Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw LP Non Locking 2.7mmX11mm 131227211 [3641474]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641474
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX11mm 131227211 [3641474]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641474
Hospital Revenue Code	278
Min. Negotiated Rate	$430.98
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX12mm 131227212 [3641475]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641475
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX12mm 131227212 [3641475]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641475
Hospital Revenue Code	278
Min. Negotiated Rate	$430.98
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX13mm 131227213 [3641431]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641431
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX13mm 131227213 [3641431]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641431
Hospital Revenue Code	278
Min. Negotiated Rate	$430.98
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX14mm 131227214 [3641433]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641433
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX14mm 131227214 [3641433]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641433
Hospital Revenue Code	278
Min. Negotiated Rate	$430.98
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX15mm 131227215 [3641693]

Facility

$823.15

Service Code	HCPCS C1713
Hospital Charge Code	3641693
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 LP Non Locking 2.7mmX15mm 131227215 [3641693]

Facility

$823.15

Service Code	HCPCS C1713
Hospital Charge Code	3641693
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 LP Non Locking 2.7mmX16mm 131227216 [3641673]

Facility

$796.38

Service Code	HCPCS C1713
Hospital Charge Code	3641673
Hospital Revenue Code	278
Min. Negotiated Rate	$406.15
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: Kaiser Permanente Commercial	$501.72
Rate for Payer: Kaiser Permanente Medicaid	$406.15
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Screw LP Non Locking 2.7mmX16mm 131227216 [3641673]

Facility

$796.38

Service Code	HCPCS C1713
Hospital Charge Code	3641673
Hospital Revenue Code	278
Min. Negotiated Rate	$445.97
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Screw LP Non Locking 2.7mmX18mm 131227218 [3641897]

Facility

$466.38

Service Code	HCPCS C1713
Hospital Charge Code	3641897
Hospital Revenue Code	278
Min. Negotiated Rate	$237.85
Max. Negotiated Rate	$452.39
Rate for Payer: Cash Price	$303.15
Rate for Payer: Hawaii Western Management Group Commercial	$326.47
Rate for Payer: Health Management Network Commercial	$396.42
Rate for Payer: Kaiser Permanente Commercial	$293.82
Rate for Payer: Kaiser Permanente Medicaid	$237.85
Rate for Payer: MDX Hawaii PPO	$452.39
Rate for Payer: University Health Alliance Commercial	$261.17

Screw LP Non Locking 2.7mmX18mm 131227218 [3641897]

Facility

$466.38

Service Code	HCPCS C1713
Hospital Charge Code	3641897
Hospital Revenue Code	278
Min. Negotiated Rate	$261.17
Max. Negotiated Rate	$452.39
Rate for Payer: Cash Price	$303.15
Rate for Payer: Hawaii Western Management Group Commercial	$326.47
Rate for Payer: Health Management Network Commercial	$396.42
Rate for Payer: MDX Hawaii PPO	$452.39
Rate for Payer: University Health Alliance Commercial	$261.17

Screw LP Non Locking 2.7mmX20mm 131227220 [3641432]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641432
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX20mm 131227220 [3641432]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641432
Hospital Revenue Code	278
Min. Negotiated Rate	$430.98
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX22mm 131227222 [3641476]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641476
Hospital Revenue Code	278
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw LP Non Locking 2.7mmX22mm 131227222 [3641476]

Facility

$769.60

Service Code	HCPCS C1713
Hospital Charge Code	3641476
Hospital Revenue Code	278
Min. Negotiated Rate	$430.98
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$538.72
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$430.98

Screw Md Locking 2.7mm x 12mm 131227312 [3644107]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3644107
Hospital Revenue Code	278
Min. Negotiated Rate	$835.96
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw Md Locking 2.7mm x 12mm 131227312 [3644107]

Facility

$1,492.78

Service Code	HCPCS C1713
Hospital Charge Code	3644107
Hospital Revenue Code	278
Min. Negotiated Rate	$761.32
Max. Negotiated Rate	$1,448.00
Rate for Payer: Cash Price	$970.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,044.95
Rate for Payer: Health Management Network Commercial	$1,268.86
Rate for Payer: Kaiser Permanente Commercial	$940.45
Rate for Payer: Kaiser Permanente Medicaid	$761.32
Rate for Payer: MDX Hawaii PPO	$1,448.00
Rate for Payer: University Health Alliance Commercial	$835.96

Screw MD Locking 2.7mmX20mm 131227320 [3641677]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3641677
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 MD Locking 2.7mmX20mm 131227320 [3641677]

Facility

$1,599.38

Service Code	HCPCS C1713
Hospital Charge Code	3641677
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 MD Locking 2.7mmX26mm 131227326 [3641696]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3641696
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Screw MD Locking 2.7mmX26mm 131227326 [3641696]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3641696
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Screw Metaphyseal ST T8 SD 2.7 x 14mm 02.118.514 [3640042M]

Facility

$679.64

Service Code	HCPCS C1713
Hospital Charge Code	3640042M
Hospital Revenue Code	278
Min. Negotiated Rate	$346.62
Max. Negotiated Rate	$659.25
Rate for Payer: Cash Price	$441.77
Rate for Payer: Hawaii Western Management Group Commercial	$475.75
Rate for Payer: Health Management Network Commercial	$577.69
Rate for Payer: Kaiser Permanente Commercial	$428.17
Rate for Payer: Kaiser Permanente Medicaid	$346.62
Rate for Payer: MDX Hawaii PPO	$659.25
Rate for Payer: University Health Alliance Commercial	$380.60

Know your out-of-pocket cost for care.

All Charges