Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$561.05
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: MDX Hawaii PPO	$971.82
Rate for Payer: University Health Alliance Commercial	$561.05

Screw Locking 2.5mmx12mm So-25l-So-012-Ta [3643688]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643688
Hospital Revenue Code	278
Min. Negotiated Rate	$980.00
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx12mm So-25l-So-012-Ta [3643688]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643688
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$892.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx14mm So-25l-So-014-Ta [3643689]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643689
Hospital Revenue Code	278
Min. Negotiated Rate	$980.00
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx14mm So-25l-So-014-Ta [3643689]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643689
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$892.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx16mm So-25l-So-016-Ta [3643690]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643690
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$892.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx16mm So-25l-So-016-Ta [3643690]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643690
Hospital Revenue Code	278
Min. Negotiated Rate	$980.00
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx18mm So-25l-So-018-Ta [3643691]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643691
Hospital Revenue Code	278
Min. Negotiated Rate	$980.00
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking 2.5mmx18mm So-25l-So-018-Ta [3643691]

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	3643691
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$892.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Screw Locking Cortical 3.5 X 10mm 816135010 [3643593]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3643593
Hospital Revenue Code	278
Min. Negotiated Rate	$647.03
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: Kaiser Permanente Commercial	$799.27
Rate for Payer: Kaiser Permanente Medicaid	$647.03
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 X 10mm 816135010 [3643593]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3643593
Hospital Revenue Code	278
Min. Negotiated Rate	$710.47
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 X 12mm 816135012 [3642847]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3642847
Hospital Revenue Code	278
Min. Negotiated Rate	$710.47
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 X 12mm 816135012 [3642847]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3642847
Hospital Revenue Code	278
Min. Negotiated Rate	$647.03
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: Kaiser Permanente Commercial	$799.27
Rate for Payer: Kaiser Permanente Medicaid	$647.03
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 X 14mm 816135014 [3640872B]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3640872B
Hospital Revenue Code	278
Min. Negotiated Rate	$679.26
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: Kaiser Permanente Commercial	$839.08
Rate for Payer: Kaiser Permanente Medicaid	$679.26
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 14mm 816135014 [3640872B]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3640872B
Hospital Revenue Code	278
Min. Negotiated Rate	$745.85
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 16mm 816135016 [3641499]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3641499
Hospital Revenue Code	278
Min. Negotiated Rate	$745.85
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 16mm 816135016 [3641499]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3641499
Hospital Revenue Code	278
Min. Negotiated Rate	$679.26
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: Kaiser Permanente Commercial	$839.08
Rate for Payer: Kaiser Permanente Medicaid	$679.26
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 18mm 816135018 [3640872]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3640872
Hospital Revenue Code	278
Min. Negotiated Rate	$679.26
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: Kaiser Permanente Commercial	$839.08
Rate for Payer: Kaiser Permanente Medicaid	$679.26
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 18mm 816135018 [3640872]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3640872
Hospital Revenue Code	278
Min. Negotiated Rate	$745.85
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 20mm 816135020 [3641828]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3641828
Hospital Revenue Code	278
Min. Negotiated Rate	$647.03
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: Kaiser Permanente Commercial	$799.27
Rate for Payer: Kaiser Permanente Medicaid	$647.03
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 X 20mm 816135020 [3641828]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3641828
Hospital Revenue Code	278
Min. Negotiated Rate	$710.47
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 X 28mm 816135028 [3641310]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3641310
Hospital Revenue Code	278
Min. Negotiated Rate	$679.26
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: Kaiser Permanente Commercial	$839.08
Rate for Payer: Kaiser Permanente Medicaid	$679.26
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 X 28mm 816135028 [3641310]

Facility

$1,331.88

Service Code	HCPCS C1713
Hospital Charge Code	3641310
Hospital Revenue Code	278
Min. Negotiated Rate	$745.85
Max. Negotiated Rate	$1,291.92
Rate for Payer: Cash Price	$865.72
Rate for Payer: Hawaii Western Management Group Commercial	$932.32
Rate for Payer: Health Management Network Commercial	$1,132.10
Rate for Payer: MDX Hawaii PPO	$1,291.92
Rate for Payer: University Health Alliance Commercial	$745.85

Screw Locking Cortical 3.5 x 40mm 816135040 [3644233]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3644233
Hospital Revenue Code	278
Min. Negotiated Rate	$647.03
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: Kaiser Permanente Commercial	$799.27
Rate for Payer: Kaiser Permanente Medicaid	$647.03
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Screw Locking Cortical 3.5 x 40mm 816135040 [3644233]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3644233
Hospital Revenue Code	278
Min. Negotiated Rate	$710.47
Max. Negotiated Rate	$1,230.63
Rate for Payer: Cash Price	$824.65
Rate for Payer: Hawaii Western Management Group Commercial	$888.08
Rate for Payer: Health Management Network Commercial	$1,078.39
Rate for Payer: MDX Hawaii PPO	$1,230.63
Rate for Payer: University Health Alliance Commercial	$710.47

Know your out-of-pocket cost for care.

All Charges