Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw Val 3.0x14mm Ti Ar-8933v-14 [3644043]

Facility

$1,204.50

Service Code	HCPCS C1713
Hospital Charge Code	3644043
Hospital Revenue Code	278
Min. Negotiated Rate	$674.52
Max. Negotiated Rate	$1,168.37
Rate for Payer: Cash Price	$782.92
Rate for Payer: Hawaii Western Management Group Commercial	$843.15
Rate for Payer: Health Management Network Commercial	$1,023.83
Rate for Payer: MDX Hawaii PPO	$1,168.37
Rate for Payer: University Health Alliance Commercial	$674.52

Screw Val 3.0x14mm Ti Ar-8933v-14 [3644043]

Facility

$1,204.50

Service Code	HCPCS C1713
Hospital Charge Code	3644043
Hospital Revenue Code	278
Min. Negotiated Rate	$614.29
Max. Negotiated Rate	$1,168.37
Rate for Payer: Cash Price	$782.92
Rate for Payer: Hawaii Western Management Group Commercial	$843.15
Rate for Payer: Health Management Network Commercial	$1,023.83
Rate for Payer: Kaiser Permanente Commercial	$758.84
Rate for Payer: Kaiser Permanente Medicaid	$614.29
Rate for Payer: MDX Hawaii PPO	$1,168.37
Rate for Payer: University Health Alliance Commercial	$674.52

Screw Val 3.0 x 16mm Ti AR-8933V-16 [3644044]

Facility

$1,204.50

Service Code	HCPCS C1713
Hospital Charge Code	3644044
Hospital Revenue Code	278
Min. Negotiated Rate	$674.52
Max. Negotiated Rate	$1,168.37
Rate for Payer: Cash Price	$782.92
Rate for Payer: Hawaii Western Management Group Commercial	$843.15
Rate for Payer: Health Management Network Commercial	$1,023.83
Rate for Payer: MDX Hawaii PPO	$1,168.37
Rate for Payer: University Health Alliance Commercial	$674.52

Screw Val 3.0 x 16mm Ti AR-8933V-16 [3644044]

Facility

$1,204.50

Service Code	HCPCS C1713
Hospital Charge Code	3644044
Hospital Revenue Code	278
Min. Negotiated Rate	$614.29
Max. Negotiated Rate	$1,168.37
Rate for Payer: Cash Price	$782.92
Rate for Payer: Hawaii Western Management Group Commercial	$843.15
Rate for Payer: Health Management Network Commercial	$1,023.83
Rate for Payer: Kaiser Permanente Commercial	$758.84
Rate for Payer: Kaiser Permanente Medicaid	$614.29
Rate for Payer: MDX Hawaii PPO	$1,168.37
Rate for Payer: University Health Alliance Commercial	$674.52

Screw Val 3.0 x 18mm Ti AR-8933V-18 [3644045]

Facility

$1,204.50

Service Code	HCPCS C1713
Hospital Charge Code	3644045
Hospital Revenue Code	278
Min. Negotiated Rate	$614.29
Max. Negotiated Rate	$1,168.37
Rate for Payer: Cash Price	$782.92
Rate for Payer: Hawaii Western Management Group Commercial	$843.15
Rate for Payer: Health Management Network Commercial	$1,023.83
Rate for Payer: Kaiser Permanente Commercial	$758.84
Rate for Payer: Kaiser Permanente Medicaid	$614.29
Rate for Payer: MDX Hawaii PPO	$1,168.37
Rate for Payer: University Health Alliance Commercial	$674.52

Screw Val 3.0 x 18mm Ti AR-8933V-18 [3644045]

Facility

$1,204.50

Service Code	HCPCS C1713
Hospital Charge Code	3644045
Hospital Revenue Code	278
Min. Negotiated Rate	$674.52
Max. Negotiated Rate	$1,168.37
Rate for Payer: Cash Price	$782.92
Rate for Payer: Hawaii Western Management Group Commercial	$843.15
Rate for Payer: Health Management Network Commercial	$1,023.83
Rate for Payer: MDX Hawaii PPO	$1,168.37
Rate for Payer: University Health Alliance Commercial	$674.52

Screw VAL Kreulock Ti 2.4 x 16mm AR-8724VCL-16 [3644594]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644594
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VAL Kreulock Ti 2.4 x 16mm AR-8724VCL-16 [3644594]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644594
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VAL Kreulock Ti 2.4 x 18mm AR-8724VCL-18 [3644595]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VAL Kreulock Ti 2.4 x 18mm AR-8724VCL-18 [3644595]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VAL Kreulock Ti 2.4 x 22mm AR-8724VCL-22 [3644596]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VAL Kreulock Ti 2.4 x 22mm AR-8724VCL-22 [3644596]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 14mm AR-8933VCL-14 [3644239]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644239
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 14mm AR-8933VCL-14 [3644239]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644239
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 16mm AR-8933VCL-16 [3644240]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 16mm AR-8933VCL-16 [3644240]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 18mm AR-8933VCL-18 [3644241]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644241
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 18mm AR-8933VCL-18 [3644241]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644241
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 20mm AR-8933VCL-20 [3644242]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Val Kreulock Ti 3.0mm x 20mm AR-8933VCL-20 [3644242]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3644242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VaL Kreulock Ti 3.0 x 10mm AR-8933VCL-10 [3645403]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3645403
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw VaL Kreulock Ti 3.0 x 10mm AR-8933VCL-10 [3645403]

Facility

$2,711.50

Service Code	HCPCS C1713
Hospital Charge Code	3645403
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.44
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,898.05
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,518.44

Screw Va Locking Self Tap 3.5mm 80mm 02.127.180 [3644266]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3644266
Hospital Revenue Code	278
Min. Negotiated Rate	$547.18
Max. Negotiated Rate	$1,040.72
Rate for Payer: Cash Price	$697.39
Rate for Payer: Hawaii Western Management Group Commercial	$751.04
Rate for Payer: Health Management Network Commercial	$911.97
Rate for Payer: Kaiser Permanente Commercial	$675.93
Rate for Payer: Kaiser Permanente Medicaid	$547.18
Rate for Payer: MDX Hawaii PPO	$1,040.72
Rate for Payer: University Health Alliance Commercial	$600.83

Screw Va Locking Self Tap 3.5mm 80mm 02.127.180 [3644266]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3644266
Hospital Revenue Code	278
Min. Negotiated Rate	$600.83
Max. Negotiated Rate	$1,040.72
Rate for Payer: Cash Price	$697.39
Rate for Payer: Hawaii Western Management Group Commercial	$751.04
Rate for Payer: Health Management Network Commercial	$911.97
Rate for Payer: MDX Hawaii PPO	$1,040.72
Rate for Payer: University Health Alliance Commercial	$600.83

Screw Va Locking Self Tap 3.5mm 85mm 02.127.185 [3644267]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3644267
Hospital Revenue Code	278
Min. Negotiated Rate	$547.18
Max. Negotiated Rate	$1,040.72
Rate for Payer: Cash Price	$697.39
Rate for Payer: Hawaii Western Management Group Commercial	$751.04
Rate for Payer: Health Management Network Commercial	$911.97
Rate for Payer: Kaiser Permanente Commercial	$675.93
Rate for Payer: Kaiser Permanente Medicaid	$547.18
Rate for Payer: MDX Hawaii PPO	$1,040.72
Rate for Payer: University Health Alliance Commercial	$600.83

Know your out-of-pocket cost for care.

All Charges