Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Fully Threaded 2.0mmX10mm 331-2010 [3641847]

Facility

$423.94

Service Code	HCPCS C1713
Hospital Charge Code	3641847
Hospital Revenue Code	278
Min. Negotiated Rate	$216.21
Max. Negotiated Rate	$411.22
Rate for Payer: Cash Price	$275.56
Rate for Payer: Hawaii Western Management Group Commercial	$296.76
Rate for Payer: Health Management Network Commercial	$360.35
Rate for Payer: Kaiser Permanente Commercial	$267.08
Rate for Payer: Kaiser Permanente Medicaid	$216.21
Rate for Payer: MDX Hawaii PPO	$411.22
Rate for Payer: University Health Alliance Commercial	$237.41

Screw Fully Threaded 2.0mmx16mm 331-2016 [3643646]

Facility

$460.75

Service Code	HCPCS C1713
Hospital Charge Code	3643646
Hospital Revenue Code	278
Min. Negotiated Rate	$234.98
Max. Negotiated Rate	$446.93
Rate for Payer: Cash Price	$299.49
Rate for Payer: Hawaii Western Management Group Commercial	$322.52
Rate for Payer: Health Management Network Commercial	$391.64
Rate for Payer: Kaiser Permanente Commercial	$290.27
Rate for Payer: Kaiser Permanente Medicaid	$234.98
Rate for Payer: MDX Hawaii PPO	$446.93
Rate for Payer: University Health Alliance Commercial	$258.02

Screw Fully Threaded 2.0mmx16mm 331-2016 [3643646]

Facility

$460.75

Service Code	HCPCS C1713
Hospital Charge Code	3643646
Hospital Revenue Code	278
Min. Negotiated Rate	$258.02
Max. Negotiated Rate	$446.93
Rate for Payer: Cash Price	$299.49
Rate for Payer: Hawaii Western Management Group Commercial	$322.52
Rate for Payer: Health Management Network Commercial	$391.64
Rate for Payer: MDX Hawaii PPO	$446.93
Rate for Payer: University Health Alliance Commercial	$258.02

Screw Fully Threaded 2.0mmX9mm 331-2009 [3641846]

Facility

$423.94

Service Code	HCPCS C1713
Hospital Charge Code	3641846
Hospital Revenue Code	278
Min. Negotiated Rate	$216.21
Max. Negotiated Rate	$411.22
Rate for Payer: Cash Price	$275.56
Rate for Payer: Hawaii Western Management Group Commercial	$296.76
Rate for Payer: Health Management Network Commercial	$360.35
Rate for Payer: Kaiser Permanente Commercial	$267.08
Rate for Payer: Kaiser Permanente Medicaid	$216.21
Rate for Payer: MDX Hawaii PPO	$411.22
Rate for Payer: University Health Alliance Commercial	$237.41

Screw Fully Threaded 2.0mmX9mm 331-2009 [3641846]

Facility

$423.94

Service Code	HCPCS C1713
Hospital Charge Code	3641846
Hospital Revenue Code	278
Min. Negotiated Rate	$237.41
Max. Negotiated Rate	$411.22
Rate for Payer: Cash Price	$275.56
Rate for Payer: Hawaii Western Management Group Commercial	$296.76
Rate for Payer: Health Management Network Commercial	$360.35
Rate for Payer: MDX Hawaii PPO	$411.22
Rate for Payer: University Health Alliance Commercial	$237.41

Screw Fully Threaded Angled Lock 1.6mm x 10mm 330-1610 [3644893]

Facility

$1,123.03

Service Code	HCPCS C1713
Hospital Charge Code	3644893
Hospital Revenue Code	278
Min. Negotiated Rate	$572.75
Max. Negotiated Rate	$1,089.34
Rate for Payer: Cash Price	$729.97
Rate for Payer: Hawaii Western Management Group Commercial	$786.12
Rate for Payer: Health Management Network Commercial	$954.58
Rate for Payer: Kaiser Permanente Commercial	$707.51
Rate for Payer: Kaiser Permanente Medicaid	$572.75
Rate for Payer: MDX Hawaii PPO	$1,089.34
Rate for Payer: University Health Alliance Commercial	$628.90

Screw Fully Threaded Angled Lock 1.6mm x 10mm 330-1610 [3644893]

Facility

$1,123.03

Service Code	HCPCS C1713
Hospital Charge Code	3644893
Hospital Revenue Code	278
Min. Negotiated Rate	$628.90
Max. Negotiated Rate	$1,089.34
Rate for Payer: Cash Price	$729.97
Rate for Payer: Hawaii Western Management Group Commercial	$786.12
Rate for Payer: Health Management Network Commercial	$954.58
Rate for Payer: MDX Hawaii PPO	$1,089.34
Rate for Payer: University Health Alliance Commercial	$628.90

Screw Fully Threaded Angled Lock 1.6mm x 6mm 330-1606 [3643647]

Facility

$1,123.03

Service Code	HCPCS C1713
Hospital Charge Code	3643647
Hospital Revenue Code	278
Min. Negotiated Rate	$628.90
Max. Negotiated Rate	$1,089.34
Rate for Payer: Cash Price	$729.97
Rate for Payer: Hawaii Western Management Group Commercial	$786.12
Rate for Payer: Health Management Network Commercial	$954.58
Rate for Payer: MDX Hawaii PPO	$1,089.34
Rate for Payer: University Health Alliance Commercial	$628.90

Screw Fully Threaded Angled Lock 1.6mm x 6mm 330-1606 [3643647]

Facility

$1,123.03

Service Code	HCPCS C1713
Hospital Charge Code	3643647
Hospital Revenue Code	278
Min. Negotiated Rate	$572.75
Max. Negotiated Rate	$1,089.34
Rate for Payer: Cash Price	$729.97
Rate for Payer: Hawaii Western Management Group Commercial	$786.12
Rate for Payer: Health Management Network Commercial	$954.58
Rate for Payer: Kaiser Permanente Commercial	$707.51
Rate for Payer: Kaiser Permanente Medicaid	$572.75
Rate for Payer: MDX Hawaii PPO	$1,089.34
Rate for Payer: University Health Alliance Commercial	$628.90

Screw Fully Threaded Angled Lock 1.6mm x 8mm 330-1608 [3644892]

Facility

$1,123.03

Service Code	HCPCS C1713
Hospital Charge Code	3644892
Hospital Revenue Code	278
Min. Negotiated Rate	$572.75
Max. Negotiated Rate	$1,089.34
Rate for Payer: Cash Price	$729.97
Rate for Payer: Hawaii Western Management Group Commercial	$786.12
Rate for Payer: Health Management Network Commercial	$954.58
Rate for Payer: Kaiser Permanente Commercial	$707.51
Rate for Payer: Kaiser Permanente Medicaid	$572.75
Rate for Payer: MDX Hawaii PPO	$1,089.34
Rate for Payer: University Health Alliance Commercial	$628.90

Screw Fully Threaded Angled Lock 1.6mm x 8mm 330-1608 [3644892]

Facility

$1,123.03

Service Code	HCPCS C1713
Hospital Charge Code	3644892
Hospital Revenue Code	278
Min. Negotiated Rate	$628.90
Max. Negotiated Rate	$1,089.34
Rate for Payer: Cash Price	$729.97
Rate for Payer: Hawaii Western Management Group Commercial	$786.12
Rate for Payer: Health Management Network Commercial	$954.58
Rate for Payer: MDX Hawaii PPO	$1,089.34
Rate for Payer: University Health Alliance Commercial	$628.90

Screw Headless Comp 3.5mmx22mm Ti Hcs-35022 [3643987]

Facility

$3,104.00

Service Code	HCPCS C1713
Hospital Charge Code	3643987
Hospital Revenue Code	278
Min. Negotiated Rate	$1,583.04
Max. Negotiated Rate	$3,010.88
Rate for Payer: Cash Price	$2,017.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,172.80
Rate for Payer: Health Management Network Commercial	$2,638.40
Rate for Payer: Kaiser Permanente Commercial	$1,955.52
Rate for Payer: Kaiser Permanente Medicaid	$1,583.04
Rate for Payer: MDX Hawaii PPO	$3,010.88
Rate for Payer: University Health Alliance Commercial	$1,738.24

Screw Headless Comp 3.5mmx22mm Ti Hcs-35022 [3643987]

Facility

$3,104.00

Service Code	HCPCS C1713
Hospital Charge Code	3643987
Hospital Revenue Code	278
Min. Negotiated Rate	$1,738.24
Max. Negotiated Rate	$3,010.88
Rate for Payer: Cash Price	$2,017.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,172.80
Rate for Payer: Health Management Network Commercial	$2,638.40
Rate for Payer: MDX Hawaii PPO	$3,010.88
Rate for Payer: University Health Alliance Commercial	$1,738.24

Screw Headless Comp Ti 2.5mm x 22mm HCS-25022 [3644426]

Facility

$3,104.00

Service Code	HCPCS C1713
Hospital Charge Code	3644426
Hospital Revenue Code	278
Min. Negotiated Rate	$1,738.24
Max. Negotiated Rate	$3,010.88
Rate for Payer: Cash Price	$2,017.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,172.80
Rate for Payer: Health Management Network Commercial	$2,638.40
Rate for Payer: MDX Hawaii PPO	$3,010.88
Rate for Payer: University Health Alliance Commercial	$1,738.24

Screw Headless Comp Ti 2.5mm x 22mm HCS-25022 [3644426]

Facility

$3,104.00

Service Code	HCPCS C1713
Hospital Charge Code	3644426
Hospital Revenue Code	278
Min. Negotiated Rate	$1,583.04
Max. Negotiated Rate	$3,010.88
Rate for Payer: Cash Price	$2,017.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,172.80
Rate for Payer: Health Management Network Commercial	$2,638.40
Rate for Payer: Kaiser Permanente Commercial	$1,955.52
Rate for Payer: Kaiser Permanente Medicaid	$1,583.04
Rate for Payer: MDX Hawaii PPO	$3,010.88
Rate for Payer: University Health Alliance Commercial	$1,738.24

Screw Headless Comp Ti 2.5mm x 24mm HCS-25024 [3644427]

Facility

$3,104.00

Service Code	HCPCS C1713
Hospital Charge Code	3644427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,583.04
Max. Negotiated Rate	$3,010.88
Rate for Payer: Cash Price	$2,017.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,172.80
Rate for Payer: Health Management Network Commercial	$2,638.40
Rate for Payer: Kaiser Permanente Commercial	$1,955.52
Rate for Payer: Kaiser Permanente Medicaid	$1,583.04
Rate for Payer: MDX Hawaii PPO	$3,010.88
Rate for Payer: University Health Alliance Commercial	$1,738.24

Screw Headless Comp Ti 2.5mm x 24mm HCS-25024 [3644427]

Facility

$3,104.00

Service Code	HCPCS C1713
Hospital Charge Code	3644427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,738.24
Max. Negotiated Rate	$3,010.88
Rate for Payer: Cash Price	$2,017.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,172.80
Rate for Payer: Health Management Network Commercial	$2,638.40
Rate for Payer: MDX Hawaii PPO	$3,010.88
Rate for Payer: University Health Alliance Commercial	$1,738.24

Screw Hfn A/r 60mm 814501060 [3644293]

Facility

$2,249.23

Service Code	HCPCS C1713
Hospital Charge Code	3644293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,259.57
Max. Negotiated Rate	$2,181.75
Rate for Payer: Cash Price	$1,462.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,574.46
Rate for Payer: Health Management Network Commercial	$1,911.85
Rate for Payer: MDX Hawaii PPO	$2,181.75
Rate for Payer: University Health Alliance Commercial	$1,259.57

Screw Hfn A/r 60mm 814501060 [3644293]

Facility

$2,249.23

Service Code	HCPCS C1713
Hospital Charge Code	3644293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.11
Max. Negotiated Rate	$2,181.75
Rate for Payer: Cash Price	$1,462.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,574.46
Rate for Payer: Health Management Network Commercial	$1,911.85
Rate for Payer: Kaiser Permanente Commercial	$1,417.01
Rate for Payer: Kaiser Permanente Medicaid	$1,147.11
Rate for Payer: MDX Hawaii PPO	$2,181.75
Rate for Payer: University Health Alliance Commercial	$1,259.57

Screw HFN A/R 65mm 814501065 [3642576]

Facility

$1,657.43

Service Code	HCPCS C1713
Hospital Charge Code	3642576
Hospital Revenue Code	278
Min. Negotiated Rate	$928.16
Max. Negotiated Rate	$1,607.71
Rate for Payer: Cash Price	$1,077.33
Rate for Payer: Hawaii Western Management Group Commercial	$1,160.20
Rate for Payer: Health Management Network Commercial	$1,408.82
Rate for Payer: MDX Hawaii PPO	$1,607.71
Rate for Payer: University Health Alliance Commercial	$928.16

Screw HFN A/R 65mm 814501065 [3642576]

Facility

$1,657.43

Service Code	HCPCS C1713
Hospital Charge Code	3642576
Hospital Revenue Code	278
Min. Negotiated Rate	$845.29
Max. Negotiated Rate	$1,607.71
Rate for Payer: Cash Price	$1,077.33
Rate for Payer: Hawaii Western Management Group Commercial	$1,160.20
Rate for Payer: Health Management Network Commercial	$1,408.82
Rate for Payer: Kaiser Permanente Commercial	$1,044.18
Rate for Payer: Kaiser Permanente Medicaid	$845.29
Rate for Payer: MDX Hawaii PPO	$1,607.71
Rate for Payer: University Health Alliance Commercial	$928.16

Screw High Compression Peg Locking Ti 2.7mmX16mm HCLP-27160-TS [3643189]

Facility

$737.47

Service Code	HCPCS C1713
Hospital Charge Code	3643189
Hospital Revenue Code	278
Min. Negotiated Rate	$376.11
Max. Negotiated Rate	$715.35
Rate for Payer: Cash Price	$479.36
Rate for Payer: Hawaii Western Management Group Commercial	$516.23
Rate for Payer: Health Management Network Commercial	$626.85
Rate for Payer: Kaiser Permanente Commercial	$464.61
Rate for Payer: Kaiser Permanente Medicaid	$376.11
Rate for Payer: MDX Hawaii PPO	$715.35
Rate for Payer: University Health Alliance Commercial	$412.98

Screw High Compression Peg Locking Ti 2.7mmX16mm HCLP-27160-TS [3643189]

Facility

$737.47

Service Code	HCPCS C1713
Hospital Charge Code	3643189
Hospital Revenue Code	278
Min. Negotiated Rate	$412.98
Max. Negotiated Rate	$715.35
Rate for Payer: Cash Price	$479.36
Rate for Payer: Hawaii Western Management Group Commercial	$516.23
Rate for Payer: Health Management Network Commercial	$626.85
Rate for Payer: MDX Hawaii PPO	$715.35
Rate for Payer: University Health Alliance Commercial	$412.98

Screw High Compression Peg Locking Ti 2.7mmX20mm HCLP27200TS [3643097]

Facility

$476.88

Service Code	HCPCS C1713
Hospital Charge Code	3643097
Hospital Revenue Code	278
Min. Negotiated Rate	$243.21
Max. Negotiated Rate	$462.57
Rate for Payer: Cash Price	$309.97
Rate for Payer: Hawaii Western Management Group Commercial	$333.82
Rate for Payer: Health Management Network Commercial	$405.35
Rate for Payer: Kaiser Permanente Commercial	$300.43
Rate for Payer: Kaiser Permanente Medicaid	$243.21
Rate for Payer: MDX Hawaii PPO	$462.57
Rate for Payer: University Health Alliance Commercial	$267.05

Screw High Compression Peg Locking Ti 2.7mmX20mm HCLP27200TS [3643097]

Facility

$476.88

Service Code	HCPCS C1713
Hospital Charge Code	3643097
Hospital Revenue Code	278
Min. Negotiated Rate	$267.05
Max. Negotiated Rate	$462.57
Rate for Payer: Cash Price	$309.97
Rate for Payer: Hawaii Western Management Group Commercial	$333.82
Rate for Payer: Health Management Network Commercial	$405.35
Rate for Payer: MDX Hawaii PPO	$462.57
Rate for Payer: University Health Alliance Commercial	$267.05

Know your out-of-pocket cost for care.

All Charges