Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Chimaera Lag Screw Gradual Reamer 193970 [3643387]

Facility

$6,910.50

Service Code	HCPCS C1713
Hospital Charge Code	3643387
Hospital Revenue Code	278
Min. Negotiated Rate	$3,869.88
Max. Negotiated Rate	$6,703.19
Rate for Payer: Cash Price	$4,491.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,837.35
Rate for Payer: Health Management Network Commercial	$5,873.93
Rate for Payer: MDX Hawaii PPO	$6,703.19
Rate for Payer: University Health Alliance Commercial	$3,869.88

Hip Chimaera Thrd Guidewire Strl 3.2x400mm 99-193287 [3643381]

Facility

$2,732.00

Service Code	HCPCS C1769
Hospital Charge Code	3643381
Hospital Revenue Code	272
Min. Negotiated Rate	$2,322.20
Max. Negotiated Rate	$2,650.04
Rate for Payer: Cash Price	$1,775.80
Rate for Payer: Health Management Network Commercial	$2,322.20
Rate for Payer: MDX Hawaii PPO	$2,650.04

Hip Chimaera Thrd Guidewire Strl 3.2x400mm 99-193287 [3643381]

Facility

$2,732.00

Service Code	HCPCS C1769
Hospital Charge Code	3643381
Hospital Revenue Code	272
Min. Negotiated Rate	$1,393.32
Max. Negotiated Rate	$2,650.04
Rate for Payer: Cash Price	$1,775.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,595.40
Rate for Payer: Health Management Network Commercial	$2,322.20
Rate for Payer: Kaiser Permanente Commercial	$1,721.16
Rate for Payer: Kaiser Permanente Medicaid	$1,393.32
Rate for Payer: MDX Hawaii PPO	$2,650.04
Rate for Payer: University Health Alliance Commercial	$1,991.35

Hip CoCr Fem Hd 12/14 28mm +0 801802802 [3640712]

Facility

$2,502.50

Service Code	HCPCS C1776
Hospital Charge Code	3640712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.40
Max. Negotiated Rate	$2,427.43
Rate for Payer: Cash Price	$1,626.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,751.75
Rate for Payer: Health Management Network Commercial	$2,127.12
Rate for Payer: MDX Hawaii PPO	$2,427.43
Rate for Payer: University Health Alliance Commercial	$1,401.40

Hip CoCr Fem Hd 12/14 28mm +0 801802802 [3640712]

Facility

$2,502.50

Service Code	HCPCS C1776
Hospital Charge Code	3640712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.28
Max. Negotiated Rate	$2,427.43
Rate for Payer: Cash Price	$1,626.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,751.75
Rate for Payer: Health Management Network Commercial	$2,127.12
Rate for Payer: Kaiser Permanente Commercial	$1,576.58
Rate for Payer: Kaiser Permanente Medicaid	$1,276.28
Rate for Payer: MDX Hawaii PPO	$2,427.43
Rate for Payer: University Health Alliance Commercial	$1,401.40

Hip Cocr Fem Hd 12/14 28mm -3.5 00-8022-028-01 [3643913]

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643913
Hospital Revenue Code	278
Min. Negotiated Rate	$980.00
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Hip Cocr Fem Hd 12/14 28mm -3.5 00-8022-028-01 [3643913]

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643913
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.00
Rate for Payer: Health Management Network Commercial	$1,487.50
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$892.50
Rate for Payer: MDX Hawaii PPO	$1,697.50
Rate for Payer: University Health Alliance Commercial	$980.00

Hip Cocr Fem Hd 12/14 28mm -3.5 802202801 [3644036]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644036
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip Cocr Fem Hd 12/14 28mm -3.5 802202801 [3644036]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644036
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip COCR Fem HD 12/14 28mm +7 802202804 [3644564]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644564
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip COCR Fem HD 12/14 28mm +7 802202804 [3644564]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644564
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem Hd Mod 28mm -3 163661 [3640670]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3640670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem Hd Mod 28mm -3 163661 [3640670]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3640670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem HD Mod 28mm +3mm Neck 163663 [3642698]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3642698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem HD Mod 28mm +3mm Neck 163663 [3642698]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3642698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem HD Mod 28mm +6mm Neck 163638 [3642751]

Facility

$3,099.25

Service Code	HCPCS C1776
Hospital Charge Code	3642751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,580.62
Max. Negotiated Rate	$3,006.27
Rate for Payer: Cash Price	$2,014.51
Rate for Payer: Hawaii Western Management Group Commercial	$2,169.47
Rate for Payer: Health Management Network Commercial	$2,634.36
Rate for Payer: Kaiser Permanente Commercial	$1,952.53
Rate for Payer: Kaiser Permanente Medicaid	$1,580.62
Rate for Payer: MDX Hawaii PPO	$3,006.27
Rate for Payer: University Health Alliance Commercial	$1,735.58

Hip CoCr Fem HD Mod 28mm +6mm Neck 163638 [3642751]

Facility

$3,099.25

Service Code	HCPCS C1776
Hospital Charge Code	3642751
Hospital Revenue Code	278
Min. Negotiated Rate	$1,735.58
Max. Negotiated Rate	$3,006.27
Rate for Payer: Cash Price	$2,014.51
Rate for Payer: Hawaii Western Management Group Commercial	$2,169.47
Rate for Payer: Health Management Network Commercial	$2,634.36
Rate for Payer: MDX Hawaii PPO	$3,006.27
Rate for Payer: University Health Alliance Commercial	$1,735.58

Hip CoCr Fem HD Mod 28mm - 6mm Neck 163660 [3642597]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3642597
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem HD Mod 28mm - 6mm Neck 163660 [3642597]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3642597
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem Hd Mod 28mm TP1 Taper 163662 [3640695]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3640695
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip CoCr Fem Hd Mod 28mm TP1 Taper 163662 [3640695]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3640695
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip Cocr Fem Hd Zb 12/14 28mm +0 802202802 [3643679]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3643679
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip Cocr Fem Hd Zb 12/14 28mm +0 802202802 [3643679]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3643679
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip Cocr Fem Hd Zb 12/14 28mm +3.5 802202803 [3644017]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Hip Cocr Fem Hd Zb 12/14 28mm +3.5 802202803 [3644017]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Know your out-of-pocket cost for care.

All Charges