Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Acumed Screw Lock Hex 2.7mm x 10mm 30-0325 [3644059]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644059
Hospital Revenue Code	278
Min. Negotiated Rate	$546.66
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: Kaiser Permanente Commercial	$675.28
Rate for Payer: Kaiser Permanente Medicaid	$546.66
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Lock Hex 2.7mm x 8mm 30-0324 [3644060]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644060
Hospital Revenue Code	278
Min. Negotiated Rate	$546.66
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: Kaiser Permanente Commercial	$675.28
Rate for Payer: Kaiser Permanente Medicaid	$546.66
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Lock Hex 2.7mm x 8mm 30-0324 [3644060]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644060
Hospital Revenue Code	278
Min. Negotiated Rate	$600.25
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Lock Hex 3.5mmX12mm 30-0234 [3641744]

Facility

$1,080.63

Service Code	HCPCS C1713
Hospital Charge Code	3641744
Hospital Revenue Code	278
Min. Negotiated Rate	$551.12
Max. Negotiated Rate	$1,048.21
Rate for Payer: Cash Price	$702.41
Rate for Payer: Hawaii Western Management Group Commercial	$756.44
Rate for Payer: Health Management Network Commercial	$918.54
Rate for Payer: Kaiser Permanente Commercial	$680.80
Rate for Payer: Kaiser Permanente Medicaid	$551.12
Rate for Payer: MDX Hawaii PPO	$1,048.21
Rate for Payer: University Health Alliance Commercial	$605.15

Acumed Screw Lock Hex 3.5mmX12mm 30-0234 [3641744]

Facility

$1,080.63

Service Code	HCPCS C1713
Hospital Charge Code	3641744
Hospital Revenue Code	278
Min. Negotiated Rate	$605.15
Max. Negotiated Rate	$1,048.21
Rate for Payer: Cash Price	$702.41
Rate for Payer: Hawaii Western Management Group Commercial	$756.44
Rate for Payer: Health Management Network Commercial	$918.54
Rate for Payer: MDX Hawaii PPO	$1,048.21
Rate for Payer: University Health Alliance Commercial	$605.15

Acumed Screw Lock Hex 3.5mm x 20mm 30-0238 [3644056]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644056
Hospital Revenue Code	278
Min. Negotiated Rate	$600.25
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Lock Hex 3.5mm x 20mm 30-0238 [3644056]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644056
Hospital Revenue Code	278
Min. Negotiated Rate	$546.66
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: Kaiser Permanente Commercial	$675.28
Rate for Payer: Kaiser Permanente Medicaid	$546.66
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Lock Hex 3.5mm x 8mm 30-0232 [3644055]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644055
Hospital Revenue Code	278
Min. Negotiated Rate	$546.66
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: Kaiser Permanente Commercial	$675.28
Rate for Payer: Kaiser Permanente Medicaid	$546.66
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Lock Hex 3.5mm x 8mm 30-0232 [3644055]

Facility

$1,071.88

Service Code	HCPCS C1713
Hospital Charge Code	3644055
Hospital Revenue Code	278
Min. Negotiated Rate	$600.25
Max. Negotiated Rate	$1,039.72
Rate for Payer: Cash Price	$696.72
Rate for Payer: Hawaii Western Management Group Commercial	$750.32
Rate for Payer: Health Management Network Commercial	$911.10
Rate for Payer: MDX Hawaii PPO	$1,039.72
Rate for Payer: University Health Alliance Commercial	$600.25

Acumed Screw Non-Lock Hex 2.7mm x 14mm 30-0346 [3644062]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644062
Hospital Revenue Code	278
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: Kaiser Permanente Commercial	$344.53
Rate for Payer: Kaiser Permanente Medicaid	$278.91
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 2.7mm x 14mm 30-0346 [3644062]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644062
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 2.7mm x 32mm 30-0355 [3644061]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644061
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 2.7mm x 32mm 30-0355 [3644061]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644061
Hospital Revenue Code	278
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: Kaiser Permanente Commercial	$344.53
Rate for Payer: Kaiser Permanente Medicaid	$278.91
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 3.5mm x 20mm 30-0261 [3644051]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644051
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 3.5mm x 20mm 30-0261 [3644051]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644051
Hospital Revenue Code	278
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: Kaiser Permanente Commercial	$344.53
Rate for Payer: Kaiser Permanente Medicaid	$278.91
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 3.5mmx22mm 30-0262 [3644050]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644050
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 3.5mmx22mm 30-0262 [3644050]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644050
Hospital Revenue Code	278
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: Kaiser Permanente Commercial	$344.53
Rate for Payer: Kaiser Permanente Medicaid	$278.91
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 3.5mm x 26mm 30-0264 [3644057]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644057
Hospital Revenue Code	278
Min. Negotiated Rate	$278.91
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: Kaiser Permanente Commercial	$344.53
Rate for Payer: Kaiser Permanente Medicaid	$278.91
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

Acumed Screw Non-Lock Hex 3.5mm x 26mm 30-0264 [3644057]

Facility

$546.88

Service Code	HCPCS C1713
Hospital Charge Code	3644057
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$530.47
Rate for Payer: Cash Price	$355.47
Rate for Payer: Hawaii Western Management Group Commercial	$382.82
Rate for Payer: Health Management Network Commercial	$464.85
Rate for Payer: MDX Hawaii PPO	$530.47
Rate for Payer: University Health Alliance Commercial	$306.25

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$16,563.45

Service Code	MSDRG 880
Min. Negotiated Rate	$11,860.64
Max. Negotiated Rate	$16,563.45
Rate for Payer: AlohaCare Medicare	$12,629.30
Rate for Payer: Devoted Health Medicare	$13,892.23
Rate for Payer: Hawaii Medical Service Association Commercial	$11,860.64
Rate for Payer: Hawaii Medical Service Association Medicare	$12,629.30
Rate for Payer: Humana Medicare	$12,629.30
Rate for Payer: Kaiser Permanente Commercial	$16,563.45
Rate for Payer: Kaiser Permanente Medicare	$12,629.30
Rate for Payer: Ohana Health Plan Medicare	$12,629.30
Rate for Payer: UnitedHealthcare Medicare	$12,629.30

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$48,816.68

Service Code	MSDRG 289
Min. Negotiated Rate	$22,450.47
Max. Negotiated Rate	$48,816.68
Rate for Payer: AlohaCare Medicare	$22,450.47
Rate for Payer: Devoted Health Medicare	$24,695.52
Rate for Payer: Hawaii Medical Service Association Commercial	$48,816.68
Rate for Payer: Hawaii Medical Service Association Medicare	$22,450.47
Rate for Payer: Humana Medicare	$22,450.47
Rate for Payer: Kaiser Permanente Commercial	$29,444.03
Rate for Payer: Kaiser Permanente Medicare	$22,450.47
Rate for Payer: Ohana Health Plan Medicare	$22,450.47
Rate for Payer: UnitedHealthcare Medicare	$22,450.47

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$48,816.68

Service Code	MSDRG 288
Min. Negotiated Rate	$35,594.02
Max. Negotiated Rate	$48,816.68
Rate for Payer: AlohaCare Medicare	$35,594.02
Rate for Payer: Devoted Health Medicare	$39,153.42
Rate for Payer: Hawaii Medical Service Association Commercial	$48,816.68
Rate for Payer: Hawaii Medical Service Association Medicare	$35,594.02
Rate for Payer: Humana Medicare	$35,594.02
Rate for Payer: Kaiser Permanente Commercial	$46,681.95
Rate for Payer: Kaiser Permanente Medicare	$35,594.02
Rate for Payer: Ohana Health Plan Medicare	$35,594.02
Rate for Payer: UnitedHealthcare Medicare	$35,594.02

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$48,816.68

Service Code	MSDRG 290
Min. Negotiated Rate	$12,228.13
Max. Negotiated Rate	$48,816.68
Rate for Payer: AlohaCare Medicare	$12,228.13
Rate for Payer: Devoted Health Medicare	$13,450.94
Rate for Payer: Hawaii Medical Service Association Commercial	$48,816.68
Rate for Payer: Hawaii Medical Service Association Medicare	$12,228.13
Rate for Payer: Humana Medicare	$12,228.13
Rate for Payer: Kaiser Permanente Commercial	$16,037.33
Rate for Payer: Kaiser Permanente Medicare	$12,228.13
Rate for Payer: Ohana Health Plan Medicare	$12,228.13
Rate for Payer: UnitedHealthcare Medicare	$12,228.13

ACUTE ANXIETY & DELIRIUM STATES

Facility

$2,932.22

Service Code	APR-DRG 7561
Min. Negotiated Rate	$2,932.22
Max. Negotiated Rate	$2,932.22
Rate for Payer: AlohaCare Medicaid	$2,932.22
Rate for Payer: Hawaii Medical Service Association ABD	$2,932.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,932.22
Rate for Payer: Kaiser Permanente Medicaid	$2,932.22
Rate for Payer: Ohana Health Plan Medicaid	$2,932.22
Rate for Payer: UnitedHealthcare Medicaid	$2,932.22

ACUTE ANXIETY & DELIRIUM STATES

Facility

$3,524.67

Service Code	APR-DRG 7562
Min. Negotiated Rate	$3,524.67
Max. Negotiated Rate	$3,524.67
Rate for Payer: AlohaCare Medicaid	$3,524.67
Rate for Payer: Hawaii Medical Service Association ABD	$3,524.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,524.67
Rate for Payer: Kaiser Permanente Medicaid	$3,524.67
Rate for Payer: Ohana Health Plan Medicaid	$3,524.67
Rate for Payer: UnitedHealthcare Medicaid	$3,524.67

Know your out-of-pocket cost for care.

All Charges