Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 40mm 04.045.040TS [3643704]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643704
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 40mm 04.045.040TS [3643704]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643704
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 42mm 04.045.042TS [3643705]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643705
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 42mm 04.045.042TS [3643705]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643705
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 44mm 04.045.04TS [3643706]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643706
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 44mm 04.045.04TS [3643706]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643706
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 46mm 04.045.046TS [3643707]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643707
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 46mm 04.045.046TS [3643707]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643707
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 48mm 04.045.048s [3643708]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643708
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 48mm 04.045.048s [3643708]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643708
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 50mm 04.045.050S [3643709]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643709
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 50mm 04.045.050S [3643709]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643709
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 52mm 04.045.052TS [3643710]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643710
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 52mm 04.045.052TS [3643710]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643710
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 56mm 04.045.056TS [3643712]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643712
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 56mm 04.045.056TS [3643712]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643712
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 60mm 04.045.060TS [3643714]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643714
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 60mm 04.045.060TS [3643714]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643714
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 62mm 04.045.062TS [3643715]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643715
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 62mm 04.045.062TS [3643715]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643715
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 64mm 04.045.064TS [3643716]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643716
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 64mm 04.045.064TS [3643716]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643716
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 66mm 04.045.066TS [3643717]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643717
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 66mm 04.045.066TS [3643717]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643717
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

Know your out-of-pocket cost for care.

All Charges