Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$6,265.00
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: MDX Hawaii PPO	$10,851.88
Rate for Payer: University Health Alliance Commercial	$6,265.00

Hip Empowr Acet Dm Metal Liner 46h 951-01-46H [3644133]

Facility

$11,187.50

Service Code	HCPCS C1776
Hospital Charge Code	3644133
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

Hip Empowr Acet Dm Metal Liner 46h 951-01-46H [3644133]

Facility

$11,187.50

Service Code	HCPCS C1776
Hospital Charge Code	3644133
Hospital Revenue Code	278
Min. Negotiated Rate	$6,265.00
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: MDX Hawaii PPO	$10,851.88
Rate for Payer: University Health Alliance Commercial	$6,265.00

Hip Empowr Acet Dm Poly Bearing 46h 952-28-46H [3644134]

Facility

$9,252.00

Service Code	HCPCS C1776
Hospital Charge Code	3644134
Hospital Revenue Code	278
Min. Negotiated Rate	$5,181.12
Max. Negotiated Rate	$8,974.44
Rate for Payer: Cash Price	$6,013.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,476.40
Rate for Payer: Health Management Network Commercial	$7,864.20
Rate for Payer: MDX Hawaii PPO	$8,974.44
Rate for Payer: University Health Alliance Commercial	$5,181.12

Hip Empowr Acet Dm Poly Bearing 46h 952-28-46H [3644134]

Facility

$9,252.00

Service Code	HCPCS C1776
Hospital Charge Code	3644134
Hospital Revenue Code	278
Min. Negotiated Rate	$4,718.52
Max. Negotiated Rate	$8,974.44
Rate for Payer: Cash Price	$6,013.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,476.40
Rate for Payer: Health Management Network Commercial	$7,864.20
Rate for Payer: Kaiser Permanente Commercial	$5,828.76
Rate for Payer: Kaiser Permanente Medicaid	$4,718.52
Rate for Payer: MDX Hawaii PPO	$8,974.44
Rate for Payer: University Health Alliance Commercial	$5,181.12

Hip Empowr Acet Dm Poly Bearing Sz44g 952-28-44G [3644080]

Facility

$9,252.00

Service Code	HCPCS C1776
Hospital Charge Code	3644080
Hospital Revenue Code	278
Min. Negotiated Rate	$4,718.52
Max. Negotiated Rate	$8,974.44
Rate for Payer: Cash Price	$6,013.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,476.40
Rate for Payer: Health Management Network Commercial	$7,864.20
Rate for Payer: Kaiser Permanente Commercial	$5,828.76
Rate for Payer: Kaiser Permanente Medicaid	$4,718.52
Rate for Payer: MDX Hawaii PPO	$8,974.44
Rate for Payer: University Health Alliance Commercial	$5,181.12

Hip Empowr Acet Dm Poly Bearing Sz44g 952-28-44G [3644080]

Facility

$9,252.00

Service Code	HCPCS C1776
Hospital Charge Code	3644080
Hospital Revenue Code	278
Min. Negotiated Rate	$5,181.12
Max. Negotiated Rate	$8,974.44
Rate for Payer: Cash Price	$6,013.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,476.40
Rate for Payer: Health Management Network Commercial	$7,864.20
Rate for Payer: MDX Hawaii PPO	$8,974.44
Rate for Payer: University Health Alliance Commercial	$5,181.12

Hip Empowr Acet Liner HXe+ Neutral Sz 36E 941-01-36E [3643015]

Facility

$11,450.00

Service Code	HCPCS C1776
Hospital Charge Code	3643015
Hospital Revenue Code	278
Min. Negotiated Rate	$6,412.00
Max. Negotiated Rate	$11,106.50
Rate for Payer: Cash Price	$7,442.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,015.00
Rate for Payer: Health Management Network Commercial	$9,732.50
Rate for Payer: MDX Hawaii PPO	$11,106.50
Rate for Payer: University Health Alliance Commercial	$6,412.00

Hip Empowr Acet Liner HXe+ Neutral Sz 36E 941-01-36E [3643015]

Facility

$11,450.00

Service Code	HCPCS C1776
Hospital Charge Code	3643015
Hospital Revenue Code	278
Min. Negotiated Rate	$5,839.50
Max. Negotiated Rate	$11,106.50
Rate for Payer: Cash Price	$7,442.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,015.00
Rate for Payer: Health Management Network Commercial	$9,732.50
Rate for Payer: Kaiser Permanente Commercial	$7,213.50
Rate for Payer: Kaiser Permanente Medicaid	$5,839.50
Rate for Payer: MDX Hawaii PPO	$11,106.50
Rate for Payer: University Health Alliance Commercial	$6,412.00

Hip Empowr Acet Liner HXe+, Neutral Sz 36F 941-01-36F [3643054]

Facility

$7,105.00

Service Code	HCPCS C1776
Hospital Charge Code	3643054
Hospital Revenue Code	278
Min. Negotiated Rate	$3,978.80
Max. Negotiated Rate	$6,891.85
Rate for Payer: Cash Price	$4,618.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,973.50
Rate for Payer: Health Management Network Commercial	$6,039.25
Rate for Payer: MDX Hawaii PPO	$6,891.85
Rate for Payer: University Health Alliance Commercial	$3,978.80

Hip Empowr Acet Liner HXe+, Neutral Sz 36F 941-01-36F [3643054]

Facility

$7,105.00

Service Code	HCPCS C1776
Hospital Charge Code	3643054
Hospital Revenue Code	278
Min. Negotiated Rate	$3,623.55
Max. Negotiated Rate	$6,891.85
Rate for Payer: Cash Price	$4,618.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,973.50
Rate for Payer: Health Management Network Commercial	$6,039.25
Rate for Payer: Kaiser Permanente Commercial	$4,476.15
Rate for Payer: Kaiser Permanente Medicaid	$3,623.55
Rate for Payer: MDX Hawaii PPO	$6,891.85
Rate for Payer: University Health Alliance Commercial	$3,978.80

Hip Empowr Acet Liner HXe+ Neutral Sz 36G 941-01-36G [3643163]

Facility

$11,450.00

Service Code	HCPCS C1776
Hospital Charge Code	3643163
Hospital Revenue Code	278
Min. Negotiated Rate	$5,839.50
Max. Negotiated Rate	$11,106.50
Rate for Payer: Cash Price	$7,442.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,015.00
Rate for Payer: Health Management Network Commercial	$9,732.50
Rate for Payer: Kaiser Permanente Commercial	$7,213.50
Rate for Payer: Kaiser Permanente Medicaid	$5,839.50
Rate for Payer: MDX Hawaii PPO	$11,106.50
Rate for Payer: University Health Alliance Commercial	$6,412.00

Hip Empowr Acet Liner HXe+ Neutral Sz 36G 941-01-36G [3643163]

Facility

$11,450.00

Service Code	HCPCS C1776
Hospital Charge Code	3643163
Hospital Revenue Code	278
Min. Negotiated Rate	$6,412.00
Max. Negotiated Rate	$11,106.50
Rate for Payer: Cash Price	$7,442.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,015.00
Rate for Payer: Health Management Network Commercial	$9,732.50
Rate for Payer: MDX Hawaii PPO	$11,106.50
Rate for Payer: University Health Alliance Commercial	$6,412.00

Hip Empowr Acet Liner HXe+ Neutral Sz 36H 941-01-36H [3643056]

Facility

$11,450.00

Service Code	HCPCS C1776
Hospital Charge Code	3643056
Hospital Revenue Code	278
Min. Negotiated Rate	$6,412.00
Max. Negotiated Rate	$11,106.50
Rate for Payer: Cash Price	$7,442.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,015.00
Rate for Payer: Health Management Network Commercial	$9,732.50
Rate for Payer: MDX Hawaii PPO	$11,106.50
Rate for Payer: University Health Alliance Commercial	$6,412.00

Hip Empowr Acet Liner HXe+ Neutral Sz 36H 941-01-36H [3643056]

Facility

$11,450.00

Service Code	HCPCS C1776
Hospital Charge Code	3643056
Hospital Revenue Code	278
Min. Negotiated Rate	$5,839.50
Max. Negotiated Rate	$11,106.50
Rate for Payer: Cash Price	$7,442.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,015.00
Rate for Payer: Health Management Network Commercial	$9,732.50
Rate for Payer: Kaiser Permanente Commercial	$7,213.50
Rate for Payer: Kaiser Permanente Medicaid	$5,839.50
Rate for Payer: MDX Hawaii PPO	$11,106.50
Rate for Payer: University Health Alliance Commercial	$6,412.00

Hip Endo Ii Head Component Sz 43mm 12-139010 [3645501]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645501
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Hip Endo Ii Head Component Sz 43mm 12-139010 [3645501]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645501
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Hip Endo II Head Component Sz 44mm 12-139012 [3645009]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645009
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Hip Endo II Head Component Sz 44mm 12-139012 [3645009]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645009
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Hip Endo Ii Head Component Sz 48mm 12-139020 [3645503]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645503
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Hip Endo Ii Head Component Sz 48mm 12-139020 [3645503]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3645503
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Hip Endo Ii Taper Insert -3mm T1 139248 [3645500]

Facility

$742.83

Service Code	HCPCS C1776
Hospital Charge Code	3645500
Hospital Revenue Code	278
Min. Negotiated Rate	$378.84
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: Kaiser Permanente Commercial	$467.98
Rate for Payer: Kaiser Permanente Medicaid	$378.84
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Hip Endo Ii Taper Insert -3mm T1 139248 [3645500]

Facility

$742.83

Service Code	HCPCS C1776
Hospital Charge Code	3645500
Hospital Revenue Code	278
Min. Negotiated Rate	$415.98
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Hip ENDO II Taper Insert -6mm T1 139249 [3641415]

Facility

$742.83

Service Code	HCPCS C1776
Hospital Charge Code	3641415
Hospital Revenue Code	278
Min. Negotiated Rate	$378.84
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: Kaiser Permanente Commercial	$467.98
Rate for Payer: Kaiser Permanente Medicaid	$378.84
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Hip ENDO II Taper Insert -6mm T1 139249 [3641415]

Facility

$742.83

Service Code	HCPCS C1776
Hospital Charge Code	3641415
Hospital Revenue Code	278
Min. Negotiated Rate	$415.98
Max. Negotiated Rate	$720.55
Rate for Payer: Cash Price	$482.84
Rate for Payer: Hawaii Western Management Group Commercial	$519.98
Rate for Payer: Health Management Network Commercial	$631.41
Rate for Payer: MDX Hawaii PPO	$720.55
Rate for Payer: University Health Alliance Commercial	$415.98

Know your out-of-pocket cost for care.

All Charges