Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw High Compression Peg Locking Ti 2.7mmX21mm HCLP27210TS [3643098]

Facility

$710.70

Service Code	HCPCS C1713
Hospital Charge Code	3643098
Hospital Revenue Code	278
Min. Negotiated Rate	$362.46
Max. Negotiated Rate	$689.38
Rate for Payer: Cash Price	$461.96
Rate for Payer: Hawaii Western Management Group Commercial	$497.49
Rate for Payer: Health Management Network Commercial	$604.10
Rate for Payer: Kaiser Permanente Commercial	$447.74
Rate for Payer: Kaiser Permanente Medicaid	$362.46
Rate for Payer: MDX Hawaii PPO	$689.38
Rate for Payer: University Health Alliance Commercial	$397.99

Screw High Compression Peg Locking Ti 2.7mmX21mm HCLP27210TS [3643098]

Facility

$710.70

Service Code	HCPCS C1713
Hospital Charge Code	3643098
Hospital Revenue Code	278
Min. Negotiated Rate	$397.99
Max. Negotiated Rate	$689.38
Rate for Payer: Cash Price	$461.96
Rate for Payer: Hawaii Western Management Group Commercial	$497.49
Rate for Payer: Health Management Network Commercial	$604.10
Rate for Payer: MDX Hawaii PPO	$689.38
Rate for Payer: University Health Alliance Commercial	$397.99

Screw High Compression Peg Locking Ti 2.7mm x 22mm HCLP-27220-TS [3643420]

Facility

$737.47

Service Code	HCPCS C1713
Hospital Charge Code	3643420
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 2.7mm x 22mm HCLP-27220-TS [3643420]

Facility

$737.47

Service Code	HCPCS C1713
Hospital Charge Code	3643420
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 2.7mmx24mm HCLP-27240-TS [3643900]

Facility

$737.47

Service Code	HCPCS C1713
Hospital Charge Code	3643900
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 2.7mmx24mm HCLP-27240-TS [3643900]

Facility

$737.47

Service Code	HCPCS C1713
Hospital Charge Code	3643900
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 2.7mmX26mm HCLP-27260-TS [3643190]

Facility

$476.88

Service Code	HCPCS C1713
Hospital Charge Code	3643190
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 2.7mmX26mm HCLP-27260-TS [3643190]

Facility

$476.88

Service Code	HCPCS C1713
Hospital Charge Code	3643190
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

Screw Kreulock Ti 3.5mm x 22mm AR-8935CL-22 [3644988]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644988
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Kreulock Ti 3.5mm x 22mm AR-8935CL-22 [3644988]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644988
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Lag DHS/DCS 12.7mm Thread 120mm 280.200 [3644420]

Facility

$2,752.24

Service Code	HCPCS C1713
Hospital Charge Code	3644420
Hospital Revenue Code	278
Min. Negotiated Rate	$1,403.64
Max. Negotiated Rate	$2,669.67
Rate for Payer: Cash Price	$1,788.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,926.57
Rate for Payer: Health Management Network Commercial	$2,339.40
Rate for Payer: Kaiser Permanente Commercial	$1,733.91
Rate for Payer: Kaiser Permanente Medicaid	$1,403.64
Rate for Payer: MDX Hawaii PPO	$2,669.67
Rate for Payer: University Health Alliance Commercial	$1,541.25

Screw Lag DHS/DCS 12.7mm Thread 120mm 280.200 [3644420]

Facility

$2,752.24

Service Code	HCPCS C1713
Hospital Charge Code	3644420
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.25
Max. Negotiated Rate	$2,669.67
Rate for Payer: Cash Price	$1,788.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,926.57
Rate for Payer: Health Management Network Commercial	$2,339.40
Rate for Payer: MDX Hawaii PPO	$2,669.67
Rate for Payer: University Health Alliance Commercial	$1,541.25

Screw Lag HFN 10.5mm x 125mm 814510125 [3642615]

Facility

$3,415.30

Service Code	HCPCS C1713
Hospital Charge Code	3642615
Hospital Revenue Code	278
Min. Negotiated Rate	$1,741.80
Max. Negotiated Rate	$3,312.84
Rate for Payer: Cash Price	$2,219.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,390.71
Rate for Payer: Health Management Network Commercial	$2,903.01
Rate for Payer: Kaiser Permanente Commercial	$2,151.64
Rate for Payer: Kaiser Permanente Medicaid	$1,741.80
Rate for Payer: MDX Hawaii PPO	$3,312.84
Rate for Payer: University Health Alliance Commercial	$1,912.57

Screw Lag HFN 10.5mm x 125mm 814510125 [3642615]

Facility

$3,415.30

Service Code	HCPCS C1713
Hospital Charge Code	3642615
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.57
Max. Negotiated Rate	$3,312.84
Rate for Payer: Cash Price	$2,219.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,390.71
Rate for Payer: Health Management Network Commercial	$2,903.01
Rate for Payer: MDX Hawaii PPO	$3,312.84
Rate for Payer: University Health Alliance Commercial	$1,912.57

Screw Lag Hfn 10.5mm x 75mm 814510075 [3644294]

Facility

$4,894.10

Service Code	HCPCS C1713
Hospital Charge Code	3644294
Hospital Revenue Code	278
Min. Negotiated Rate	$2,495.99
Max. Negotiated Rate	$4,747.28
Rate for Payer: Cash Price	$3,181.17
Rate for Payer: Hawaii Western Management Group Commercial	$3,425.87
Rate for Payer: Health Management Network Commercial	$4,159.98
Rate for Payer: Kaiser Permanente Commercial	$3,083.28
Rate for Payer: Kaiser Permanente Medicaid	$2,495.99
Rate for Payer: MDX Hawaii PPO	$4,747.28
Rate for Payer: University Health Alliance Commercial	$2,740.70

Screw Lag Hfn 10.5mm x 75mm 814510075 [3644294]

Facility

$4,894.10

Service Code	HCPCS C1713
Hospital Charge Code	3644294
Hospital Revenue Code	278
Min. Negotiated Rate	$2,740.70
Max. Negotiated Rate	$4,747.28
Rate for Payer: Cash Price	$3,181.17
Rate for Payer: Hawaii Western Management Group Commercial	$3,425.87
Rate for Payer: Health Management Network Commercial	$4,159.98
Rate for Payer: MDX Hawaii PPO	$4,747.28
Rate for Payer: University Health Alliance Commercial	$2,740.70

Screw Lock 3.5mm x 12mm Ti 00-2369-012-35 [3645383]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645383
Hospital Revenue Code	278
Min. Negotiated Rate	$562.92
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 12mm Ti 00-2369-012-35 [3645383]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645383
Hospital Revenue Code	278
Min. Negotiated Rate	$512.66
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: Kaiser Permanente Commercial	$633.29
Rate for Payer: Kaiser Permanente Medicaid	$512.66
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 16mm Ti 00-2369-016-35 [3645384]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645384
Hospital Revenue Code	278
Min. Negotiated Rate	$512.66
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: Kaiser Permanente Commercial	$633.29
Rate for Payer: Kaiser Permanente Medicaid	$512.66
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 16mm Ti 00-2369-016-35 [3645384]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645384
Hospital Revenue Code	278
Min. Negotiated Rate	$562.92
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 18mm Ti 00-2369-018-35 [3645385]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645385
Hospital Revenue Code	278
Min. Negotiated Rate	$512.66
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: Kaiser Permanente Commercial	$633.29
Rate for Payer: Kaiser Permanente Medicaid	$512.66
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 18mm Ti 00-2369-018-35 [3645385]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645385
Hospital Revenue Code	278
Min. Negotiated Rate	$562.92
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 22mm Ti 00-2369-022-35 [3645381]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645381
Hospital Revenue Code	278
Min. Negotiated Rate	$512.66
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: Kaiser Permanente Commercial	$633.29
Rate for Payer: Kaiser Permanente Medicaid	$512.66
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mm x 22mm Ti 00-2369-022-35 [3645381]

Facility

$1,005.22

Service Code	HCPCS C1713
Hospital Charge Code	3645381
Hospital Revenue Code	278
Min. Negotiated Rate	$562.92
Max. Negotiated Rate	$975.06
Rate for Payer: Cash Price	$653.39
Rate for Payer: Hawaii Western Management Group Commercial	$703.65
Rate for Payer: Health Management Network Commercial	$854.44
Rate for Payer: MDX Hawaii PPO	$975.06
Rate for Payer: University Health Alliance Commercial	$562.92

Screw Lock 3.5mmx30mm Ti Ffl35300ts [3643504]

Facility

$1,001.88

Service Code	HCPCS C1713
Hospital Charge Code	3643504
Hospital Revenue Code	278
Min. Negotiated Rate	$510.96
Max. Negotiated Rate	$971.82
Rate for Payer: Cash Price	$651.22
Rate for Payer: Hawaii Western Management Group Commercial	$701.32
Rate for Payer: Health Management Network Commercial	$851.60
Rate for Payer: Kaiser Permanente Commercial	$631.18
Rate for Payer: Kaiser Permanente Medicaid	$510.96
Rate for Payer: MDX Hawaii PPO	$971.82
Rate for Payer: University Health Alliance Commercial	$561.05

Know your out-of-pocket cost for care.

All Charges