Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$86.65
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: MDX Hawaii PPO	$150.09
Rate for Payer: University Health Alliance Commercial	$86.65

Screw Self Tap Cortex 4.5mm x 46mm 214.846 [3606604]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606604
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 46mm 214.846 [3606604]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606604
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 48mm 214.848 [3606605]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606605
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 48mm 214.848 [3606605]

Facility

$350.04

Service Code	HCPCS C1713
Hospital Charge Code	3606605
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 4.5mmx64mm 214.864 [3606612]

Facility

$154.73

Service Code	HCPCS C1713
Hospital Charge Code	3606612
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

Screw Self Tap Cortex 4.5mmx64mm 214.864 [3606612]

Facility

$154.73

Service Code	HCPCS C1713
Hospital Charge Code	3606612
Hospital Revenue Code	278
Min. Negotiated Rate	$86.65
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: MDX Hawaii PPO	$150.09
Rate for Payer: University Health Alliance Commercial	$86.65

Screw Self Tap Cortex 4.5mmx70mm 214.870 [3606614]

Facility

$154.73

Service Code	HCPCS C1713
Hospital Charge Code	3606614
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

Screw Self Tap Cortex 4.5mmx70mm 214.870 [3606614]

Facility

$154.73

Service Code	HCPCS C1713
Hospital Charge Code	3606614
Hospital Revenue Code	278
Min. Negotiated Rate	$86.65
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: MDX Hawaii PPO	$150.09
Rate for Payer: University Health Alliance Commercial	$86.65

Screw Self Tap Cortex 4.5mmx80mm 214.880 [3643613]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3643613
Hospital Revenue Code	278
Min. Negotiated Rate	$144.42
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Self Tap Cortex 4.5mmx80mm 214.880 [3643613]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3643613
Hospital Revenue Code	278
Min. Negotiated Rate	$131.52
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: Kaiser Permanente Commercial	$162.47
Rate for Payer: Kaiser Permanente Medicaid	$131.52
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Self Tap Cortex 4.5mmx85mm 214.885 [3643614]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3643614
Hospital Revenue Code	278
Min. Negotiated Rate	$131.52
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: Kaiser Permanente Commercial	$162.47
Rate for Payer: Kaiser Permanente Medicaid	$131.52
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Self Tap Cortex 4.5mmx85mm 214.885 [3643614]

Facility

$257.89

Service Code	HCPCS C1713
Hospital Charge Code	3643614
Hospital Revenue Code	278
Min. Negotiated Rate	$144.42
Max. Negotiated Rate	$250.15
Rate for Payer: Cash Price	$167.63
Rate for Payer: Hawaii Western Management Group Commercial	$180.52
Rate for Payer: Health Management Network Commercial	$219.21
Rate for Payer: MDX Hawaii PPO	$250.15
Rate for Payer: University Health Alliance Commercial	$144.42

Screw Self Tap Cortex 4.5mmx90mm 214.890 [3644100]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3644100
Hospital Revenue Code	278
Min. Negotiated Rate	$191.37
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Screw Self Tap Cortex 4.5mmx90mm 214.890 [3644100]

Facility

$341.74

Service Code	HCPCS C1713
Hospital Charge Code	3644100
Hospital Revenue Code	278
Min. Negotiated Rate	$174.29
Max. Negotiated Rate	$331.49
Rate for Payer: Cash Price	$222.13
Rate for Payer: Hawaii Western Management Group Commercial	$239.22
Rate for Payer: Health Management Network Commercial	$290.48
Rate for Payer: Kaiser Permanente Commercial	$215.30
Rate for Payer: Kaiser Permanente Medicaid	$174.29
Rate for Payer: MDX Hawaii PPO	$331.49
Rate for Payer: University Health Alliance Commercial	$191.37

Screw T15 LP Cort 3.5 X 10mm NS 110017710 [3642968]

Facility

$428.45

Service Code	HCPCS C1713
Hospital Charge Code	3642968
Hospital Revenue Code	278
Min. Negotiated Rate	$239.93
Max. Negotiated Rate	$415.60
Rate for Payer: Cash Price	$278.49
Rate for Payer: Hawaii Western Management Group Commercial	$299.92
Rate for Payer: Health Management Network Commercial	$364.18
Rate for Payer: MDX Hawaii PPO	$415.60
Rate for Payer: University Health Alliance Commercial	$239.93

Screw T15 LP Cort 3.5 X 10mm NS 110017710 [3642968]

Facility

$428.45

Service Code	HCPCS C1713
Hospital Charge Code	3642968
Hospital Revenue Code	278
Min. Negotiated Rate	$218.51
Max. Negotiated Rate	$415.60
Rate for Payer: Cash Price	$278.49
Rate for Payer: Hawaii Western Management Group Commercial	$299.92
Rate for Payer: Health Management Network Commercial	$364.18
Rate for Payer: Kaiser Permanente Commercial	$269.92
Rate for Payer: Kaiser Permanente Medicaid	$218.51
Rate for Payer: MDX Hawaii PPO	$415.60
Rate for Payer: University Health Alliance Commercial	$239.93

Screw T15 Lp Cort 3.5 X 12mm Ns 110017712 [3643592]

Facility

$428.45

Service Code	HCPCS C1713
Hospital Charge Code	3643592
Hospital Revenue Code	278
Min. Negotiated Rate	$218.51
Max. Negotiated Rate	$415.60
Rate for Payer: Cash Price	$278.49
Rate for Payer: Hawaii Western Management Group Commercial	$299.92
Rate for Payer: Health Management Network Commercial	$364.18
Rate for Payer: Kaiser Permanente Commercial	$269.92
Rate for Payer: Kaiser Permanente Medicaid	$218.51
Rate for Payer: MDX Hawaii PPO	$415.60
Rate for Payer: University Health Alliance Commercial	$239.93

Screw T15 Lp Cort 3.5 X 12mm Ns 110017712 [3643592]

Facility

$428.45

Service Code	HCPCS C1713
Hospital Charge Code	3643592
Hospital Revenue Code	278
Min. Negotiated Rate	$239.93
Max. Negotiated Rate	$415.60
Rate for Payer: Cash Price	$278.49
Rate for Payer: Hawaii Western Management Group Commercial	$299.92
Rate for Payer: Health Management Network Commercial	$364.18
Rate for Payer: MDX Hawaii PPO	$415.60
Rate for Payer: University Health Alliance Commercial	$239.93

Screw T15 LP Cort 3.5 X 14mm NS 110017714 [3643194]

Facility

$607.65

Service Code	HCPCS C1713
Hospital Charge Code	3643194
Hospital Revenue Code	278
Min. Negotiated Rate	$309.90
Max. Negotiated Rate	$589.42
Rate for Payer: Cash Price	$394.97
Rate for Payer: Hawaii Western Management Group Commercial	$425.36
Rate for Payer: Health Management Network Commercial	$516.50
Rate for Payer: Kaiser Permanente Commercial	$382.82
Rate for Payer: Kaiser Permanente Medicaid	$309.90
Rate for Payer: MDX Hawaii PPO	$589.42
Rate for Payer: University Health Alliance Commercial	$340.28

Screw T15 LP Cort 3.5 X 14mm NS 110017714 [3643194]

Facility

$607.65

Service Code	HCPCS C1713
Hospital Charge Code	3643194
Hospital Revenue Code	278
Min. Negotiated Rate	$340.28
Max. Negotiated Rate	$589.42
Rate for Payer: Cash Price	$394.97
Rate for Payer: Hawaii Western Management Group Commercial	$425.36
Rate for Payer: Health Management Network Commercial	$516.50
Rate for Payer: MDX Hawaii PPO	$589.42
Rate for Payer: University Health Alliance Commercial	$340.28

Screw T15 LP Cort 3.5 X 16mm NS 110017716 [3642972]

Facility

$607.65

Service Code	HCPCS C1713
Hospital Charge Code	3642972
Hospital Revenue Code	278
Min. Negotiated Rate	$309.90
Max. Negotiated Rate	$589.42
Rate for Payer: Cash Price	$394.97
Rate for Payer: Hawaii Western Management Group Commercial	$425.36
Rate for Payer: Health Management Network Commercial	$516.50
Rate for Payer: Kaiser Permanente Commercial	$382.82
Rate for Payer: Kaiser Permanente Medicaid	$309.90
Rate for Payer: MDX Hawaii PPO	$589.42
Rate for Payer: University Health Alliance Commercial	$340.28

Screw T15 LP Cort 3.5 X 16mm NS 110017716 [3642972]

Facility

$607.65

Service Code	HCPCS C1713
Hospital Charge Code	3642972
Hospital Revenue Code	278
Min. Negotiated Rate	$340.28
Max. Negotiated Rate	$589.42
Rate for Payer: Cash Price	$394.97
Rate for Payer: Hawaii Western Management Group Commercial	$425.36
Rate for Payer: Health Management Network Commercial	$516.50
Rate for Payer: MDX Hawaii PPO	$589.42
Rate for Payer: University Health Alliance Commercial	$340.28

Screw T15 LP Cort 3.5 X 26mm NS 110017726 [3642142]

Facility

$654.80

Service Code	HCPCS C1713
Hospital Charge Code	3642142
Hospital Revenue Code	278
Min. Negotiated Rate	$333.95
Max. Negotiated Rate	$635.16
Rate for Payer: Cash Price	$425.62
Rate for Payer: Hawaii Western Management Group Commercial	$458.36
Rate for Payer: Health Management Network Commercial	$556.58
Rate for Payer: Kaiser Permanente Commercial	$412.52
Rate for Payer: Kaiser Permanente Medicaid	$333.95
Rate for Payer: MDX Hawaii PPO	$635.16
Rate for Payer: University Health Alliance Commercial	$366.69

Screw T15 LP Cort 3.5 X 26mm NS 110017726 [3642142]

Facility

$654.80

Service Code	HCPCS C1713
Hospital Charge Code	3642142
Hospital Revenue Code	278
Min. Negotiated Rate	$366.69
Max. Negotiated Rate	$635.16
Rate for Payer: Cash Price	$425.62
Rate for Payer: Hawaii Western Management Group Commercial	$458.36
Rate for Payer: Health Management Network Commercial	$556.58
Rate for Payer: MDX Hawaii PPO	$635.16
Rate for Payer: University Health Alliance Commercial	$366.69

Know your out-of-pocket cost for care.

All Charges