Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Ncb Cort Self-Tap 3.5mmx40mm 02.03131.040 [3645480]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645480
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 3.5mmx40mm 02.03131.040 [3645480]

Facility

$1,084.26

Service Code	HCPCS C1713
Hospital Charge Code	3645480
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 Non Locking 1.5mm x 11mm 1312-20-511 [3642820]

Facility

$829.58

Service Code	HCPCS C1713
Hospital Charge Code	3642820
Hospital Revenue Code	278
Min. Negotiated Rate	$423.09
Max. Negotiated Rate	$804.69
Rate for Payer: Cash Price	$539.23
Rate for Payer: Hawaii Western Management Group Commercial	$580.71
Rate for Payer: Health Management Network Commercial	$705.14
Rate for Payer: Kaiser Permanente Commercial	$522.64
Rate for Payer: Kaiser Permanente Medicaid	$423.09
Rate for Payer: MDX Hawaii PPO	$804.69
Rate for Payer: University Health Alliance Commercial	$464.56

Screw Non Locking 1.5mm x 11mm 1312-20-511 [3642820]

Facility

$829.58

Service Code	HCPCS C1713
Hospital Charge Code	3642820
Hospital Revenue Code	278
Min. Negotiated Rate	$464.56
Max. Negotiated Rate	$804.69
Rate for Payer: Cash Price	$539.23
Rate for Payer: Hawaii Western Management Group Commercial	$580.71
Rate for Payer: Health Management Network Commercial	$705.14
Rate for Payer: MDX Hawaii PPO	$804.69
Rate for Payer: University Health Alliance Commercial	$464.56

Screw Non Locking 1.5mm x 15mm 1312-20-515 [3644310]

Facility

$829.58

Service Code	HCPCS C1713
Hospital Charge Code	3644310
Hospital Revenue Code	278
Min. Negotiated Rate	$423.09
Max. Negotiated Rate	$804.69
Rate for Payer: Cash Price	$539.23
Rate for Payer: Hawaii Western Management Group Commercial	$580.71
Rate for Payer: Health Management Network Commercial	$705.14
Rate for Payer: Kaiser Permanente Commercial	$522.64
Rate for Payer: Kaiser Permanente Medicaid	$423.09
Rate for Payer: MDX Hawaii PPO	$804.69
Rate for Payer: University Health Alliance Commercial	$464.56

Screw Non Locking 1.5mm x 15mm 1312-20-515 [3644310]

Facility

$829.58

Service Code	HCPCS C1713
Hospital Charge Code	3644310
Hospital Revenue Code	278
Min. Negotiated Rate	$464.56
Max. Negotiated Rate	$804.69
Rate for Payer: Cash Price	$539.23
Rate for Payer: Hawaii Western Management Group Commercial	$580.71
Rate for Payer: Health Management Network Commercial	$705.14
Rate for Payer: MDX Hawaii PPO	$804.69
Rate for Payer: University Health Alliance Commercial	$464.56

Screw Polyaxial Locking Cann COCR 2.5mm x 20mm PALS-25200-CC [3644277]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3644277
Hospital Revenue Code	278
Min. Negotiated Rate	$539.97
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: Kaiser Permanente Commercial	$667.03
Rate for Payer: Kaiser Permanente Medicaid	$539.97
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Polyaxial Locking Cann COCR 2.5mm x 20mm PALS-25200-CC [3644277]

Facility

$1,058.77

Service Code	HCPCS C1713
Hospital Charge Code	3644277
Hospital Revenue Code	278
Min. Negotiated Rate	$592.91
Max. Negotiated Rate	$1,027.01
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$741.14
Rate for Payer: Health Management Network Commercial	$899.95
Rate for Payer: MDX Hawaii PPO	$1,027.01
Rate for Payer: University Health Alliance Commercial	$592.91

Screw Recon Ti 6.5mm 100mm 04.046.700s [3642919]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3642919
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.44
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: Kaiser Permanente Commercial	$1,270.43
Rate for Payer: Kaiser Permanente Medicaid	$1,028.44
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 100mm 04.046.700s [3642919]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3642919
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.27
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 75mm 04.046.675S [3642917]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3642917
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.27
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 75mm 04.046.675S [3642917]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3642917
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.44
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: Kaiser Permanente Commercial	$1,270.43
Rate for Payer: Kaiser Permanente Medicaid	$1,028.44
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 80mm 04.046.680S [3642914]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3642914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.44
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: Kaiser Permanente Commercial	$1,270.43
Rate for Payer: Kaiser Permanente Medicaid	$1,028.44
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 80mm 04.046.680S [3642914]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3642914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.27
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 85mm 04.046.685s [3643832]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3643832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.44
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: Kaiser Permanente Commercial	$1,270.43
Rate for Payer: Kaiser Permanente Medicaid	$1,028.44
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Recon Ti 6.5mm 85mm 04.046.685s [3643832]

Facility

$2,016.55

Service Code	HCPCS C1713
Hospital Charge Code	3643832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.27
Max. Negotiated Rate	$1,956.05
Rate for Payer: Cash Price	$1,310.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.59
Rate for Payer: Health Management Network Commercial	$1,714.07
Rate for Payer: MDX Hawaii PPO	$1,956.05
Rate for Payer: University Health Alliance Commercial	$1,129.27

Screw Self Tap Cortex 4.5mm x 32mm 214.832 [3606597]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606597
Hospital Revenue Code	278
Min. Negotiated Rate	$178.52
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: Kaiser Permanente Commercial	$220.53
Rate for Payer: Kaiser Permanente Medicaid	$178.52
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 32mm 214.832 [3606597]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606597
Hospital Revenue Code	278
Min. Negotiated Rate	$196.02
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 34mm 214.834 [3606598]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606598
Hospital Revenue Code	278
Min. Negotiated Rate	$196.02
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 34mm 214.834 [3606598]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606598
Hospital Revenue Code	278
Min. Negotiated Rate	$178.52
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: Kaiser Permanente Commercial	$220.53
Rate for Payer: Kaiser Permanente Medicaid	$178.52
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 38mm 214.838 [3606600]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606600
Hospital Revenue Code	278
Min. Negotiated Rate	$178.52
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: Kaiser Permanente Commercial	$220.53
Rate for Payer: Kaiser Permanente Medicaid	$178.52
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 38mm 214.838 [3606600]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606600
Hospital Revenue Code	278
Min. Negotiated Rate	$196.02
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 42mm 214.842 [3606602]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606602
Hospital Revenue Code	278
Min. Negotiated Rate	$178.52
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: Kaiser Permanente Commercial	$220.53
Rate for Payer: Kaiser Permanente Medicaid	$178.52
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mm x 42mm 214.842 [3606602]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606602
Hospital Revenue Code	278
Min. Negotiated Rate	$196.02
Max. Negotiated Rate	$339.54
Rate for Payer: Cash Price	$227.53
Rate for Payer: Hawaii Western Management Group Commercial	$245.03
Rate for Payer: Health Management Network Commercial	$297.53
Rate for Payer: MDX Hawaii PPO	$339.54
Rate for Payer: University Health Alliance Commercial	$196.02

Screw Self Tap Cortex 4.5mmX44mm 214.844 [3606603]

Facility

$154.73

Service Code	HCPCS C1713
Hospital Charge Code	3606603
Hospital Revenue Code	278
Min. Negotiated Rate	$78.91
Max. Negotiated Rate	$150.09
Rate for Payer: Cash Price	$100.57
Rate for Payer: Hawaii Western Management Group Commercial	$108.31
Rate for Payer: Health Management Network Commercial	$131.52
Rate for Payer: Kaiser Permanente Commercial	$97.48
Rate for Payer: Kaiser Permanente Medicaid	$78.91
Rate for Payer: MDX Hawaii PPO	$150.09
Rate for Payer: University Health Alliance Commercial	$86.65

Know your out-of-pocket cost for care.

All Charges