Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,606.70
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 Cortex St 4.5x56mm 414.856 [3640264V]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3640264V
Hospital Revenue Code	278
Min. Negotiated Rate	$122.03
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: Kaiser Permanente Commercial	$150.74
Rate for Payer: Kaiser Permanente Medicaid	$122.03
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Ti Cortex St 4.5x56mm 414.856 [3640264V]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3640264V
Hospital Revenue Code	278
Min. Negotiated Rate	$133.99
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Ti Cortex St 4.5x60mm 414.860 [3640264N]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3640264N
Hospital Revenue Code	278
Min. Negotiated Rate	$122.03
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: Kaiser Permanente Commercial	$150.74
Rate for Payer: Kaiser Permanente Medicaid	$122.03
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Ti Cortex St 4.5x60mm 414.860 [3640264N]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3640264N
Hospital Revenue Code	278
Min. Negotiated Rate	$133.99
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Ti Cortex St 4.5x62mm 414.862 [3640264W]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3640264W
Hospital Revenue Code	278
Min. Negotiated Rate	$122.03
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: Kaiser Permanente Commercial	$150.74
Rate for Payer: Kaiser Permanente Medicaid	$122.03
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Ti Cortex St 4.5x62mm 414.862 [3640264W]

Facility

$239.27

Service Code	HCPCS C1713
Hospital Charge Code	3640264W
Hospital Revenue Code	278
Min. Negotiated Rate	$133.99
Max. Negotiated Rate	$232.09
Rate for Payer: Cash Price	$155.53
Rate for Payer: Hawaii Western Management Group Commercial	$167.49
Rate for Payer: Health Management Network Commercial	$203.38
Rate for Payer: MDX Hawaii PPO	$232.09
Rate for Payer: University Health Alliance Commercial	$133.99

Screw Trochlear Comp Female [3643276]

Facility

$1,287.00

Service Code	HCPCS C1713
Hospital Charge Code	3643276
Hospital Revenue Code	278
Min. Negotiated Rate	$656.37
Max. Negotiated Rate	$1,248.39
Rate for Payer: Cash Price	$836.55
Rate for Payer: Hawaii Western Management Group Commercial	$900.90
Rate for Payer: Health Management Network Commercial	$1,093.95
Rate for Payer: Kaiser Permanente Commercial	$810.81
Rate for Payer: Kaiser Permanente Medicaid	$656.37
Rate for Payer: MDX Hawaii PPO	$1,248.39
Rate for Payer: University Health Alliance Commercial	$720.72

Screw Trochlear Comp Female [3643276]

Facility

$1,287.00

Service Code	HCPCS C1713
Hospital Charge Code	3643276
Hospital Revenue Code	278
Min. Negotiated Rate	$720.72
Max. Negotiated Rate	$1,248.39
Rate for Payer: Cash Price	$836.55
Rate for Payer: Hawaii Western Management Group Commercial	$900.90
Rate for Payer: Health Management Network Commercial	$1,093.95
Rate for Payer: MDX Hawaii PPO	$1,248.39
Rate for Payer: University Health Alliance Commercial	$720.72

Screw Trochlear Comp Locking Cap [3643278]

Facility

$1,050.00

Service Code	HCPCS C1713
Hospital Charge Code	3643278
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

Screw Trochlear Comp Locking Cap [3643278]

Facility

$1,050.00

Service Code	HCPCS C1713
Hospital Charge Code	3643278
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

Screw Trochlear Comp Male 65mm Tcsm65 [3643495]

Facility

$809.38

Service Code	HCPCS C1713
Hospital Charge Code	3643495
Hospital Revenue Code	278
Min. Negotiated Rate	$412.78
Max. Negotiated Rate	$785.10
Rate for Payer: Cash Price	$526.10
Rate for Payer: Hawaii Western Management Group Commercial	$566.57
Rate for Payer: Health Management Network Commercial	$687.97
Rate for Payer: Kaiser Permanente Commercial	$509.91
Rate for Payer: Kaiser Permanente Medicaid	$412.78
Rate for Payer: MDX Hawaii PPO	$785.10
Rate for Payer: University Health Alliance Commercial	$453.25

Screw Trochlear Comp Male 65mm Tcsm65 [3643495]

Facility

$809.38

Service Code	HCPCS C1713
Hospital Charge Code	3643495
Hospital Revenue Code	278
Min. Negotiated Rate	$453.25
Max. Negotiated Rate	$785.10
Rate for Payer: Cash Price	$526.10
Rate for Payer: Hawaii Western Management Group Commercial	$566.57
Rate for Payer: Health Management Network Commercial	$687.97
Rate for Payer: MDX Hawaii PPO	$785.10
Rate for Payer: University Health Alliance Commercial	$453.25

Screw UniCortical NCB 5.0mmX18mm 02.03151.018 [3642525]

Facility

$1,400.42

Service Code	HCPCS C1713
Hospital Charge Code	3642525
Hospital Revenue Code	278
Min. Negotiated Rate	$714.21
Max. Negotiated Rate	$1,358.41
Rate for Payer: Cash Price	$910.27
Rate for Payer: Hawaii Western Management Group Commercial	$980.29
Rate for Payer: Health Management Network Commercial	$1,190.36
Rate for Payer: Kaiser Permanente Commercial	$882.26
Rate for Payer: Kaiser Permanente Medicaid	$714.21
Rate for Payer: MDX Hawaii PPO	$1,358.41
Rate for Payer: University Health Alliance Commercial	$784.24

Screw UniCortical NCB 5.0mmX18mm 02.03151.018 [3642525]

Facility

$1,400.42

Service Code	HCPCS C1713
Hospital Charge Code	3642525
Hospital Revenue Code	278
Min. Negotiated Rate	$784.24
Max. Negotiated Rate	$1,358.41
Rate for Payer: Cash Price	$910.27
Rate for Payer: Hawaii Western Management Group Commercial	$980.29
Rate for Payer: Health Management Network Commercial	$1,190.36
Rate for Payer: MDX Hawaii PPO	$1,358.41
Rate for Payer: University Health Alliance Commercial	$784.24

Screw VA Cann Locking 5.0mm 75mm 02.231.675 [3640150]

Facility

$1,934.81

Service Code	HCPCS C1713
Hospital Charge Code	3640150
Hospital Revenue Code	278
Min. Negotiated Rate	$1,083.49
Max. Negotiated Rate	$1,876.77
Rate for Payer: Cash Price	$1,257.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,354.37
Rate for Payer: Health Management Network Commercial	$1,644.59
Rate for Payer: MDX Hawaii PPO	$1,876.77
Rate for Payer: University Health Alliance Commercial	$1,083.49

Screw VA Cann Locking 5.0mm 75mm 02.231.675 [3640150]

Facility

$1,934.81

Service Code	HCPCS C1713
Hospital Charge Code	3640150
Hospital Revenue Code	278
Min. Negotiated Rate	$986.75
Max. Negotiated Rate	$1,876.77
Rate for Payer: Cash Price	$1,257.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,354.37
Rate for Payer: Health Management Network Commercial	$1,644.59
Rate for Payer: Kaiser Permanente Commercial	$1,218.93
Rate for Payer: Kaiser Permanente Medicaid	$986.75
Rate for Payer: MDX Hawaii PPO	$1,876.77
Rate for Payer: University Health Alliance Commercial	$1,083.49

Screw Va Cann Locking 5.0mm 80mm 02.231.680 [3645476]

Facility

$1,934.81

Service Code	HCPCS C1713
Hospital Charge Code	3645476
Hospital Revenue Code	278
Min. Negotiated Rate	$986.75
Max. Negotiated Rate	$1,876.77
Rate for Payer: Cash Price	$1,257.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,354.37
Rate for Payer: Health Management Network Commercial	$1,644.59
Rate for Payer: Kaiser Permanente Commercial	$1,218.93
Rate for Payer: Kaiser Permanente Medicaid	$986.75
Rate for Payer: MDX Hawaii PPO	$1,876.77
Rate for Payer: University Health Alliance Commercial	$1,083.49

Screw Va Cann Locking 5.0mm 80mm 02.231.680 [3645476]

Facility

$1,934.81

Service Code	HCPCS C1713
Hospital Charge Code	3645476
Hospital Revenue Code	278
Min. Negotiated Rate	$1,083.49
Max. Negotiated Rate	$1,876.77
Rate for Payer: Cash Price	$1,257.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,354.37
Rate for Payer: Health Management Network Commercial	$1,644.59
Rate for Payer: MDX Hawaii PPO	$1,876.77
Rate for Payer: University Health Alliance Commercial	$1,083.49

Screw VAL 2.7mm x 28mm AR-18827V-28 [3644814]

Facility

$1,855.63

Service Code	HCPCS C1713
Hospital Charge Code	3644814
Hospital Revenue Code	278
Min. Negotiated Rate	$946.37
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,298.94
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: Kaiser Permanente Commercial	$1,169.05
Rate for Payer: Kaiser Permanente Medicaid	$946.37
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,039.15

Screw VAL 2.7mm x 28mm AR-18827V-28 [3644814]

Facility

$1,855.63

Service Code	HCPCS C1713
Hospital Charge Code	3644814
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.15
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,298.94
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,039.15

Screw VAL 2.7mm x 36mm AR-18827V-36 [3644815]

Facility

$1,855.63

Service Code	HCPCS C1713
Hospital Charge Code	3644815
Hospital Revenue Code	278
Min. Negotiated Rate	$946.37
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,298.94
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: Kaiser Permanente Commercial	$1,169.05
Rate for Payer: Kaiser Permanente Medicaid	$946.37
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,039.15

Screw VAL 2.7mm x 36mm AR-18827V-36 [3644815]

Facility

$1,855.63

Service Code	HCPCS C1713
Hospital Charge Code	3644815
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.15
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,298.94
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,039.15

Screw VAL 2.7mm x 44mm AR-18827V-44 [3644816]

Facility

$1,855.63

Service Code	HCPCS C1713
Hospital Charge Code	3644816
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.15
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,298.94
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,039.15

Screw VAL 2.7mm x 44mm AR-18827V-44 [3644816]

Facility

$1,855.63

Service Code	HCPCS C1713
Hospital Charge Code	3644816
Hospital Revenue Code	278
Min. Negotiated Rate	$946.37
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,298.94
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: Kaiser Permanente Commercial	$1,169.05
Rate for Payer: Kaiser Permanente Medicaid	$946.37
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,039.15

Know your out-of-pocket cost for care.

All Charges