Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Arcos Rev Sys Std Cone Sz B 70mm 11-301322 [3644263]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644263
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 70mm 11-301322 [3644263]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644263
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 B 80mm 11-301342 [3644681]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644681
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 80mm 11-301342 [3644681]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644681
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 C 70mm 11-301323 [3644759]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644759
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 C 70mm 11-301323 [3644759]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644759
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 Troch Bolt 42mm 11-302142 [3643586]

Facility

$3,621.50

Service Code	HCPCS C1776
Hospital Charge Code	3643586
Hospital Revenue Code	278
Min. Negotiated Rate	$1,846.96
Max. Negotiated Rate	$3,512.86
Rate for Payer: Cash Price	$2,353.98
Rate for Payer: Hawaii Western Management Group Commercial	$2,535.05
Rate for Payer: Health Management Network Commercial	$3,078.28
Rate for Payer: Kaiser Permanente Commercial	$2,281.55
Rate for Payer: Kaiser Permanente Medicaid	$1,846.96
Rate for Payer: MDX Hawaii PPO	$3,512.86
Rate for Payer: University Health Alliance Commercial	$2,028.04

Hip Arcos Rev Sys Troch Bolt 42mm 11-302142 [3643586]

Facility

$3,621.50

Service Code	HCPCS C1776
Hospital Charge Code	3643586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,028.04
Max. Negotiated Rate	$3,512.86
Rate for Payer: Cash Price	$2,353.98
Rate for Payer: Hawaii Western Management Group Commercial	$2,535.05
Rate for Payer: Health Management Network Commercial	$3,078.28
Rate for Payer: MDX Hawaii PPO	$3,512.86
Rate for Payer: University Health Alliance Commercial	$2,028.04

Hip Arcos Rev Sys Troch Claw Small 100mm 11-302102 [3643334]

Facility

$5,370.50

Service Code	HCPCS C1776
Hospital Charge Code	3643334
Hospital Revenue Code	278
Min. Negotiated Rate	$3,007.48
Max. Negotiated Rate	$5,209.39
Rate for Payer: Cash Price	$3,490.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,759.35
Rate for Payer: Health Management Network Commercial	$4,564.93
Rate for Payer: MDX Hawaii PPO	$5,209.39
Rate for Payer: University Health Alliance Commercial	$3,007.48

Hip Arcos Rev Sys Troch Claw Small 100mm 11-302102 [3643334]

Facility

$5,370.50

Service Code	HCPCS C1776
Hospital Charge Code	3643334
Hospital Revenue Code	278
Min. Negotiated Rate	$2,738.95
Max. Negotiated Rate	$5,209.39
Rate for Payer: Cash Price	$3,490.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,759.35
Rate for Payer: Health Management Network Commercial	$4,564.93
Rate for Payer: Kaiser Permanente Commercial	$3,383.41
Rate for Payer: Kaiser Permanente Medicaid	$2,738.95
Rate for Payer: MDX Hawaii PPO	$5,209.39
Rate for Payer: University Health Alliance Commercial	$3,007.48

Hip Avenir STD Stem Cem 3 Taper 12/14 01.06010.203 [3644866]

Facility

$6,928.00

Service Code	HCPCS C1776
Hospital Charge Code	3644866
Hospital Revenue Code	278
Min. Negotiated Rate	$3,533.28
Max. Negotiated Rate	$6,720.16
Rate for Payer: Cash Price	$4,503.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,849.60
Rate for Payer: Health Management Network Commercial	$5,888.80
Rate for Payer: Kaiser Permanente Commercial	$4,364.64
Rate for Payer: Kaiser Permanente Medicaid	$3,533.28
Rate for Payer: MDX Hawaii PPO	$6,720.16
Rate for Payer: University Health Alliance Commercial	$3,879.68

Hip Avenir STD Stem Cem 3 Taper 12/14 01.06010.203 [3644866]

Facility

$6,928.00

Service Code	HCPCS C1776
Hospital Charge Code	3644866
Hospital Revenue Code	278
Min. Negotiated Rate	$3,879.68
Max. Negotiated Rate	$6,720.16
Rate for Payer: Cash Price	$4,503.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,849.60
Rate for Payer: Health Management Network Commercial	$5,888.80
Rate for Payer: MDX Hawaii PPO	$6,720.16
Rate for Payer: University Health Alliance Commercial	$3,879.68

Hip Avenir Std Stem Cem 4 Taper 12/14 01.06010.204 [3644806]

Facility

$6,928.00

Service Code	HCPCS C1776
Hospital Charge Code	3644806
Hospital Revenue Code	278
Min. Negotiated Rate	$3,879.68
Max. Negotiated Rate	$6,720.16
Rate for Payer: Cash Price	$4,503.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,849.60
Rate for Payer: Health Management Network Commercial	$5,888.80
Rate for Payer: MDX Hawaii PPO	$6,720.16
Rate for Payer: University Health Alliance Commercial	$3,879.68

Hip Avenir Std Stem Cem 4 Taper 12/14 01.06010.204 [3644806]

Facility

$6,928.00

Service Code	HCPCS C1776
Hospital Charge Code	3644806
Hospital Revenue Code	278
Min. Negotiated Rate	$3,533.28
Max. Negotiated Rate	$6,720.16
Rate for Payer: Cash Price	$4,503.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,849.60
Rate for Payer: Health Management Network Commercial	$5,888.80
Rate for Payer: Kaiser Permanente Commercial	$4,364.64
Rate for Payer: Kaiser Permanente Medicaid	$3,533.28
Rate for Payer: MDX Hawaii PPO	$6,720.16
Rate for Payer: University Health Alliance Commercial	$3,879.68

Hip Avenir Std Stem Cem 7 Taper 12/14 01.06010.207 [3644805]

Facility

$6,928.00

Service Code	HCPCS C1776
Hospital Charge Code	3644805
Hospital Revenue Code	278
Min. Negotiated Rate	$3,533.28
Max. Negotiated Rate	$6,720.16
Rate for Payer: Cash Price	$4,503.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,849.60
Rate for Payer: Health Management Network Commercial	$5,888.80
Rate for Payer: Kaiser Permanente Commercial	$4,364.64
Rate for Payer: Kaiser Permanente Medicaid	$3,533.28
Rate for Payer: MDX Hawaii PPO	$6,720.16
Rate for Payer: University Health Alliance Commercial	$3,879.68

Hip Avenir Std Stem Cem 7 Taper 12/14 01.06010.207 [3644805]

Facility

$6,928.00

Service Code	HCPCS C1776
Hospital Charge Code	3644805
Hospital Revenue Code	278
Min. Negotiated Rate	$3,879.68
Max. Negotiated Rate	$6,720.16
Rate for Payer: Cash Price	$4,503.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,849.60
Rate for Payer: Health Management Network Commercial	$5,888.80
Rate for Payer: MDX Hawaii PPO	$6,720.16
Rate for Payer: University Health Alliance Commercial	$3,879.68

Hip Biolox Delta Ceramic Fem Head 28mm -3.5mm 400-03-281 [3644135]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3644135
Hospital Revenue Code	278
Min. Negotiated Rate	$4,147.32
Max. Negotiated Rate	$7,888.04
Rate for Payer: Cash Price	$5,285.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,692.40
Rate for Payer: Health Management Network Commercial	$6,912.20
Rate for Payer: Kaiser Permanente Commercial	$5,123.16
Rate for Payer: Kaiser Permanente Medicaid	$4,147.32
Rate for Payer: MDX Hawaii PPO	$7,888.04
Rate for Payer: University Health Alliance Commercial	$4,553.92

Hip Biolox Delta Ceramic Fem Head 28mm -3.5mm 400-03-281 [3644135]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3644135
Hospital Revenue Code	278
Min. Negotiated Rate	$4,553.92
Max. Negotiated Rate	$7,888.04
Rate for Payer: Cash Price	$5,285.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,692.40
Rate for Payer: Health Management Network Commercial	$6,912.20
Rate for Payer: MDX Hawaii PPO	$7,888.04
Rate for Payer: University Health Alliance Commercial	$4,553.92

Hip Biolox Delta Ceramic Fem Head 28mm Neutral 400-03-282 [3644077]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3644077
Hospital Revenue Code	278
Min. Negotiated Rate	$4,553.92
Max. Negotiated Rate	$7,888.04
Rate for Payer: Cash Price	$5,285.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,692.40
Rate for Payer: Health Management Network Commercial	$6,912.20
Rate for Payer: MDX Hawaii PPO	$7,888.04
Rate for Payer: University Health Alliance Commercial	$4,553.92

Hip Biolox Delta Ceramic Fem Head 28mm Neutral 400-03-282 [3644077]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3644077
Hospital Revenue Code	278
Min. Negotiated Rate	$4,147.32
Max. Negotiated Rate	$7,888.04
Rate for Payer: Cash Price	$5,285.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,692.40
Rate for Payer: Health Management Network Commercial	$6,912.20
Rate for Payer: Kaiser Permanente Commercial	$5,123.16
Rate for Payer: Kaiser Permanente Medicaid	$4,147.32
Rate for Payer: MDX Hawaii PPO	$7,888.04
Rate for Payer: University Health Alliance Commercial	$4,553.92

Hip Biolox Delta Ceramic Fem Head 36mm -4.0mm 400-03-361 [3643016]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3643016
Hospital Revenue Code	278
Min. Negotiated Rate	$4,147.32
Max. Negotiated Rate	$7,888.04
Rate for Payer: Cash Price	$5,285.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,692.40
Rate for Payer: Health Management Network Commercial	$6,912.20
Rate for Payer: Kaiser Permanente Commercial	$5,123.16
Rate for Payer: Kaiser Permanente Medicaid	$4,147.32
Rate for Payer: MDX Hawaii PPO	$7,888.04
Rate for Payer: University Health Alliance Commercial	$4,553.92

Hip Biolox Delta Ceramic Fem Head 36mm -4.0mm 400-03-361 [3643016]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3643016
Hospital Revenue Code	278
Min. Negotiated Rate	$4,553.92
Max. Negotiated Rate	$7,888.04
Rate for Payer: Cash Price	$5,285.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,692.40
Rate for Payer: Health Management Network Commercial	$6,912.20
Rate for Payer: MDX Hawaii PPO	$7,888.04
Rate for Payer: University Health Alliance Commercial	$4,553.92

Hip Biolox Delta Cer Fem Head 36mm +3mm 650-0662 [3642611]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3642611
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Hip Biolox Delta Cer Fem Head 36mm +3mm 650-0662 [3642611]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3642611
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.15
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: Kaiser Permanente Commercial	$2,514.01
Rate for Payer: Kaiser Permanente Medicaid	$2,035.15
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Hip Biolox Delta Cer Fem Head 36mm +6mm 650-0663 [3642659]

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	3642659
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.00
Max. Negotiated Rate	$3,055.50
Rate for Payer: Cash Price	$2,047.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.00
Rate for Payer: Health Management Network Commercial	$2,677.50
Rate for Payer: MDX Hawaii PPO	$3,055.50
Rate for Payer: University Health Alliance Commercial	$1,764.00

Know your out-of-pocket cost for care.

All Charges