Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Distal Centralizer 11mm OD 00-7859-011-00 [3640620]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3640620
Hospital Revenue Code	278
Min. Negotiated Rate	$268.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 11mm OD 00-7859-011-00 [3640620]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3640620
Hospital Revenue Code	278
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 12mm OD 00-7859-012-00 [3640646]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3640646
Hospital Revenue Code	278
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 12mm OD 00-7859-012-00 [3640646]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3640646
Hospital Revenue Code	278
Min. Negotiated Rate	$268.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 14mm Od 00-7859-014-00 [3644040]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3644040
Hospital Revenue Code	278
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 14mm Od 00-7859-014-00 [3644040]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3644040
Hospital Revenue Code	278
Min. Negotiated Rate	$268.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 9mm OD 00-7859-009-00 [3640641]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3640641
Hospital Revenue Code	278
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer 9mm OD 00-7859-009-00 [3640641]

Facility

$480.00

Service Code	HCPCS C1776
Hospital Charge Code	3640641
Hospital Revenue Code	278
Min. Negotiated Rate	$268.80
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: University Health Alliance Commercial	$268.80

Hip Distal Centralizer/centering Sleeve 11mm 162657 [3643972]

Facility

$796.38

Service Code	HCPCS C1776
Hospital Charge Code	3643972
Hospital Revenue Code	278
Min. Negotiated Rate	$406.15
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: Kaiser Permanente Commercial	$501.72
Rate for Payer: Kaiser Permanente Medicaid	$406.15
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Hip Distal Centralizer/centering Sleeve 11mm 162657 [3643972]

Facility

$796.38

Service Code	HCPCS C1776
Hospital Charge Code	3643972
Hospital Revenue Code	278
Min. Negotiated Rate	$445.97
Max. Negotiated Rate	$772.49
Rate for Payer: Cash Price	$517.65
Rate for Payer: Hawaii Western Management Group Commercial	$557.47
Rate for Payer: Health Management Network Commercial	$676.92
Rate for Payer: MDX Hawaii PPO	$772.49
Rate for Payer: University Health Alliance Commercial	$445.97

Hip Echo Bi Metric FP STD Fem Stem Sz12X140mm 192012 [3641338]

Facility

$9,483.00

Service Code	HCPCS C1776
Hospital Charge Code	3641338
Hospital Revenue Code	278
Min. Negotiated Rate	$4,836.33
Max. Negotiated Rate	$9,198.51
Rate for Payer: Cash Price	$6,163.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,638.10
Rate for Payer: Health Management Network Commercial	$8,060.55
Rate for Payer: Kaiser Permanente Commercial	$5,974.29
Rate for Payer: Kaiser Permanente Medicaid	$4,836.33
Rate for Payer: MDX Hawaii PPO	$9,198.51
Rate for Payer: University Health Alliance Commercial	$5,310.48

Hip Echo Bi Metric FP STD Fem Stem Sz12X140mm 192012 [3641338]

Facility

$9,483.00

Service Code	HCPCS C1776
Hospital Charge Code	3641338
Hospital Revenue Code	278
Min. Negotiated Rate	$5,310.48
Max. Negotiated Rate	$9,198.51
Rate for Payer: Cash Price	$6,163.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,638.10
Rate for Payer: Health Management Network Commercial	$8,060.55
Rate for Payer: MDX Hawaii PPO	$9,198.51
Rate for Payer: University Health Alliance Commercial	$5,310.48

Hip Echo FX Lat Fem Sz11mm 12-151411 [3644862]

Facility

$4,890.50

Service Code	HCPCS C1776
Hospital Charge Code	3644862
Hospital Revenue Code	278
Min. Negotiated Rate	$2,738.68
Max. Negotiated Rate	$4,743.78
Rate for Payer: Cash Price	$3,178.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,423.35
Rate for Payer: Health Management Network Commercial	$4,156.93
Rate for Payer: MDX Hawaii PPO	$4,743.78
Rate for Payer: University Health Alliance Commercial	$2,738.68

Hip Echo FX Lat Fem Sz11mm 12-151411 [3644862]

Facility

$4,890.50

Service Code	HCPCS C1776
Hospital Charge Code	3644862
Hospital Revenue Code	278
Min. Negotiated Rate	$2,494.16
Max. Negotiated Rate	$4,743.78
Rate for Payer: Cash Price	$3,178.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,423.35
Rate for Payer: Health Management Network Commercial	$4,156.93
Rate for Payer: Kaiser Permanente Commercial	$3,081.01
Rate for Payer: Kaiser Permanente Medicaid	$2,494.16
Rate for Payer: MDX Hawaii PPO	$4,743.78
Rate for Payer: University Health Alliance Commercial	$2,738.68

Hip Empowr Acet Cup Cluster Hole Sz 50E 940-02-50E [3643014]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3643014
Hospital Revenue Code	278
Min. Negotiated Rate	$6,472.76
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 50E 940-02-50E [3643014]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3643014
Hospital Revenue Code	278
Min. Negotiated Rate	$5,894.84
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: Kaiser Permanente Commercial	$7,281.85
Rate for Payer: Kaiser Permanente Medicaid	$5,894.84
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 52F 940-02-52F [3643053]

Facility

$7,182.50

Service Code	HCPCS C1776
Hospital Charge Code	3643053
Hospital Revenue Code	278
Min. Negotiated Rate	$4,022.20
Max. Negotiated Rate	$6,967.02
Rate for Payer: Cash Price	$4,668.62
Rate for Payer: Hawaii Western Management Group Commercial	$5,027.75
Rate for Payer: Health Management Network Commercial	$6,105.12
Rate for Payer: MDX Hawaii PPO	$6,967.02
Rate for Payer: University Health Alliance Commercial	$4,022.20

Hip Empowr Acet Cup Cluster Hole Sz 52F 940-02-52F [3643053]

Facility

$7,182.50

Service Code	HCPCS C1776
Hospital Charge Code	3643053
Hospital Revenue Code	278
Min. Negotiated Rate	$3,663.07
Max. Negotiated Rate	$6,967.02
Rate for Payer: Cash Price	$4,668.62
Rate for Payer: Hawaii Western Management Group Commercial	$5,027.75
Rate for Payer: Health Management Network Commercial	$6,105.12
Rate for Payer: Kaiser Permanente Commercial	$4,524.98
Rate for Payer: Kaiser Permanente Medicaid	$3,663.07
Rate for Payer: MDX Hawaii PPO	$6,967.02
Rate for Payer: University Health Alliance Commercial	$4,022.20

Hip Empowr Acet Cup Cluster Hole Sz 54G 940-02-54G [3643162]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3643162
Hospital Revenue Code	278
Min. Negotiated Rate	$6,472.76
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 54G 940-02-54G [3643162]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3643162
Hospital Revenue Code	278
Min. Negotiated Rate	$5,894.84
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: Kaiser Permanente Commercial	$7,281.85
Rate for Payer: Kaiser Permanente Medicaid	$5,894.84
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 56H 940-02-56H [3643055]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3643055
Hospital Revenue Code	278
Min. Negotiated Rate	$5,894.84
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: Kaiser Permanente Commercial	$7,281.85
Rate for Payer: Kaiser Permanente Medicaid	$5,894.84
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 56H 940-02-56H [3643055]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3643055
Hospital Revenue Code	278
Min. Negotiated Rate	$6,472.76
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 58H 940-02-58H [3642380]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3642380
Hospital Revenue Code	278
Min. Negotiated Rate	$6,472.76
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Cup Cluster Hole Sz 58H 940-02-58H [3642380]

Facility

$11,558.50

Service Code	HCPCS C1776
Hospital Charge Code	3642380
Hospital Revenue Code	278
Min. Negotiated Rate	$5,894.84
Max. Negotiated Rate	$11,211.75
Rate for Payer: Cash Price	$7,513.02
Rate for Payer: Hawaii Western Management Group Commercial	$8,090.95
Rate for Payer: Health Management Network Commercial	$9,824.73
Rate for Payer: Kaiser Permanente Commercial	$7,281.85
Rate for Payer: Kaiser Permanente Medicaid	$5,894.84
Rate for Payer: MDX Hawaii PPO	$11,211.75
Rate for Payer: University Health Alliance Commercial	$6,472.76

Hip Empowr Acet Dm Metal Liner 44g 951-01-44G [3644078]

Facility

$11,187.50

Service Code	HCPCS C1776
Hospital Charge Code	3644078
Hospital Revenue Code	278
Min. Negotiated Rate	$5,705.62
Max. Negotiated Rate	$10,851.88
Rate for Payer: Cash Price	$7,271.88
Rate for Payer: Hawaii Western Management Group Commercial	$7,831.25
Rate for Payer: Health Management Network Commercial	$9,509.38
Rate for Payer: Kaiser Permanente Commercial	$7,048.12
Rate for Payer: Kaiser Permanente Medicaid	$5,705.62
Rate for Payer: MDX Hawaii PPO	$10,851.88
Rate for Payer: University Health Alliance Commercial	$6,265.00

Know your out-of-pocket cost for care.

All Charges