Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Tk Nexgen Por Tm Patella 10mmx38mm [3643467]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3643467
Hospital Revenue Code	278
Min. Negotiated Rate	$3,010.00
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Tk Psn All Poly Pat Ve 29mm x 8.0mm 42-5402-000-29 [3644147]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Tk Psn All Poly Pat Ve 29mm x 8.0mm 42-5402-000-29 [3644147]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3644147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Tk Psn Asf Cps Ve 14mm Rt 3-5 Cd 42-5226-004-14 [3643991]

Facility

$3,670.00

Service Code	HCPCS C1776
Hospital Charge Code	3643991
Hospital Revenue Code	278
Min. Negotiated Rate	$2,055.20
Max. Negotiated Rate	$3,559.90
Rate for Payer: Cash Price	$2,385.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,569.00
Rate for Payer: Health Management Network Commercial	$3,119.50
Rate for Payer: MDX Hawaii PPO	$3,559.90
Rate for Payer: University Health Alliance Commercial	$2,055.20

Tk Psn Asf Cps Ve 14mm Rt 3-5 Cd 42-5226-004-14 [3643991]

Facility

$3,670.00

Service Code	HCPCS C1776
Hospital Charge Code	3643991
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.70
Max. Negotiated Rate	$3,559.90
Rate for Payer: Cash Price	$2,385.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,569.00
Rate for Payer: Health Management Network Commercial	$3,119.50
Rate for Payer: Kaiser Permanente Commercial	$2,312.10
Rate for Payer: Kaiser Permanente Medicaid	$1,871.70
Rate for Payer: MDX Hawaii PPO	$3,559.90
Rate for Payer: University Health Alliance Commercial	$2,055.20

Tk Psn Asf Mc Ve 10mm Lt 8-9 Cd 42-5121-005-10 [3644034]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3644034
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

Tk Psn Asf Mc Ve 10mm Lt 8-9 Cd 42-5121-005-10 [3644034]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3644034
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.75
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: Kaiser Permanente Commercial	$2,094.75
Rate for Payer: Kaiser Permanente Medicaid	$1,695.75
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Tk Psn Asf Mc Ve 13mm Lt 4-5 Cd 42-5121-003-13 [3644067]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644067
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Tk Psn Asf Mc Ve 13mm Lt 4-5 Cd 42-5121-003-13 [3644067]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644067
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Tk Psn Canary Tibial Ext 14mmx58mm [3643369]

Facility

$3,100.00

Service Code	HCPCS C1889
Hospital Charge Code	3643369
Hospital Revenue Code	278
Min. Negotiated Rate	$1,581.00
Max. Negotiated Rate	$3,007.00
Rate for Payer: Cash Price	$2,015.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,170.00
Rate for Payer: Health Management Network Commercial	$2,635.00
Rate for Payer: Kaiser Permanente Commercial	$1,953.00
Rate for Payer: Kaiser Permanente Medicaid	$1,581.00
Rate for Payer: MDX Hawaii PPO	$3,007.00
Rate for Payer: University Health Alliance Commercial	$1,736.00

Tk Psn Canary Tibial Ext 14mmx58mm [3643369]

Facility

$3,100.00

Service Code	HCPCS C1889
Hospital Charge Code	3643369
Hospital Revenue Code	278
Min. Negotiated Rate	$1,736.00
Max. Negotiated Rate	$3,007.00
Rate for Payer: Cash Price	$2,015.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,170.00
Rate for Payer: Health Management Network Commercial	$2,635.00
Rate for Payer: MDX Hawaii PPO	$3,007.00
Rate for Payer: University Health Alliance Commercial	$1,736.00

TK PSN Fem Cr Cmt Tin Std Sz5 Cd LT 42-5726-058-01 [3644223]

Facility

$16,203.00

Service Code	HCPCS C1776
Hospital Charge Code	3644223
Hospital Revenue Code	278
Min. Negotiated Rate	$8,263.53
Max. Negotiated Rate	$15,716.91
Rate for Payer: Cash Price	$10,531.95
Rate for Payer: Hawaii Western Management Group Commercial	$11,342.10
Rate for Payer: Health Management Network Commercial	$13,772.55
Rate for Payer: Kaiser Permanente Commercial	$10,207.89
Rate for Payer: Kaiser Permanente Medicaid	$8,263.53
Rate for Payer: MDX Hawaii PPO	$15,716.91
Rate for Payer: University Health Alliance Commercial	$9,073.68

TK PSN Fem Cr Cmt Tin Std Sz5 Cd LT 42-5726-058-01 [3644223]

Facility

$16,203.00

Service Code	HCPCS C1776
Hospital Charge Code	3644223
Hospital Revenue Code	278
Min. Negotiated Rate	$9,073.68
Max. Negotiated Rate	$15,716.91
Rate for Payer: Cash Price	$10,531.95
Rate for Payer: Hawaii Western Management Group Commercial	$11,342.10
Rate for Payer: Health Management Network Commercial	$13,772.55
Rate for Payer: MDX Hawaii PPO	$15,716.91
Rate for Payer: University Health Alliance Commercial	$9,073.68

Tk Psn Fem Cr Pps Ccr Std Sz4 Rt 42-5086-056-02 [3644069]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644069
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Tk Psn Fem Cr Pps Ccr Std Sz4 Rt 42-5086-056-02 [3644069]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644069
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Tk Psn Rev 3mm Offset Stem Ext 13x135mm 42-5603-135-13 [3643982]

Facility

$5,787.50

Service Code	HCPCS C1776
Hospital Charge Code	3643982
Hospital Revenue Code	278
Min. Negotiated Rate	$3,241.00
Max. Negotiated Rate	$5,613.88
Rate for Payer: Cash Price	$3,761.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,051.25
Rate for Payer: Health Management Network Commercial	$4,919.38
Rate for Payer: MDX Hawaii PPO	$5,613.88
Rate for Payer: University Health Alliance Commercial	$3,241.00

Tk Psn Rev 3mm Offset Stem Ext 13x135mm 42-5603-135-13 [3643982]

Facility

$5,787.50

Service Code	HCPCS C1776
Hospital Charge Code	3643982
Hospital Revenue Code	278
Min. Negotiated Rate	$2,951.62
Max. Negotiated Rate	$5,613.88
Rate for Payer: Cash Price	$3,761.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,051.25
Rate for Payer: Health Management Network Commercial	$4,919.38
Rate for Payer: Kaiser Permanente Commercial	$3,646.12
Rate for Payer: Kaiser Permanente Medicaid	$2,951.62
Rate for Payer: MDX Hawaii PPO	$5,613.88
Rate for Payer: University Health Alliance Commercial	$3,241.00

Tk Psn Rev Tib Fixed Keel Cmt Sz C Rt 42-5420-064-02 [3643983]

Facility

$6,225.00

Service Code	HCPCS C1776
Hospital Charge Code	3643983
Hospital Revenue Code	278
Min. Negotiated Rate	$3,486.00
Max. Negotiated Rate	$6,038.25
Rate for Payer: Cash Price	$4,046.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,357.50
Rate for Payer: Health Management Network Commercial	$5,291.25
Rate for Payer: MDX Hawaii PPO	$6,038.25
Rate for Payer: University Health Alliance Commercial	$3,486.00

Tk Psn Rev Tib Fixed Keel Cmt Sz C Rt 42-5420-064-02 [3643983]

Facility

$6,225.00

Service Code	HCPCS C1776
Hospital Charge Code	3643983
Hospital Revenue Code	278
Min. Negotiated Rate	$3,174.75
Max. Negotiated Rate	$6,038.25
Rate for Payer: Cash Price	$4,046.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,357.50
Rate for Payer: Health Management Network Commercial	$5,291.25
Rate for Payer: Kaiser Permanente Commercial	$3,921.75
Rate for Payer: Kaiser Permanente Medicaid	$3,174.75
Rate for Payer: MDX Hawaii PPO	$6,038.25
Rate for Payer: University Health Alliance Commercial	$3,486.00

Tk Traiathlon Tibial Aug Half Block Sz5 5mm [3643945]

Facility

$2,653.90

Service Code	HCPCS C1769
Hospital Charge Code	3643945
Hospital Revenue Code	272
Min. Negotiated Rate	$2,255.82
Max. Negotiated Rate	$2,574.28
Rate for Payer: Cash Price	$1,725.04
Rate for Payer: Health Management Network Commercial	$2,255.82
Rate for Payer: MDX Hawaii PPO	$2,574.28

Tk Traiathlon Tibial Aug Half Block Sz5 5mm [3643945]

Facility

$2,653.90

Service Code	HCPCS C1769
Hospital Charge Code	3643945
Hospital Revenue Code	272
Min. Negotiated Rate	$1,353.49
Max. Negotiated Rate	$2,574.28
Rate for Payer: Cash Price	$1,725.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,521.20
Rate for Payer: Health Management Network Commercial	$2,255.82
Rate for Payer: Kaiser Permanente Commercial	$1,671.96
Rate for Payer: Kaiser Permanente Medicaid	$1,353.49
Rate for Payer: MDX Hawaii PPO	$2,574.28
Rate for Payer: University Health Alliance Commercial	$1,934.43

Tk Triathlon Fluted Steam 18mmx100mm Ts [3643946]

Facility

$3,025.98

Service Code	HCPCS C1769
Hospital Charge Code	3643946
Hospital Revenue Code	272
Min. Negotiated Rate	$1,543.25
Max. Negotiated Rate	$2,935.20
Rate for Payer: Cash Price	$1,966.89
Rate for Payer: Hawaii Western Management Group Commercial	$2,874.68
Rate for Payer: Health Management Network Commercial	$2,572.08
Rate for Payer: Kaiser Permanente Commercial	$1,906.37
Rate for Payer: Kaiser Permanente Medicaid	$1,543.25
Rate for Payer: MDX Hawaii PPO	$2,935.20
Rate for Payer: University Health Alliance Commercial	$2,205.64

Tk Triathlon Fluted Steam 18mmx100mm Ts [3643946]

Facility

$3,025.98

Service Code	HCPCS C1769
Hospital Charge Code	3643946
Hospital Revenue Code	272
Min. Negotiated Rate	$2,572.08
Max. Negotiated Rate	$2,935.20
Rate for Payer: Cash Price	$1,966.89
Rate for Payer: Health Management Network Commercial	$2,572.08
Rate for Payer: MDX Hawaii PPO	$2,935.20

Tk Triathlon Tibial Aug Half Block Sz5 5mm [3643944]

Facility

$2,653.90

Service Code	HCPCS C1769
Hospital Charge Code	3643944
Hospital Revenue Code	272
Min. Negotiated Rate	$1,353.49
Max. Negotiated Rate	$2,574.28
Rate for Payer: Cash Price	$1,725.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,521.20
Rate for Payer: Health Management Network Commercial	$2,255.82
Rate for Payer: Kaiser Permanente Commercial	$1,671.96
Rate for Payer: Kaiser Permanente Medicaid	$1,353.49
Rate for Payer: MDX Hawaii PPO	$2,574.28
Rate for Payer: University Health Alliance Commercial	$1,934.43

Tk Triathlon Tibial Aug Half Block Sz5 5mm [3643944]

Facility

$2,653.90

Service Code	HCPCS C1769
Hospital Charge Code	3643944
Hospital Revenue Code	272
Min. Negotiated Rate	$2,255.82
Max. Negotiated Rate	$2,574.28
Rate for Payer: Cash Price	$1,725.04
Rate for Payer: Health Management Network Commercial	$2,255.82
Rate for Payer: MDX Hawaii PPO	$2,574.28

Know your out-of-pocket cost for care.

All Charges