Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$380.60
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: MDX Hawaii PPO	$659.25
Rate for Payer: University Health Alliance Commercial	$380.60

Screw Metaphyseal ST T8 SD 2.7 x 16mm 02.118.516 [3640042A]

Facility

$679.64

Service Code	HCPCS C1713
Hospital Charge Code	3640042A
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

Screw Metaphyseal ST T8 SD 2.7 x 16mm 02.118.516 [3640042A]

Facility

$679.64

Service Code	HCPCS C1713
Hospital Charge Code	3640042A
Hospital Revenue Code	278
Min. Negotiated Rate	$380.60
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: MDX Hawaii PPO	$659.25
Rate for Payer: University Health Alliance Commercial	$380.60

Screw Metaphyseal ST T8 SD 2.7 x 18mm 02.118.518 [3640042B]

Facility

$679.64

Service Code	HCPCS C1713
Hospital Charge Code	3640042B
Hospital Revenue Code	278
Min. Negotiated Rate	$380.60
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: MDX Hawaii PPO	$659.25
Rate for Payer: University Health Alliance Commercial	$380.60

Screw Metaphyseal ST T8 SD 2.7 x 18mm 02.118.518 [3640042B]

Facility

$679.64

Service Code	HCPCS C1713
Hospital Charge Code	3640042B
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

Screw Metaphyseal ST T8 SD 2.7 x 24mm 02.118.524 [3640042D]

Facility

$398.47

Service Code	HCPCS C1713
Hospital Charge Code	3640042D
Hospital Revenue Code	278
Min. Negotiated Rate	$203.22
Max. Negotiated Rate	$386.52
Rate for Payer: Cash Price	$259.01
Rate for Payer: Hawaii Western Management Group Commercial	$278.93
Rate for Payer: Health Management Network Commercial	$338.70
Rate for Payer: Kaiser Permanente Commercial	$251.04
Rate for Payer: Kaiser Permanente Medicaid	$203.22
Rate for Payer: MDX Hawaii PPO	$386.52
Rate for Payer: University Health Alliance Commercial	$223.14

Screw Metaphyseal ST T8 SD 2.7 x 24mm 02.118.524 [3640042D]

Facility

$398.47

Service Code	HCPCS C1713
Hospital Charge Code	3640042D
Hospital Revenue Code	278
Min. Negotiated Rate	$223.14
Max. Negotiated Rate	$386.52
Rate for Payer: Cash Price	$259.01
Rate for Payer: Hawaii Western Management Group Commercial	$278.93
Rate for Payer: Health Management Network Commercial	$338.70
Rate for Payer: MDX Hawaii PPO	$386.52
Rate for Payer: University Health Alliance Commercial	$223.14

Screw Micro Comp FT Cann 2.5mm x 20mm AR-8725-20H [3644732]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644732
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.81
Max. Negotiated Rate	$3,037.07
Rate for Payer: Cash Price	$2,035.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,191.70
Rate for Payer: Health Management Network Commercial	$2,661.35
Rate for Payer: Kaiser Permanente Commercial	$1,972.53
Rate for Payer: Kaiser Permanente Medicaid	$1,596.81
Rate for Payer: MDX Hawaii PPO	$3,037.07
Rate for Payer: University Health Alliance Commercial	$1,753.36

Screw Micro Comp FT Cann 2.5mm x 20mm AR-8725-20H [3644732]

Facility

$3,131.00

Service Code	HCPCS C1713
Hospital Charge Code	3644732
Hospital Revenue Code	278
Min. Negotiated Rate	$1,753.36
Max. Negotiated Rate	$3,037.07
Rate for Payer: Cash Price	$2,035.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,191.70
Rate for Payer: Health Management Network Commercial	$2,661.35
Rate for Payer: MDX Hawaii PPO	$3,037.07
Rate for Payer: University Health Alliance Commercial	$1,753.36

Screw Mlt Thrd Comp 3.5mmx48mm Ti Mtnl35480ts [3643496]

Facility

$721.88

Service Code	HCPCS C1713
Hospital Charge Code	3643496
Hospital Revenue Code	278
Min. Negotiated Rate	$368.16
Max. Negotiated Rate	$700.22
Rate for Payer: Cash Price	$469.22
Rate for Payer: Hawaii Western Management Group Commercial	$505.32
Rate for Payer: Health Management Network Commercial	$613.60
Rate for Payer: Kaiser Permanente Commercial	$454.78
Rate for Payer: Kaiser Permanente Medicaid	$368.16
Rate for Payer: MDX Hawaii PPO	$700.22
Rate for Payer: University Health Alliance Commercial	$404.25

Screw Mlt Thrd Comp 3.5mmx48mm Ti Mtnl35480ts [3643496]

Facility

$721.88

Service Code	HCPCS C1713
Hospital Charge Code	3643496
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$700.22
Rate for Payer: Cash Price	$469.22
Rate for Payer: Hawaii Western Management Group Commercial	$505.32
Rate for Payer: Health Management Network Commercial	$613.60
Rate for Payer: MDX Hawaii PPO	$700.22
Rate for Payer: University Health Alliance Commercial	$404.25

Screw Mlt Thrd Lock 2.7mmx22mm Ti Mtls27220ts [3643497]

Facility

$774.38

Service Code	HCPCS C1713
Hospital Charge Code	3643497
Hospital Revenue Code	278
Min. Negotiated Rate	$394.93
Max. Negotiated Rate	$751.15
Rate for Payer: Cash Price	$503.35
Rate for Payer: Hawaii Western Management Group Commercial	$542.07
Rate for Payer: Health Management Network Commercial	$658.22
Rate for Payer: Kaiser Permanente Commercial	$487.86
Rate for Payer: Kaiser Permanente Medicaid	$394.93
Rate for Payer: MDX Hawaii PPO	$751.15
Rate for Payer: University Health Alliance Commercial	$433.65

Screw Mlt Thrd Lock 2.7mmx22mm Ti Mtls27220ts [3643497]

Facility

$774.38

Service Code	HCPCS C1713
Hospital Charge Code	3643497
Hospital Revenue Code	278
Min. Negotiated Rate	$433.65
Max. Negotiated Rate	$751.15
Rate for Payer: Cash Price	$503.35
Rate for Payer: Hawaii Western Management Group Commercial	$542.07
Rate for Payer: Health Management Network Commercial	$658.22
Rate for Payer: MDX Hawaii PPO	$751.15
Rate for Payer: University Health Alliance Commercial	$433.65

Screw Mlt Thrd Lock 2.7mmx24mm Ti Mtls27240ts [3643498]

Facility

$774.38

Service Code	HCPCS C1713
Hospital Charge Code	3643498
Hospital Revenue Code	278
Min. Negotiated Rate	$433.65
Max. Negotiated Rate	$751.15
Rate for Payer: Cash Price	$503.35
Rate for Payer: Hawaii Western Management Group Commercial	$542.07
Rate for Payer: Health Management Network Commercial	$658.22
Rate for Payer: MDX Hawaii PPO	$751.15
Rate for Payer: University Health Alliance Commercial	$433.65

Screw Mlt Thrd Lock 2.7mmx24mm Ti Mtls27240ts [3643498]

Facility

$774.38

Service Code	HCPCS C1713
Hospital Charge Code	3643498
Hospital Revenue Code	278
Min. Negotiated Rate	$394.93
Max. Negotiated Rate	$751.15
Rate for Payer: Cash Price	$503.35
Rate for Payer: Hawaii Western Management Group Commercial	$542.07
Rate for Payer: Health Management Network Commercial	$658.22
Rate for Payer: Kaiser Permanente Commercial	$487.86
Rate for Payer: Kaiser Permanente Medicaid	$394.93
Rate for Payer: MDX Hawaii PPO	$751.15
Rate for Payer: University Health Alliance Commercial	$433.65

Screw Mlt Thrd Lock 2.7mmx30mm Ti Mtls27300ts [3643500]

Facility

$774.38

Service Code	HCPCS C1713
Hospital Charge Code	3643500
Hospital Revenue Code	278
Min. Negotiated Rate	$394.93
Max. Negotiated Rate	$751.15
Rate for Payer: Cash Price	$503.35
Rate for Payer: Hawaii Western Management Group Commercial	$542.07
Rate for Payer: Health Management Network Commercial	$658.22
Rate for Payer: Kaiser Permanente Commercial	$487.86
Rate for Payer: Kaiser Permanente Medicaid	$394.93
Rate for Payer: MDX Hawaii PPO	$751.15
Rate for Payer: University Health Alliance Commercial	$433.65

Screw Mlt Thrd Lock 2.7mmx30mm Ti Mtls27300ts [3643500]

Facility

$774.38

Service Code	HCPCS C1713
Hospital Charge Code	3643500
Hospital Revenue Code	278
Min. Negotiated Rate	$433.65
Max. Negotiated Rate	$751.15
Rate for Payer: Cash Price	$503.35
Rate for Payer: Hawaii Western Management Group Commercial	$542.07
Rate for Payer: Health Management Network Commercial	$658.22
Rate for Payer: MDX Hawaii PPO	$751.15
Rate for Payer: University Health Alliance Commercial	$433.65

Screw Mlt Thrd Lock Ti 2.7mm x 26mm MTLS-27260-TS [3643499]

Facility

$1,101.61

Service Code	HCPCS C1713
Hospital Charge Code	3643499
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 Mlt Thrd Lock Ti 2.7mm x 26mm MTLS-27260-TS [3643499]

Facility

$1,101.61

Service Code	HCPCS C1713
Hospital Charge Code	3643499
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 Ncb Cort Self-Tap 3.5mmx22mm 02.03131.022 [3645483]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645483
Hospital Revenue Code	278
Min. Negotiated Rate	$607.19
Max. Negotiated Rate	$1,051.73
Rate for Payer: Cash Price	$704.77
Rate for Payer: Hawaii Western Management Group Commercial	$758.98
Rate for Payer: Health Management Network Commercial	$921.62
Rate for Payer: MDX Hawaii PPO	$1,051.73
Rate for Payer: University Health Alliance Commercial	$607.19

Screw Ncb Cort Self-Tap 3.5mmx22mm 02.03131.022 [3645483]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645483
Hospital Revenue Code	278
Min. Negotiated Rate	$552.97
Max. Negotiated Rate	$1,051.73
Rate for Payer: Cash Price	$704.77
Rate for Payer: Hawaii Western Management Group Commercial	$758.98
Rate for Payer: Health Management Network Commercial	$921.62
Rate for Payer: Kaiser Permanente Commercial	$683.08
Rate for Payer: Kaiser Permanente Medicaid	$552.97
Rate for Payer: MDX Hawaii PPO	$1,051.73
Rate for Payer: University Health Alliance Commercial	$607.19

Screw Ncb Cort Self-Tap 3.5mmx30mm 02.03131.030 [3645481]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645481
Hospital Revenue Code	278
Min. Negotiated Rate	$552.97
Max. Negotiated Rate	$1,051.73
Rate for Payer: Cash Price	$704.77
Rate for Payer: Hawaii Western Management Group Commercial	$758.98
Rate for Payer: Health Management Network Commercial	$921.62
Rate for Payer: Kaiser Permanente Commercial	$683.08
Rate for Payer: Kaiser Permanente Medicaid	$552.97
Rate for Payer: MDX Hawaii PPO	$1,051.73
Rate for Payer: University Health Alliance Commercial	$607.19

Screw Ncb Cort Self-Tap 3.5mmx30mm 02.03131.030 [3645481]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645481
Hospital Revenue Code	278
Min. Negotiated Rate	$607.19
Max. Negotiated Rate	$1,051.73
Rate for Payer: Cash Price	$704.77
Rate for Payer: Hawaii Western Management Group Commercial	$758.98
Rate for Payer: Health Management Network Commercial	$921.62
Rate for Payer: MDX Hawaii PPO	$1,051.73
Rate for Payer: University Health Alliance Commercial	$607.19

Screw Ncb Cort Self-Tap 3.5mmx36mm 02.03131.036 [3645482]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645482
Hospital Revenue Code	278
Min. Negotiated Rate	$552.97
Max. Negotiated Rate	$1,051.73
Rate for Payer: Cash Price	$704.77
Rate for Payer: Hawaii Western Management Group Commercial	$758.98
Rate for Payer: Health Management Network Commercial	$921.62
Rate for Payer: Kaiser Permanente Commercial	$683.08
Rate for Payer: Kaiser Permanente Medicaid	$552.97
Rate for Payer: MDX Hawaii PPO	$1,051.73
Rate for Payer: University Health Alliance Commercial	$607.19

Screw Ncb Cort Self-Tap 3.5mmx36mm 02.03131.036 [3645482]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645482
Hospital Revenue Code	278
Min. Negotiated Rate	$607.19
Max. Negotiated Rate	$1,051.73
Rate for Payer: Cash Price	$704.77
Rate for Payer: Hawaii Western Management Group Commercial	$758.98
Rate for Payer: Health Management Network Commercial	$921.62
Rate for Payer: MDX Hawaii PPO	$1,051.73
Rate for Payer: University Health Alliance Commercial	$607.19

Know your out-of-pocket cost for care.

All Charges