Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cortical 2.7mm x 28mm AR-18827-28 [3644810]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644810
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 28mm AR-18827-28 [3644810]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644810
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 32mm AR-18827-32 [3644811]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644811
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 32mm AR-18827-32 [3644811]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644811
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 34mm AR-18827-34 [3644812]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644812
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 34mm AR-18827-34 [3644812]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644812
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 55mm AR-18827-55 [3644886]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644886
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 55mm AR-18827-55 [3644886]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644886
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 60mm AR-18827-60 [3644887]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644887
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 2.7mm x 60mm AR-18827-60 [3644887]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3644887
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Cortical 3.5mmx14mm So-35-So-L14-T [3643618]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643618
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx14mm So-35-So-L14-T [3643618]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643618
Hospital Revenue Code	278
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx16mm So-35-So-L16-T [3643619]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643619
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx16mm So-35-So-L16-T [3643619]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643619
Hospital Revenue Code	278
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx18mm So-35-So-L18-T [3643620]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643620
Hospital Revenue Code	278
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx18mm So-35-So-L18-T [3643620]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx20mm So-35-So-L20-T [3643621]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643621
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mmx20mm So-35-So-L20-T [3643621]

Facility

$1,856.25

Service Code	HCPCS C1713
Hospital Charge Code	3643621
Hospital Revenue Code	278
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,299.38
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,039.50

Screw Cortical 3.5mm x 25mm 8010-250 [3644653]

Facility

$2,414.25

Service Code	HCPCS C1713
Hospital Charge Code	3644653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.98
Max. Negotiated Rate	$2,341.82
Rate for Payer: Cash Price	$1,569.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,689.97
Rate for Payer: Health Management Network Commercial	$2,052.11
Rate for Payer: MDX Hawaii PPO	$2,341.82
Rate for Payer: University Health Alliance Commercial	$1,351.98

Screw Cortical 3.5mm x 25mm 8010-250 [3644653]

Facility

$2,414.25

Service Code	HCPCS C1713
Hospital Charge Code	3644653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,231.27
Max. Negotiated Rate	$2,341.82
Rate for Payer: Cash Price	$1,569.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,689.97
Rate for Payer: Health Management Network Commercial	$2,052.11
Rate for Payer: Kaiser Permanente Commercial	$1,520.98
Rate for Payer: Kaiser Permanente Medicaid	$1,231.27
Rate for Payer: MDX Hawaii PPO	$2,341.82
Rate for Payer: University Health Alliance Commercial	$1,351.98

Screw Cortical 3.5mm X 38mm 815037038 [3642049]

Facility

$467.40

Service Code	HCPCS C1713
Hospital Charge Code	3642049
Hospital Revenue Code	278
Min. Negotiated Rate	$238.37
Max. Negotiated Rate	$453.38
Rate for Payer: Cash Price	$303.81
Rate for Payer: Hawaii Western Management Group Commercial	$327.18
Rate for Payer: Health Management Network Commercial	$397.29
Rate for Payer: Kaiser Permanente Commercial	$294.46
Rate for Payer: Kaiser Permanente Medicaid	$238.37
Rate for Payer: MDX Hawaii PPO	$453.38
Rate for Payer: University Health Alliance Commercial	$261.74

Screw Cortical 3.5mm X 38mm 815037038 [3642049]

Facility

$467.40

Service Code	HCPCS C1713
Hospital Charge Code	3642049
Hospital Revenue Code	278
Min. Negotiated Rate	$261.74
Max. Negotiated Rate	$453.38
Rate for Payer: Cash Price	$303.81
Rate for Payer: Hawaii Western Management Group Commercial	$327.18
Rate for Payer: Health Management Network Commercial	$397.29
Rate for Payer: MDX Hawaii PPO	$453.38
Rate for Payer: University Health Alliance Commercial	$261.74

Screw Cortical 3.5mm X 42mm 815037042 [3642263]

Facility

$467.40

Service Code	HCPCS C1713
Hospital Charge Code	3642263
Hospital Revenue Code	278
Min. Negotiated Rate	$238.37
Max. Negotiated Rate	$453.38
Rate for Payer: Cash Price	$303.81
Rate for Payer: Hawaii Western Management Group Commercial	$327.18
Rate for Payer: Health Management Network Commercial	$397.29
Rate for Payer: Kaiser Permanente Commercial	$294.46
Rate for Payer: Kaiser Permanente Medicaid	$238.37
Rate for Payer: MDX Hawaii PPO	$453.38
Rate for Payer: University Health Alliance Commercial	$261.74

Screw Cortical 3.5mm X 42mm 815037042 [3642263]

Facility

$467.40

Service Code	HCPCS C1713
Hospital Charge Code	3642263
Hospital Revenue Code	278
Min. Negotiated Rate	$261.74
Max. Negotiated Rate	$453.38
Rate for Payer: Cash Price	$303.81
Rate for Payer: Hawaii Western Management Group Commercial	$327.18
Rate for Payer: Health Management Network Commercial	$397.29
Rate for Payer: MDX Hawaii PPO	$453.38
Rate for Payer: University Health Alliance Commercial	$261.74

Screw Cortical 3.5x17.5mm Dt735175 [3643932]

Facility

$1,487.06

Service Code	HCPCS C1713
Hospital Charge Code	3643932
Hospital Revenue Code	278
Min. Negotiated Rate	$758.40
Max. Negotiated Rate	$1,442.45
Rate for Payer: Cash Price	$966.59
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.94
Rate for Payer: Health Management Network Commercial	$1,264.00
Rate for Payer: Kaiser Permanente Commercial	$936.85
Rate for Payer: Kaiser Permanente Medicaid	$758.40
Rate for Payer: MDX Hawaii PPO	$1,442.45
Rate for Payer: University Health Alliance Commercial	$832.75

Know your out-of-pocket cost for care.

All Charges