Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Arcos Rev Lat Troch Bolt 32mm 11-302132 [3643857]

Facility

$2,425.50

Service Code	HCPCS C1776
Hospital Charge Code	3643857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,358.28
Max. Negotiated Rate	$2,352.74
Rate for Payer: Cash Price	$1,576.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,697.85
Rate for Payer: Health Management Network Commercial	$2,061.68
Rate for Payer: MDX Hawaii PPO	$2,352.74
Rate for Payer: University Health Alliance Commercial	$1,358.28

Hip Arcos Rev Sys Distal Stem 13mmx150mm 11-300813 [3643377]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3643377
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Distal Stem 13mmx150mm 11-300813 [3643377]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3643377
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Distal Stem 15mmx150mm [3643318]

Facility

$12,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643318
Hospital Revenue Code	278
Min. Negotiated Rate	$6,183.75
Max. Negotiated Rate	$11,761.25
Rate for Payer: Cash Price	$7,881.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,487.50
Rate for Payer: Health Management Network Commercial	$10,306.25
Rate for Payer: Kaiser Permanente Commercial	$7,638.75
Rate for Payer: Kaiser Permanente Medicaid	$6,183.75
Rate for Payer: MDX Hawaii PPO	$11,761.25
Rate for Payer: University Health Alliance Commercial	$6,790.00

Hip Arcos Rev Sys Distal Stem 15mmx150mm [3643318]

Facility

$12,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643318
Hospital Revenue Code	278
Min. Negotiated Rate	$6,790.00
Max. Negotiated Rate	$11,761.25
Rate for Payer: Cash Price	$7,881.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,487.50
Rate for Payer: Health Management Network Commercial	$10,306.25
Rate for Payer: MDX Hawaii PPO	$11,761.25
Rate for Payer: University Health Alliance Commercial	$6,790.00

Hip Arcos Rev Sys Distal Stem 16mmX150mm 11-300816 [3642407]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3642407
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Distal Stem 16mmX150mm 11-300816 [3642407]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3642407
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Distal Stem 18x150mm [3643847]

Facility

$12,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643847
Hospital Revenue Code	278
Min. Negotiated Rate	$6,183.75
Max. Negotiated Rate	$11,761.25
Rate for Payer: Cash Price	$7,881.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,487.50
Rate for Payer: Health Management Network Commercial	$10,306.25
Rate for Payer: Kaiser Permanente Commercial	$7,638.75
Rate for Payer: Kaiser Permanente Medicaid	$6,183.75
Rate for Payer: MDX Hawaii PPO	$11,761.25
Rate for Payer: University Health Alliance Commercial	$6,790.00

Hip Arcos Rev Sys Distal Stem 18x150mm [3643847]

Facility

$12,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643847
Hospital Revenue Code	278
Min. Negotiated Rate	$6,790.00
Max. Negotiated Rate	$11,761.25
Rate for Payer: Cash Price	$7,881.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,487.50
Rate for Payer: Health Management Network Commercial	$10,306.25
Rate for Payer: MDX Hawaii PPO	$11,761.25
Rate for Payer: University Health Alliance Commercial	$6,790.00

Hip Arcos Rev Sys Dist Stem w/Lock Screw 11-300918 [3644758]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644758
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Dist Stem w/Lock Screw 11-300918 [3644758]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644758
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Dist Stem w/Lock Screw 13 x 250 11-301013 [3644683]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644683
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Dist Stem w/Lock Screw 13 x 250 11-301013 [3644683]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644683
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Dist Stem w/Lock Screw 14 x 250 11-301014 [3644682]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644682
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Dist Stem w/Lock Screw 14 x 250 11-301014 [3644682]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644682
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys High Cone Sz C 80mm [3643587]

Facility

$12,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643587
Hospital Revenue Code	278
Min. Negotiated Rate	$6,790.00
Max. Negotiated Rate	$11,761.25
Rate for Payer: Cash Price	$7,881.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,487.50
Rate for Payer: Health Management Network Commercial	$10,306.25
Rate for Payer: MDX Hawaii PPO	$11,761.25
Rate for Payer: University Health Alliance Commercial	$6,790.00

Hip Arcos Rev Sys High Cone Sz C 80mm [3643587]

Facility

$12,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643587
Hospital Revenue Code	278
Min. Negotiated Rate	$6,183.75
Max. Negotiated Rate	$11,761.25
Rate for Payer: Cash Price	$7,881.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,487.50
Rate for Payer: Health Management Network Commercial	$10,306.25
Rate for Payer: Kaiser Permanente Commercial	$7,638.75
Rate for Payer: Kaiser Permanente Medicaid	$6,183.75
Rate for Payer: MDX Hawaii PPO	$11,761.25
Rate for Payer: University Health Alliance Commercial	$6,790.00

Hip Arcos Rev Sys Mod Fem Prox Lock Screw 11-301000 [3643938]

Facility

$3,234.00

Service Code	HCPCS C1713
Hospital Charge Code	3643938
Hospital Revenue Code	278
Min. Negotiated Rate	$1,649.34
Max. Negotiated Rate	$3,136.98
Rate for Payer: Cash Price	$2,102.10
Rate for Payer: Hawaii Western Management Group Commercial	$2,263.80
Rate for Payer: Health Management Network Commercial	$2,748.90
Rate for Payer: Kaiser Permanente Commercial	$2,037.42
Rate for Payer: Kaiser Permanente Medicaid	$1,649.34
Rate for Payer: MDX Hawaii PPO	$3,136.98
Rate for Payer: University Health Alliance Commercial	$1,811.04

Hip Arcos Rev Sys Mod Fem Prox Lock Screw 11-301000 [3643938]

Facility

$3,234.00

Service Code	HCPCS C1713
Hospital Charge Code	3643938
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.04
Max. Negotiated Rate	$3,136.98
Rate for Payer: Cash Price	$2,102.10
Rate for Payer: Hawaii Western Management Group Commercial	$2,263.80
Rate for Payer: Health Management Network Commercial	$2,748.90
Rate for Payer: MDX Hawaii PPO	$3,136.98
Rate for Payer: University Health Alliance Commercial	$1,811.04

Hip Arcos Rev Sys Std Cone Sz A 50mm 11-301300 [3643317]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3643317
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Std Cone Sz A 50mm 11-301300 [3643317]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3643317
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Std Cone Sz A 70mm 11-301321 [3645382]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3645382
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Std Cone Sz A 70mm 11-301321 [3645382]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3645382
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Sys Std Cone Sz B 60mm 11-301302 [3642804]

Facility

$19,613.75

Service Code	HCPCS C1776
Hospital Charge Code	3642804
Hospital Revenue Code	278
Min. Negotiated Rate	$10,983.70
Max. Negotiated Rate	$19,025.34
Rate for Payer: Cash Price	$12,748.94
Rate for Payer: Hawaii Western Management Group Commercial	$13,729.62
Rate for Payer: Health Management Network Commercial	$16,671.69
Rate for Payer: MDX Hawaii PPO	$19,025.34
Rate for Payer: University Health Alliance Commercial	$10,983.70

Hip Arcos Rev Sys Std Cone Sz B 60mm 11-301302 [3642804]

Facility

$19,613.75

Service Code	HCPCS C1776
Hospital Charge Code	3642804
Hospital Revenue Code	278
Min. Negotiated Rate	$10,003.01
Max. Negotiated Rate	$19,025.34
Rate for Payer: Cash Price	$12,748.94
Rate for Payer: Hawaii Western Management Group Commercial	$13,729.62
Rate for Payer: Health Management Network Commercial	$16,671.69
Rate for Payer: Kaiser Permanente Commercial	$12,356.66
Rate for Payer: Kaiser Permanente Medicaid	$10,003.01
Rate for Payer: MDX Hawaii PPO	$19,025.34
Rate for Payer: University Health Alliance Commercial	$10,983.70

Know your out-of-pocket cost for care.

All Charges