Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Hip Fem Stem Std Echo Fx Sz9mm 12-151309 [3640698]

Facility

$4,890.50

Service Code	HCPCS C1776
Hospital Charge Code	3640698
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 Sz9mm 12-151309 [3640698]

Facility

$4,890.50

Service Code	HCPCS C1776
Hospital Charge Code	3640698
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 Sz 10 P2 Porous Coated Std Offset 425-96-010 [3642378]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3642378
Hospital Revenue Code	278
Min. Negotiated Rate	$9,803.99
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: Kaiser Permanente Commercial	$12,110.81
Rate for Payer: Kaiser Permanente Medicaid	$9,803.99
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 10 P2 Porous Coated Std Offset 425-96-010 [3642378]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3642378
Hospital Revenue Code	278
Min. Negotiated Rate	$10,765.16
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 11 P2 Porous Coated Std Offset 425-96-011 [3644403]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3644403
Hospital Revenue Code	278
Min. Negotiated Rate	$9,803.99
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: Kaiser Permanente Commercial	$12,110.81
Rate for Payer: Kaiser Permanente Medicaid	$9,803.99
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 11 P2 Porous Coated Std Offset 425-96-011 [3644403]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3644403
Hospital Revenue Code	278
Min. Negotiated Rate	$10,765.16
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 12 P2 Porous Coated Std Offset 425-96-012 [3642379]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3642379
Hospital Revenue Code	278
Min. Negotiated Rate	$9,803.99
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: Kaiser Permanente Commercial	$12,110.81
Rate for Payer: Kaiser Permanente Medicaid	$9,803.99
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 12 P2 Porous Coated Std Offset 425-96-012 [3642379]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3642379
Hospital Revenue Code	278
Min. Negotiated Rate	$10,765.16
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz13 P2 Porous Coated Std Offset 425-96-013 [3644079]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3644079
Hospital Revenue Code	278
Min. Negotiated Rate	$10,765.16
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz13 P2 Porous Coated Std Offset 425-96-013 [3644079]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3644079
Hospital Revenue Code	278
Min. Negotiated Rate	$9,803.99
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: Kaiser Permanente Commercial	$12,110.81
Rate for Payer: Kaiser Permanente Medicaid	$9,803.99
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 7 P2 Porous Coated Std Offset 425-96-007 [3644312]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3644312
Hospital Revenue Code	278
Min. Negotiated Rate	$9,803.99
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: Kaiser Permanente Commercial	$12,110.81
Rate for Payer: Kaiser Permanente Medicaid	$9,803.99
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 7 P2 Porous Coated Std Offset 425-96-007 [3644312]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3644312
Hospital Revenue Code	278
Min. Negotiated Rate	$10,765.16
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 9 P2 Porous Coated Std Offset 425-96-009 [3643057]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3643057
Hospital Revenue Code	278
Min. Negotiated Rate	$9,803.99
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: Kaiser Permanente Commercial	$12,110.81
Rate for Payer: Kaiser Permanente Medicaid	$9,803.99
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

Hip Fem Sz 9 P2 Porous Coated Std Offset 425-96-009 [3643057]

Facility

$19,223.50

Service Code	HCPCS C1776
Hospital Charge Code	3643057
Hospital Revenue Code	278
Min. Negotiated Rate	$10,765.16
Max. Negotiated Rate	$18,646.79
Rate for Payer: Cash Price	$12,495.28
Rate for Payer: Hawaii Western Management Group Commercial	$13,456.45
Rate for Payer: Health Management Network Commercial	$16,339.98
Rate for Payer: MDX Hawaii PPO	$18,646.79
Rate for Payer: University Health Alliance Commercial	$10,765.16

HIP & FEMUR FRACTURE REPAIR

Facility

$15,450.11

Service Code	APR-DRG 3084
Min. Negotiated Rate	$15,450.11
Max. Negotiated Rate	$15,450.11
Rate for Payer: AlohaCare Medicaid	$15,450.11
Rate for Payer: Hawaii Medical Service Association ABD	$15,450.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,450.11
Rate for Payer: Kaiser Permanente Medicaid	$15,450.11
Rate for Payer: Ohana Health Plan Medicaid	$15,450.11
Rate for Payer: UnitedHealthcare Medicaid	$15,450.11

HIP & FEMUR FRACTURE REPAIR

Facility

$6,936.06

Service Code	APR-DRG 3081
Min. Negotiated Rate	$6,936.06
Max. Negotiated Rate	$6,936.06
Rate for Payer: AlohaCare Medicaid	$6,936.06
Rate for Payer: Hawaii Medical Service Association ABD	$6,936.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,936.06
Rate for Payer: Kaiser Permanente Medicaid	$6,936.06
Rate for Payer: Ohana Health Plan Medicaid	$6,936.06
Rate for Payer: UnitedHealthcare Medicaid	$6,936.06

HIP & FEMUR FRACTURE REPAIR

Facility

$8,256.79

Service Code	APR-DRG 3082
Min. Negotiated Rate	$8,256.79
Max. Negotiated Rate	$8,256.79
Rate for Payer: AlohaCare Medicaid	$8,256.79
Rate for Payer: Hawaii Medical Service Association ABD	$8,256.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,256.79
Rate for Payer: Kaiser Permanente Medicaid	$8,256.79
Rate for Payer: Ohana Health Plan Medicaid	$8,256.79
Rate for Payer: UnitedHealthcare Medicaid	$8,256.79

HIP & FEMUR FRACTURE REPAIR

Facility

$10,628.24

Service Code	APR-DRG 3083
Min. Negotiated Rate	$10,628.24
Max. Negotiated Rate	$10,628.24
Rate for Payer: AlohaCare Medicaid	$10,628.24
Rate for Payer: Hawaii Medical Service Association ABD	$10,628.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,628.24
Rate for Payer: Kaiser Permanente Medicaid	$10,628.24
Rate for Payer: Ohana Health Plan Medicaid	$10,628.24
Rate for Payer: UnitedHealthcare Medicaid	$10,628.24

Hip Freedom All Poly Acet Cup 50mm 11-107122 [3644992]

Facility

$10,914.50

Service Code	HCPCS C1776
Hospital Charge Code	3644992
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.12
Max. Negotiated Rate	$10,587.07
Rate for Payer: Cash Price	$7,094.42
Rate for Payer: Hawaii Western Management Group Commercial	$7,640.15
Rate for Payer: Health Management Network Commercial	$9,277.33
Rate for Payer: MDX Hawaii PPO	$10,587.07
Rate for Payer: University Health Alliance Commercial	$6,112.12

Hip Freedom All Poly Acet Cup 50mm 11-107122 [3644992]

Facility

$10,914.50

Service Code	HCPCS C1776
Hospital Charge Code	3644992
Hospital Revenue Code	278
Min. Negotiated Rate	$5,566.40
Max. Negotiated Rate	$10,587.07
Rate for Payer: Cash Price	$7,094.42
Rate for Payer: Hawaii Western Management Group Commercial	$7,640.15
Rate for Payer: Health Management Network Commercial	$9,277.33
Rate for Payer: Kaiser Permanente Commercial	$6,876.14
Rate for Payer: Kaiser Permanente Medicaid	$5,566.40
Rate for Payer: MDX Hawaii PPO	$10,587.07
Rate for Payer: University Health Alliance Commercial	$6,112.12

Hip Freedom All Poly Acet Cup 52mm 11-107123 [3644523]

Facility

$10,914.50

Service Code	HCPCS C1776
Hospital Charge Code	3644523
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.12
Max. Negotiated Rate	$10,587.07
Rate for Payer: Cash Price	$7,094.42
Rate for Payer: Hawaii Western Management Group Commercial	$7,640.15
Rate for Payer: Health Management Network Commercial	$9,277.33
Rate for Payer: MDX Hawaii PPO	$10,587.07
Rate for Payer: University Health Alliance Commercial	$6,112.12

Hip Freedom All Poly Acet Cup 52mm 11-107123 [3644523]

Facility

$10,914.50

Service Code	HCPCS C1776
Hospital Charge Code	3644523
Hospital Revenue Code	278
Min. Negotiated Rate	$5,566.40
Max. Negotiated Rate	$10,587.07
Rate for Payer: Cash Price	$7,094.42
Rate for Payer: Hawaii Western Management Group Commercial	$7,640.15
Rate for Payer: Health Management Network Commercial	$9,277.33
Rate for Payer: Kaiser Permanente Commercial	$6,876.14
Rate for Payer: Kaiser Permanente Medicaid	$5,566.40
Rate for Payer: MDX Hawaii PPO	$10,587.07
Rate for Payer: University Health Alliance Commercial	$6,112.12

Hip Freedom All Poly Acet Cup 60mm 11-107127 [3643835]

Facility

$6,722.50

Service Code	HCPCS C1776
Hospital Charge Code	3643835
Hospital Revenue Code	278
Min. Negotiated Rate	$3,428.47
Max. Negotiated Rate	$6,520.82
Rate for Payer: Cash Price	$4,369.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,705.75
Rate for Payer: Health Management Network Commercial	$5,714.12
Rate for Payer: Kaiser Permanente Commercial	$4,235.18
Rate for Payer: Kaiser Permanente Medicaid	$3,428.47
Rate for Payer: MDX Hawaii PPO	$6,520.82
Rate for Payer: University Health Alliance Commercial	$3,764.60

Hip Freedom All Poly Acet Cup 60mm 11-107127 [3643835]

Facility

$6,722.50

Service Code	HCPCS C1776
Hospital Charge Code	3643835
Hospital Revenue Code	278
Min. Negotiated Rate	$3,764.60
Max. Negotiated Rate	$6,520.82
Rate for Payer: Cash Price	$4,369.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,705.75
Rate for Payer: Health Management Network Commercial	$5,714.12
Rate for Payer: MDX Hawaii PPO	$6,520.82
Rate for Payer: University Health Alliance Commercial	$3,764.60

Hip Freedom All Poly Acet Cup 62mm 11-107128 [3644861]

Facility

$10,914.50

Service Code	HCPCS C1776
Hospital Charge Code	3644861
Hospital Revenue Code	278
Min. Negotiated Rate	$5,566.40
Max. Negotiated Rate	$10,587.07
Rate for Payer: Cash Price	$7,094.42
Rate for Payer: Hawaii Western Management Group Commercial	$7,640.15
Rate for Payer: Health Management Network Commercial	$9,277.33
Rate for Payer: Kaiser Permanente Commercial	$6,876.14
Rate for Payer: Kaiser Permanente Medicaid	$5,566.40
Rate for Payer: MDX Hawaii PPO	$10,587.07
Rate for Payer: University Health Alliance Commercial	$6,112.12

Know your out-of-pocket cost for care.

All Charges