Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$133.73
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: MDX Hawaii PPO	$231.64
Rate for Payer: University Health Alliance Commercial	$133.73

Screw Cortex ST SD 3.5mm x 18mm 02.200.018 [3641687]

Facility

$238.80

Service Code	HCPCS C1713
Hospital Charge Code	3641687
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

Screw Cortex ST SD 3.5mm x 18mm 02.200.018 [3641687]

Facility

$238.80

Service Code	HCPCS C1713
Hospital Charge Code	3641687
Hospital Revenue Code	278
Min. Negotiated Rate	$133.73
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: MDX Hawaii PPO	$231.64
Rate for Payer: University Health Alliance Commercial	$133.73

Screw Cortex ST SD 3.5mm x 20mm 02.200.020 [3643656]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643656
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 20mm 02.200.020 [3643656]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643656
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 22mm 02.200.022 [3643692]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643692
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 22mm 02.200.022 [3643692]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3643692
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 3.5mmx26mm 02.200.026 [3643657]

Facility

$170.60

Service Code	HCPCS C1713
Hospital Charge Code	3643657
Hospital Revenue Code	278
Min. Negotiated Rate	$87.01
Max. Negotiated Rate	$165.48
Rate for Payer: Cash Price	$110.89
Rate for Payer: Hawaii Western Management Group Commercial	$119.42
Rate for Payer: Health Management Network Commercial	$145.01
Rate for Payer: Kaiser Permanente Commercial	$107.48
Rate for Payer: Kaiser Permanente Medicaid	$87.01
Rate for Payer: MDX Hawaii PPO	$165.48
Rate for Payer: University Health Alliance Commercial	$95.54

Screw Cortex St Sd 3.5mmx26mm 02.200.026 [3643657]

Facility

$170.60

Service Code	HCPCS C1713
Hospital Charge Code	3643657
Hospital Revenue Code	278
Min. Negotiated Rate	$95.54
Max. Negotiated Rate	$165.48
Rate for Payer: Cash Price	$110.89
Rate for Payer: Hawaii Western Management Group Commercial	$119.42
Rate for Payer: Health Management Network Commercial	$145.01
Rate for Payer: MDX Hawaii PPO	$165.48
Rate for Payer: University Health Alliance Commercial	$95.54

Screw Cortex St Sd 3.5mmx28mm 02.200.028 [3644092]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644092
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 3.5mmx28mm 02.200.028 [3644092]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644092
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 30mm 02.200.030 [3644074]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644074
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 30mm 02.200.030 [3644074]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644074
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 34mm 02.200.034 [3644075]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644075
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 34mm 02.200.034 [3644075]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644075
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 3.5mmx36mm 02.200.036 [3644076]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644076
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 3.5mmx36mm 02.200.036 [3644076]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3644076
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 T4 SD 1.5 x 7mm 02.214.107 [3642008]

Facility

$406.40

Service Code	HCPCS C1713
Hospital Charge Code	3642008
Hospital Revenue Code	278
Min. Negotiated Rate	$207.26
Max. Negotiated Rate	$394.21
Rate for Payer: Cash Price	$264.16
Rate for Payer: Hawaii Western Management Group Commercial	$284.48
Rate for Payer: Health Management Network Commercial	$345.44
Rate for Payer: Kaiser Permanente Commercial	$256.03
Rate for Payer: Kaiser Permanente Medicaid	$207.26
Rate for Payer: MDX Hawaii PPO	$394.21
Rate for Payer: University Health Alliance Commercial	$227.58

Screw Cortex ST T4 SD 1.5 x 7mm 02.214.107 [3642008]

Facility

$406.40

Service Code	HCPCS C1713
Hospital Charge Code	3642008
Hospital Revenue Code	278
Min. Negotiated Rate	$227.58
Max. Negotiated Rate	$394.21
Rate for Payer: Cash Price	$264.16
Rate for Payer: Hawaii Western Management Group Commercial	$284.48
Rate for Payer: Health Management Network Commercial	$345.44
Rate for Payer: MDX Hawaii PPO	$394.21
Rate for Payer: University Health Alliance Commercial	$227.58

Screw Cortex ST T4 SD 1.5 x 9mm 02.214.109 [3642010]

Facility

$406.40

Service Code	HCPCS C1713
Hospital Charge Code	3642010
Hospital Revenue Code	278
Min. Negotiated Rate	$227.58
Max. Negotiated Rate	$394.21
Rate for Payer: Cash Price	$264.16
Rate for Payer: Hawaii Western Management Group Commercial	$284.48
Rate for Payer: Health Management Network Commercial	$345.44
Rate for Payer: MDX Hawaii PPO	$394.21
Rate for Payer: University Health Alliance Commercial	$227.58

Screw Cortex ST T4 SD 1.5 x 9mm 02.214.109 [3642010]

Facility

$406.40

Service Code	HCPCS C1713
Hospital Charge Code	3642010
Hospital Revenue Code	278
Min. Negotiated Rate	$207.26
Max. Negotiated Rate	$394.21
Rate for Payer: Cash Price	$264.16
Rate for Payer: Hawaii Western Management Group Commercial	$284.48
Rate for Payer: Health Management Network Commercial	$345.44
Rate for Payer: Kaiser Permanente Commercial	$256.03
Rate for Payer: Kaiser Permanente Medicaid	$207.26
Rate for Payer: MDX Hawaii PPO	$394.21
Rate for Payer: University Health Alliance Commercial	$227.58

Screw Cortex ST T8 SD 2.4 x 28mm 201.778 [3642620]

Facility

$465.91

Service Code	HCPCS C1713
Hospital Charge Code	3642620
Hospital Revenue Code	278
Min. Negotiated Rate	$260.91
Max. Negotiated Rate	$451.93
Rate for Payer: Cash Price	$302.84
Rate for Payer: Hawaii Western Management Group Commercial	$326.14
Rate for Payer: Health Management Network Commercial	$396.02
Rate for Payer: MDX Hawaii PPO	$451.93
Rate for Payer: University Health Alliance Commercial	$260.91

Screw Cortex ST T8 SD 2.4 x 28mm 201.778 [3642620]

Facility

$465.91

Service Code	HCPCS C1713
Hospital Charge Code	3642620
Hospital Revenue Code	278
Min. Negotiated Rate	$237.61
Max. Negotiated Rate	$451.93
Rate for Payer: Cash Price	$302.84
Rate for Payer: Hawaii Western Management Group Commercial	$326.14
Rate for Payer: Health Management Network Commercial	$396.02
Rate for Payer: Kaiser Permanente Commercial	$293.52
Rate for Payer: Kaiser Permanente Medicaid	$237.61
Rate for Payer: MDX Hawaii PPO	$451.93
Rate for Payer: University Health Alliance Commercial	$260.91

Screw Cortex ST T8 SD 2.4 x 30mm 201.780 [3645012]

Facility

$560.96

Service Code	HCPCS C1713
Hospital Charge Code	3645012
Hospital Revenue Code	278
Min. Negotiated Rate	$286.09
Max. Negotiated Rate	$544.13
Rate for Payer: Cash Price	$364.62
Rate for Payer: Hawaii Western Management Group Commercial	$392.67
Rate for Payer: Health Management Network Commercial	$476.82
Rate for Payer: Kaiser Permanente Commercial	$353.40
Rate for Payer: Kaiser Permanente Medicaid	$286.09
Rate for Payer: MDX Hawaii PPO	$544.13
Rate for Payer: University Health Alliance Commercial	$314.14

Screw Cortex ST T8 SD 2.4 x 30mm 201.780 [3645012]

Facility

$560.96

Service Code	HCPCS C1713
Hospital Charge Code	3645012
Hospital Revenue Code	278
Min. Negotiated Rate	$314.14
Max. Negotiated Rate	$544.13
Rate for Payer: Cash Price	$364.62
Rate for Payer: Hawaii Western Management Group Commercial	$392.67
Rate for Payer: Health Management Network Commercial	$476.82
Rate for Payer: MDX Hawaii PPO	$544.13
Rate for Payer: University Health Alliance Commercial	$314.14

Know your out-of-pocket cost for care.

All Charges