Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$832.75
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: MDX Hawaii PPO	$1,442.45
Rate for Payer: University Health Alliance Commercial	$832.75

Screw Cortical 3.5x27.5mm Dt735275 [3643933]

Facility

$1,487.06

Service Code	HCPCS C1713
Hospital Charge Code	3643933
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

Screw Cortical 3.5x27.5mm Dt735275 [3643933]

Facility

$1,487.06

Service Code	HCPCS C1713
Hospital Charge Code	3643933
Hospital Revenue Code	278
Min. Negotiated Rate	$832.75
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: MDX Hawaii PPO	$1,442.45
Rate for Payer: University Health Alliance Commercial	$832.75

Screw Cortical 4.5x44mm Ar-13380-44 [3644010]

Facility

$1,720.13

Service Code	HCPCS C1713
Hospital Charge Code	3644010
Hospital Revenue Code	278
Min. Negotiated Rate	$877.27
Max. Negotiated Rate	$1,668.53
Rate for Payer: Cash Price	$1,118.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,204.09
Rate for Payer: Health Management Network Commercial	$1,462.11
Rate for Payer: Kaiser Permanente Commercial	$1,083.68
Rate for Payer: Kaiser Permanente Medicaid	$877.27
Rate for Payer: MDX Hawaii PPO	$1,668.53
Rate for Payer: University Health Alliance Commercial	$963.27

Screw Cortical 4.5x44mm Ar-13380-44 [3644010]

Facility

$1,720.13

Service Code	HCPCS C1713
Hospital Charge Code	3644010
Hospital Revenue Code	278
Min. Negotiated Rate	$963.27
Max. Negotiated Rate	$1,668.53
Rate for Payer: Cash Price	$1,118.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,204.09
Rate for Payer: Health Management Network Commercial	$1,462.11
Rate for Payer: MDX Hawaii PPO	$1,668.53
Rate for Payer: University Health Alliance Commercial	$963.27

Screw Cortical 4.5x50mm Ar-13380-50 [3644011]

Facility

$1,720.13

Service Code	HCPCS C1713
Hospital Charge Code	3644011
Hospital Revenue Code	278
Min. Negotiated Rate	$963.27
Max. Negotiated Rate	$1,668.53
Rate for Payer: Cash Price	$1,118.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,204.09
Rate for Payer: Health Management Network Commercial	$1,462.11
Rate for Payer: MDX Hawaii PPO	$1,668.53
Rate for Payer: University Health Alliance Commercial	$963.27

Screw Cortical 4.5x50mm Ar-13380-50 [3644011]

Facility

$1,720.13

Service Code	HCPCS C1713
Hospital Charge Code	3644011
Hospital Revenue Code	278
Min. Negotiated Rate	$877.27
Max. Negotiated Rate	$1,668.53
Rate for Payer: Cash Price	$1,118.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,204.09
Rate for Payer: Health Management Network Commercial	$1,462.11
Rate for Payer: Kaiser Permanente Commercial	$1,083.68
Rate for Payer: Kaiser Permanente Medicaid	$877.27
Rate for Payer: MDX Hawaii PPO	$1,668.53
Rate for Payer: University Health Alliance Commercial	$963.27

Screw Cortical Bone 5.0mm x 28mm 814550028 [3644295]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3644295
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Screw Cortical Bone 5.0mm x 28mm 814550028 [3644295]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3644295
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Screw Cortical Bone 5.0mmx60mm 8145-50-060 [3643984]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643984
Hospital Revenue Code	278
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Screw Cortical Bone 5.0mmx60mm 8145-50-060 [3643984]

Facility

$1,183.88

Service Code	HCPCS C1713
Hospital Charge Code	3643984
Hospital Revenue Code	278
Min. Negotiated Rate	$603.78
Max. Negotiated Rate	$1,148.36
Rate for Payer: Cash Price	$769.52
Rate for Payer: Hawaii Western Management Group Commercial	$828.72
Rate for Payer: Health Management Network Commercial	$1,006.30
Rate for Payer: Kaiser Permanente Commercial	$745.84
Rate for Payer: Kaiser Permanente Medicaid	$603.78
Rate for Payer: MDX Hawaii PPO	$1,148.36
Rate for Payer: University Health Alliance Commercial	$662.97

Screw Cortical Captured 5.0mm x 34mm AR-9093-50-034 [3644735]

Facility

$2,327.13

Service Code	HCPCS C1713
Hospital Charge Code	3644735
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.84
Max. Negotiated Rate	$2,257.32
Rate for Payer: Cash Price	$1,512.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,628.99
Rate for Payer: Health Management Network Commercial	$1,978.06
Rate for Payer: Kaiser Permanente Commercial	$1,466.09
Rate for Payer: Kaiser Permanente Medicaid	$1,186.84
Rate for Payer: MDX Hawaii PPO	$2,257.32
Rate for Payer: University Health Alliance Commercial	$1,303.19

Screw Cortical Captured 5.0mm x 34mm AR-9093-50-034 [3644735]

Facility

$2,327.13

Service Code	HCPCS C1713
Hospital Charge Code	3644735
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.19
Max. Negotiated Rate	$2,257.32
Rate for Payer: Cash Price	$1,512.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,628.99
Rate for Payer: Health Management Network Commercial	$1,978.06
Rate for Payer: MDX Hawaii PPO	$2,257.32
Rate for Payer: University Health Alliance Commercial	$1,303.19

Screw Cortical Captured 5.0mm x 36mm AR-9093-50-036 [3644620]

Facility

$2,327.13

Service Code	HCPCS C1713
Hospital Charge Code	3644620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.19
Max. Negotiated Rate	$2,257.32
Rate for Payer: Cash Price	$1,512.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,628.99
Rate for Payer: Health Management Network Commercial	$1,978.06
Rate for Payer: MDX Hawaii PPO	$2,257.32
Rate for Payer: University Health Alliance Commercial	$1,303.19

Screw Cortical Captured 5.0mm x 36mm AR-9093-50-036 [3644620]

Facility

$2,327.13

Service Code	HCPCS C1713
Hospital Charge Code	3644620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.84
Max. Negotiated Rate	$2,257.32
Rate for Payer: Cash Price	$1,512.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,628.99
Rate for Payer: Health Management Network Commercial	$1,978.06
Rate for Payer: Kaiser Permanente Commercial	$1,466.09
Rate for Payer: Kaiser Permanente Medicaid	$1,186.84
Rate for Payer: MDX Hawaii PPO	$2,257.32
Rate for Payer: University Health Alliance Commercial	$1,303.19

Screw Cortical Locking Ti 3.5mmX10mm COLS-35100-TS [3643205]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3643205
Hospital Revenue Code	278
Min. Negotiated Rate	$388.99
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmX10mm COLS-35100-TS [3643205]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3643205
Hospital Revenue Code	278
Min. Negotiated Rate	$354.26
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: Kaiser Permanente Commercial	$437.62
Rate for Payer: Kaiser Permanente Medicaid	$354.26
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmx12mm [3643307]

Facility

$463.75

Service Code	HCPCS C1713
Hospital Charge Code	3643307
Hospital Revenue Code	278
Min. Negotiated Rate	$236.51
Max. Negotiated Rate	$449.84
Rate for Payer: Cash Price	$301.44
Rate for Payer: Hawaii Western Management Group Commercial	$324.62
Rate for Payer: Health Management Network Commercial	$394.19
Rate for Payer: Kaiser Permanente Commercial	$292.16
Rate for Payer: Kaiser Permanente Medicaid	$236.51
Rate for Payer: MDX Hawaii PPO	$449.84
Rate for Payer: University Health Alliance Commercial	$259.70

Screw Cortical Locking Ti 3.5mmx12mm [3643307]

Facility

$463.75

Service Code	HCPCS C1713
Hospital Charge Code	3643307
Hospital Revenue Code	278
Min. Negotiated Rate	$259.70
Max. Negotiated Rate	$449.84
Rate for Payer: Cash Price	$301.44
Rate for Payer: Hawaii Western Management Group Commercial	$324.62
Rate for Payer: Health Management Network Commercial	$394.19
Rate for Payer: MDX Hawaii PPO	$449.84
Rate for Payer: University Health Alliance Commercial	$259.70

Screw Cortical Locking Ti 3.5mmX13mm COLS-35130-TS [3643185]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3643185
Hospital Revenue Code	278
Min. Negotiated Rate	$354.26
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: Kaiser Permanente Commercial	$437.62
Rate for Payer: Kaiser Permanente Medicaid	$354.26
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmX13mm COLS-35130-TS [3643185]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3643185
Hospital Revenue Code	278
Min. Negotiated Rate	$388.99
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmX14mm COLS35140TS [3642636]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3642636
Hospital Revenue Code	278
Min. Negotiated Rate	$388.99
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmX14mm COLS35140TS [3642636]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3642636
Hospital Revenue Code	278
Min. Negotiated Rate	$354.26
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: Kaiser Permanente Commercial	$437.62
Rate for Payer: Kaiser Permanente Medicaid	$354.26
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmX18mm COLS35180TS [3642638]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3642638
Hospital Revenue Code	278
Min. Negotiated Rate	$354.26
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: Kaiser Permanente Commercial	$437.62
Rate for Payer: Kaiser Permanente Medicaid	$354.26
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Screw Cortical Locking Ti 3.5mmX18mm COLS35180TS [3642638]

Facility

$694.63

Service Code	HCPCS C1713
Hospital Charge Code	3642638
Hospital Revenue Code	278
Min. Negotiated Rate	$388.99
Max. Negotiated Rate	$673.79
Rate for Payer: Cash Price	$451.51
Rate for Payer: Hawaii Western Management Group Commercial	$486.24
Rate for Payer: Health Management Network Commercial	$590.44
Rate for Payer: MDX Hawaii PPO	$673.79
Rate for Payer: University Health Alliance Commercial	$388.99

Know your out-of-pocket cost for care.

All Charges