Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 26mm 02.211.026 [3640041I]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041I
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 26mm 02.211.026 [3640041I]

Facility

$1,078.05

Service Code	HCPCS C1713
Hospital Charge Code	3640041I
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 30mm 02.211.030 [3640041K]

Facility

$1,017.48

Service Code	HCPCS C1713
Hospital Charge Code	3640041K
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 30mm 02.211.030 [3640041K]

Facility

$1,017.48

Service Code	HCPCS C1713
Hospital Charge Code	3640041K
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 32mm 02.211.032 [3640041P]

Facility

$1,017.48

Service Code	HCPCS C1713
Hospital Charge Code	3640041P
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 32mm 02.211.032 [3640041P]

Facility

$1,017.48

Service Code	HCPCS C1713
Hospital Charge Code	3640041P
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 Lock Periprosthetic 5.0mmx14mm 02.231.014 [3640303A]

Facility

$1,252.35

Service Code	HCPCS C1713
Hospital Charge Code	3640303A
Hospital Revenue Code	278
Min. Negotiated Rate	$701.32
Max. Negotiated Rate	$1,214.78
Rate for Payer: Cash Price	$814.03
Rate for Payer: Hawaii Western Management Group Commercial	$876.64
Rate for Payer: Health Management Network Commercial	$1,064.50
Rate for Payer: MDX Hawaii PPO	$1,214.78
Rate for Payer: University Health Alliance Commercial	$701.32

Screw Va Lock Periprosthetic 5.0mmx14mm 02.231.014 [3640303A]

Facility

$1,252.35

Service Code	HCPCS C1713
Hospital Charge Code	3640303A
Hospital Revenue Code	278
Min. Negotiated Rate	$638.70
Max. Negotiated Rate	$1,214.78
Rate for Payer: Cash Price	$814.03
Rate for Payer: Hawaii Western Management Group Commercial	$876.64
Rate for Payer: Health Management Network Commercial	$1,064.50
Rate for Payer: Kaiser Permanente Commercial	$788.98
Rate for Payer: Kaiser Permanente Medicaid	$638.70
Rate for Payer: MDX Hawaii PPO	$1,214.78
Rate for Payer: University Health Alliance Commercial	$701.32

Screw Va Lock Periprosthetic 5.0mmx16mm 02.231.016 [3640303B]

Facility

$1,252.35

Service Code	HCPCS C1713
Hospital Charge Code	3640303B
Hospital Revenue Code	278
Min. Negotiated Rate	$638.70
Max. Negotiated Rate	$1,214.78
Rate for Payer: Cash Price	$814.03
Rate for Payer: Hawaii Western Management Group Commercial	$876.64
Rate for Payer: Health Management Network Commercial	$1,064.50
Rate for Payer: Kaiser Permanente Commercial	$788.98
Rate for Payer: Kaiser Permanente Medicaid	$638.70
Rate for Payer: MDX Hawaii PPO	$1,214.78
Rate for Payer: University Health Alliance Commercial	$701.32

Screw Va Lock Periprosthetic 5.0mmx16mm 02.231.016 [3640303B]

Facility

$1,252.35

Service Code	HCPCS C1713
Hospital Charge Code	3640303B
Hospital Revenue Code	278
Min. Negotiated Rate	$701.32
Max. Negotiated Rate	$1,214.78
Rate for Payer: Cash Price	$814.03
Rate for Payer: Hawaii Western Management Group Commercial	$876.64
Rate for Payer: Health Management Network Commercial	$1,064.50
Rate for Payer: MDX Hawaii PPO	$1,214.78
Rate for Payer: University Health Alliance Commercial	$701.32

Screw Va Lock Periprosthetic 5.0mmx18mm 02.231.018 [3640303C]

Facility

$1,252.35

Service Code	HCPCS C1713
Hospital Charge Code	3640303C
Hospital Revenue Code	278
Min. Negotiated Rate	$701.32
Max. Negotiated Rate	$1,214.78
Rate for Payer: Cash Price	$814.03
Rate for Payer: Hawaii Western Management Group Commercial	$876.64
Rate for Payer: Health Management Network Commercial	$1,064.50
Rate for Payer: MDX Hawaii PPO	$1,214.78
Rate for Payer: University Health Alliance Commercial	$701.32

Screw Va Lock Periprosthetic 5.0mmx18mm 02.231.018 [3640303C]

Facility

$1,252.35

Service Code	HCPCS C1713
Hospital Charge Code	3640303C
Hospital Revenue Code	278
Min. Negotiated Rate	$638.70
Max. Negotiated Rate	$1,214.78
Rate for Payer: Cash Price	$814.03
Rate for Payer: Hawaii Western Management Group Commercial	$876.64
Rate for Payer: Health Management Network Commercial	$1,064.50
Rate for Payer: Kaiser Permanente Commercial	$788.98
Rate for Payer: Kaiser Permanente Medicaid	$638.70
Rate for Payer: MDX Hawaii PPO	$1,214.78
Rate for Payer: University Health Alliance Commercial	$701.32

Screw VA Lock ST SD 5.0mm 34mm 02.231.234 [3645418]

Facility

$1,483.81

Service Code	HCPCS C1713
Hospital Charge Code	3645418
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 Lock ST SD 5.0mm 34mm 02.231.234 [3645418]

Facility

$1,483.81

Service Code	HCPCS C1713
Hospital Charge Code	3645418
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 Lock St Sd 5.0mmx42mm 02.231.242 [3644097]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644097
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 Lock St Sd 5.0mmx42mm 02.231.242 [3644097]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644097
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 Lock St Sd 5.0mmx60mm 02.231.260 [3644098]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644098
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 Lock St Sd 5.0mmx60mm 02.231.260 [3644098]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644098
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 Lock St Sd 5.0mmx90mm 02.231.290 [3644099]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644099
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 Lock St Sd 5.0mmx90mm 02.231.290 [3644099]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644099
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 Lock St Sd 5.0x38mm 02.231.238 [3644096]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644096
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 Lock St Sd 5.0x38mm 02.231.238 [3644096]

Facility

$1,265.04

Service Code	HCPCS C1713
Hospital Charge Code	3644096
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 Lock St T8 Sd 2.7x44mm 02.211.044 [3640041S]

Facility

$727.52

Service Code	HCPCS C1713
Hospital Charge Code	3640041S
Hospital Revenue Code	278
Min. Negotiated Rate	$371.04
Max. Negotiated Rate	$705.69
Rate for Payer: Cash Price	$472.89
Rate for Payer: Hawaii Western Management Group Commercial	$509.26
Rate for Payer: Health Management Network Commercial	$618.39
Rate for Payer: Kaiser Permanente Commercial	$458.34
Rate for Payer: Kaiser Permanente Medicaid	$371.04
Rate for Payer: MDX Hawaii PPO	$705.69
Rate for Payer: University Health Alliance Commercial	$407.41

Screw Va Lock St T8 Sd 2.7x44mm 02.211.044 [3640041S]

Facility

$727.52

Service Code	HCPCS C1713
Hospital Charge Code	3640041S
Hospital Revenue Code	278
Min. Negotiated Rate	$407.41
Max. Negotiated Rate	$705.69
Rate for Payer: Cash Price	$472.89
Rate for Payer: Hawaii Western Management Group Commercial	$509.26
Rate for Payer: Health Management Network Commercial	$618.39
Rate for Payer: MDX Hawaii PPO	$705.69
Rate for Payer: University Health Alliance Commercial	$407.41

Know your out-of-pocket cost for care.

All Charges