Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Cortical Non-Lock Ti 3.5mm x 44mm PANL-35440-TS [3644082]

Facility

$887.41

Service Code	HCPCS C1713
Hospital Charge Code	3644082
Hospital Revenue Code	278
Min. Negotiated Rate	$452.58
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$621.19
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: Kaiser Permanente Commercial	$559.07
Rate for Payer: Kaiser Permanente Medicaid	$452.58
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$496.95

Screw Cort Lopro 3.0 x 10mm Ti AR-8933-10 [3644042]

Facility

$805.00

Service Code	HCPCS C1713
Hospital Charge Code	3644042
Hospital Revenue Code	278
Min. Negotiated Rate	$410.55
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Hawaii Western Management Group Commercial	$563.50
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$507.15
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: University Health Alliance Commercial	$450.80

Screw Cort Lopro 3.0 x 10mm Ti AR-8933-10 [3644042]

Facility

$805.00

Service Code	HCPCS C1713
Hospital Charge Code	3644042
Hospital Revenue Code	278
Min. Negotiated Rate	$450.80
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Hawaii Western Management Group Commercial	$563.50
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: University Health Alliance Commercial	$450.80

Screw Cort Non Lock Ti 3.54mmx28mm PANL-35280-TS [3645438]

Facility

$887.41

Service Code	HCPCS C1713
Hospital Charge Code	3645438
Hospital Revenue Code	278
Min. Negotiated Rate	$496.95
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$621.19
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$496.95

Screw Cort Non Lock Ti 3.54mmx28mm PANL-35280-TS [3645438]

Facility

$887.41

Service Code	HCPCS C1713
Hospital Charge Code	3645438
Hospital Revenue Code	278
Min. Negotiated Rate	$452.58
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$621.19
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: Kaiser Permanente Commercial	$559.07
Rate for Payer: Kaiser Permanente Medicaid	$452.58
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$496.95

Screw Cort Non Lock Ti 3.5mm x 18mm PANL-35180-TS [3643447]

Facility

$455.00

Service Code	HCPCS C1713
Hospital Charge Code	3643447
Hospital Revenue Code	278
Min. Negotiated Rate	$254.80
Max. Negotiated Rate	$441.35
Rate for Payer: Cash Price	$295.75
Rate for Payer: Hawaii Western Management Group Commercial	$318.50
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: MDX Hawaii PPO	$441.35
Rate for Payer: University Health Alliance Commercial	$254.80

Screw Cort Non Lock Ti 3.5mm x 18mm PANL-35180-TS [3643447]

Facility

$455.00

Service Code	HCPCS C1713
Hospital Charge Code	3643447
Hospital Revenue Code	278
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$441.35
Rate for Payer: Cash Price	$295.75
Rate for Payer: Hawaii Western Management Group Commercial	$318.50
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: Kaiser Permanente Commercial	$286.65
Rate for Payer: Kaiser Permanente Medicaid	$232.05
Rate for Payer: MDX Hawaii PPO	$441.35
Rate for Payer: University Health Alliance Commercial	$254.80

Screw Cort Non Lock Ti 3.5mm x 22mm PANL-35220-TS [3643450]

Facility

$621.25

Service Code	HCPCS C1713
Hospital Charge Code	3643450
Hospital Revenue Code	278
Min. Negotiated Rate	$316.84
Max. Negotiated Rate	$602.61
Rate for Payer: Cash Price	$403.81
Rate for Payer: Hawaii Western Management Group Commercial	$434.88
Rate for Payer: Health Management Network Commercial	$528.06
Rate for Payer: Kaiser Permanente Commercial	$391.39
Rate for Payer: Kaiser Permanente Medicaid	$316.84
Rate for Payer: MDX Hawaii PPO	$602.61
Rate for Payer: University Health Alliance Commercial	$347.90

Screw Cort Non Lock Ti 3.5mm x 22mm PANL-35220-TS [3643450]

Facility

$621.25

Service Code	HCPCS C1713
Hospital Charge Code	3643450
Hospital Revenue Code	278
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$602.61
Rate for Payer: Cash Price	$403.81
Rate for Payer: Hawaii Western Management Group Commercial	$434.88
Rate for Payer: Health Management Network Commercial	$528.06
Rate for Payer: MDX Hawaii PPO	$602.61
Rate for Payer: University Health Alliance Commercial	$347.90

Screw Drill A/R 2112-01-505 [3640914]

Facility

$3,381.20

Hospital Charge Code	3640914
Hospital Revenue Code	272
Min. Negotiated Rate	$2,874.02
Max. Negotiated Rate	$3,279.76
Rate for Payer: Cash Price	$2,197.78
Rate for Payer: Health Management Network Commercial	$2,874.02
Rate for Payer: MDX Hawaii PPO	$3,279.76

Screw Drill A/R 2112-01-505 [3640914]

Facility

$3,381.20

Hospital Charge Code	3640914
Hospital Revenue Code	272
Min. Negotiated Rate	$1,724.41
Max. Negotiated Rate	$3,279.76
Rate for Payer: Cash Price	$2,197.78
Rate for Payer: Hawaii Western Management Group Commercial	$3,212.14
Rate for Payer: Health Management Network Commercial	$2,874.02
Rate for Payer: Kaiser Permanente Commercial	$2,130.16
Rate for Payer: Kaiser Permanente Medicaid	$1,724.41
Rate for Payer: MDX Hawaii PPO	$3,279.76
Rate for Payer: University Health Alliance Commercial	$2,464.56

Screw Driver Attach Cann 3/16 Sq Connect P99-190-TX25 [3644914]

Facility

$2,127.25

Hospital Charge Code	3644914
Hospital Revenue Code	272
Min. Negotiated Rate	$1,084.90
Max. Negotiated Rate	$2,063.43
Rate for Payer: Cash Price	$1,382.71
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.89
Rate for Payer: Health Management Network Commercial	$1,808.16
Rate for Payer: Kaiser Permanente Commercial	$1,340.17
Rate for Payer: Kaiser Permanente Medicaid	$1,084.90
Rate for Payer: MDX Hawaii PPO	$2,063.43
Rate for Payer: University Health Alliance Commercial	$1,550.55

Screw Driver Attach Cann 3/16 Sq Connect P99-190-TX25 [3644914]

Facility

$2,127.25

Hospital Charge Code	3644914
Hospital Revenue Code	272
Min. Negotiated Rate	$1,808.16
Max. Negotiated Rate	$2,063.43
Rate for Payer: Cash Price	$1,382.71
Rate for Payer: Health Management Network Commercial	$1,808.16
Rate for Payer: MDX Hawaii PPO	$2,063.43

Screw Driver Attach Cann AO HX-6 P99-190-TX06 [3644497]

Facility

$1,527.63

Hospital Charge Code	3644497
Hospital Revenue Code	272
Min. Negotiated Rate	$779.09
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.25
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: Kaiser Permanente Commercial	$962.41
Rate for Payer: Kaiser Permanente Medicaid	$779.09
Rate for Payer: MDX Hawaii PPO	$1,481.80
Rate for Payer: University Health Alliance Commercial	$1,113.49

Screw Driver Attach Cann AO HX-6 P99-190-TX06 [3644497]

Facility

$1,527.63

Hospital Charge Code	3644497
Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.49
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: MDX Hawaii PPO	$1,481.80

Screw Driver Attach Cann Mod TX-8 P99-190-TT08 [3644913]

Facility

$1,748.00

Hospital Charge Code	3644913
Hospital Revenue Code	272
Min. Negotiated Rate	$1,485.80
Max. Negotiated Rate	$1,695.56
Rate for Payer: Cash Price	$1,136.20
Rate for Payer: Health Management Network Commercial	$1,485.80
Rate for Payer: MDX Hawaii PPO	$1,695.56

Screw Driver Attach Cann Mod TX-8 P99-190-TT08 [3644913]

Facility

$1,748.00

Hospital Charge Code	3644913
Hospital Revenue Code	272
Min. Negotiated Rate	$891.48
Max. Negotiated Rate	$1,695.56
Rate for Payer: Cash Price	$1,136.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,660.60
Rate for Payer: Health Management Network Commercial	$1,485.80
Rate for Payer: Kaiser Permanente Commercial	$1,101.24
Rate for Payer: Kaiser Permanente Medicaid	$891.48
Rate for Payer: MDX Hawaii PPO	$1,695.56
Rate for Payer: University Health Alliance Commercial	$1,274.12

Screw Driver Attachment Cann AO TX-10 P99-190-TT10 [3644339]

Facility

$1,527.63

Hospital Charge Code	3644339
Hospital Revenue Code	272
Min. Negotiated Rate	$779.09
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.25
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: Kaiser Permanente Commercial	$962.41
Rate for Payer: Kaiser Permanente Medicaid	$779.09
Rate for Payer: MDX Hawaii PPO	$1,481.80
Rate for Payer: University Health Alliance Commercial	$1,113.49

Screw Driver Attachment Cann AO TX-10 P99-190-TT10 [3644339]

Facility

$1,527.63

Hospital Charge Code	3644339
Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.49
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: MDX Hawaii PPO	$1,481.80

Screw Driver Attachment Solid AO HX-10 Short Taper P99-191-TR10 [3644340]

Facility

$1,527.63

Hospital Charge Code	3644340
Hospital Revenue Code	272
Min. Negotiated Rate	$779.09
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.25
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: Kaiser Permanente Commercial	$962.41
Rate for Payer: Kaiser Permanente Medicaid	$779.09
Rate for Payer: MDX Hawaii PPO	$1,481.80
Rate for Payer: University Health Alliance Commercial	$1,113.49

Screw Driver Attachment Solid AO HX-10 Short Taper P99-191-TR10 [3644340]

Facility

$1,527.63

Hospital Charge Code	3644340
Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.49
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: MDX Hawaii PPO	$1,481.80

Screw Driver Attach Solid Long HX-10 x 83mm P99-191-AF10 [3644915]

Facility

$1,750.56

Hospital Charge Code	3644915
Hospital Revenue Code	272
Min. Negotiated Rate	$892.79
Max. Negotiated Rate	$1,698.04
Rate for Payer: Cash Price	$1,137.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,663.03
Rate for Payer: Health Management Network Commercial	$1,487.98
Rate for Payer: Kaiser Permanente Commercial	$1,102.85
Rate for Payer: Kaiser Permanente Medicaid	$892.79
Rate for Payer: MDX Hawaii PPO	$1,698.04
Rate for Payer: University Health Alliance Commercial	$1,275.98

Screw Driver Attach Solid Long HX-10 x 83mm P99-191-AF10 [3644915]

Facility

$1,750.56

Hospital Charge Code	3644915
Hospital Revenue Code	272
Min. Negotiated Rate	$1,487.98
Max. Negotiated Rate	$1,698.04
Rate for Payer: Cash Price	$1,137.86
Rate for Payer: Health Management Network Commercial	$1,487.98
Rate for Payer: MDX Hawaii PPO	$1,698.04

Screw Driver Attch Solid AO TX-7 P99-191-TS07 [3644498]

Facility

$1,527.63

Hospital Charge Code	3644498
Hospital Revenue Code	272
Min. Negotiated Rate	$1,298.49
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: MDX Hawaii PPO	$1,481.80

Screw Driver Attch Solid AO TX-7 P99-191-TS07 [3644498]

Facility

$1,527.63

Hospital Charge Code	3644498
Hospital Revenue Code	272
Min. Negotiated Rate	$779.09
Max. Negotiated Rate	$1,481.80
Rate for Payer: Cash Price	$992.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.25
Rate for Payer: Health Management Network Commercial	$1,298.49
Rate for Payer: Kaiser Permanente Commercial	$962.41
Rate for Payer: Kaiser Permanente Medicaid	$779.09
Rate for Payer: MDX Hawaii PPO	$1,481.80
Rate for Payer: University Health Alliance Commercial	$1,113.49

Know your out-of-pocket cost for care.

All Charges