Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$51,444.34

Service Code	MSDRG 521
Min. Negotiated Rate	$37,751.08
Max. Negotiated Rate	$51,444.34
Rate for Payer: AlohaCare Medicare	$37,751.08
Rate for Payer: Devoted Health Medicare	$41,526.19
Rate for Payer: Hawaii Medical Service Association Commercial	$51,444.34
Rate for Payer: Hawaii Medical Service Association Medicare	$37,751.08
Rate for Payer: Humana Medicare	$37,751.08
Rate for Payer: Kaiser Permanente Commercial	$49,510.95
Rate for Payer: Kaiser Permanente Medicare	$37,751.08
Rate for Payer: Ohana Health Plan Medicare	$37,751.08
Rate for Payer: UnitedHealthcare Medicare	$37,751.08

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$37,510.49

Service Code	MSDRG 522
Min. Negotiated Rate	$27,853.61
Max. Negotiated Rate	$37,510.49
Rate for Payer: AlohaCare Medicare	$27,853.61
Rate for Payer: Devoted Health Medicare	$30,638.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,510.49
Rate for Payer: Hawaii Medical Service Association Medicare	$27,853.61
Rate for Payer: Humana Medicare	$27,853.61
Rate for Payer: Kaiser Permanente Commercial	$36,530.32
Rate for Payer: Kaiser Permanente Medicare	$27,853.61
Rate for Payer: Ohana Health Plan Medicare	$27,853.61
Rate for Payer: UnitedHealthcare Medicare	$27,853.61

Hip Shell Bipolar Cup 43mm x 28 Ringloc 11-165210 [3642893]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642893
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 43mm x 28 Ringloc 11-165210 [3642893]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642893
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 44mm OD X 28mm ID Ringloc 11-165212 [3642454]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642454
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 44mm OD X 28mm ID Ringloc 11-165212 [3642454]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642454
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 45mm x 28mm Ringloc 11-165214 [3640669]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3640669
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 45mm x 28mm Ringloc 11-165214 [3640669]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3640669
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 46mm X 28mm Ringloc 11-165216 [3642428]

Facility

$2,997.50

Service Code	HCPCS C1776
Hospital Charge Code	3642428
Hospital Revenue Code	278
Min. Negotiated Rate	$1,528.72
Max. Negotiated Rate	$2,907.57
Rate for Payer: Cash Price	$1,948.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,098.25
Rate for Payer: Health Management Network Commercial	$2,547.88
Rate for Payer: Kaiser Permanente Commercial	$1,888.42
Rate for Payer: Kaiser Permanente Medicaid	$1,528.72
Rate for Payer: MDX Hawaii PPO	$2,907.57
Rate for Payer: University Health Alliance Commercial	$1,678.60

Hip Shell Bipolar Cup 46mm X 28mm Ringloc 11-165216 [3642428]

Facility

$2,997.50

Service Code	HCPCS C1776
Hospital Charge Code	3642428
Hospital Revenue Code	278
Min. Negotiated Rate	$1,678.60
Max. Negotiated Rate	$2,907.57
Rate for Payer: Cash Price	$1,948.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,098.25
Rate for Payer: Health Management Network Commercial	$2,547.88
Rate for Payer: MDX Hawaii PPO	$2,907.57
Rate for Payer: University Health Alliance Commercial	$1,678.60

Hip Shell Bipolar Cup 47mm x 28 Ringloc 11-165218 [3640696]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3640696
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 47mm x 28 Ringloc 11-165218 [3640696]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3640696
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 48mm X 28mm Ringloc 11-165220 [3642387]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642387
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 48mm X 28mm Ringloc 11-165220 [3642387]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642387
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 49mm X 28mm Ringloc 11-165222 [3642350]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642350
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 49mm X 28mm Ringloc 11-165222 [3642350]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642350
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 50mm x 28mm Ringloc 11-165224 [3644038]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3644038
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 50mm x 28mm Ringloc 11-165224 [3644038]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3644038
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 51mm X 28mm Ringloc 11-165226 [3642941]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642941
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 51mm X 28mm Ringloc 11-165226 [3642941]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3642941
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 52mm X 28mm Ringloc 11-165228 [3643153]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3643153
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 52mm X 28mm Ringloc 11-165228 [3643153]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3643153
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 53mm X 28mm Ringloc 11-165230 [3643309]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3643309
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 53mm X 28mm Ringloc 11-165230 [3643309]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3643309
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.44
Max. Negotiated Rate	$3,927.53
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Hip Shell Bipolar Cup 54mmx28mm Ringloc 11-165232 [3643458]

Facility

$4,049.00

Service Code	HCPCS C1776
Hospital Charge Code	3643458
Hospital Revenue Code	278
Min. Negotiated Rate	$2,064.99
Max. Negotiated Rate	$3,927.53
Rate for Payer: Kaiser Permanente Commercial	$2,550.87
Rate for Payer: Cash Price	$2,631.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,834.30
Rate for Payer: Health Management Network Commercial	$3,441.65
Rate for Payer: Kaiser Permanente Medicaid	$2,064.99
Rate for Payer: MDX Hawaii PPO	$3,927.53
Rate for Payer: University Health Alliance Commercial	$2,267.44

Know your out-of-pocket cost for care.

All Charges