Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$1,606.50
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: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,606.50
Rate for Payer: MDX Hawaii PPO	$3,055.50
Rate for Payer: University Health Alliance Commercial	$1,764.00

Hip Biolox Delta Cer Head 36mm -3mm Type1 650-0660 [3642674]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3642674
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 Head 36mm -3mm Type1 650-0660 [3642674]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3642674
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 Head 36mm Type1 650-0661 [3642593]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3642593
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 Head 36mm Type1 650-0661 [3642593]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3642593
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 Opt Ceramic Fem Head 36mm 400-03-362 [3641401]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3641401
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 Opt Ceramic Fem Head 36mm 400-03-362 [3641401]

Facility

$8,132.00

Service Code	HCPCS C1776
Hospital Charge Code	3641401
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 Opt Ceramic Head 28mm 650-1055 [3641234]

Facility

$6,490.50

Service Code	HCPCS C1776
Hospital Charge Code	3641234
Hospital Revenue Code	278
Min. Negotiated Rate	$3,634.68
Max. Negotiated Rate	$6,295.78
Rate for Payer: Cash Price	$4,218.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,543.35
Rate for Payer: Health Management Network Commercial	$5,516.93
Rate for Payer: MDX Hawaii PPO	$6,295.78
Rate for Payer: University Health Alliance Commercial	$3,634.68

Hip Biolox Delta Opt Ceramic Head 28mm 650-1055 [3641234]

Facility

$6,490.50

Service Code	HCPCS C1776
Hospital Charge Code	3641234
Hospital Revenue Code	278
Min. Negotiated Rate	$3,310.16
Max. Negotiated Rate	$6,295.78
Rate for Payer: Cash Price	$4,218.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,543.35
Rate for Payer: Health Management Network Commercial	$5,516.93
Rate for Payer: Kaiser Permanente Commercial	$4,089.01
Rate for Payer: Kaiser Permanente Medicaid	$3,310.16
Rate for Payer: MDX Hawaii PPO	$6,295.78
Rate for Payer: University Health Alliance Commercial	$3,634.68

Hip Biolox Opt Head 28 x +7 Taper 12/14 00-8777-028-04 [3644971]

Facility

$6,490.50

Service Code	HCPCS C1776
Hospital Charge Code	3644971
Hospital Revenue Code	278
Min. Negotiated Rate	$3,310.16
Max. Negotiated Rate	$6,295.78
Rate for Payer: Cash Price	$4,218.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,543.35
Rate for Payer: Health Management Network Commercial	$5,516.93
Rate for Payer: Kaiser Permanente Commercial	$4,089.01
Rate for Payer: Kaiser Permanente Medicaid	$3,310.16
Rate for Payer: MDX Hawaii PPO	$6,295.78
Rate for Payer: University Health Alliance Commercial	$3,634.68

Hip Biolox Opt Head 28 x +7 Taper 12/14 00-8777-028-04 [3644971]

Facility

$6,490.50

Service Code	HCPCS C1776
Hospital Charge Code	3644971
Hospital Revenue Code	278
Min. Negotiated Rate	$3,634.68
Max. Negotiated Rate	$6,295.78
Rate for Payer: Cash Price	$4,218.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,543.35
Rate for Payer: Health Management Network Commercial	$5,516.93
Rate for Payer: MDX Hawaii PPO	$6,295.78
Rate for Payer: University Health Alliance Commercial	$3,634.68

Hip Biolox Option Cer Head 36mm Type16/18 650-1057 [3641337]

Facility

$6,490.50

Service Code	HCPCS C1776
Hospital Charge Code	3641337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,634.68
Max. Negotiated Rate	$6,295.78
Rate for Payer: Cash Price	$4,218.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,543.35
Rate for Payer: Health Management Network Commercial	$5,516.93
Rate for Payer: MDX Hawaii PPO	$6,295.78
Rate for Payer: University Health Alliance Commercial	$3,634.68

Hip Biolox Option Cer Head 36mm Type16/18 650-1057 [3641337]

Facility

$6,490.50

Service Code	HCPCS C1776
Hospital Charge Code	3641337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,310.16
Max. Negotiated Rate	$6,295.78
Rate for Payer: Cash Price	$4,218.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,543.35
Rate for Payer: Health Management Network Commercial	$5,516.93
Rate for Payer: Kaiser Permanente Commercial	$4,089.01
Rate for Payer: Kaiser Permanente Medicaid	$3,310.16
Rate for Payer: MDX Hawaii PPO	$6,295.78
Rate for Payer: University Health Alliance Commercial	$3,634.68

Hip Biolox Option Cer Head 40mm Type16/18 6501058 [3641909]

Facility

$6,825.00

Service Code	HCPCS C1776
Hospital Charge Code	3641909
Hospital Revenue Code	278
Min. Negotiated Rate	$3,480.75
Max. Negotiated Rate	$6,620.25
Rate for Payer: Cash Price	$4,436.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,777.50
Rate for Payer: Health Management Network Commercial	$5,801.25
Rate for Payer: Kaiser Permanente Commercial	$4,299.75
Rate for Payer: Kaiser Permanente Medicaid	$3,480.75
Rate for Payer: MDX Hawaii PPO	$6,620.25
Rate for Payer: University Health Alliance Commercial	$3,822.00

Hip Biolox Option Cer Head 40mm Type16/18 6501058 [3641909]

Facility

$6,825.00

Service Code	HCPCS C1776
Hospital Charge Code	3641909
Hospital Revenue Code	278
Min. Negotiated Rate	$3,822.00
Max. Negotiated Rate	$6,620.25
Rate for Payer: Cash Price	$4,436.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,777.50
Rate for Payer: Health Management Network Commercial	$5,801.25
Rate for Payer: MDX Hawaii PPO	$6,620.25
Rate for Payer: University Health Alliance Commercial	$3,822.00

Hip Biolox Option Type1 Taper Slv +3mm 650-1067 [3641233]

Facility

$930.25

Service Code	HCPCS C1776
Hospital Charge Code	3641233
Hospital Revenue Code	278
Min. Negotiated Rate	$474.43
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$651.17
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: Kaiser Permanente Commercial	$586.06
Rate for Payer: Kaiser Permanente Medicaid	$474.43
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$520.94

Hip Biolox Option Type1 Taper Slv +3mm 650-1067 [3641233]

Facility

$930.25

Service Code	HCPCS C1776
Hospital Charge Code	3641233
Hospital Revenue Code	278
Min. Negotiated Rate	$520.94
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$651.17
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$520.94

Hip Chimaera 4.2mm Distal Drill Bit Long 193286 [3643391]

Facility

$6,165.00

Hospital Charge Code	3643391
Hospital Revenue Code	272
Min. Negotiated Rate	$5,240.25
Max. Negotiated Rate	$5,980.05
Rate for Payer: Cash Price	$4,007.25
Rate for Payer: Health Management Network Commercial	$5,240.25
Rate for Payer: MDX Hawaii PPO	$5,980.05

Hip Chimaera 4.2mm Distal Drill Bit Long 193286 [3643391]

Facility

$6,165.00

Hospital Charge Code	3643391
Hospital Revenue Code	272
Min. Negotiated Rate	$3,144.15
Max. Negotiated Rate	$5,980.05
Rate for Payer: Kaiser Permanente Medicaid	$3,144.15
Rate for Payer: Cash Price	$4,007.25
Rate for Payer: Hawaii Western Management Group Commercial	$5,856.75
Rate for Payer: Health Management Network Commercial	$5,240.25
Rate for Payer: Kaiser Permanente Commercial	$3,883.95
Rate for Payer: MDX Hawaii PPO	$5,980.05
Rate for Payer: University Health Alliance Commercial	$4,493.67

Hip Chimaera 4.2mm Distal Drill Bit Short193285 [3643386]

Facility

$2,198.00

Hospital Charge Code	3643386
Hospital Revenue Code	272
Min. Negotiated Rate	$1,120.98
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,428.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,088.10
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: Kaiser Permanente Commercial	$1,384.74
Rate for Payer: Kaiser Permanente Medicaid	$1,120.98
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: University Health Alliance Commercial	$1,602.12

Hip Chimaera 4.2mm Distal Drill Bit Short193285 [3643386]

Facility

$2,198.00

Hospital Charge Code	3643386
Hospital Revenue Code	272
Min. Negotiated Rate	$1,868.30
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,428.70
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: MDX Hawaii PPO	$2,132.06

Hip Chimaera Guidewire W/olive Strl 0.3x980mm 99-173281 [3643382]

Facility

$2,046.00

Service Code	HCPCS C1769
Hospital Charge Code	3643382
Hospital Revenue Code	272
Min. Negotiated Rate	$1,043.46
Max. Negotiated Rate	$1,984.62
Rate for Payer: Cash Price	$1,329.90
Rate for Payer: Hawaii Western Management Group Commercial	$1,943.70
Rate for Payer: Health Management Network Commercial	$1,739.10
Rate for Payer: Kaiser Permanente Commercial	$1,288.98
Rate for Payer: Kaiser Permanente Medicaid	$1,043.46
Rate for Payer: MDX Hawaii PPO	$1,984.62
Rate for Payer: University Health Alliance Commercial	$1,491.33

Hip Chimaera Guidewire W/olive Strl 0.3x980mm 99-173281 [3643382]

Facility

$2,046.00

Service Code	HCPCS C1769
Hospital Charge Code	3643382
Hospital Revenue Code	272
Min. Negotiated Rate	$1,739.10
Max. Negotiated Rate	$1,984.62
Rate for Payer: Cash Price	$1,329.90
Rate for Payer: Health Management Network Commercial	$1,739.10
Rate for Payer: MDX Hawaii PPO	$1,984.62

Hip Chimaera Hfs Lag Screw Fixed 110mm [3643490]

Facility

$3,180.00

Service Code	HCPCS C1713
Hospital Charge Code	3643490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.80
Max. Negotiated Rate	$3,084.60
Rate for Payer: Cash Price	$2,067.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,226.00
Rate for Payer: Health Management Network Commercial	$2,703.00
Rate for Payer: Kaiser Permanente Commercial	$2,003.40
Rate for Payer: Kaiser Permanente Medicaid	$1,621.80
Rate for Payer: MDX Hawaii PPO	$3,084.60
Rate for Payer: University Health Alliance Commercial	$1,780.80

Hip Chimaera Hfs Lag Screw Fixed 110mm [3643490]

Facility

$3,180.00

Service Code	HCPCS C1713
Hospital Charge Code	3643490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,780.80
Max. Negotiated Rate	$3,084.60
Rate for Payer: Cash Price	$2,067.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,226.00
Rate for Payer: Health Management Network Commercial	$2,703.00
Rate for Payer: MDX Hawaii PPO	$3,084.60
Rate for Payer: University Health Alliance Commercial	$1,780.80

Know your out-of-pocket cost for care.

All Charges