Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Trimed Screw Cortical 2.3mmX24mm TRX2.3-24 [3642474]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3642474
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 2.3mmX24mm TRX2.3-24 [3642474]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3642474
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 2.7mmx10mm Hex2.7-10 [3643897]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643897
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 2.7mmx10mm Hex2.7-10 [3643897]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643897
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 2.7mmx12mm Hex2.7-12 [3643898]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643898
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 2.7mmx12mm Hex2.7-12 [3643898]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643898
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 2.7mmx14mm Hex2.7-14 [3643899]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643899
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 2.7mmx14mm Hex2.7-14 [3643899]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643899
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 2.7mmx8mm Hex2.7-08 [3643896]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643896
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 2.7mmx8mm Hex2.7-08 [3643896]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3643896
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 3.5mmx14mm TRXC3.5-14T [3643966]

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	3643966
Hospital Revenue Code	278
Min. Negotiated Rate	$252.70
Max. Negotiated Rate	$437.71
Rate for Payer: Cash Price	$293.31
Rate for Payer: Hawaii Western Management Group Commercial	$315.88
Rate for Payer: Health Management Network Commercial	$383.56
Rate for Payer: MDX Hawaii PPO	$437.71
Rate for Payer: University Health Alliance Commercial	$252.70

Trimed Screw Cortical 3.5mmx14mm TRXC3.5-14T [3643966]

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	3643966
Hospital Revenue Code	278
Min. Negotiated Rate	$230.14
Max. Negotiated Rate	$437.71
Rate for Payer: Cash Price	$293.31
Rate for Payer: Hawaii Western Management Group Commercial	$315.88
Rate for Payer: Health Management Network Commercial	$383.56
Rate for Payer: Kaiser Permanente Commercial	$284.29
Rate for Payer: Kaiser Permanente Medicaid	$230.14
Rate for Payer: MDX Hawaii PPO	$437.71
Rate for Payer: University Health Alliance Commercial	$252.70

Trimed Screw Cortical 3.5mmx18mm TRXC3.5-18T [3643967]

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	3643967
Hospital Revenue Code	278
Min. Negotiated Rate	$230.14
Max. Negotiated Rate	$437.71
Rate for Payer: Cash Price	$293.31
Rate for Payer: Hawaii Western Management Group Commercial	$315.88
Rate for Payer: Health Management Network Commercial	$383.56
Rate for Payer: Kaiser Permanente Commercial	$284.29
Rate for Payer: Kaiser Permanente Medicaid	$230.14
Rate for Payer: MDX Hawaii PPO	$437.71
Rate for Payer: University Health Alliance Commercial	$252.70

Trimed Screw Cortical 3.5mmx18mm TRXC3.5-18T [3643967]

Facility

$451.25

Service Code	HCPCS C1713
Hospital Charge Code	3643967
Hospital Revenue Code	278
Min. Negotiated Rate	$252.70
Max. Negotiated Rate	$437.71
Rate for Payer: Cash Price	$293.31
Rate for Payer: Hawaii Western Management Group Commercial	$315.88
Rate for Payer: Health Management Network Commercial	$383.56
Rate for Payer: MDX Hawaii PPO	$437.71
Rate for Payer: University Health Alliance Commercial	$252.70

Trimed Screw Cortical Lock 3.2mm x 12mm LHEX3.2-12 [3644283]

Facility

$849.93

Service Code	HCPCS C1713
Hospital Charge Code	3644283
Hospital Revenue Code	278
Min. Negotiated Rate	$475.96
Max. Negotiated Rate	$824.43
Rate for Payer: Cash Price	$552.45
Rate for Payer: Hawaii Western Management Group Commercial	$594.95
Rate for Payer: Health Management Network Commercial	$722.44
Rate for Payer: MDX Hawaii PPO	$824.43
Rate for Payer: University Health Alliance Commercial	$475.96

Trimed Screw Cortical Lock 3.2mm x 12mm LHEX3.2-12 [3644283]

Facility

$849.93

Service Code	HCPCS C1713
Hospital Charge Code	3644283
Hospital Revenue Code	278
Min. Negotiated Rate	$433.46
Max. Negotiated Rate	$824.43
Rate for Payer: Cash Price	$552.45
Rate for Payer: Hawaii Western Management Group Commercial	$594.95
Rate for Payer: Health Management Network Commercial	$722.44
Rate for Payer: Kaiser Permanente Commercial	$535.46
Rate for Payer: Kaiser Permanente Medicaid	$433.46
Rate for Payer: MDX Hawaii PPO	$824.43
Rate for Payer: University Health Alliance Commercial	$475.96

Trimed Screw Cortical Lock 3.2mm x 14mm LHEX3.2-14 [3640325]

Facility

$849.93

Service Code	HCPCS C1713
Hospital Charge Code	3640325
Hospital Revenue Code	278
Min. Negotiated Rate	$475.96
Max. Negotiated Rate	$824.43
Rate for Payer: Cash Price	$552.45
Rate for Payer: Hawaii Western Management Group Commercial	$594.95
Rate for Payer: Health Management Network Commercial	$722.44
Rate for Payer: MDX Hawaii PPO	$824.43
Rate for Payer: University Health Alliance Commercial	$475.96

Trimed Screw Cortical Lock 3.2mm x 14mm LHEX3.2-14 [3640325]

Facility

$849.93

Service Code	HCPCS C1713
Hospital Charge Code	3640325
Hospital Revenue Code	278
Min. Negotiated Rate	$433.46
Max. Negotiated Rate	$824.43
Rate for Payer: Cash Price	$552.45
Rate for Payer: Hawaii Western Management Group Commercial	$594.95
Rate for Payer: Health Management Network Commercial	$722.44
Rate for Payer: Kaiser Permanente Commercial	$535.46
Rate for Payer: Kaiser Permanente Medicaid	$433.46
Rate for Payer: MDX Hawaii PPO	$824.43
Rate for Payer: University Health Alliance Commercial	$475.96

Trimed Screw Cort Lock 3.2mmx10mm LHEX3.2-10 [3645420]

Facility

$849.93

Service Code	HCPCS C1713
Hospital Charge Code	3645420
Hospital Revenue Code	278
Min. Negotiated Rate	$475.96
Max. Negotiated Rate	$824.43
Rate for Payer: Cash Price	$552.45
Rate for Payer: Hawaii Western Management Group Commercial	$594.95
Rate for Payer: Health Management Network Commercial	$722.44
Rate for Payer: MDX Hawaii PPO	$824.43
Rate for Payer: University Health Alliance Commercial	$475.96

Trimed Screw Cort Lock 3.2mmx10mm LHEX3.2-10 [3645420]

Facility

$849.93

Service Code	HCPCS C1713
Hospital Charge Code	3645420
Hospital Revenue Code	278
Min. Negotiated Rate	$433.46
Max. Negotiated Rate	$824.43
Rate for Payer: Cash Price	$552.45
Rate for Payer: Hawaii Western Management Group Commercial	$594.95
Rate for Payer: Health Management Network Commercial	$722.44
Rate for Payer: Kaiser Permanente Commercial	$535.46
Rate for Payer: Kaiser Permanente Medicaid	$433.46
Rate for Payer: MDX Hawaii PPO	$824.43
Rate for Payer: University Health Alliance Commercial	$475.96

Trimed Screw Hex Cortical 3.2mm HEX3.2-10 [3640079]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079
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 Hex Cortical 3.2mm HEX3.2-10 [3640079]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079
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 Hex Cortical 3.2mm HEX3.2-12 [3640079A]

Facility

$742.83

Service Code	HCPCS C1713
Hospital Charge Code	3640079A
Hospital Revenue Code	278
Min. Negotiated Rate	$415.98
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Trimed Screw Hex Cortical 3.2mm HEX3.2-12 [3640079A]

Facility

$742.83

Service Code	HCPCS C1713
Hospital Charge Code	3640079A
Hospital Revenue Code	278
Min. Negotiated Rate	$378.84
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: Kaiser Permanente Commercial	$467.98
Rate for Payer: Kaiser Permanente Medicaid	$378.84
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Trimed Screw Hex Cortical 3.2mm HEX3.2-13 [3640079C]

Facility

$742.83

Service Code	HCPCS C1713
Hospital Charge Code	3640079C
Hospital Revenue Code	278
Min. Negotiated Rate	$415.98
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Know your out-of-pocket cost for care.

All Charges