Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$527.52
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: Kaiser Permanente Commercial	$651.64
Rate for Payer: Kaiser Permanente Medicaid	$527.52
Rate for Payer: MDX Hawaii PPO	$1,003.32
Rate for Payer: University Health Alliance Commercial	$579.24

Screw Lock Self Tap 3.5mm x 16mm 212.104 [3606422]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606422
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 16mm 212.104 [3606422]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606422
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 18mm 212.105 [3606423]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606423
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 18mm 212.105 [3606423]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606423
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 20mm 212.106 [3606424]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606424
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 20mm 212.106 [3606424]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606424
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 22mm 212.107 [3606425]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606425
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 22mm 212.107 [3606425]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606425
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 24mm 212.108 [3606426]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606426
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 24mm 212.108 [3606426]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606426
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 26mm 212.109 [3606427]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606427
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 26mm 212.109 [3606427]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606427
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 28mm 212.110 [3606428]

Facility

$1,043.78

Service Code	HCPCS C1713
Hospital Charge Code	3606428
Hospital Revenue Code	278
Min. Negotiated Rate	$532.33
Max. Negotiated Rate	$1,012.47
Rate for Payer: Cash Price	$678.46
Rate for Payer: Hawaii Western Management Group Commercial	$730.65
Rate for Payer: Health Management Network Commercial	$887.21
Rate for Payer: Kaiser Permanente Commercial	$657.58
Rate for Payer: Kaiser Permanente Medicaid	$532.33
Rate for Payer: MDX Hawaii PPO	$1,012.47
Rate for Payer: University Health Alliance Commercial	$584.52

Screw Lock Self Tap 3.5mm x 28mm 212.110 [3606428]

Facility

$1,043.78

Service Code	HCPCS C1713
Hospital Charge Code	3606428
Hospital Revenue Code	278
Min. Negotiated Rate	$584.52
Max. Negotiated Rate	$1,012.47
Rate for Payer: Cash Price	$678.46
Rate for Payer: Hawaii Western Management Group Commercial	$730.65
Rate for Payer: Health Management Network Commercial	$887.21
Rate for Payer: MDX Hawaii PPO	$1,012.47
Rate for Payer: University Health Alliance Commercial	$584.52

Screw Lock Self Tap 3.5mm x 50mm 212.121 [3606436]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606436
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 50mm 212.121 [3606436]

Facility

$917.72

Service Code	HCPCS C1713
Hospital Charge Code	3606436
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 5.0x30mm 212.209 [3606492]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606492
Hospital Revenue Code	278
Min. Negotiated Rate	$381.81
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: Kaiser Permanente Commercial	$471.65
Rate for Payer: Kaiser Permanente Medicaid	$381.81
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x30mm 212.209 [3606492]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606492
Hospital Revenue Code	278
Min. Negotiated Rate	$419.24
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x32mm 212.210 [3606493]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606493
Hospital Revenue Code	278
Min. Negotiated Rate	$419.24
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x32mm 212.210 [3606493]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606493
Hospital Revenue Code	278
Min. Negotiated Rate	$381.81
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: Kaiser Permanente Commercial	$471.65
Rate for Payer: Kaiser Permanente Medicaid	$381.81
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x34mm 212.211 [3606494]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606494
Hospital Revenue Code	278
Min. Negotiated Rate	$381.81
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: Kaiser Permanente Commercial	$471.65
Rate for Payer: Kaiser Permanente Medicaid	$381.81
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x34mm 212.211 [3606494]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606494
Hospital Revenue Code	278
Min. Negotiated Rate	$419.24
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x70mm 212.223 [3606486]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606486
Hospital Revenue Code	278
Min. Negotiated Rate	$419.24
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Screw Lock Self Tap 5.0x70mm 212.223 [3606486]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606486
Hospital Revenue Code	278
Min. Negotiated Rate	$381.81
Max. Negotiated Rate	$726.19
Rate for Payer: Cash Price	$486.62
Rate for Payer: Hawaii Western Management Group Commercial	$524.05
Rate for Payer: Health Management Network Commercial	$636.35
Rate for Payer: Kaiser Permanente Commercial	$471.65
Rate for Payer: Kaiser Permanente Medicaid	$381.81
Rate for Payer: MDX Hawaii PPO	$726.19
Rate for Payer: University Health Alliance Commercial	$419.24

Know your out-of-pocket cost for care.

All Charges