Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$487.02
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: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Locking ST T8 SD 2.7 x 14mm 202.214 [3640017B]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3640017B
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

Screw Locking ST T8 SD 2.7 x 14mm 202.214 [3640017B]

Facility

$869.68

Service Code	HCPCS C1713
Hospital Charge Code	3640017B
Hospital Revenue Code	278
Min. Negotiated Rate	$487.02
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: MDX Hawaii PPO	$843.59
Rate for Payer: University Health Alliance Commercial	$487.02

Screw Locking ST T8 SD 2.7 x 16mm 202.216 [3640017C]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3640017C
Hospital Revenue Code	278
Min. Negotiated Rate	$309.45
Max. Negotiated Rate	$588.57
Rate for Payer: Cash Price	$394.40
Rate for Payer: Hawaii Western Management Group Commercial	$424.74
Rate for Payer: Health Management Network Commercial	$515.75
Rate for Payer: Kaiser Permanente Commercial	$382.27
Rate for Payer: Kaiser Permanente Medicaid	$309.45
Rate for Payer: MDX Hawaii PPO	$588.57
Rate for Payer: University Health Alliance Commercial	$339.79

Screw Locking ST T8 SD 2.7 x 16mm 202.216 [3640017C]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3640017C
Hospital Revenue Code	278
Min. Negotiated Rate	$339.79
Max. Negotiated Rate	$588.57
Rate for Payer: Cash Price	$394.40
Rate for Payer: Hawaii Western Management Group Commercial	$424.74
Rate for Payer: Health Management Network Commercial	$515.75
Rate for Payer: MDX Hawaii PPO	$588.57
Rate for Payer: University Health Alliance Commercial	$339.79

Screw Locking St T8 Sd 2.7x22mm 202.222 [3640017F]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3640017F
Hospital Revenue Code	278
Min. Negotiated Rate	$309.45
Max. Negotiated Rate	$588.57
Rate for Payer: Cash Price	$394.40
Rate for Payer: Hawaii Western Management Group Commercial	$424.74
Rate for Payer: Health Management Network Commercial	$515.75
Rate for Payer: Kaiser Permanente Commercial	$382.27
Rate for Payer: Kaiser Permanente Medicaid	$309.45
Rate for Payer: MDX Hawaii PPO	$588.57
Rate for Payer: University Health Alliance Commercial	$339.79

Screw Locking St T8 Sd 2.7x22mm 202.222 [3640017F]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3640017F
Hospital Revenue Code	278
Min. Negotiated Rate	$339.79
Max. Negotiated Rate	$588.57
Rate for Payer: Cash Price	$394.40
Rate for Payer: Hawaii Western Management Group Commercial	$424.74
Rate for Payer: Health Management Network Commercial	$515.75
Rate for Payer: MDX Hawaii PPO	$588.57
Rate for Payer: University Health Alliance Commercial	$339.79

Screw Locking St T8 Sd 2.7x28mm 202.228 [3640017I]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3640017I
Hospital Revenue Code	278
Min. Negotiated Rate	$309.45
Max. Negotiated Rate	$588.57
Rate for Payer: Cash Price	$394.40
Rate for Payer: Hawaii Western Management Group Commercial	$424.74
Rate for Payer: Health Management Network Commercial	$515.75
Rate for Payer: Kaiser Permanente Commercial	$382.27
Rate for Payer: Kaiser Permanente Medicaid	$309.45
Rate for Payer: MDX Hawaii PPO	$588.57
Rate for Payer: University Health Alliance Commercial	$339.79

Screw Locking St T8 Sd 2.7x28mm 202.228 [3640017I]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3640017I
Hospital Revenue Code	278
Min. Negotiated Rate	$339.79
Max. Negotiated Rate	$588.57
Rate for Payer: Cash Price	$394.40
Rate for Payer: Hawaii Western Management Group Commercial	$424.74
Rate for Payer: Health Management Network Commercial	$515.75
Rate for Payer: MDX Hawaii PPO	$588.57
Rate for Payer: University Health Alliance Commercial	$339.79

Screw Locking St T8 Sd 2.7 x 44mm 202.244 [3644153]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3644153
Hospital Revenue Code	278
Min. Negotiated Rate	$191.37
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Screw Locking St T8 Sd 2.7 x 44mm 202.244 [3644153]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3644153
Hospital Revenue Code	278
Min. Negotiated Rate	$174.29
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: Kaiser Permanente Commercial	$215.30
Rate for Payer: Kaiser Permanente Medicaid	$174.29
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Screw Locking TFN Ti 5.0mm 34mm 04.005.524S [3606184B]

Facility

$1,764.40

Service Code	HCPCS C1713
Hospital Charge Code	3606184B
Hospital Revenue Code	278
Min. Negotiated Rate	$988.06
Max. Negotiated Rate	$1,711.47
Rate for Payer: Cash Price	$1,146.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,235.08
Rate for Payer: Health Management Network Commercial	$1,499.74
Rate for Payer: MDX Hawaii PPO	$1,711.47
Rate for Payer: University Health Alliance Commercial	$988.06

Screw Locking TFN Ti 5.0mm 34mm 04.005.524S [3606184B]

Facility

$1,764.40

Service Code	HCPCS C1713
Hospital Charge Code	3606184B
Hospital Revenue Code	278
Min. Negotiated Rate	$899.84
Max. Negotiated Rate	$1,711.47
Rate for Payer: Cash Price	$1,146.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,235.08
Rate for Payer: Health Management Network Commercial	$1,499.74
Rate for Payer: Kaiser Permanente Commercial	$1,111.57
Rate for Payer: Kaiser Permanente Medicaid	$899.84
Rate for Payer: MDX Hawaii PPO	$1,711.47
Rate for Payer: University Health Alliance Commercial	$988.06

Screw Locking TFN Ti 5.0mm 36mm 04.005.526S [3606184C]

Facility

$1,547.92

Service Code	HCPCS C1713
Hospital Charge Code	3606184C
Hospital Revenue Code	278
Min. Negotiated Rate	$866.84
Max. Negotiated Rate	$1,501.48
Rate for Payer: Cash Price	$1,006.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.54
Rate for Payer: Health Management Network Commercial	$1,315.73
Rate for Payer: MDX Hawaii PPO	$1,501.48
Rate for Payer: University Health Alliance Commercial	$866.84

Screw Locking TFN Ti 5.0mm 36mm 04.005.526S [3606184C]

Facility

$1,547.92

Service Code	HCPCS C1713
Hospital Charge Code	3606184C
Hospital Revenue Code	278
Min. Negotiated Rate	$789.44
Max. Negotiated Rate	$1,501.48
Rate for Payer: Cash Price	$1,006.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.54
Rate for Payer: Health Management Network Commercial	$1,315.73
Rate for Payer: Kaiser Permanente Commercial	$975.19
Rate for Payer: Kaiser Permanente Medicaid	$789.44
Rate for Payer: MDX Hawaii PPO	$1,501.48
Rate for Payer: University Health Alliance Commercial	$866.84

Screw Locking TFN Ti 5.0mm 48mm 04.005.538 [3606184I]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3606184I
Hospital Revenue Code	278
Min. Negotiated Rate	$557.41
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: Kaiser Permanente Commercial	$688.56
Rate for Payer: Kaiser Permanente Medicaid	$557.41
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking TFN Ti 5.0mm 48mm 04.005.538 [3606184I]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3606184I
Hospital Revenue Code	278
Min. Negotiated Rate	$612.06
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking TFN Ti 5.0mm 52mm 04.005.542 [3606184K]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3606184K
Hospital Revenue Code	278
Min. Negotiated Rate	$557.41
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: Kaiser Permanente Commercial	$688.56
Rate for Payer: Kaiser Permanente Medicaid	$557.41
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking TFN Ti 5.0mm 52mm 04.005.542 [3606184K]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3606184K
Hospital Revenue Code	278
Min. Negotiated Rate	$612.06
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking Tfn Ti 5.0mm 70mm [3640004F]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3640004F
Hospital Revenue Code	278
Min. Negotiated Rate	$612.06
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking Tfn Ti 5.0mm 70mm [3640004F]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3640004F
Hospital Revenue Code	278
Min. Negotiated Rate	$557.41
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: Kaiser Permanente Commercial	$688.56
Rate for Payer: Kaiser Permanente Medicaid	$557.41
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking Tfn Ti 5.0mm 74mm [3640004H]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3640004H
Hospital Revenue Code	278
Min. Negotiated Rate	$557.41
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: Kaiser Permanente Commercial	$688.56
Rate for Payer: Kaiser Permanente Medicaid	$557.41
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking Tfn Ti 5.0mm 74mm [3640004H]

Facility

$1,092.96

Service Code	HCPCS C1713
Hospital Charge Code	3640004H
Hospital Revenue Code	278
Min. Negotiated Rate	$612.06
Max. Negotiated Rate	$1,060.17
Rate for Payer: Cash Price	$710.42
Rate for Payer: Hawaii Western Management Group Commercial	$765.07
Rate for Payer: Health Management Network Commercial	$929.02
Rate for Payer: MDX Hawaii PPO	$1,060.17
Rate for Payer: University Health Alliance Commercial	$612.06

Screw Locking Ti 4.0mm 26mm 04.005.416S [3640093B]

Facility

$1,547.92

Service Code	HCPCS C1713
Hospital Charge Code	3640093B
Hospital Revenue Code	278
Min. Negotiated Rate	$789.44
Max. Negotiated Rate	$1,501.48
Rate for Payer: Cash Price	$1,006.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.54
Rate for Payer: Health Management Network Commercial	$1,315.73
Rate for Payer: Kaiser Permanente Commercial	$975.19
Rate for Payer: Kaiser Permanente Medicaid	$789.44
Rate for Payer: MDX Hawaii PPO	$1,501.48
Rate for Payer: University Health Alliance Commercial	$866.84

Screw Locking Ti 4.0mm 26mm 04.005.416S [3640093B]

Facility

$1,547.92

Service Code	HCPCS C1713
Hospital Charge Code	3640093B
Hospital Revenue Code	278
Min. Negotiated Rate	$866.84
Max. Negotiated Rate	$1,501.48
Rate for Payer: Cash Price	$1,006.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.54
Rate for Payer: Health Management Network Commercial	$1,315.73
Rate for Payer: MDX Hawaii PPO	$1,501.48
Rate for Payer: University Health Alliance Commercial	$866.84

Know your out-of-pocket cost for care.

All Charges