Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 HEX3.2-14 [3640079B]

Facility

$742.83

Service Code	HCPCS C1713
Hospital Charge Code	3640079B
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 HEX3.2-14 [3640079B]

Facility

$742.83

Service Code	HCPCS C1713
Hospital Charge Code	3640079B
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 Hex3.2-15 [3640079D]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079D
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 Hex Cortical 3.2mm Hex3.2-15 [3640079D]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079D
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 Hex Cortical 3.2mmx16mm Hex3.2 [3640079E]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079E
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 3.2mmx16mm Hex3.2 [3640079E]

Facility

$606.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079E
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 3.2mmx8mm Hex3.2 [3640079F]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079F
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 Hex Cortical 3.2mmx8mm Hex3.2 [3640079F]

Facility

$427.50

Service Code	HCPCS C1713
Hospital Charge Code	3640079F
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 Va Lock 2.7mmx22mm TRXV2.7-22T [3643964]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643964
Hospital Revenue Code	278
Min. Negotiated Rate	$312.38
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: Kaiser Permanente Commercial	$385.88
Rate for Payer: Kaiser Permanente Medicaid	$312.38
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 2.7mmx22mm TRXV2.7-22T [3643964]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643964
Hospital Revenue Code	278
Min. Negotiated Rate	$343.00
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 2.7mmx24mm TRXV2.7-24T [3643965]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643965
Hospital Revenue Code	278
Min. Negotiated Rate	$343.00
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 2.7mmx24mm TRXV2.7-24T [3643965]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643965
Hospital Revenue Code	278
Min. Negotiated Rate	$312.38
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: Kaiser Permanente Commercial	$385.88
Rate for Payer: Kaiser Permanente Medicaid	$312.38
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 3.5mmx22mm TRXV3.5-22T [3643968]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643968
Hospital Revenue Code	278
Min. Negotiated Rate	$312.38
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: Kaiser Permanente Commercial	$385.88
Rate for Payer: Kaiser Permanente Medicaid	$312.38
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 3.5mmx22mm TRXV3.5-22T [3643968]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643968
Hospital Revenue Code	278
Min. Negotiated Rate	$343.00
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 3.5mmx30mm TRXV3.5-30T [3643969]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643969
Hospital Revenue Code	278
Min. Negotiated Rate	$343.00
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Screw Va Lock 3.5mmx30mm TRXV3.5-30T [3643969]

Facility

$612.50

Service Code	HCPCS C1713
Hospital Charge Code	3643969
Hospital Revenue Code	278
Min. Negotiated Rate	$312.38
Max. Negotiated Rate	$594.12
Rate for Payer: Cash Price	$398.12
Rate for Payer: Hawaii Western Management Group Commercial	$428.75
Rate for Payer: Health Management Network Commercial	$520.62
Rate for Payer: Kaiser Permanente Commercial	$385.88
Rate for Payer: Kaiser Permanente Medicaid	$312.38
Rate for Payer: MDX Hawaii PPO	$594.12
Rate for Payer: University Health Alliance Commercial	$343.00

Trimed Twist Drill 2.3mm DRILL-2.3/080 [3640944]

Facility

$1,026.64

Hospital Charge Code	3640944
Hospital Revenue Code	272
Min. Negotiated Rate	$872.64
Max. Negotiated Rate	$995.84
Rate for Payer: Cash Price	$667.32
Rate for Payer: Health Management Network Commercial	$872.64
Rate for Payer: MDX Hawaii PPO	$995.84

Trimed Twist Drill 2.3mm DRILL-2.3/080 [3640944]

Facility

$1,026.64

Hospital Charge Code	3640944
Hospital Revenue Code	272
Min. Negotiated Rate	$523.59
Max. Negotiated Rate	$995.84
Rate for Payer: Cash Price	$667.32
Rate for Payer: Hawaii Western Management Group Commercial	$975.31
Rate for Payer: Health Management Network Commercial	$872.64
Rate for Payer: Kaiser Permanente Commercial	$646.78
Rate for Payer: Kaiser Permanente Medicaid	$523.59
Rate for Payer: MDX Hawaii PPO	$995.84
Rate for Payer: University Health Alliance Commercial	$748.32

Trimed Wire K 1.1mm WIRE-1.1/100 [3640955]

Facility

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	3640955
Hospital Revenue Code	278
Min. Negotiated Rate	$127.68
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: University Health Alliance Commercial	$127.68

Trimed Wire K 1.1mm WIRE-1.1/100 [3640955]

Facility

$228.00

Service Code	HCPCS C1713
Hospital Charge Code	3640955
Hospital Revenue Code	278
Min. Negotiated Rate	$116.28
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$143.64
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: University Health Alliance Commercial	$127.68

Trimed Wire K 1.6mm Wire-1.6/150 [3643961]

Facility

$140.00

Hospital Charge Code	3643961
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$91.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: MDX Hawaii PPO	$135.80

Trimed Wire K 1.6mm Wire-1.6/150 [3643961]

Facility

$140.00

Hospital Charge Code	3643961
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$91.00
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$102.05

Tripledam Cann Twist-In w/Valve 7mmx7cm AR-6570TD [3643824]

Facility

$396.63

Hospital Charge Code	3643824
Hospital Revenue Code	272
Min. Negotiated Rate	$337.14
Max. Negotiated Rate	$384.73
Rate for Payer: Cash Price	$257.81
Rate for Payer: Health Management Network Commercial	$337.14
Rate for Payer: MDX Hawaii PPO	$384.73

Tripledam Cann Twist-In w/Valve 7mmx7cm AR-6570TD [3643824]

Facility

$396.63

Hospital Charge Code	3643824
Hospital Revenue Code	272
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$384.73
Rate for Payer: Cash Price	$257.81
Rate for Payer: Hawaii Western Management Group Commercial	$376.80
Rate for Payer: Health Management Network Commercial	$337.14
Rate for Payer: Kaiser Permanente Commercial	$249.88
Rate for Payer: Kaiser Permanente Medicaid	$202.28
Rate for Payer: MDX Hawaii PPO	$384.73
Rate for Payer: University Health Alliance Commercial	$289.10

Know your out-of-pocket cost for care.

All Charges