Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Ti 4.5mm Multiloc 34mm 04.019.034 [3645489]

Facility

$1,971.86

Service Code	HCPCS C1713
Hospital Charge Code	3645489
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.65
Max. Negotiated Rate	$1,912.70
Rate for Payer: Cash Price	$1,281.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,380.30
Rate for Payer: Health Management Network Commercial	$1,676.08
Rate for Payer: Kaiser Permanente Commercial	$1,242.27
Rate for Payer: Kaiser Permanente Medicaid	$1,005.65
Rate for Payer: MDX Hawaii PPO	$1,912.70
Rate for Payer: University Health Alliance Commercial	$1,104.24

Screw Ti 4.5mm Multiloc 34mm 04.019.034 [3645489]

Facility

$1,971.86

Service Code	HCPCS C1713
Hospital Charge Code	3645489
Hospital Revenue Code	278
Min. Negotiated Rate	$1,104.24
Max. Negotiated Rate	$1,912.70
Rate for Payer: Cash Price	$1,281.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,380.30
Rate for Payer: Health Management Network Commercial	$1,676.08
Rate for Payer: MDX Hawaii PPO	$1,912.70
Rate for Payer: University Health Alliance Commercial	$1,104.24

Screw Ti 4.5mm Multiloc 36mm 04.019.036 [3645490]

Facility

$1,971.86

Service Code	HCPCS C1713
Hospital Charge Code	3645490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,104.24
Max. Negotiated Rate	$1,912.70
Rate for Payer: Cash Price	$1,281.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,380.30
Rate for Payer: Health Management Network Commercial	$1,676.08
Rate for Payer: MDX Hawaii PPO	$1,912.70
Rate for Payer: University Health Alliance Commercial	$1,104.24

Screw Ti 4.5mm Multiloc 36mm 04.019.036 [3645490]

Facility

$1,971.86

Service Code	HCPCS C1713
Hospital Charge Code	3645490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.65
Max. Negotiated Rate	$1,912.70
Rate for Payer: Cash Price	$1,281.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,380.30
Rate for Payer: Health Management Network Commercial	$1,676.08
Rate for Payer: Kaiser Permanente Commercial	$1,242.27
Rate for Payer: Kaiser Permanente Medicaid	$1,005.65
Rate for Payer: MDX Hawaii PPO	$1,912.70
Rate for Payer: University Health Alliance Commercial	$1,104.24

Screw Ti 4.5mm Multiloc 44mm 04.019.044 [3645491]

Facility

$1,971.86

Service Code	HCPCS C1713
Hospital Charge Code	3645491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.65
Max. Negotiated Rate	$1,912.70
Rate for Payer: Cash Price	$1,281.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,380.30
Rate for Payer: Health Management Network Commercial	$1,676.08
Rate for Payer: Kaiser Permanente Commercial	$1,242.27
Rate for Payer: Kaiser Permanente Medicaid	$1,005.65
Rate for Payer: MDX Hawaii PPO	$1,912.70
Rate for Payer: University Health Alliance Commercial	$1,104.24

Screw Ti 4.5mm Multiloc 44mm 04.019.044 [3645491]

Facility

$1,971.86

Service Code	HCPCS C1713
Hospital Charge Code	3645491
Hospital Revenue Code	278
Min. Negotiated Rate	$1,104.24
Max. Negotiated Rate	$1,912.70
Rate for Payer: Cash Price	$1,281.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,380.30
Rate for Payer: Health Management Network Commercial	$1,676.08
Rate for Payer: MDX Hawaii PPO	$1,912.70
Rate for Payer: University Health Alliance Commercial	$1,104.24

Screw Ti 4.5mm Multiloc 54mm 04.019.054S [3644526]

Facility

$2,300.53

Service Code	HCPCS C1713
Hospital Charge Code	3644526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,173.27
Max. Negotiated Rate	$2,231.51
Rate for Payer: Cash Price	$1,495.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.37
Rate for Payer: Health Management Network Commercial	$1,955.45
Rate for Payer: Kaiser Permanente Commercial	$1,449.33
Rate for Payer: Kaiser Permanente Medicaid	$1,173.27
Rate for Payer: MDX Hawaii PPO	$2,231.51
Rate for Payer: University Health Alliance Commercial	$1,288.30

Screw Ti 4.5mm Multiloc 54mm 04.019.054S [3644526]

Facility

$2,300.53

Service Code	HCPCS C1713
Hospital Charge Code	3644526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,288.30
Max. Negotiated Rate	$2,231.51
Rate for Payer: Cash Price	$1,495.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.37
Rate for Payer: Health Management Network Commercial	$1,955.45
Rate for Payer: MDX Hawaii PPO	$2,231.51
Rate for Payer: University Health Alliance Commercial	$1,288.30

Screw Ti 4.5mm Multiloc 60mm 04.019.060S [3644525]

Facility

$2,300.53

Service Code	HCPCS C1713
Hospital Charge Code	3644525
Hospital Revenue Code	278
Min. Negotiated Rate	$1,288.30
Max. Negotiated Rate	$2,231.51
Rate for Payer: Cash Price	$1,495.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.37
Rate for Payer: Health Management Network Commercial	$1,955.45
Rate for Payer: MDX Hawaii PPO	$2,231.51
Rate for Payer: University Health Alliance Commercial	$1,288.30

Screw Ti 4.5mm Multiloc 60mm 04.019.060S [3644525]

Facility

$2,300.53

Service Code	HCPCS C1713
Hospital Charge Code	3644525
Hospital Revenue Code	278
Min. Negotiated Rate	$1,173.27
Max. Negotiated Rate	$2,231.51
Rate for Payer: Cash Price	$1,495.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.37
Rate for Payer: Health Management Network Commercial	$1,955.45
Rate for Payer: Kaiser Permanente Commercial	$1,449.33
Rate for Payer: Kaiser Permanente Medicaid	$1,173.27
Rate for Payer: MDX Hawaii PPO	$2,231.51
Rate for Payer: University Health Alliance Commercial	$1,288.30

Screw Ti Cann Comp Hdless 2.0mm x 26mm 04.334.026 [3644876]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 2.0mm x 26mm 04.334.026 [3644876]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 2.0mm x 30mm 04.334.030 [3644877]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 2.0mm x 30mm 04.334.030 [3644877]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 2.5mm x 30mm 04.334.130 [3644878]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 2.5mm x 30mm 04.334.130 [3644878]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 30mm 04.334.230 [3644879]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644879
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 30mm 04.334.230 [3644879]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644879
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 32mm 04.334.232 [3644880]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 32mm 04.334.232 [3644880]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 34mm 04.334.234 [3644881]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 34mm 04.334.234 [3644881]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 36mm 04.334.236 [3644882]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.70
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 36mm 04.334.236 [3644882]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Screw Ti Cann Comp Hdless 3.0mm x 40mm 04.334.240 [3644883]

Facility

$2,869.10

Service Code	HCPCS C1713
Hospital Charge Code	3644883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.24
Max. Negotiated Rate	$2,783.03
Rate for Payer: Cash Price	$1,864.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,008.37
Rate for Payer: Health Management Network Commercial	$2,438.74
Rate for Payer: Kaiser Permanente Commercial	$1,807.53
Rate for Payer: Kaiser Permanente Medicaid	$1,463.24
Rate for Payer: MDX Hawaii PPO	$2,783.03
Rate for Payer: University Health Alliance Commercial	$1,606.70

Know your out-of-pocket cost for care.

All Charges