Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Partial Knee Oxford Anat Brg LT MD Sz3 PMA 159547 [3641288]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3641288
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.00
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Partial Knee Oxford Anat Brg Lt XLG Sz4 PMA 159562 [3644865]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3644865
Hospital Revenue Code	278
Min. Negotiated Rate	$2,297.68
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg Lt XLG Sz4 PMA 159562 [3644865]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3644865
Hospital Revenue Code	278
Min. Negotiated Rate	$2,092.53
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: Kaiser Permanente Commercial	$2,584.89
Rate for Payer: Kaiser Permanente Medicaid	$2,092.53
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg RT MD Sz3 PMA 159575 [3642216]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3642216
Hospital Revenue Code	278
Min. Negotiated Rate	$2,092.53
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: Kaiser Permanente Commercial	$2,584.89
Rate for Payer: Kaiser Permanente Medicaid	$2,092.53
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg RT MD Sz3 PMA 159575 [3642216]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3642216
Hospital Revenue Code	278
Min. Negotiated Rate	$2,297.68
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg RT MD Sz4 PMA 159576 [3640890]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3640890
Hospital Revenue Code	278
Min. Negotiated Rate	$2,092.53
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: Kaiser Permanente Commercial	$2,584.89
Rate for Payer: Kaiser Permanente Medicaid	$2,092.53
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg RT MD Sz4 PMA 159576 [3640890]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3640890
Hospital Revenue Code	278
Min. Negotiated Rate	$2,297.68
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Sawblade Cmntd Stryker 3Pk 506298 [3627868]

Facility

$1,983.75

Hospital Charge Code	3627868
Hospital Revenue Code	272
Min. Negotiated Rate	$1,011.71
Max. Negotiated Rate	$1,924.24
Rate for Payer: Cash Price	$1,289.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.56
Rate for Payer: Health Management Network Commercial	$1,686.19
Rate for Payer: Kaiser Permanente Commercial	$1,249.76
Rate for Payer: Kaiser Permanente Medicaid	$1,011.71
Rate for Payer: MDX Hawaii PPO	$1,924.24
Rate for Payer: University Health Alliance Commercial	$1,445.96

Partial Knee Oxford Sawblade Cmntd Stryker 3Pk 506298 [3627868]

Facility

$1,983.75

Hospital Charge Code	3627868
Hospital Revenue Code	272
Min. Negotiated Rate	$1,686.19
Max. Negotiated Rate	$1,924.24
Rate for Payer: Cash Price	$1,289.44
Rate for Payer: Health Management Network Commercial	$1,686.19
Rate for Payer: MDX Hawaii PPO	$1,924.24

Partial Knee Oxford TwinPeg Cmntd Fem LG PMA 161470 [3641028]

Facility

$7,348.00

Service Code	HCPCS C1776
Hospital Charge Code	3641028
Hospital Revenue Code	278
Min. Negotiated Rate	$3,747.48
Max. Negotiated Rate	$7,127.56
Rate for Payer: Cash Price	$4,776.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,143.60
Rate for Payer: Health Management Network Commercial	$6,245.80
Rate for Payer: Kaiser Permanente Commercial	$4,629.24
Rate for Payer: Kaiser Permanente Medicaid	$3,747.48
Rate for Payer: MDX Hawaii PPO	$7,127.56
Rate for Payer: University Health Alliance Commercial	$4,114.88

Partial Knee Oxford TwinPeg Cmntd Fem LG PMA 161470 [3641028]

Facility

$7,348.00

Service Code	HCPCS C1776
Hospital Charge Code	3641028
Hospital Revenue Code	278
Min. Negotiated Rate	$4,114.88
Max. Negotiated Rate	$7,127.56
Rate for Payer: Cash Price	$4,776.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,143.60
Rate for Payer: Health Management Network Commercial	$6,245.80
Rate for Payer: MDX Hawaii PPO	$7,127.56
Rate for Payer: University Health Alliance Commercial	$4,114.88

Partial Knee Oxford TwinPeg Cmntd Fem MD PMA 161469 [3640889]

Facility

$7,348.00

Service Code	HCPCS C1776
Hospital Charge Code	3640889
Hospital Revenue Code	278
Min. Negotiated Rate	$3,747.48
Max. Negotiated Rate	$7,127.56
Rate for Payer: Cash Price	$4,776.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,143.60
Rate for Payer: Health Management Network Commercial	$6,245.80
Rate for Payer: Kaiser Permanente Commercial	$4,629.24
Rate for Payer: Kaiser Permanente Medicaid	$3,747.48
Rate for Payer: MDX Hawaii PPO	$7,127.56
Rate for Payer: University Health Alliance Commercial	$4,114.88

Partial Knee Oxford TwinPeg Cmntd Fem MD PMA 161469 [3640889]

Facility

$7,348.00

Service Code	HCPCS C1776
Hospital Charge Code	3640889
Hospital Revenue Code	278
Min. Negotiated Rate	$4,114.88
Max. Negotiated Rate	$7,127.56
Rate for Payer: Cash Price	$4,776.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,143.60
Rate for Payer: Health Management Network Commercial	$6,245.80
Rate for Payer: MDX Hawaii PPO	$7,127.56
Rate for Payer: University Health Alliance Commercial	$4,114.88

Partial Knee Oxford TwinPeg Cmntd Fem XLG PMA 161471 [3642065]

Facility

$7,348.00

Service Code	HCPCS C1776
Hospital Charge Code	3642065
Hospital Revenue Code	278
Min. Negotiated Rate	$3,747.48
Max. Negotiated Rate	$7,127.56
Rate for Payer: Cash Price	$4,776.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,143.60
Rate for Payer: Health Management Network Commercial	$6,245.80
Rate for Payer: Kaiser Permanente Commercial	$4,629.24
Rate for Payer: Kaiser Permanente Medicaid	$3,747.48
Rate for Payer: MDX Hawaii PPO	$7,127.56
Rate for Payer: University Health Alliance Commercial	$4,114.88

Partial Knee Oxford TwinPeg Cmntd Fem XLG PMA 161471 [3642065]

Facility

$7,348.00

Service Code	HCPCS C1776
Hospital Charge Code	3642065
Hospital Revenue Code	278
Min. Negotiated Rate	$4,114.88
Max. Negotiated Rate	$7,127.56
Rate for Payer: Cash Price	$4,776.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,143.60
Rate for Payer: Health Management Network Commercial	$6,245.80
Rate for Payer: MDX Hawaii PPO	$7,127.56
Rate for Payer: University Health Alliance Commercial	$4,114.88

Partial Knee Oxford Uni Tib Tray Cmntd SzC 154723 [3640888]

Facility

$7,278.00

Service Code	HCPCS C1776
Hospital Charge Code	3640888
Hospital Revenue Code	278
Min. Negotiated Rate	$4,075.68
Max. Negotiated Rate	$7,059.66
Rate for Payer: Cash Price	$4,730.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,094.60
Rate for Payer: Health Management Network Commercial	$6,186.30
Rate for Payer: MDX Hawaii PPO	$7,059.66
Rate for Payer: University Health Alliance Commercial	$4,075.68

Partial Knee Oxford Uni Tib Tray Cmntd SzC 154723 [3640888]

Facility

$7,278.00

Service Code	HCPCS C1776
Hospital Charge Code	3640888
Hospital Revenue Code	278
Min. Negotiated Rate	$3,711.78
Max. Negotiated Rate	$7,059.66
Rate for Payer: Cash Price	$4,730.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,094.60
Rate for Payer: Health Management Network Commercial	$6,186.30
Rate for Payer: Kaiser Permanente Commercial	$4,585.14
Rate for Payer: Kaiser Permanente Medicaid	$3,711.78
Rate for Payer: MDX Hawaii PPO	$7,059.66
Rate for Payer: University Health Alliance Commercial	$4,075.68

Partial Knee Oxford Uni Tib Tray Cmntd SzC LM 154722 [3641029]

Facility

$5,073.75

Service Code	HCPCS C1776
Hospital Charge Code	3641029
Hospital Revenue Code	278
Min. Negotiated Rate	$2,841.30
Max. Negotiated Rate	$4,921.54
Rate for Payer: Cash Price	$3,297.94
Rate for Payer: Hawaii Western Management Group Commercial	$3,551.62
Rate for Payer: Health Management Network Commercial	$4,312.69
Rate for Payer: MDX Hawaii PPO	$4,921.54
Rate for Payer: University Health Alliance Commercial	$2,841.30

Partial Knee Oxford Uni Tib Tray Cmntd SzC LM 154722 [3641029]

Facility

$5,073.75

Service Code	HCPCS C1776
Hospital Charge Code	3641029
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.61
Max. Negotiated Rate	$4,921.54
Rate for Payer: Cash Price	$3,297.94
Rate for Payer: Hawaii Western Management Group Commercial	$3,551.62
Rate for Payer: Health Management Network Commercial	$4,312.69
Rate for Payer: Kaiser Permanente Commercial	$3,196.46
Rate for Payer: Kaiser Permanente Medicaid	$2,587.61
Rate for Payer: MDX Hawaii PPO	$4,921.54
Rate for Payer: University Health Alliance Commercial	$2,841.30

Partial Knee Oxford Uni Tib Tray Cmntd SzD LM 154724 [3641260]

Facility

$7,278.00

Service Code	HCPCS C1776
Hospital Charge Code	3641260
Hospital Revenue Code	278
Min. Negotiated Rate	$3,711.78
Max. Negotiated Rate	$7,059.66
Rate for Payer: Cash Price	$4,730.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,094.60
Rate for Payer: Health Management Network Commercial	$6,186.30
Rate for Payer: Kaiser Permanente Commercial	$4,585.14
Rate for Payer: Kaiser Permanente Medicaid	$3,711.78
Rate for Payer: MDX Hawaii PPO	$7,059.66
Rate for Payer: University Health Alliance Commercial	$4,075.68

Partial Knee Oxford Uni Tib Tray Cmntd SzD LM 154724 [3641260]

Facility

$7,278.00

Service Code	HCPCS C1776
Hospital Charge Code	3641260
Hospital Revenue Code	278
Min. Negotiated Rate	$4,075.68
Max. Negotiated Rate	$7,059.66
Rate for Payer: Cash Price	$4,730.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,094.60
Rate for Payer: Health Management Network Commercial	$6,186.30
Rate for Payer: MDX Hawaii PPO	$7,059.66
Rate for Payer: University Health Alliance Commercial	$4,075.68

Partial Knee Oxford Uni Tib Tray Cmntd Sz D RM 154725 [3641417]

Facility

$7,278.00

Service Code	HCPCS C1776
Hospital Charge Code	3641417
Hospital Revenue Code	278
Min. Negotiated Rate	$4,075.68
Max. Negotiated Rate	$7,059.66
Rate for Payer: Cash Price	$4,730.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,094.60
Rate for Payer: Health Management Network Commercial	$6,186.30
Rate for Payer: MDX Hawaii PPO	$7,059.66
Rate for Payer: University Health Alliance Commercial	$4,075.68

Partial Knee Oxford Uni Tib Tray Cmntd Sz D RM 154725 [3641417]

Facility

$7,278.00

Service Code	HCPCS C1776
Hospital Charge Code	3641417
Hospital Revenue Code	278
Min. Negotiated Rate	$3,711.78
Max. Negotiated Rate	$7,059.66
Rate for Payer: Cash Price	$4,730.70
Rate for Payer: Hawaii Western Management Group Commercial	$5,094.60
Rate for Payer: Health Management Network Commercial	$6,186.30
Rate for Payer: Kaiser Permanente Commercial	$4,585.14
Rate for Payer: Kaiser Permanente Medicaid	$3,711.78
Rate for Payer: MDX Hawaii PPO	$7,059.66
Rate for Payer: University Health Alliance Commercial	$4,075.68

Partial Knee Oxford Uni Tib Tray Cmntd Sz E LM 154726 [3643160]

Facility

$5,148.75

Service Code	HCPCS C1776
Hospital Charge Code	3643160
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.86
Max. Negotiated Rate	$4,994.29
Rate for Payer: Cash Price	$3,346.69
Rate for Payer: Hawaii Western Management Group Commercial	$3,604.12
Rate for Payer: Health Management Network Commercial	$4,376.44
Rate for Payer: Kaiser Permanente Commercial	$3,243.71
Rate for Payer: Kaiser Permanente Medicaid	$2,625.86
Rate for Payer: MDX Hawaii PPO	$4,994.29
Rate for Payer: University Health Alliance Commercial	$2,883.30

Partial Knee Oxford Uni Tib Tray Cmntd Sz E LM 154726 [3643160]

Facility

$5,148.75

Service Code	HCPCS C1776
Hospital Charge Code	3643160
Hospital Revenue Code	278
Min. Negotiated Rate	$2,883.30
Max. Negotiated Rate	$4,994.29
Rate for Payer: Cash Price	$3,346.69
Rate for Payer: Hawaii Western Management Group Commercial	$3,604.12
Rate for Payer: Health Management Network Commercial	$4,376.44
Rate for Payer: MDX Hawaii PPO	$4,994.29
Rate for Payer: University Health Alliance Commercial	$2,883.30

Know your out-of-pocket cost for care.

All Charges