Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Screw VA Locking ST SD 5.0mm 70mm 02.231.270 [3640223A]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3640223A
Hospital Revenue Code	278
Min. Negotiated Rate	$645.17
Max. Negotiated Rate	$1,227.09
Rate for Payer: Cash Price	$822.28
Rate for Payer: Hawaii Western Management Group Commercial	$885.53
Rate for Payer: Health Management Network Commercial	$1,075.28
Rate for Payer: Kaiser Permanente Commercial	$796.98
Rate for Payer: Kaiser Permanente Medicaid	$645.17
Rate for Payer: MDX Hawaii PPO	$1,227.09
Rate for Payer: University Health Alliance Commercial	$708.42

Screw VA Locking ST SD 5.0mm 70mm 02.231.270 [3640223A]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3640223A
Hospital Revenue Code	278
Min. Negotiated Rate	$708.42
Max. Negotiated Rate	$1,227.09
Rate for Payer: Cash Price	$822.28
Rate for Payer: Hawaii Western Management Group Commercial	$885.53
Rate for Payer: Health Management Network Commercial	$1,075.28
Rate for Payer: MDX Hawaii PPO	$1,227.09
Rate for Payer: University Health Alliance Commercial	$708.42

Screw VA Locking ST SD 5.0mm 75mm 02.231.275 [3640223B]

Facility

$1,265.05

Service Code	HCPCS C1713
Hospital Charge Code	3640223B
Hospital Revenue Code	278
Min. Negotiated Rate	$708.43
Max. Negotiated Rate	$1,227.10
Rate for Payer: Cash Price	$822.28
Rate for Payer: Hawaii Western Management Group Commercial	$885.53
Rate for Payer: Health Management Network Commercial	$1,075.29
Rate for Payer: MDX Hawaii PPO	$1,227.10
Rate for Payer: University Health Alliance Commercial	$708.43

Screw VA Locking ST SD 5.0mm 75mm 02.231.275 [3640223B]

Facility

$1,265.05

Service Code	HCPCS C1713
Hospital Charge Code	3640223B
Hospital Revenue Code	278
Min. Negotiated Rate	$645.18
Max. Negotiated Rate	$1,227.10
Rate for Payer: Cash Price	$822.28
Rate for Payer: Hawaii Western Management Group Commercial	$885.53
Rate for Payer: Health Management Network Commercial	$1,075.29
Rate for Payer: Kaiser Permanente Commercial	$796.98
Rate for Payer: Kaiser Permanente Medicaid	$645.18
Rate for Payer: MDX Hawaii PPO	$1,227.10
Rate for Payer: University Health Alliance Commercial	$708.43

Screw VA Locking ST SD 5.0mm 80mm 02.231.280 [3640223E]

Facility

$1,483.81

Service Code	HCPCS C1713
Hospital Charge Code	3640223E
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 80mm 02.231.280 [3640223E]

Facility

$1,483.81

Service Code	HCPCS C1713
Hospital Charge Code	3640223E
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

Screw Va Locking St Sd 5.0mmx85mm 02.231.285 [3640223M]

Facility

$1,265.05

Service Code	HCPCS C1713
Hospital Charge Code	3640223M
Hospital Revenue Code	278
Min. Negotiated Rate	$708.43
Max. Negotiated Rate	$1,227.10
Rate for Payer: Cash Price	$822.28
Rate for Payer: Hawaii Western Management Group Commercial	$885.53
Rate for Payer: Health Management Network Commercial	$1,075.29
Rate for Payer: MDX Hawaii PPO	$1,227.10
Rate for Payer: University Health Alliance Commercial	$708.43

Screw Va Locking St Sd 5.0mmx85mm 02.231.285 [3640223M]

Facility

$1,265.05

Service Code	HCPCS C1713
Hospital Charge Code	3640223M
Hospital Revenue Code	278
Min. Negotiated Rate	$645.18
Max. Negotiated Rate	$1,227.10
Rate for Payer: Cash Price	$822.28
Rate for Payer: Hawaii Western Management Group Commercial	$885.53
Rate for Payer: Health Management Network Commercial	$1,075.29
Rate for Payer: Kaiser Permanente Commercial	$796.98
Rate for Payer: Kaiser Permanente Medicaid	$645.18
Rate for Payer: MDX Hawaii PPO	$1,227.10
Rate for Payer: University Health Alliance Commercial	$708.43

Screw VA Locking ST T4 SD 1.5 x 11mm 02.130.211 [3641090]

Facility

$983.80

Service Code	HCPCS C1713
Hospital Charge Code	3641090
Hospital Revenue Code	278
Min. Negotiated Rate	$501.74
Max. Negotiated Rate	$954.29
Rate for Payer: Cash Price	$639.47
Rate for Payer: Hawaii Western Management Group Commercial	$688.66
Rate for Payer: Health Management Network Commercial	$836.23
Rate for Payer: Kaiser Permanente Commercial	$619.79
Rate for Payer: Kaiser Permanente Medicaid	$501.74
Rate for Payer: MDX Hawaii PPO	$954.29
Rate for Payer: University Health Alliance Commercial	$550.93

Screw VA Locking ST T4 SD 1.5 x 11mm 02.130.211 [3641090]

Facility

$983.80

Service Code	HCPCS C1713
Hospital Charge Code	3641090
Hospital Revenue Code	278
Min. Negotiated Rate	$550.93
Max. Negotiated Rate	$954.29
Rate for Payer: Cash Price	$639.47
Rate for Payer: Hawaii Western Management Group Commercial	$688.66
Rate for Payer: Health Management Network Commercial	$836.23
Rate for Payer: MDX Hawaii PPO	$954.29
Rate for Payer: University Health Alliance Commercial	$550.93

Screw VA Locking ST T8 SD 2.7mmX14mm 02.211.014 [3640041F]

Facility

$1,017.49

Service Code	HCPCS C1713
Hospital Charge Code	3640041F
Hospital Revenue Code	278
Min. Negotiated Rate	$518.92
Max. Negotiated Rate	$986.97
Rate for Payer: Cash Price	$661.37
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.87
Rate for Payer: Kaiser Permanente Commercial	$641.02
Rate for Payer: Kaiser Permanente Medicaid	$518.92
Rate for Payer: MDX Hawaii PPO	$986.97
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7mmX14mm 02.211.014 [3640041F]

Facility

$1,017.49

Service Code	HCPCS C1713
Hospital Charge Code	3640041F
Hospital Revenue Code	278
Min. Negotiated Rate	$569.79
Max. Negotiated Rate	$986.97
Rate for Payer: Cash Price	$661.37
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.87
Rate for Payer: MDX Hawaii PPO	$986.97
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 10mm 02.211.010 [3640041D]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041D
Hospital Revenue Code	278
Min. Negotiated Rate	$549.81
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: Kaiser Permanente Commercial	$679.17
Rate for Payer: Kaiser Permanente Medicaid	$549.81
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Screw VA Locking ST T8 SD 2.7 x 10mm 02.211.010 [3640041D]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041D
Hospital Revenue Code	278
Min. Negotiated Rate	$603.71
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Screw VA Locking ST T8 SD 2.7 x 12mm 02.211.012 [3640041E]

Facility

$1,017.48

Service Code	HCPCS C1713
Hospital Charge Code	3640041E
Hospital Revenue Code	278
Min. Negotiated Rate	$518.91
Max. Negotiated Rate	$986.96
Rate for Payer: Cash Price	$661.36
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.86
Rate for Payer: Kaiser Permanente Commercial	$641.01
Rate for Payer: Kaiser Permanente Medicaid	$518.91
Rate for Payer: MDX Hawaii PPO	$986.96
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 12mm 02.211.012 [3640041E]

Facility

$1,017.48

Service Code	HCPCS C1713
Hospital Charge Code	3640041E
Hospital Revenue Code	278
Min. Negotiated Rate	$569.79
Max. Negotiated Rate	$986.96
Rate for Payer: Cash Price	$661.36
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.86
Rate for Payer: MDX Hawaii PPO	$986.96
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 16mm 02.211.016 [3640041G]

Facility

$1,017.49

Service Code	HCPCS C1713
Hospital Charge Code	3640041G
Hospital Revenue Code	278
Min. Negotiated Rate	$518.92
Max. Negotiated Rate	$986.97
Rate for Payer: Cash Price	$661.37
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.87
Rate for Payer: Kaiser Permanente Commercial	$641.02
Rate for Payer: Kaiser Permanente Medicaid	$518.92
Rate for Payer: MDX Hawaii PPO	$986.97
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 16mm 02.211.016 [3640041G]

Facility

$1,017.49

Service Code	HCPCS C1713
Hospital Charge Code	3640041G
Hospital Revenue Code	278
Min. Negotiated Rate	$569.79
Max. Negotiated Rate	$986.97
Rate for Payer: Cash Price	$661.37
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.87
Rate for Payer: MDX Hawaii PPO	$986.97
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 18mm 02.211.018 [3640041H]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041H
Hospital Revenue Code	278
Min. Negotiated Rate	$603.71
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Screw VA Locking ST T8 SD 2.7 x 18mm 02.211.018 [3640041H]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041H
Hospital Revenue Code	278
Min. Negotiated Rate	$549.81
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: Kaiser Permanente Commercial	$679.17
Rate for Payer: Kaiser Permanente Medicaid	$549.81
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Screw VA Locking ST T8 SD 2.7 x 20mm 02.211.020 [3640041B]

Facility

$1,017.49

Service Code	HCPCS C1713
Hospital Charge Code	3640041B
Hospital Revenue Code	278
Min. Negotiated Rate	$569.79
Max. Negotiated Rate	$986.97
Rate for Payer: Cash Price	$661.37
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.87
Rate for Payer: MDX Hawaii PPO	$986.97
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 20mm 02.211.020 [3640041B]

Facility

$1,017.49

Service Code	HCPCS C1713
Hospital Charge Code	3640041B
Hospital Revenue Code	278
Min. Negotiated Rate	$518.92
Max. Negotiated Rate	$986.97
Rate for Payer: Cash Price	$661.37
Rate for Payer: Hawaii Western Management Group Commercial	$712.24
Rate for Payer: Health Management Network Commercial	$864.87
Rate for Payer: Kaiser Permanente Commercial	$641.02
Rate for Payer: Kaiser Permanente Medicaid	$518.92
Rate for Payer: MDX Hawaii PPO	$986.97
Rate for Payer: University Health Alliance Commercial	$569.79

Screw VA Locking ST T8 SD 2.7 x 22mm 02.211.022 [3640041]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041
Hospital Revenue Code	278
Min. Negotiated Rate	$549.81
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: Kaiser Permanente Commercial	$679.17
Rate for Payer: Kaiser Permanente Medicaid	$549.81
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Screw VA Locking ST T8 SD 2.7 x 22mm 02.211.022 [3640041]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041
Hospital Revenue Code	278
Min. Negotiated Rate	$603.71
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Screw VA Locking ST T8 SD 2.7 x 24mm 02.211.024 [3640041A]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041A
Hospital Revenue Code	278
Min. Negotiated Rate	$549.81
Max. Negotiated Rate	$1,045.71
Rate for Payer: Cash Price	$700.73
Rate for Payer: Hawaii Western Management Group Commercial	$754.63
Rate for Payer: Health Management Network Commercial	$916.34
Rate for Payer: Kaiser Permanente Commercial	$679.17
Rate for Payer: Kaiser Permanente Medicaid	$549.81
Rate for Payer: MDX Hawaii PPO	$1,045.71
Rate for Payer: University Health Alliance Commercial	$603.71

Know your out-of-pocket cost for care.

All Charges