Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Endo Ii Taper Insert Std 0mm T 139247 [3643970]

Facility

$742.83

Service Code	HCPCS C1776
Hospital Charge Code	3643970
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 Std 0mm T 139247 [3643970]

Facility

$742.83

Service Code	HCPCS C1776
Hospital Charge Code	3643970
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 Fem Stem Avenir Cml HA HO Col Sz 5 574202050 [3644606]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644606
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cml HA HO Col Sz 5 574202050 [3644606]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644606
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 3 574202030 [3644549]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644549
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 3 574202030 [3644549]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644549
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 4 574202040 [3644575]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644575
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 4 574202040 [3644575]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644575
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 6.5 574202065 [3644577]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644577
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 6.5 574202065 [3644577]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644577
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 7 574202070 [3644760]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644760
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Cmpl HA HO Col Sz 7 574202070 [3644760]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644760
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Comp Ha Std Col Sz7.5 574201075 [3644035]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644035
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Comp Ha Std Col Sz7.5 574201075 [3644035]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644035
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Comp HA Std Col Sz7 574201070 [3644413]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644413
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Comp HA Std Col Sz7 574201070 [3644413]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644413
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl HA Std Col Sz 0 574201000 [3644842]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644842
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl HA Std Col Sz 0 574201000 [3644842]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644842
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl HA STD COL Sz 1 574201010 [3644404]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644404
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl HA STD COL Sz 1 574201010 [3644404]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644404
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl Ha Std Col Sz 2 574201020 [3644303]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644303
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl Ha Std Col Sz 2 574201020 [3644303]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644303
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl HA STD COL Sz 3 574201030 [3644256]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644256
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl HA STD COL Sz 3 574201030 [3644256]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644256
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Hip Fem Stem Avenir Compl Ha Std Col Sz 4 [3644018]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3644018
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Know your out-of-pocket cost for care.

All Charges