Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Locking Ti 4.0mm 28mm 04.005.418S [3640093C]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093C
Hospital Revenue Code	278
Min. Negotiated Rate	$896.21
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: Kaiser Permanente Commercial	$1,107.09
Rate for Payer: Kaiser Permanente Medicaid	$896.21
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 28mm 04.005.418S [3640093C]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093C
Hospital Revenue Code	278
Min. Negotiated Rate	$984.08
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 30mm 04.005.420S [3640143]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640143
Hospital Revenue Code	278
Min. Negotiated Rate	$896.21
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: Kaiser Permanente Commercial	$1,107.09
Rate for Payer: Kaiser Permanente Medicaid	$896.21
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 30mm 04.005.420S [3640143]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640143
Hospital Revenue Code	278
Min. Negotiated Rate	$984.08
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 34mm 04.005.424S [3640093E]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093E
Hospital Revenue Code	278
Min. Negotiated Rate	$896.21
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: Kaiser Permanente Commercial	$1,107.09
Rate for Payer: Kaiser Permanente Medicaid	$896.21
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 34mm 04.005.424S [3640093E]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093E
Hospital Revenue Code	278
Min. Negotiated Rate	$984.08
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 38mm 04.005.428S [3640093F]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093F
Hospital Revenue Code	278
Min. Negotiated Rate	$984.08
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 38mm 04.005.428S [3640093F]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093F
Hospital Revenue Code	278
Min. Negotiated Rate	$896.21
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: Kaiser Permanente Commercial	$1,107.09
Rate for Payer: Kaiser Permanente Medicaid	$896.21
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 52mm 04.005.442S [3640093P]

Facility

$1,392.81

Service Code	HCPCS C1713
Hospital Charge Code	3640093P
Hospital Revenue Code	278
Min. Negotiated Rate	$710.33
Max. Negotiated Rate	$1,351.03
Rate for Payer: Cash Price	$905.33
Rate for Payer: Hawaii Western Management Group Commercial	$974.97
Rate for Payer: Health Management Network Commercial	$1,183.89
Rate for Payer: Kaiser Permanente Commercial	$877.47
Rate for Payer: Kaiser Permanente Medicaid	$710.33
Rate for Payer: MDX Hawaii PPO	$1,351.03
Rate for Payer: University Health Alliance Commercial	$779.97

Screw Locking Ti 4.0mm 52mm 04.005.442S [3640093P]

Facility

$1,392.81

Service Code	HCPCS C1713
Hospital Charge Code	3640093P
Hospital Revenue Code	278
Min. Negotiated Rate	$779.97
Max. Negotiated Rate	$1,351.03
Rate for Payer: Cash Price	$905.33
Rate for Payer: Hawaii Western Management Group Commercial	$974.97
Rate for Payer: Health Management Network Commercial	$1,183.89
Rate for Payer: MDX Hawaii PPO	$1,351.03
Rate for Payer: University Health Alliance Commercial	$779.97

Screw Locking Ti 4.0mm 64mm 04.005.454S [3640093T]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093T
Hospital Revenue Code	278
Min. Negotiated Rate	$896.21
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: Kaiser Permanente Commercial	$1,107.09
Rate for Payer: Kaiser Permanente Medicaid	$896.21
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 4.0mm 64mm 04.005.454S [3640093T]

Facility

$1,757.28

Service Code	HCPCS C1713
Hospital Charge Code	3640093T
Hospital Revenue Code	278
Min. Negotiated Rate	$984.08
Max. Negotiated Rate	$1,704.56
Rate for Payer: Cash Price	$1,142.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,230.10
Rate for Payer: Health Management Network Commercial	$1,493.69
Rate for Payer: MDX Hawaii PPO	$1,704.56
Rate for Payer: University Health Alliance Commercial	$984.08

Screw Locking Ti 5.0mm 26mm 04.045.026TS [3643697]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643697
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.38
Max. Negotiated Rate	$1,755.31
Rate for Payer: Cash Price	$1,176.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,266.72
Rate for Payer: Health Management Network Commercial	$1,538.16
Rate for Payer: MDX Hawaii PPO	$1,755.31
Rate for Payer: University Health Alliance Commercial	$1,013.38

Screw Locking Ti 5.0mm 26mm 04.045.026TS [3643697]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643697
Hospital Revenue Code	278
Min. Negotiated Rate	$922.90
Max. Negotiated Rate	$1,755.31
Rate for Payer: Cash Price	$1,176.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,266.72
Rate for Payer: Health Management Network Commercial	$1,538.16
Rate for Payer: Kaiser Permanente Commercial	$1,140.05
Rate for Payer: Kaiser Permanente Medicaid	$922.90
Rate for Payer: MDX Hawaii PPO	$1,755.31
Rate for Payer: University Health Alliance Commercial	$1,013.38

Screw Locking Ti 5.0mm 28mm 04.045.028TS [3643698]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643698
Hospital Revenue Code	278
Min. Negotiated Rate	$997.08
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: Kaiser Permanente Commercial	$1,231.68
Rate for Payer: Kaiser Permanente Medicaid	$997.08
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Screw Locking Ti 5.0mm 28mm 04.045.028TS [3643698]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,094.83
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Screw Locking Ti 5.0mm 30mm 04.045.030TS [3643699]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643699
Hospital Revenue Code	278
Min. Negotiated Rate	$1,094.83
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Screw Locking Ti 5.0mm 30mm 04.045.030TS [3643699]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643699
Hospital Revenue Code	278
Min. Negotiated Rate	$997.08
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: Kaiser Permanente Commercial	$1,231.68
Rate for Payer: Kaiser Permanente Medicaid	$997.08
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Screw Locking Ti 5.0mm 32mm 04.045.032TS [3643700]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643700
Hospital Revenue Code	278
Min. Negotiated Rate	$997.08
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: Kaiser Permanente Commercial	$1,231.68
Rate for Payer: Kaiser Permanente Medicaid	$997.08
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Screw Locking Ti 5.0mm 32mm 04.045.032TS [3643700]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643700
Hospital Revenue Code	278
Min. Negotiated Rate	$1,094.83
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Screw Locking Ti 5.0mm 34mm 04.045.034TS [3643701]

Facility

$1,955.26

Service Code	HCPCS C1713
Hospital Charge Code	3643701
Hospital Revenue Code	278
Min. Negotiated Rate	$997.18
Max. Negotiated Rate	$1,896.60
Rate for Payer: Cash Price	$1,270.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.68
Rate for Payer: Health Management Network Commercial	$1,661.97
Rate for Payer: Kaiser Permanente Commercial	$1,231.81
Rate for Payer: Kaiser Permanente Medicaid	$997.18
Rate for Payer: MDX Hawaii PPO	$1,896.60
Rate for Payer: University Health Alliance Commercial	$1,094.95

Screw Locking Ti 5.0mm 34mm 04.045.034TS [3643701]

Facility

$1,955.26

Service Code	HCPCS C1713
Hospital Charge Code	3643701
Hospital Revenue Code	278
Min. Negotiated Rate	$1,094.95
Max. Negotiated Rate	$1,896.60
Rate for Payer: Cash Price	$1,270.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.68
Rate for Payer: Health Management Network Commercial	$1,661.97
Rate for Payer: MDX Hawaii PPO	$1,896.60
Rate for Payer: University Health Alliance Commercial	$1,094.95

Screw Locking Ti 5.0mm 36mm 04.045.036TS [3643702]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643702
Hospital Revenue Code	278
Min. Negotiated Rate	$922.90
Max. Negotiated Rate	$1,755.31
Rate for Payer: Cash Price	$1,176.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,266.72
Rate for Payer: Health Management Network Commercial	$1,538.16
Rate for Payer: Kaiser Permanente Commercial	$1,140.05
Rate for Payer: Kaiser Permanente Medicaid	$922.90
Rate for Payer: MDX Hawaii PPO	$1,755.31
Rate for Payer: University Health Alliance Commercial	$1,013.38

Screw Locking Ti 5.0mm 36mm 04.045.036TS [3643702]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643702
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.38
Max. Negotiated Rate	$1,755.31
Rate for Payer: Cash Price	$1,176.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,266.72
Rate for Payer: Health Management Network Commercial	$1,538.16
Rate for Payer: MDX Hawaii PPO	$1,755.31
Rate for Payer: University Health Alliance Commercial	$1,013.38

Screw Locking Ti 5.0mm 38mm 04.045.038TS [3643703]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643703
Hospital Revenue Code	278
Min. Negotiated Rate	$997.08
Max. Negotiated Rate	$1,896.40
Rate for Payer: Cash Price	$1,270.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.54
Rate for Payer: Health Management Network Commercial	$1,661.79
Rate for Payer: Kaiser Permanente Commercial	$1,231.68
Rate for Payer: Kaiser Permanente Medicaid	$997.08
Rate for Payer: MDX Hawaii PPO	$1,896.40
Rate for Payer: University Health Alliance Commercial	$1,094.83

Know your out-of-pocket cost for care.

All Charges