Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Lopro 3.5 x 18mm DRP Cort AR-8735-18 [3644598]

Facility

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	3644598
Hospital Revenue Code	278
Min. Negotiated Rate	$337.88
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$463.75
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: Kaiser Permanente Commercial	$417.38
Rate for Payer: Kaiser Permanente Medicaid	$337.88
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$371.00

Screw Lopro 3.5 x 18mm DRP Cort AR-8735-18 [3644598]

Facility

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	3644598
Hospital Revenue Code	278
Min. Negotiated Rate	$371.00
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$463.75
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$371.00

Screw LoPro Cortex 2.4mm x 32mm AR-8916CX24-32 [3644889]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644889
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 Cortex 2.4mm x 32mm AR-8916CX24-32 [3644889]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644889
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 Cortex 2.4mm x 34mm AR-8916CX24-34 [3644890]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644890
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 Cortex 2.4mm x 34mm AR-8916CX24-34 [3644890]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644890
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 Cortex 2.4mm x 36mm AR-8916CX24-36 [3644891]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644891
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 Cortex 2.4mm x 36mm AR-8916CX24-36 [3644891]

Facility

$1,112.32

Service Code	HCPCS C1713
Hospital Charge Code	3644891
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 Lo-Pro Ss 4.0x12mm Canc AR-8840-12 [3645477]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3645477
Hospital Revenue Code	278
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: Kaiser Permanente Commercial	$267.99
Rate for Payer: Kaiser Permanente Medicaid	$216.94
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Lo-Pro Ss 4.0x12mm Canc AR-8840-12 [3645477]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3645477
Hospital Revenue Code	278
Min. Negotiated Rate	$238.21
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Lo-Pro SS 4.0 x 28mm Canc AR-8840-28 [3644673]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3644673
Hospital Revenue Code	278
Min. Negotiated Rate	$238.21
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Lo-Pro SS 4.0 x 28mm Canc AR-8840-28 [3644673]

Facility

$425.38

Service Code	HCPCS C1713
Hospital Charge Code	3644673
Hospital Revenue Code	278
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$412.62
Rate for Payer: Cash Price	$276.50
Rate for Payer: Hawaii Western Management Group Commercial	$297.77
Rate for Payer: Health Management Network Commercial	$361.57
Rate for Payer: Kaiser Permanente Commercial	$267.99
Rate for Payer: Kaiser Permanente Medicaid	$216.94
Rate for Payer: MDX Hawaii PPO	$412.62
Rate for Payer: University Health Alliance Commercial	$238.21

Screw Lo-Pro SS 4.0 x 30mm Cann Lng Thd AR-8840CL-30 [3644674]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644674
Hospital Revenue Code	278
Min. Negotiated Rate	$815.68
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: Kaiser Permanente Commercial	$1,007.61
Rate for Payer: Kaiser Permanente Medicaid	$815.68
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lo-Pro SS 4.0 x 30mm Cann Lng Thd AR-8840CL-30 [3644674]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644674
Hospital Revenue Code	278
Min. Negotiated Rate	$895.65
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lopro SS 4.0 x 40mm Cann LNG THD AR-8840CL-40 [3644527]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644527
Hospital Revenue Code	278
Min. Negotiated Rate	$815.68
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: Kaiser Permanente Commercial	$1,007.61
Rate for Payer: Kaiser Permanente Medicaid	$815.68
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lopro SS 4.0 x 40mm Cann LNG THD AR-8840CL-40 [3644527]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644527
Hospital Revenue Code	278
Min. Negotiated Rate	$895.65
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lo-Pro SS 4.0 x 45mm Cann Lng Thd AR-8840CL-45 [3644675]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644675
Hospital Revenue Code	278
Min. Negotiated Rate	$895.65
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lo-Pro SS 4.0 x 45mm Cann Lng Thd AR-8840CL-45 [3644675]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644675
Hospital Revenue Code	278
Min. Negotiated Rate	$815.68
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: Kaiser Permanente Commercial	$1,007.61
Rate for Payer: Kaiser Permanente Medicaid	$815.68
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw LoPro SS 4.0 x 50mm Cann LNG THD AR-8840CL-50 [3643230]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3643230
Hospital Revenue Code	278
Min. Negotiated Rate	$895.65
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw LoPro SS 4.0 x 50mm Cann LNG THD AR-8840CL-50 [3643230]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3643230
Hospital Revenue Code	278
Min. Negotiated Rate	$815.68
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: Kaiser Permanente Commercial	$1,007.61
Rate for Payer: Kaiser Permanente Medicaid	$815.68
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lo-Pro SS 4.0 x 60mm Cann Lng Thd AR-8840CL-60 [3644676]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644676
Hospital Revenue Code	278
Min. Negotiated Rate	$815.68
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: Kaiser Permanente Commercial	$1,007.61
Rate for Payer: Kaiser Permanente Medicaid	$815.68
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lo-Pro SS 4.0 x 60mm Cann Lng Thd AR-8840CL-60 [3644676]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3644676
Hospital Revenue Code	278
Min. Negotiated Rate	$895.65
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Screw Lopro SS Lock 2.7 x 10mm AR-8827L-10 [3644227]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644227
Hospital Revenue Code	278
Min. Negotiated Rate	$589.13
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: Kaiser Permanente Commercial	$727.75
Rate for Payer: Kaiser Permanente Medicaid	$589.13
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

Screw Lopro SS Lock 2.7 x 10mm AR-8827L-10 [3644227]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3644227
Hospital Revenue Code	278
Min. Negotiated Rate	$646.89
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

Screw LoPro SS Lock 2.7 x 12mm AR-8827L-12 [3643130]

Facility

$1,155.16

Service Code	HCPCS C1713
Hospital Charge Code	3643130
Hospital Revenue Code	278
Min. Negotiated Rate	$589.13
Max. Negotiated Rate	$1,120.51
Rate for Payer: Cash Price	$750.85
Rate for Payer: Hawaii Western Management Group Commercial	$808.61
Rate for Payer: Health Management Network Commercial	$981.89
Rate for Payer: Kaiser Permanente Commercial	$727.75
Rate for Payer: Kaiser Permanente Medicaid	$589.13
Rate for Payer: MDX Hawaii PPO	$1,120.51
Rate for Payer: University Health Alliance Commercial	$646.89

Know your out-of-pocket cost for care.

All Charges