commercial	$180.94

Screw Cortex ST SD 3.5mm x 12mm 02.200.012 [3643138]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643138
Hospital Revenue Code	278
Min. Negotiated Rate	$133.99
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Cortex ST SD 3.5mm x 12mm 02.200.012 [3643138]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643138
Hospital Revenue Code	278
Min. Negotiated Rate	$122.03
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: Kaiser Permanente Commercial	$150.74
Rate for Payer: Kaiser Permanente Medicaid	$122.03
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Cortex ST SD 3.5mm x 14mm 02.200.014 [3643655]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643655
Hospital Revenue Code	278
Min. Negotiated Rate	$122.03
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: Kaiser Permanente Commercial	$150.74
Rate for Payer: Kaiser Permanente Medicaid	$122.03
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Cortex ST SD 3.5mm x 14mm 02.200.014 [3643655]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643655
Hospital Revenue Code	278
Min. Negotiated Rate	$133.99
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Cortex ST SD 3.5mm x 16mm 02.200.016 [3641686]

Facility

$238.80

Service Code	HCPCS C1713
Hospital Charge Code	3641686
Hospital Revenue Code	278
Min. Negotiated Rate	$121.79
Max. Negotiated Rate	$231.64
Rate for Payer: Cash Price	$155.22
Rate for Payer: Hawaii Western Management Group Commercial	$167.16
Rate for Payer: Health Management Network Commercial	$202.98
Rate for Payer: Kaiser Permanente Commercial	$150.44
Rate for Payer: Kaiser Permanente Medicaid	$121.79
Rate for Payer: MDX Hawaii PPO	$231.64
Rate for Payer: University Health Alliance Commercial	$133.73

Know your out-of-pocket cost for care.

All Charges