Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 3.5 x 30mm 02.127.130 [3640406S]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406S
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw Va Locking Self Tap 3.5 x 30mm 02.127.130 [3640406S]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406S
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw Va Locking Self Tap 3.5 x 32mm 02.127.132 [3640406T]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406T
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw Va Locking Self Tap 3.5 x 32mm 02.127.132 [3640406T]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406T
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw Va Locking Self Tap 3.5 x 40mm 02.127.140 [3640406V]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406V
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw Va Locking Self Tap 3.5 x 40mm 02.127.140 [3640406V]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406V
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 44mm 02.127.144 [3640406H]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3640406H
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 3.5 x 44mm 02.127.144 [3640406H]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3640406H
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 3.5 x 46mm 02.127.146 [3640406G]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3640406G
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 3.5 x 46mm 02.127.146 [3640406G]

Facility

$1,072.91

Service Code	HCPCS C1713
Hospital Charge Code	3640406G
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 3.5 x 54mm 02.127.154 [3640406AA]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406AA
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw Va Locking Self Tap 3.5 x 54mm 02.127.154 [3640406AA]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406AA
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 56mm 02.127.156 [3640406D]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406D
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 56mm 02.127.156 [3640406D]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406D
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 60mm 02.127.160 [3640406E]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406E
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 60mm 02.127.160 [3640406E]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406E
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 65mm 02.127.165 [3640406B]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406B
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 65mm 02.127.165 [3640406B]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406B
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 70mm 02.127.170 [3640406A]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406A
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 70mm 02.127.170 [3640406A]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406A
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 75mm 02.127.175 [3640406]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406
Hospital Revenue Code	278
Min. Negotiated Rate	$747.35
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking Self Tap 3.5 x 75mm 02.127.175 [3640406]

Facility

$1,334.55

Service Code	HCPCS C1713
Hospital Charge Code	3640406
Hospital Revenue Code	278
Min. Negotiated Rate	$680.62
Max. Negotiated Rate	$1,294.51
Rate for Payer: Cash Price	$867.46
Rate for Payer: Hawaii Western Management Group Commercial	$934.18
Rate for Payer: Health Management Network Commercial	$1,134.37
Rate for Payer: Kaiser Permanente Commercial	$840.77
Rate for Payer: Kaiser Permanente Medicaid	$680.62
Rate for Payer: MDX Hawaii PPO	$1,294.51
Rate for Payer: University Health Alliance Commercial	$747.35

Screw VA Locking ST SD 5.0mm 46mm 02.231.246 [3640223D]

Facility

$1,483.81

Service Code	HCPCS C1713
Hospital Charge Code	3640223D
Hospital Revenue Code	278
Min. Negotiated Rate	$756.74
Max. Negotiated Rate	$1,439.30
Rate for Payer: Cash Price	$964.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,038.67
Rate for Payer: Health Management Network Commercial	$1,261.24
Rate for Payer: Kaiser Permanente Commercial	$934.80
Rate for Payer: Kaiser Permanente Medicaid	$756.74
Rate for Payer: MDX Hawaii PPO	$1,439.30
Rate for Payer: University Health Alliance Commercial	$830.93

Screw VA Locking ST SD 5.0mm 46mm 02.231.246 [3640223D]

Facility

$1,483.81

Service Code	HCPCS C1713
Hospital Charge Code	3640223D
Hospital Revenue Code	278
Min. Negotiated Rate	$830.93
Max. Negotiated Rate	$1,439.30
Rate for Payer: Cash Price	$964.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,038.67
Rate for Payer: Health Management Network Commercial	$1,261.24
Rate for Payer: MDX Hawaii PPO	$1,439.30
Rate for Payer: University Health Alliance Commercial	$830.93

Know your out-of-pocket cost for care.

All Charges