Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$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 Constr Hd 36mm T1 -6mm 11-107016 [3644522]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3644522
Hospital Revenue Code	278
Min. Negotiated Rate	$3,265.53
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: Kaiser Permanente Commercial	$4,033.89
Rate for Payer: Kaiser Permanente Medicaid	$3,265.53
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Constr Hd 36mm T1 -6mm 11-107016 [3644522]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3644522
Hospital Revenue Code	278
Min. Negotiated Rate	$3,585.68
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Constr Hd 36mm T1 +9mm 11-107021 [3644521]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3644521
Hospital Revenue Code	278
Min. Negotiated Rate	$3,265.53
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: Kaiser Permanente Commercial	$4,033.89
Rate for Payer: Kaiser Permanente Medicaid	$3,265.53
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Constr Hd 36mm T1 +9mm 11-107021 [3644521]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3644521
Hospital Revenue Code	278
Min. Negotiated Rate	$3,585.68
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Constr HD COCR 36mm +6mm 802403605 [3644985]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3644985
Hospital Revenue Code	278
Min. Negotiated Rate	$3,265.53
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: Kaiser Permanente Commercial	$4,033.89
Rate for Payer: Kaiser Permanente Medicaid	$3,265.53
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Constr HD COCR 36mm +6mm 802403605 [3644985]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3644985
Hospital Revenue Code	278
Min. Negotiated Rate	$3,585.68
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Constr Hd T1 36mm +3mm 11-107019 [3643838]

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	3643838
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,275.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

Hip Freedom Constr Hd T1 36mm +3mm 11-107019 [3643838]

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	3643838
Hospital Revenue Code	278
Min. Negotiated Rate	$1,785.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,275.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Kaiser Permanente Commercial	$2,205.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

Hip Freedom Sys All Poly Acet Cup 56mm 11-107125 [3642749]

Facility

$11,285.50

Service Code	HCPCS C1776
Hospital Charge Code	3642749
Hospital Revenue Code	278
Min. Negotiated Rate	$5,755.60
Max. Negotiated Rate	$10,946.93
Rate for Payer: Cash Price	$7,335.58
Rate for Payer: Hawaii Western Management Group Commercial	$7,899.85
Rate for Payer: Health Management Network Commercial	$9,592.67
Rate for Payer: Kaiser Permanente Commercial	$7,109.86
Rate for Payer: Kaiser Permanente Medicaid	$5,755.60
Rate for Payer: MDX Hawaii PPO	$10,946.93
Rate for Payer: University Health Alliance Commercial	$6,319.88

Hip Freedom Sys All Poly Acet Cup 56mm 11-107125 [3642749]

Facility

$11,285.50

Service Code	HCPCS C1776
Hospital Charge Code	3642749
Hospital Revenue Code	278
Min. Negotiated Rate	$6,319.88
Max. Negotiated Rate	$10,946.93
Rate for Payer: Cash Price	$7,335.58
Rate for Payer: Hawaii Western Management Group Commercial	$7,899.85
Rate for Payer: Health Management Network Commercial	$9,592.67
Rate for Payer: MDX Hawaii PPO	$10,946.93
Rate for Payer: University Health Alliance Commercial	$6,319.88

Hip Freedom Sys Constr Head Std Type 1 36mm 11-107018 [3642750]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3642750
Hospital Revenue Code	278
Min. Negotiated Rate	$3,265.53
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: Kaiser Permanente Commercial	$4,033.89
Rate for Payer: Kaiser Permanente Medicaid	$3,265.53
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

Hip Freedom Sys Constr Head Std Type 1 36mm 11-107018 [3642750]

Facility

$6,403.00

Service Code	HCPCS C1776
Hospital Charge Code	3642750
Hospital Revenue Code	278
Min. Negotiated Rate	$3,585.68
Max. Negotiated Rate	$6,210.91
Rate for Payer: Cash Price	$4,161.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,482.10
Rate for Payer: Health Management Network Commercial	$5,442.55
Rate for Payer: MDX Hawaii PPO	$6,210.91
Rate for Payer: University Health Alliance Commercial	$3,585.68

HIP JOINT REPLACEMENT

Facility

$11,951.52

Service Code	APR-DRG 3013
Min. Negotiated Rate	$11,951.52
Max. Negotiated Rate	$11,951.52
Rate for Payer: AlohaCare Medicaid	$11,951.52
Rate for Payer: Hawaii Medical Service Association ABD	$11,951.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,951.52
Rate for Payer: Kaiser Permanente Medicaid	$11,951.52
Rate for Payer: Ohana Health Plan Medicaid	$11,951.52
Rate for Payer: UnitedHealthcare Medicaid	$11,951.52

HIP JOINT REPLACEMENT

Facility

$8,582.83

Service Code	APR-DRG 3011
Min. Negotiated Rate	$8,582.83
Max. Negotiated Rate	$8,582.83
Rate for Payer: AlohaCare Medicaid	$8,582.83
Rate for Payer: Hawaii Medical Service Association ABD	$8,582.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,582.83
Rate for Payer: Kaiser Permanente Medicaid	$8,582.83
Rate for Payer: Ohana Health Plan Medicaid	$8,582.83
Rate for Payer: UnitedHealthcare Medicaid	$8,582.83

HIP JOINT REPLACEMENT

Facility

$17,038.30

Service Code	APR-DRG 3014
Min. Negotiated Rate	$17,038.30
Max. Negotiated Rate	$17,038.30
Rate for Payer: AlohaCare Medicaid	$17,038.30
Rate for Payer: Hawaii Medical Service Association ABD	$17,038.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,038.30
Rate for Payer: Kaiser Permanente Medicaid	$17,038.30
Rate for Payer: Ohana Health Plan Medicaid	$17,038.30
Rate for Payer: UnitedHealthcare Medicaid	$17,038.30

HIP JOINT REPLACEMENT

Facility

$9,267.39

Service Code	APR-DRG 3012
Min. Negotiated Rate	$9,267.39
Max. Negotiated Rate	$9,267.39
Rate for Payer: AlohaCare Medicaid	$9,267.39
Rate for Payer: Hawaii Medical Service Association ABD	$9,267.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,267.39
Rate for Payer: Kaiser Permanente Medicaid	$9,267.39
Rate for Payer: Ohana Health Plan Medicaid	$9,267.39
Rate for Payer: UnitedHealthcare Medicaid	$9,267.39

Hip Prep IM Enchance Total Hip Kit 121010 [3640523]

Facility

$2,314.42

Hospital Charge Code	3640523
Hospital Revenue Code	272
Min. Negotiated Rate	$1,180.35
Max. Negotiated Rate	$2,244.99
Rate for Payer: Cash Price	$1,504.37
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.70
Rate for Payer: Health Management Network Commercial	$1,967.26
Rate for Payer: Kaiser Permanente Commercial	$1,458.08
Rate for Payer: Kaiser Permanente Medicaid	$1,180.35
Rate for Payer: MDX Hawaii PPO	$2,244.99
Rate for Payer: University Health Alliance Commercial	$1,686.98

Hip Prep IM Enchance Total Hip Kit 121010 [3640523]

Facility

$2,314.42

Hospital Charge Code	3640523
Hospital Revenue Code	272
Min. Negotiated Rate	$1,967.26
Max. Negotiated Rate	$2,244.99
Rate for Payer: Cash Price	$1,504.37
Rate for Payer: Health Management Network Commercial	$1,967.26
Rate for Payer: MDX Hawaii PPO	$2,244.99

Hip Remedy Acet Cup 46mm ID 54mm OD RHACSM [3644609]

Facility

$10,253.00

Service Code	HCPCS C1776
Hospital Charge Code	3644609
Hospital Revenue Code	278
Min. Negotiated Rate	$5,741.68
Max. Negotiated Rate	$9,945.41
Rate for Payer: Cash Price	$6,664.45
Rate for Payer: Hawaii Western Management Group Commercial	$7,177.10
Rate for Payer: Health Management Network Commercial	$8,715.05
Rate for Payer: MDX Hawaii PPO	$9,945.41
Rate for Payer: University Health Alliance Commercial	$5,741.68

Hip Remedy Acet Cup 46mm ID 54mm OD RHACSM [3644609]

Facility

$10,253.00

Service Code	HCPCS C1776
Hospital Charge Code	3644609
Hospital Revenue Code	278
Min. Negotiated Rate	$5,229.03
Max. Negotiated Rate	$9,945.41
Rate for Payer: Cash Price	$6,664.45
Rate for Payer: Hawaii Western Management Group Commercial	$7,177.10
Rate for Payer: Health Management Network Commercial	$8,715.05
Rate for Payer: Kaiser Permanente Commercial	$6,459.39
Rate for Payer: Kaiser Permanente Medicaid	$5,229.03
Rate for Payer: MDX Hawaii PPO	$9,945.41
Rate for Payer: University Health Alliance Commercial	$5,741.68

Hip Remedy Spectrum GV Mod Fem Head Small 46mm GVHDSM [3644611]

Facility

$15,503.00

Hospital Charge Code	3644611
Hospital Revenue Code	272
Min. Negotiated Rate	$7,906.53
Max. Negotiated Rate	$15,037.91
Rate for Payer: Cash Price	$10,076.95
Rate for Payer: Hawaii Western Management Group Commercial	$14,727.85
Rate for Payer: Health Management Network Commercial	$13,177.55
Rate for Payer: Kaiser Permanente Commercial	$9,766.89
Rate for Payer: Kaiser Permanente Medicaid	$7,906.53
Rate for Payer: MDX Hawaii PPO	$15,037.91
Rate for Payer: University Health Alliance Commercial	$11,300.14

Hip Remedy Spectrum GV Mod Fem Head Small 46mm GVHDSM [3644611]

Facility

$15,503.00

Hospital Charge Code	3644611
Hospital Revenue Code	272
Min. Negotiated Rate	$13,177.55
Max. Negotiated Rate	$15,037.91
Rate for Payer: Cash Price	$10,076.95
Rate for Payer: Health Management Network Commercial	$13,177.55
Rate for Payer: MDX Hawaii PPO	$15,037.91

Hip Remedy Spectrum GV Mod Fem Lng Stem Small GVLSSM [3644610]

Facility

$21,278.00

Hospital Charge Code	3644610
Hospital Revenue Code	272
Min. Negotiated Rate	$18,086.30
Max. Negotiated Rate	$20,639.66
Rate for Payer: Cash Price	$13,830.70
Rate for Payer: Health Management Network Commercial	$18,086.30
Rate for Payer: MDX Hawaii PPO	$20,639.66

Hip Remedy Spectrum GV Mod Fem Lng Stem Small GVLSSM [3644610]

Facility

$21,278.00

Hospital Charge Code	3644610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,851.78
Max. Negotiated Rate	$20,639.66
Rate for Payer: Cash Price	$13,830.70
Rate for Payer: Hawaii Western Management Group Commercial	$20,214.10
Rate for Payer: Health Management Network Commercial	$18,086.30
Rate for Payer: Kaiser Permanente Commercial	$13,405.14
Rate for Payer: Kaiser Permanente Medicaid	$10,851.78
Rate for Payer: MDX Hawaii PPO	$20,639.66
Rate for Payer: University Health Alliance Commercial	$15,509.53

Know your out-of-pocket cost for care.

All Charges