Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Lock Self Tap 5.0x75mm 212.224 [3606487]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606487
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 5.0x75mm 212.224 [3606487]

Facility

$748.65

Service Code	HCPCS C1713
Hospital Charge Code	3606487
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 St T8 Sd Recess 2.7x40mm 202.240 [3644024]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3644024
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 Lock St T8 Sd Recess 2.7x40mm 202.240 [3644024]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3644024
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 Lock St T8 Sd Recess 2.7x46mm 202.246 [3644025]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3644025
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 Lock St T8 Sd Recess 2.7x46mm 202.246 [3644025]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3644025
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 Lock St T8 Sd Recess 2.7x50mm 202.250 [3644026]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3644026
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 Lock St T8 Sd Recess 2.7x50mm 202.250 [3644026]

Facility

$606.77

Service Code	HCPCS C1713
Hospital Charge Code	3644026
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 Lock Ti 5.0mm ST SD 36mm 412.212S [3640258B]

Facility

$1,083.73

Service Code	HCPCS C1713
Hospital Charge Code	3640258B
Hospital Revenue Code	278
Min. Negotiated Rate	$552.70
Max. Negotiated Rate	$1,051.22
Rate for Payer: Cash Price	$704.42
Rate for Payer: Hawaii Western Management Group Commercial	$758.61
Rate for Payer: Health Management Network Commercial	$921.17
Rate for Payer: Kaiser Permanente Commercial	$682.75
Rate for Payer: Kaiser Permanente Medicaid	$552.70
Rate for Payer: MDX Hawaii PPO	$1,051.22
Rate for Payer: University Health Alliance Commercial	$606.89

Screw Lock Ti 5.0mm ST SD 36mm 412.212S [3640258B]

Facility

$1,083.73

Service Code	HCPCS C1713
Hospital Charge Code	3640258B
Hospital Revenue Code	278
Min. Negotiated Rate	$606.89
Max. Negotiated Rate	$1,051.22
Rate for Payer: Cash Price	$704.42
Rate for Payer: Hawaii Western Management Group Commercial	$758.61
Rate for Payer: Health Management Network Commercial	$921.17
Rate for Payer: MDX Hawaii PPO	$1,051.22
Rate for Payer: University Health Alliance Commercial	$606.89

Screw Lock Ti 5.0mm ST SD 38mm 412.213S [3640258C]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258C
Hospital Revenue Code	278
Min. Negotiated Rate	$741.28
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: Kaiser Permanente Commercial	$915.70
Rate for Payer: Kaiser Permanente Medicaid	$741.28
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 38mm 412.213S [3640258C]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258C
Hospital Revenue Code	278
Min. Negotiated Rate	$813.95
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 40mm 412.214S [3640258D]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258D
Hospital Revenue Code	278
Min. Negotiated Rate	$741.28
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: Kaiser Permanente Commercial	$915.70
Rate for Payer: Kaiser Permanente Medicaid	$741.28
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 40mm 412.214S [3640258D]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258D
Hospital Revenue Code	278
Min. Negotiated Rate	$813.95
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 42mm 412.215S [3640258E]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258E
Hospital Revenue Code	278
Min. Negotiated Rate	$813.95
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 42mm 412.215S [3640258E]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258E
Hospital Revenue Code	278
Min. Negotiated Rate	$741.28
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: Kaiser Permanente Commercial	$915.70
Rate for Payer: Kaiser Permanente Medicaid	$741.28
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 46mm 412.217S [3640258G]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258G
Hospital Revenue Code	278
Min. Negotiated Rate	$741.28
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: Kaiser Permanente Commercial	$915.70
Rate for Payer: Kaiser Permanente Medicaid	$741.28
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 46mm 412.217S [3640258G]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258G
Hospital Revenue Code	278
Min. Negotiated Rate	$813.95
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 48mm 412.218S [3640258H]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258H
Hospital Revenue Code	278
Min. Negotiated Rate	$813.95
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lock Ti 5.0mm ST SD 48mm 412.218S [3640258H]

Facility

$1,453.49

Service Code	HCPCS C1713
Hospital Charge Code	3640258H
Hospital Revenue Code	278
Min. Negotiated Rate	$741.28
Max. Negotiated Rate	$1,409.89
Rate for Payer: Cash Price	$944.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.44
Rate for Payer: Health Management Network Commercial	$1,235.47
Rate for Payer: Kaiser Permanente Commercial	$915.70
Rate for Payer: Kaiser Permanente Medicaid	$741.28
Rate for Payer: MDX Hawaii PPO	$1,409.89
Rate for Payer: University Health Alliance Commercial	$813.95

Screw Lopro 1.6 x 8mm Cort AR-18716-08 [3644469]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644469
Hospital Revenue Code	278
Min. Negotiated Rate	$567.28
Max. Negotiated Rate	$1,078.95
Rate for Payer: Cash Price	$723.01
Rate for Payer: Hawaii Western Management Group Commercial	$778.62
Rate for Payer: Health Management Network Commercial	$945.47
Rate for Payer: Kaiser Permanente Commercial	$700.76
Rate for Payer: Kaiser Permanente Medicaid	$567.28
Rate for Payer: MDX Hawaii PPO	$1,078.95
Rate for Payer: University Health Alliance Commercial	$622.90

Screw Lopro 1.6 x 8mm Cort AR-18716-08 [3644469]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644469
Hospital Revenue Code	278
Min. Negotiated Rate	$622.90
Max. Negotiated Rate	$1,078.95
Rate for Payer: Cash Price	$723.01
Rate for Payer: Hawaii Western Management Group Commercial	$778.62
Rate for Payer: Health Management Network Commercial	$945.47
Rate for Payer: MDX Hawaii PPO	$1,078.95
Rate for Payer: University Health Alliance Commercial	$622.90

Screw Lopro 2.0 x 10mm Cort AR-18720-10 [3644472]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644472
Hospital Revenue Code	278
Min. Negotiated Rate	$622.90
Max. Negotiated Rate	$1,078.95
Rate for Payer: Cash Price	$723.01
Rate for Payer: Hawaii Western Management Group Commercial	$778.62
Rate for Payer: Health Management Network Commercial	$945.47
Rate for Payer: MDX Hawaii PPO	$1,078.95
Rate for Payer: University Health Alliance Commercial	$622.90

Screw Lopro 2.0 x 10mm Cort AR-18720-10 [3644472]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644472
Hospital Revenue Code	278
Min. Negotiated Rate	$567.28
Max. Negotiated Rate	$1,078.95
Rate for Payer: Cash Price	$723.01
Rate for Payer: Hawaii Western Management Group Commercial	$778.62
Rate for Payer: Health Management Network Commercial	$945.47
Rate for Payer: Kaiser Permanente Commercial	$700.76
Rate for Payer: Kaiser Permanente Medicaid	$567.28
Rate for Payer: MDX Hawaii PPO	$1,078.95
Rate for Payer: University Health Alliance Commercial	$622.90

Screw Lopro 2.0 x 13mm Cort AR-18720-13 [3644789]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644789
Hospital Revenue Code	278
Min. Negotiated Rate	$622.90
Max. Negotiated Rate	$1,078.95
Rate for Payer: Cash Price	$723.01
Rate for Payer: Hawaii Western Management Group Commercial	$778.62
Rate for Payer: Health Management Network Commercial	$945.47
Rate for Payer: MDX Hawaii PPO	$1,078.95
Rate for Payer: University Health Alliance Commercial	$622.90

Know your out-of-pocket cost for care.

All Charges