Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw T15 LP Cort 3.5 X 28mm NS 110017728 [3641525]

Facility

$654.80

Service Code	HCPCS C1713
Hospital Charge Code	3641525
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 28mm NS 110017728 [3641525]

Facility

$654.80

Service Code	HCPCS C1713
Hospital Charge Code	3641525
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

Screw Telescoping Lag 10.5mm x 100mm AR-9094-100 [3644621]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3644621
Hospital Revenue Code	278
Min. Negotiated Rate	$3,429.75
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: Kaiser Permanente Commercial	$4,236.75
Rate for Payer: Kaiser Permanente Medicaid	$3,429.75
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Screw Telescoping Lag 10.5mm x 100mm AR-9094-100 [3644621]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3644621
Hospital Revenue Code	278
Min. Negotiated Rate	$3,766.00
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Screw Telescoping Lag 10.5mm x 85mm AR-9094-085 [3645400]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3645400
Hospital Revenue Code	278
Min. Negotiated Rate	$3,429.75
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: Kaiser Permanente Commercial	$4,236.75
Rate for Payer: Kaiser Permanente Medicaid	$3,429.75
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Screw Telescoping Lag 10.5mm x 85mm AR-9094-085 [3645400]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3645400
Hospital Revenue Code	278
Min. Negotiated Rate	$3,766.00
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Screw Telescoping Lag 10.5mm x 90mm AR-9094-090 [3644736]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3644736
Hospital Revenue Code	278
Min. Negotiated Rate	$3,766.00
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Screw Telescoping Lag 10.5mm x 90mm AR-9094-090 [3644736]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3644736
Hospital Revenue Code	278
Min. Negotiated Rate	$3,429.75
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: Kaiser Permanente Commercial	$4,236.75
Rate for Payer: Kaiser Permanente Medicaid	$3,429.75
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Screw Tenodesis Biocomposite 8 x 12mm AR-1680BC [3644461]

Facility

$3,090.50

Service Code	HCPCS C1713
Hospital Charge Code	3644461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.15
Max. Negotiated Rate	$2,997.78
Rate for Payer: Cash Price	$2,008.82
Rate for Payer: Hawaii Western Management Group Commercial	$2,163.35
Rate for Payer: Health Management Network Commercial	$2,626.93
Rate for Payer: Kaiser Permanente Commercial	$1,947.02
Rate for Payer: Kaiser Permanente Medicaid	$1,576.15
Rate for Payer: MDX Hawaii PPO	$2,997.78
Rate for Payer: University Health Alliance Commercial	$1,730.68

Screw Tenodesis Biocomposite 8 x 12mm AR-1680BC [3644461]

Facility

$3,090.50

Service Code	HCPCS C1713
Hospital Charge Code	3644461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,730.68
Max. Negotiated Rate	$2,997.78
Rate for Payer: Cash Price	$2,008.82
Rate for Payer: Hawaii Western Management Group Commercial	$2,163.35
Rate for Payer: Health Management Network Commercial	$2,626.93
Rate for Payer: MDX Hawaii PPO	$2,997.78
Rate for Payer: University Health Alliance Commercial	$1,730.68

Screw TFNA Fenestrated ST 100mm 04.038.200S [3645019]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645019
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.71
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: Kaiser Permanente Commercial	$2,887.76
Rate for Payer: Kaiser Permanente Medicaid	$2,337.71
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 100mm 04.038.200S [3645019]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645019
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.89
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 105mm 04.038.205S [3645020]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645020
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.89
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 105mm 04.038.205S [3645020]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645020
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.71
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: Kaiser Permanente Commercial	$2,887.76
Rate for Payer: Kaiser Permanente Medicaid	$2,337.71
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 80mm 04.038.180S [3645015]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.89
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 80mm 04.038.180S [3645015]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.71
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: Kaiser Permanente Commercial	$2,887.76
Rate for Payer: Kaiser Permanente Medicaid	$2,337.71
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 85mm 04.038.185S [3645016]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645016
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.89
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 85mm 04.038.185S [3645016]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645016
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.71
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: Kaiser Permanente Commercial	$2,887.76
Rate for Payer: Kaiser Permanente Medicaid	$2,337.71
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 90mm 04.038.190S [3645017]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645017
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.89
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 90mm 04.038.190S [3645017]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645017
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.71
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: Kaiser Permanente Commercial	$2,887.76
Rate for Payer: Kaiser Permanente Medicaid	$2,337.71
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 95mm 04.038.195S [3645018]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645018
Hospital Revenue Code	278
Min. Negotiated Rate	$2,566.89
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw TFNA Fenestrated ST 95mm 04.038.195S [3645018]

Facility

$4,583.74

Service Code	HCPCS C1713
Hospital Charge Code	3645018
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.71
Max. Negotiated Rate	$4,446.23
Rate for Payer: Cash Price	$2,979.43
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$3,896.18
Rate for Payer: Kaiser Permanente Commercial	$2,887.76
Rate for Payer: Kaiser Permanente Medicaid	$2,337.71
Rate for Payer: MDX Hawaii PPO	$4,446.23
Rate for Payer: University Health Alliance Commercial	$2,566.89

Screw Thrd Peg Lock Ti 2.3x28mm Tpls-23280-Ts [3643905]

Facility

$732.12

Service Code	HCPCS C1713
Hospital Charge Code	3643905
Hospital Revenue Code	278
Min. Negotiated Rate	$373.38
Max. Negotiated Rate	$710.16
Rate for Payer: Cash Price	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$512.48
Rate for Payer: Health Management Network Commercial	$622.30
Rate for Payer: Kaiser Permanente Commercial	$461.24
Rate for Payer: Kaiser Permanente Medicaid	$373.38
Rate for Payer: MDX Hawaii PPO	$710.16
Rate for Payer: University Health Alliance Commercial	$409.99

Screw Thrd Peg Lock Ti 2.3x28mm Tpls-23280-Ts [3643905]

Facility

$732.12

Service Code	HCPCS C1713
Hospital Charge Code	3643905
Hospital Revenue Code	278
Min. Negotiated Rate	$409.99
Max. Negotiated Rate	$710.16
Rate for Payer: Cash Price	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$512.48
Rate for Payer: Health Management Network Commercial	$622.30
Rate for Payer: MDX Hawaii PPO	$710.16
Rate for Payer: University Health Alliance Commercial	$409.99

Screw Threaded Peg Locking Ti 2.3mmX10mm TPLS-23100-TS [3643186]

Facility

$472.50

Service Code	HCPCS C1713
Hospital Charge Code	3643186
Hospital Revenue Code	278
Min. Negotiated Rate	$240.97
Max. Negotiated Rate	$458.32
Rate for Payer: Cash Price	$307.12
Rate for Payer: Hawaii Western Management Group Commercial	$330.75
Rate for Payer: Health Management Network Commercial	$401.62
Rate for Payer: Kaiser Permanente Commercial	$297.68
Rate for Payer: Kaiser Permanente Medicaid	$240.97
Rate for Payer: MDX Hawaii PPO	$458.32
Rate for Payer: University Health Alliance Commercial	$264.60

Know your out-of-pocket cost for care.

All Charges