Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$7,700.00
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: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Hip Fem Stem Avenir Compl Ha Std Col Sz 5 57420105 [3643678]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643678
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
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: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Hip Fem Stem Avenir Compl Ha Std Col Sz 5 57420105 [3643678]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643678
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$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: University Health Alliance Commercial	$7,700.00

Hip Fem Stem Avenir Compl Ha Std Col Sz6 [3643626]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643626
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
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: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Hip Fem Stem Avenir Compl Ha Std Col Sz6 [3643626]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643626
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

Hip Fem Stem Avenir Compl Ha Std Col Sz6.5 574201065 [3643912]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3643912
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 Sz6.5 574201065 [3643912]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3643912
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 8 574201080 [3644605]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644605
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 8 574201080 [3644605]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644605
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 Fpp Std Nc Por Echo Sz 10x130mm 192010 [3645502]

Facility

$9,483.00

Service Code	HCPCS C1776
Hospital Charge Code	3645502
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 Fem Stem Fpp Std Nc Por Echo Sz 10x130mm 192010 [3645502]

Facility

$9,483.00

Service Code	HCPCS C1776
Hospital Charge Code	3645502
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 Fem Stem Lat Echo Fx Sz15mm 12-151415 [3643825]

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	3643825
Hospital Revenue Code	278
Min. Negotiated Rate	$1,610.00
Max. Negotiated Rate	$2,788.75
Rate for Payer: Cash Price	$1,868.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,012.50
Rate for Payer: Health Management Network Commercial	$2,443.75
Rate for Payer: MDX Hawaii PPO	$2,788.75
Rate for Payer: University Health Alliance Commercial	$1,610.00

Hip Fem Stem Lat Echo Fx Sz15mm 12-151415 [3643825]

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	3643825
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,788.75
Rate for Payer: Cash Price	$1,868.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,012.50
Rate for Payer: Health Management Network Commercial	$2,443.75
Rate for Payer: Kaiser Permanente Commercial	$1,811.25
Rate for Payer: Kaiser Permanente Medicaid	$1,466.25
Rate for Payer: MDX Hawaii PPO	$2,788.75
Rate for Payer: University Health Alliance Commercial	$1,610.00

Hip Fem Stem Rpp Nc Por Echo Sz 12x140mm [3643271]

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643271
Hospital Revenue Code	278
Min. Negotiated Rate	$3,123.75
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: Kaiser Permanente Commercial	$3,858.75
Rate for Payer: Kaiser Permanente Medicaid	$3,123.75
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Hip Fem Stem Rpp Nc Por Echo Sz 12x140mm [3643271]

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3643271
Hospital Revenue Code	278
Min. Negotiated Rate	$3,430.00
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Hip Fem Stem RPP NC Por Echo Sz 7X115mm 192407 [3642599]

Facility

$12,141.25

Service Code	HCPCS C1776
Hospital Charge Code	3642599
Hospital Revenue Code	278
Min. Negotiated Rate	$6,192.04
Max. Negotiated Rate	$11,777.01
Rate for Payer: Cash Price	$7,891.81
Rate for Payer: Hawaii Western Management Group Commercial	$8,498.88
Rate for Payer: Health Management Network Commercial	$10,320.06
Rate for Payer: Kaiser Permanente Commercial	$7,648.99
Rate for Payer: Kaiser Permanente Medicaid	$6,192.04
Rate for Payer: MDX Hawaii PPO	$11,777.01
Rate for Payer: University Health Alliance Commercial	$6,799.10

Hip Fem Stem RPP NC Por Echo Sz 7X115mm 192407 [3642599]

Facility

$12,141.25

Service Code	HCPCS C1776
Hospital Charge Code	3642599
Hospital Revenue Code	278
Min. Negotiated Rate	$6,799.10
Max. Negotiated Rate	$11,777.01
Rate for Payer: Cash Price	$7,891.81
Rate for Payer: Hawaii Western Management Group Commercial	$8,498.88
Rate for Payer: Health Management Network Commercial	$10,320.06
Rate for Payer: MDX Hawaii PPO	$11,777.01
Rate for Payer: University Health Alliance Commercial	$6,799.10

Hip Fem Stem RPP NC Por Sz 11X135mm 192411 [3642630]

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3642630
Hospital Revenue Code	278
Min. Negotiated Rate	$3,430.00
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Hip Fem Stem RPP NC Por Sz 11X135mm 192411 [3642630]

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	3642630
Hospital Revenue Code	278
Min. Negotiated Rate	$3,123.75
Max. Negotiated Rate	$5,941.25
Rate for Payer: Cash Price	$3,981.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,287.50
Rate for Payer: Health Management Network Commercial	$5,206.25
Rate for Payer: Kaiser Permanente Commercial	$3,858.75
Rate for Payer: Kaiser Permanente Medicaid	$3,123.75
Rate for Payer: MDX Hawaii PPO	$5,941.25
Rate for Payer: University Health Alliance Commercial	$3,430.00

Hip Fem Stem Std Echo Fx Sz11mm 12-151311 [3642438]

Facility

$4,890.50

Service Code	HCPCS C1776
Hospital Charge Code	3642438
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 Fem Stem Std Echo Fx Sz11mm 12-151311 [3642438]

Facility

$4,890.50

Service Code	HCPCS C1776
Hospital Charge Code	3642438
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 Fem Stem Std Echo Fx Sz13mm 12-151313 [3642770]

Facility

$7,162.50

Service Code	HCPCS C1776
Hospital Charge Code	3642770
Hospital Revenue Code	278
Min. Negotiated Rate	$4,011.00
Max. Negotiated Rate	$6,947.62
Rate for Payer: Cash Price	$4,655.62
Rate for Payer: Hawaii Western Management Group Commercial	$5,013.75
Rate for Payer: Health Management Network Commercial	$6,088.12
Rate for Payer: MDX Hawaii PPO	$6,947.62
Rate for Payer: University Health Alliance Commercial	$4,011.00

Hip Fem Stem Std Echo Fx Sz13mm 12-151313 [3642770]

Facility

$7,162.50

Service Code	HCPCS C1776
Hospital Charge Code	3642770
Hospital Revenue Code	278
Min. Negotiated Rate	$3,652.88
Max. Negotiated Rate	$6,947.62
Rate for Payer: Cash Price	$4,655.62
Rate for Payer: Hawaii Western Management Group Commercial	$5,013.75
Rate for Payer: Health Management Network Commercial	$6,088.12
Rate for Payer: Kaiser Permanente Commercial	$4,512.38
Rate for Payer: Kaiser Permanente Medicaid	$3,652.88
Rate for Payer: MDX Hawaii PPO	$6,947.62
Rate for Payer: University Health Alliance Commercial	$4,011.00

Hip Fem Stem Std Echo Fx Sz17mm 12-151317 [3643837]

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	3643837
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,788.75
Rate for Payer: Cash Price	$1,868.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,012.50
Rate for Payer: Health Management Network Commercial	$2,443.75
Rate for Payer: Kaiser Permanente Commercial	$1,811.25
Rate for Payer: Kaiser Permanente Medicaid	$1,466.25
Rate for Payer: MDX Hawaii PPO	$2,788.75
Rate for Payer: University Health Alliance Commercial	$1,610.00

Hip Fem Stem Std Echo Fx Sz17mm 12-151317 [3643837]

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	3643837
Hospital Revenue Code	278
Min. Negotiated Rate	$1,610.00
Max. Negotiated Rate	$2,788.75
Rate for Payer: Cash Price	$1,868.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,012.50
Rate for Payer: Health Management Network Commercial	$2,443.75
Rate for Payer: MDX Hawaii PPO	$2,788.75
Rate for Payer: University Health Alliance Commercial	$1,610.00

Know your out-of-pocket cost for care.

All Charges