Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Trimed Plate Fixed Angle 3h 7peg Rt VPPR-3-7 [3644382]

Facility

$3,563.00

Service Code	HCPCS C1713
Hospital Charge Code	3644382
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.13
Max. Negotiated Rate	$3,456.11
Rate for Payer: Cash Price	$2,315.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,494.10
Rate for Payer: Health Management Network Commercial	$3,028.55
Rate for Payer: Kaiser Permanente Commercial	$2,244.69
Rate for Payer: Kaiser Permanente Medicaid	$1,817.13
Rate for Payer: MDX Hawaii PPO	$3,456.11
Rate for Payer: University Health Alliance Commercial	$1,995.28

Trimed Plate Fixed Angle 5h 7peg Rt VPPR-5-7 [3644437]

Facility

$4,013.00

Service Code	HCPCS C1713
Hospital Charge Code	3644437
Hospital Revenue Code	278
Min. Negotiated Rate	$2,247.28
Max. Negotiated Rate	$3,892.61
Rate for Payer: Cash Price	$2,608.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,809.10
Rate for Payer: Health Management Network Commercial	$3,411.05
Rate for Payer: MDX Hawaii PPO	$3,892.61
Rate for Payer: University Health Alliance Commercial	$2,247.28

Trimed Plate Fixed Angle 5h 7peg Rt VPPR-5-7 [3644437]

Facility

$4,013.00

Service Code	HCPCS C1713
Hospital Charge Code	3644437
Hospital Revenue Code	278
Min. Negotiated Rate	$2,046.63
Max. Negotiated Rate	$3,892.61
Rate for Payer: Cash Price	$2,608.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,809.10
Rate for Payer: Health Management Network Commercial	$3,411.05
Rate for Payer: Kaiser Permanente Commercial	$2,528.19
Rate for Payer: Kaiser Permanente Medicaid	$2,046.63
Rate for Payer: MDX Hawaii PPO	$3,892.61
Rate for Payer: University Health Alliance Commercial	$2,247.28

Trimed Plate T-Plate Foot 6 Hole TP-6 [3643960]

Facility

$2,537.50

Service Code	HCPCS C1713
Hospital Charge Code	3643960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,294.12
Max. Negotiated Rate	$2,461.38
Rate for Payer: Cash Price	$1,649.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,776.25
Rate for Payer: Health Management Network Commercial	$2,156.88
Rate for Payer: Kaiser Permanente Commercial	$1,598.62
Rate for Payer: Kaiser Permanente Medicaid	$1,294.12
Rate for Payer: MDX Hawaii PPO	$2,461.38
Rate for Payer: University Health Alliance Commercial	$1,421.00

Trimed Plate T-Plate Foot 6 Hole TP-6 [3643960]

Facility

$2,537.50

Service Code	HCPCS C1713
Hospital Charge Code	3643960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.00
Max. Negotiated Rate	$2,461.38
Rate for Payer: Cash Price	$1,649.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,776.25
Rate for Payer: Health Management Network Commercial	$2,156.88
Rate for Payer: MDX Hawaii PPO	$2,461.38
Rate for Payer: University Health Alliance Commercial	$1,421.00

Trimed Plate Volar Bearing 3H LT VLBPL-3-7 [3640954]

Facility

$6,333.00

Service Code	HCPCS C1713
Hospital Charge Code	3640954
Hospital Revenue Code	278
Min. Negotiated Rate	$3,229.83
Max. Negotiated Rate	$6,143.01
Rate for Payer: Cash Price	$4,116.45
Rate for Payer: Hawaii Western Management Group Commercial	$4,433.10
Rate for Payer: Health Management Network Commercial	$5,383.05
Rate for Payer: Kaiser Permanente Commercial	$3,989.79
Rate for Payer: Kaiser Permanente Medicaid	$3,229.83
Rate for Payer: MDX Hawaii PPO	$6,143.01
Rate for Payer: University Health Alliance Commercial	$3,546.48

Trimed Plate Volar Bearing 3H LT VLBPL-3-7 [3640954]

Facility

$6,333.00

Service Code	HCPCS C1713
Hospital Charge Code	3640954
Hospital Revenue Code	278
Min. Negotiated Rate	$3,546.48
Max. Negotiated Rate	$6,143.01
Rate for Payer: Cash Price	$4,116.45
Rate for Payer: Hawaii Western Management Group Commercial	$4,433.10
Rate for Payer: Health Management Network Commercial	$5,383.05
Rate for Payer: MDX Hawaii PPO	$6,143.01
Rate for Payer: University Health Alliance Commercial	$3,546.48

Trimed Plate Volar Bearing 5H 7Peg Rt VLBPR-5-7 [3644344]

Facility

$5,650.50

Service Code	HCPCS C1713
Hospital Charge Code	3644344
Hospital Revenue Code	278
Min. Negotiated Rate	$3,164.28
Max. Negotiated Rate	$5,480.98
Rate for Payer: Cash Price	$3,672.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,955.35
Rate for Payer: Health Management Network Commercial	$4,802.93
Rate for Payer: MDX Hawaii PPO	$5,480.98
Rate for Payer: University Health Alliance Commercial	$3,164.28

Trimed Plate Volar Bearing 5H 7Peg Rt VLBPR-5-7 [3644344]

Facility

$5,650.50

Service Code	HCPCS C1713
Hospital Charge Code	3644344
Hospital Revenue Code	278
Min. Negotiated Rate	$2,881.76
Max. Negotiated Rate	$5,480.98
Rate for Payer: Cash Price	$3,672.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,955.35
Rate for Payer: Health Management Network Commercial	$4,802.93
Rate for Payer: Kaiser Permanente Commercial	$3,559.82
Rate for Payer: Kaiser Permanente Medicaid	$2,881.76
Rate for Payer: MDX Hawaii PPO	$5,480.98
Rate for Payer: University Health Alliance Commercial	$3,164.28

Trimed Plate Volar Bearing 5H LT VLBPL-5-7 [3643047]

Facility

$5,650.50

Service Code	HCPCS C1713
Hospital Charge Code	3643047
Hospital Revenue Code	278
Min. Negotiated Rate	$3,164.28
Max. Negotiated Rate	$5,480.98
Rate for Payer: Cash Price	$3,672.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,955.35
Rate for Payer: Health Management Network Commercial	$4,802.93
Rate for Payer: MDX Hawaii PPO	$5,480.98
Rate for Payer: University Health Alliance Commercial	$3,164.28

Trimed Plate Volar Bearing 5H LT VLBPL-5-7 [3643047]

Facility

$5,650.50

Service Code	HCPCS C1713
Hospital Charge Code	3643047
Hospital Revenue Code	278
Min. Negotiated Rate	$2,881.76
Max. Negotiated Rate	$5,480.98
Rate for Payer: Cash Price	$3,672.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,955.35
Rate for Payer: Health Management Network Commercial	$4,802.93
Rate for Payer: Kaiser Permanente Commercial	$3,559.82
Rate for Payer: Kaiser Permanente Medicaid	$2,881.76
Rate for Payer: MDX Hawaii PPO	$5,480.98
Rate for Payer: University Health Alliance Commercial	$3,164.28

Trimed Screw Cortical 2.3mmX10mm TRX2.3-10 [3641937]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3641937
Hospital Revenue Code	278
Min. Negotiated Rate	$339.64
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX10mm TRX2.3-10 [3641937]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3641937
Hospital Revenue Code	278
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX12mm TRX2.3-12 [3641938]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3641938
Hospital Revenue Code	278
Min. Negotiated Rate	$218.03
Max. Negotiated Rate	$414.68
Rate for Payer: Cash Price	$277.88
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$363.38
Rate for Payer: Kaiser Permanente Commercial	$269.32
Rate for Payer: Kaiser Permanente Medicaid	$218.03
Rate for Payer: MDX Hawaii PPO	$414.68
Rate for Payer: University Health Alliance Commercial	$239.40

Trimed Screw Cortical 2.3mmX12mm TRX2.3-12 [3641938]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3641938
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$414.68
Rate for Payer: Cash Price	$277.88
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$363.38
Rate for Payer: MDX Hawaii PPO	$414.68
Rate for Payer: University Health Alliance Commercial	$239.40

Trimed Screw Cortical 2.3mmX14mm TRX2.3-14 [3641939]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3641939
Hospital Revenue Code	278
Min. Negotiated Rate	$218.03
Max. Negotiated Rate	$414.68
Rate for Payer: Cash Price	$277.88
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$363.38
Rate for Payer: Kaiser Permanente Commercial	$269.32
Rate for Payer: Kaiser Permanente Medicaid	$218.03
Rate for Payer: MDX Hawaii PPO	$414.68
Rate for Payer: University Health Alliance Commercial	$239.40

Trimed Screw Cortical 2.3mmX14mm TRX2.3-14 [3641939]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3641939
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$414.68
Rate for Payer: Cash Price	$277.88
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$363.38
Rate for Payer: MDX Hawaii PPO	$414.68
Rate for Payer: University Health Alliance Commercial	$239.40

Trimed Screw Cortical 2.3mmX16mm TRX2.3-16 [3642034]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3642034
Hospital Revenue Code	278
Min. Negotiated Rate	$218.03
Max. Negotiated Rate	$414.68
Rate for Payer: Cash Price	$277.88
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$363.38
Rate for Payer: Kaiser Permanente Commercial	$269.32
Rate for Payer: Kaiser Permanente Medicaid	$218.03
Rate for Payer: MDX Hawaii PPO	$414.68
Rate for Payer: University Health Alliance Commercial	$239.40

Trimed Screw Cortical 2.3mmX16mm TRX2.3-16 [3642034]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3642034
Hospital Revenue Code	278
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$414.68
Rate for Payer: Cash Price	$277.88
Rate for Payer: Hawaii Western Management Group Commercial	$299.25
Rate for Payer: Health Management Network Commercial	$363.38
Rate for Payer: MDX Hawaii PPO	$414.68
Rate for Payer: University Health Alliance Commercial	$239.40

Trimed Screw Cortical 2.3mmX18mm TRX2.3-18 [3640324B]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640324B
Hospital Revenue Code	278
Min. Negotiated Rate	$339.64
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX18mm TRX2.3-18 [3640324B]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640324B
Hospital Revenue Code	278
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX20mm TRX2.3-20 [3640324]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640324
Hospital Revenue Code	278
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX20mm TRX2.3-20 [3640324]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640324
Hospital Revenue Code	278
Min. Negotiated Rate	$339.64
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX22mm TRX2.3-22 [3640324A]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640324A
Hospital Revenue Code	278
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Trimed Screw Cortical 2.3mmX22mm TRX2.3-22 [3640324A]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640324A
Hospital Revenue Code	278
Min. Negotiated Rate	$339.64
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$424.55
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$339.64

Know your out-of-pocket cost for care.

All Charges