Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Locking Ti 5.0mm 68mm 04.045.068s [3643718]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643718
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 68mm 04.045.068s [3643718]

Facility

$1,809.60

Service Code	HCPCS C1713
Hospital Charge Code	3643718
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 70mm 04.045.070TS [3643719]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643719
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 70mm 04.045.070TS [3643719]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643719
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 76mm 04.045.076TS [3643722]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643722
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 76mm 04.045.076TS [3643722]

Facility

$1,955.05

Service Code	HCPCS C1713
Hospital Charge Code	3643722
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 5.0mmx90mm 04.045.090TS [3643684]

Facility

$1,623.57

Service Code	HCPCS C1713
Hospital Charge Code	3643684
Hospital Revenue Code	278
Min. Negotiated Rate	$909.20
Max. Negotiated Rate	$1,574.86
Rate for Payer: Cash Price	$1,055.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,136.50
Rate for Payer: Health Management Network Commercial	$1,380.03
Rate for Payer: MDX Hawaii PPO	$1,574.86
Rate for Payer: University Health Alliance Commercial	$909.20

Screw Locking Ti 5.0mmx90mm 04.045.090TS [3643684]

Facility

$1,623.57

Service Code	HCPCS C1713
Hospital Charge Code	3643684
Hospital Revenue Code	278
Min. Negotiated Rate	$828.02
Max. Negotiated Rate	$1,574.86
Rate for Payer: Kaiser Permanente Medicaid	$828.02
Rate for Payer: Cash Price	$1,055.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,136.50
Rate for Payer: Health Management Network Commercial	$1,380.03
Rate for Payer: Kaiser Permanente Commercial	$1,022.85
Rate for Payer: MDX Hawaii PPO	$1,574.86
Rate for Payer: University Health Alliance Commercial	$909.20

Screw Lock Multi Thrd Ti 3.5mm x 30mm MTLS-35300-TS [3643455]

Facility

$1,101.61

Service Code	HCPCS C1713
Hospital Charge Code	3643455
Hospital Revenue Code	278
Min. Negotiated Rate	$561.82
Max. Negotiated Rate	$1,068.56
Rate for Payer: Cash Price	$716.05
Rate for Payer: Hawaii Western Management Group Commercial	$771.13
Rate for Payer: Health Management Network Commercial	$936.37
Rate for Payer: Kaiser Permanente Commercial	$694.01
Rate for Payer: Kaiser Permanente Medicaid	$561.82
Rate for Payer: MDX Hawaii PPO	$1,068.56
Rate for Payer: University Health Alliance Commercial	$616.90

Screw Lock Multi Thrd Ti 3.5mm x 30mm MTLS-35300-TS [3643455]

Facility

$1,101.61

Service Code	HCPCS C1713
Hospital Charge Code	3643455
Hospital Revenue Code	278
Min. Negotiated Rate	$616.90
Max. Negotiated Rate	$1,068.56
Rate for Payer: Cash Price	$716.05
Rate for Payer: Hawaii Western Management Group Commercial	$771.13
Rate for Payer: Health Management Network Commercial	$936.37
Rate for Payer: MDX Hawaii PPO	$1,068.56
Rate for Payer: University Health Alliance Commercial	$616.90

Screw Lock Multi Thrd Ti 3.5mm x 34mm MTLS-35340-TS [3643456]

Facility

$1,101.61

Service Code	HCPCS C1713
Hospital Charge Code	3643456
Hospital Revenue Code	278
Min. Negotiated Rate	$561.82
Max. Negotiated Rate	$1,068.56
Rate for Payer: Cash Price	$716.05
Rate for Payer: Hawaii Western Management Group Commercial	$771.13
Rate for Payer: Health Management Network Commercial	$936.37
Rate for Payer: Kaiser Permanente Commercial	$694.01
Rate for Payer: Kaiser Permanente Medicaid	$561.82
Rate for Payer: MDX Hawaii PPO	$1,068.56
Rate for Payer: University Health Alliance Commercial	$616.90

Screw Lock Multi Thrd Ti 3.5mm x 34mm MTLS-35340-TS [3643456]

Facility

$1,101.61

Service Code	HCPCS C1713
Hospital Charge Code	3643456
Hospital Revenue Code	278
Min. Negotiated Rate	$616.90
Max. Negotiated Rate	$1,068.56
Rate for Payer: Cash Price	$716.05
Rate for Payer: Hawaii Western Management Group Commercial	$771.13
Rate for Payer: Health Management Network Commercial	$936.37
Rate for Payer: MDX Hawaii PPO	$1,068.56
Rate for Payer: University Health Alliance Commercial	$616.90

Screw Lock Multi Thread Ti 3.0mm x 10mm MTLS-30100-TS [3642727]

Facility

$860.64

Service Code	HCPCS C1713
Hospital Charge Code	3642727
Hospital Revenue Code	278
Min. Negotiated Rate	$438.93
Max. Negotiated Rate	$834.82
Rate for Payer: Cash Price	$559.42
Rate for Payer: Hawaii Western Management Group Commercial	$602.45
Rate for Payer: Health Management Network Commercial	$731.54
Rate for Payer: Kaiser Permanente Commercial	$542.20
Rate for Payer: Kaiser Permanente Medicaid	$438.93
Rate for Payer: MDX Hawaii PPO	$834.82
Rate for Payer: University Health Alliance Commercial	$481.96

Screw Lock Multi Thread Ti 3.0mm x 10mm MTLS-30100-TS [3642727]

Facility

$860.64

Service Code	HCPCS C1713
Hospital Charge Code	3642727
Hospital Revenue Code	278
Min. Negotiated Rate	$481.96
Max. Negotiated Rate	$834.82
Rate for Payer: Cash Price	$559.42
Rate for Payer: Hawaii Western Management Group Commercial	$602.45
Rate for Payer: Health Management Network Commercial	$731.54
Rate for Payer: MDX Hawaii PPO	$834.82
Rate for Payer: University Health Alliance Commercial	$481.96

Screw Lock Multi Thread Ti 3.0mm x 12mm MTLS-30120-TS [3642728]

Facility

$860.64

Service Code	HCPCS C1713
Hospital Charge Code	3642728
Hospital Revenue Code	278
Min. Negotiated Rate	$438.93
Max. Negotiated Rate	$834.82
Rate for Payer: Cash Price	$559.42
Rate for Payer: Hawaii Western Management Group Commercial	$602.45
Rate for Payer: Health Management Network Commercial	$731.54
Rate for Payer: Kaiser Permanente Commercial	$542.20
Rate for Payer: Kaiser Permanente Medicaid	$438.93
Rate for Payer: MDX Hawaii PPO	$834.82
Rate for Payer: University Health Alliance Commercial	$481.96

Screw Lock Multi Thread Ti 3.0mm x 12mm MTLS-30120-TS [3642728]

Facility

$860.64

Service Code	HCPCS C1713
Hospital Charge Code	3642728
Hospital Revenue Code	278
Min. Negotiated Rate	$481.96
Max. Negotiated Rate	$834.82
Rate for Payer: Cash Price	$559.42
Rate for Payer: Hawaii Western Management Group Commercial	$602.45
Rate for Payer: Health Management Network Commercial	$731.54
Rate for Payer: MDX Hawaii PPO	$834.82
Rate for Payer: University Health Alliance Commercial	$481.96

Screw Lock Multi Thread Ti 3.0mm x 14mm MTLS-30140-TS [3642774]

Facility

$823.15

Service Code	HCPCS C1713
Hospital Charge Code	3642774
Hospital Revenue Code	278
Min. Negotiated Rate	$419.81
Max. Negotiated Rate	$798.46
Rate for Payer: Cash Price	$535.05
Rate for Payer: Hawaii Western Management Group Commercial	$576.21
Rate for Payer: Health Management Network Commercial	$699.68
Rate for Payer: Kaiser Permanente Commercial	$518.58
Rate for Payer: Kaiser Permanente Medicaid	$419.81
Rate for Payer: MDX Hawaii PPO	$798.46
Rate for Payer: University Health Alliance Commercial	$460.96

Screw Lock Multi Thread Ti 3.0mm x 14mm MTLS-30140-TS [3642774]

Facility

$823.15

Service Code	HCPCS C1713
Hospital Charge Code	3642774
Hospital Revenue Code	278
Min. Negotiated Rate	$460.96
Max. Negotiated Rate	$798.46
Rate for Payer: Cash Price	$535.05
Rate for Payer: Hawaii Western Management Group Commercial	$576.21
Rate for Payer: Health Management Network Commercial	$699.68
Rate for Payer: MDX Hawaii PPO	$798.46
Rate for Payer: University Health Alliance Commercial	$460.96

Screw Lock Multi Thread Ti 3.0mmX8mm MTLS30080TS [3642772]

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	3642772
Hospital Revenue Code	278
Min. Negotiated Rate	$290.06
Max. Negotiated Rate	$551.69
Rate for Payer: Cash Price	$369.69
Rate for Payer: Hawaii Western Management Group Commercial	$398.12
Rate for Payer: Health Management Network Commercial	$483.44
Rate for Payer: Kaiser Permanente Commercial	$358.31
Rate for Payer: Kaiser Permanente Medicaid	$290.06
Rate for Payer: MDX Hawaii PPO	$551.69
Rate for Payer: University Health Alliance Commercial	$318.50

Screw Lock Multi Thread Ti 3.0mmX8mm MTLS30080TS [3642772]

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	3642772
Hospital Revenue Code	278
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$551.69
Rate for Payer: Cash Price	$369.69
Rate for Payer: Hawaii Western Management Group Commercial	$398.12
Rate for Payer: Health Management Network Commercial	$483.44
Rate for Payer: MDX Hawaii PPO	$551.69
Rate for Payer: University Health Alliance Commercial	$318.50

Screw Lock Self Tap 3.5Mm 212.115 [3606432]

Facility

$1,262.90

Service Code	HCPCS C1713
Hospital Charge Code	3606432
Hospital Revenue Code	278
Min. Negotiated Rate	$644.08
Max. Negotiated Rate	$1,225.01
Rate for Payer: Cash Price	$820.89
Rate for Payer: Hawaii Western Management Group Commercial	$884.03
Rate for Payer: Health Management Network Commercial	$1,073.46
Rate for Payer: Kaiser Permanente Commercial	$795.63
Rate for Payer: Kaiser Permanente Medicaid	$644.08
Rate for Payer: MDX Hawaii PPO	$1,225.01
Rate for Payer: University Health Alliance Commercial	$707.22

Screw Lock Self Tap 3.5Mm 212.115 [3606432]

Facility

$1,262.90

Service Code	HCPCS C1713
Hospital Charge Code	3606432
Hospital Revenue Code	278
Min. Negotiated Rate	$707.22
Max. Negotiated Rate	$1,225.01
Rate for Payer: Cash Price	$820.89
Rate for Payer: Hawaii Western Management Group Commercial	$884.03
Rate for Payer: Health Management Network Commercial	$1,073.46
Rate for Payer: MDX Hawaii PPO	$1,225.01
Rate for Payer: University Health Alliance Commercial	$707.22

Screw Lock Self Tap 3.5mm x 12mm 212.102 [3606420]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606420
Hospital Revenue Code	278
Min. Negotiated Rate	$468.04
Max. Negotiated Rate	$890.19
Rate for Payer: Cash Price	$596.52
Rate for Payer: Hawaii Western Management Group Commercial	$642.40
Rate for Payer: Health Management Network Commercial	$780.06
Rate for Payer: Kaiser Permanente Commercial	$578.16
Rate for Payer: Kaiser Permanente Medicaid	$468.04
Rate for Payer: MDX Hawaii PPO	$890.19
Rate for Payer: University Health Alliance Commercial	$513.92

Screw Lock Self Tap 3.5mm x 12mm 212.102 [3606420]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606420
Hospital Revenue Code	278
Min. Negotiated Rate	$513.92
Max. Negotiated Rate	$890.19
Rate for Payer: Cash Price	$596.52
Rate for Payer: Hawaii Western Management Group Commercial	$642.40
Rate for Payer: Health Management Network Commercial	$780.06
Rate for Payer: MDX Hawaii PPO	$890.19
Rate for Payer: University Health Alliance Commercial	$513.92

Screw Lock Self Tap 3.5mm x 14mm 212.103 [3606421]

Facility

$1,034.35

Service Code	HCPCS C1713
Hospital Charge Code	3606421
Hospital Revenue Code	278
Min. Negotiated Rate	$579.24
Max. Negotiated Rate	$1,003.32
Rate for Payer: Cash Price	$672.33
Rate for Payer: Hawaii Western Management Group Commercial	$724.04
Rate for Payer: Health Management Network Commercial	$879.20
Rate for Payer: MDX Hawaii PPO	$1,003.32
Rate for Payer: University Health Alliance Commercial	$579.24

Know your out-of-pocket cost for care.

All Charges