Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Locking Cortical 3.5 X 46mm 816135046 [3642848]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3642848
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 46mm 816135046 [3642848]

Facility

$1,268.69

Service Code	HCPCS C1713
Hospital Charge Code	3642848
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 65mm 816135065 [3641830]

Facility

$932.75

Service Code	HCPCS C1713
Hospital Charge Code	3641830
Hospital Revenue Code	278
Min. Negotiated Rate	$522.34
Max. Negotiated Rate	$904.77
Rate for Payer: Cash Price	$606.29
Rate for Payer: Hawaii Western Management Group Commercial	$652.92
Rate for Payer: Health Management Network Commercial	$792.84
Rate for Payer: MDX Hawaii PPO	$904.77
Rate for Payer: University Health Alliance Commercial	$522.34

Screw Locking Cortical 3.5 X 65mm 816135065 [3641830]

Facility

$932.75

Service Code	HCPCS C1713
Hospital Charge Code	3641830
Hospital Revenue Code	278
Min. Negotiated Rate	$475.70
Max. Negotiated Rate	$904.77
Rate for Payer: Cash Price	$606.29
Rate for Payer: Hawaii Western Management Group Commercial	$652.92
Rate for Payer: Health Management Network Commercial	$792.84
Rate for Payer: Kaiser Permanente Commercial	$587.63
Rate for Payer: Kaiser Permanente Medicaid	$475.70
Rate for Payer: MDX Hawaii PPO	$904.77
Rate for Payer: University Health Alliance Commercial	$522.34

Screw Locking SQUARE 2.7mmX10mm 131227110 [3641478]

Facility

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	3641478
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$568.75
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

Screw Locking SQUARE 2.7mmX10mm 131227110 [3641478]

Facility

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	3641478
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$568.75
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

Screw Locking SQUARE 2.7mmX12mm 131227112 [3641674]

Facility

$1,050.00

Service Code	HCPCS C1713
Hospital Charge Code	3641674
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

Screw Locking SQUARE 2.7mmX12mm 131227112 [3641674]

Facility

$1,050.00

Service Code	HCPCS C1713
Hospital Charge Code	3641674
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

Screw Locking SQUARE 2.7mmX14mm 131227114 [3641435]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641435
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX14mm 131227114 [3641435]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641435
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX15mm 131227115 [3641436]

Facility

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	3641436
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$568.75
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

Screw Locking SQUARE 2.7mmX15mm 131227115 [3641436]

Facility

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	3641436
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$568.75
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$551.25
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

Screw Locking SQUARE 2.7mmX16mm 131227116 [3641437]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641437
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX16mm 131227116 [3641437]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641437
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX18mm 131227118 [3641438]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641438
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX18mm 131227118 [3641438]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641438
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX20mm 131227120 [3641480]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641480
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX20mm 131227120 [3641480]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641480
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX22mm 131227122 [3641675]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641675
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX22mm 131227122 [3641675]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641675
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX24mm 131227124 [3641695]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641695
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking SQUARE 2.7mmX24mm 131227124 [3641695]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641695
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Screw Locking St T8 Sd 2.7 x 10mm 202.210 [3640017K]

Facility

$869.69

Service Code	HCPCS C1713
Hospital Charge Code	3640017K
Hospital Revenue Code	278
Min. Negotiated Rate	$487.03
Max. Negotiated Rate	$843.60
Rate for Payer: Cash Price	$565.30
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.24
Rate for Payer: MDX Hawaii PPO	$843.60
Rate for Payer: University Health Alliance Commercial	$487.03

Screw Locking St T8 Sd 2.7 x 10mm 202.210 [3640017K]

Facility

$869.69

Service Code	HCPCS C1713
Hospital Charge Code	3640017K
Hospital Revenue Code	278
Min. Negotiated Rate	$443.54
Max. Negotiated Rate	$843.60
Rate for Payer: Cash Price	$565.30
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.24
Rate for Payer: Kaiser Permanente Commercial	$547.90
Rate for Payer: Kaiser Permanente Medicaid	$443.54
Rate for Payer: MDX Hawaii PPO	$843.60
Rate for Payer: University Health Alliance Commercial	$487.03

Screw Locking ST T8 SD 2.7 x 12mm 202.212 [3640017A]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3640017A
Hospital Revenue Code	278
Min. Negotiated Rate	$443.54
Max. Negotiated Rate	$843.59
Rate for Payer: Cash Price	$565.29
Rate for Payer: Hawaii Western Management Group Commercial	$608.78
Rate for Payer: Health Management Network Commercial	$739.23
Rate for Payer: Kaiser Permanente Commercial	$547.90
Rate for Payer: Kaiser Permanente Medicaid	$443.54
Rate for Payer: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Know your out-of-pocket cost for care.

All Charges