Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Hip Biolox Delta Fem Hd 36mm -3.5mm 00-8775-036-01 [3644451]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3644451
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.15
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: Kaiser Permanente Commercial	$2,514.01
Rate for Payer: Kaiser Permanente Medicaid	$2,035.15
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip Biolox Delta Fem Hd 36mm -3.5mm 00-8775-036-01 [3644451]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3644451
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip BIOLOX Delta Fem HD 36mm +3.5mm 00-8775-036-03 [3641105]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3641105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip BIOLOX Delta Fem HD 36mm +3.5mm 00-8775-036-03 [3641105]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3641105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.15
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: Kaiser Permanente Commercial	$2,514.01
Rate for Payer: Kaiser Permanente Medicaid	$2,035.15
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip BIOLOX Delta Fem HD 36mm +7mm 00-8775-036-04 [3641093]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3641093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip BIOLOX Delta Fem HD 36mm +7mm 00-8775-036-04 [3641093]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3641093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.15
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: Kaiser Permanente Commercial	$2,514.01
Rate for Payer: Kaiser Permanente Medicaid	$2,035.15
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip Biolox Delta Fem Head 32mm -3.5 00-8775-032-01 [3644830]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3644830
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip Biolox Delta Fem Head 32mm -3.5 00-8775-032-01 [3644830]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3644830
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.15
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: Kaiser Permanente Commercial	$2,514.01
Rate for Payer: Kaiser Permanente Medicaid	$2,035.15
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Total Hip Biolox Option Type1 Taper 0mm 6501066 [3641370]

Facility

$1,010.63

Service Code	HCPCS C1776
Hospital Charge Code	3641370
Hospital Revenue Code	278
Min. Negotiated Rate	$565.95
Max. Negotiated Rate	$980.31
Rate for Payer: Cash Price	$656.91
Rate for Payer: Hawaii Western Management Group Commercial	$707.44
Rate for Payer: Health Management Network Commercial	$859.04
Rate for Payer: MDX Hawaii PPO	$980.31
Rate for Payer: University Health Alliance Commercial	$565.95

Total Hip Biolox Option Type1 Taper 0mm 6501066 [3641370]

Facility

$1,010.63

Service Code	HCPCS C1776
Hospital Charge Code	3641370
Hospital Revenue Code	278
Min. Negotiated Rate	$515.42
Max. Negotiated Rate	$980.31
Rate for Payer: Cash Price	$656.91
Rate for Payer: Hawaii Western Management Group Commercial	$707.44
Rate for Payer: Health Management Network Commercial	$859.04
Rate for Payer: Kaiser Permanente Commercial	$636.70
Rate for Payer: Kaiser Permanente Medicaid	$515.42
Rate for Payer: MDX Hawaii PPO	$980.31
Rate for Payer: University Health Alliance Commercial	$565.95

Total Hip Biolox Option Type1 Taper -3mm 6501065 [3641655]

Facility

$1,010.63

Service Code	HCPCS C1776
Hospital Charge Code	3641655
Hospital Revenue Code	278
Min. Negotiated Rate	$515.42
Max. Negotiated Rate	$980.31
Rate for Payer: Cash Price	$656.91
Rate for Payer: Hawaii Western Management Group Commercial	$707.44
Rate for Payer: Health Management Network Commercial	$859.04
Rate for Payer: Kaiser Permanente Commercial	$636.70
Rate for Payer: Kaiser Permanente Medicaid	$515.42
Rate for Payer: MDX Hawaii PPO	$980.31
Rate for Payer: University Health Alliance Commercial	$565.95

Total Hip Biolox Option Type1 Taper -3mm 6501065 [3641655]

Facility

$1,010.63

Service Code	HCPCS C1776
Hospital Charge Code	3641655
Hospital Revenue Code	278
Min. Negotiated Rate	$565.95
Max. Negotiated Rate	$980.31
Rate for Payer: Cash Price	$656.91
Rate for Payer: Hawaii Western Management Group Commercial	$707.44
Rate for Payer: Health Management Network Commercial	$859.04
Rate for Payer: MDX Hawaii PPO	$980.31
Rate for Payer: University Health Alliance Commercial	$565.95

Total Hip Biolox Option Type1 Taper -6mm 650-1064 [3641367]

Facility

$930.25

Service Code	HCPCS C1776
Hospital Charge Code	3641367
Hospital Revenue Code	278
Min. Negotiated Rate	$474.43
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$651.17
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: Kaiser Permanente Commercial	$586.06
Rate for Payer: Kaiser Permanente Medicaid	$474.43
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$520.94

Total Hip Biolox Option Type1 Taper -6mm 650-1064 [3641367]

Facility

$930.25

Service Code	HCPCS C1776
Hospital Charge Code	3641367
Hospital Revenue Code	278
Min. Negotiated Rate	$520.94
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$651.17
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$520.94

Total Hip Biolox Option Type1 Taper +6mm 650-1068 [3642409]

Facility

$930.25

Service Code	HCPCS C1776
Hospital Charge Code	3642409
Hospital Revenue Code	278
Min. Negotiated Rate	$474.43
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$651.17
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: Kaiser Permanente Commercial	$586.06
Rate for Payer: Kaiser Permanente Medicaid	$474.43
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$520.94

Total Hip Biolox Option Type1 Taper +6mm 650-1068 [3642409]

Facility

$930.25

Service Code	HCPCS C1776
Hospital Charge Code	3642409
Hospital Revenue Code	278
Min. Negotiated Rate	$520.94
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$651.17
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$520.94

Total Hip Bone Screw ST 6.5 x 20mm 00625006520 [3640122]

Facility

$553.44

Service Code	HCPCS C1713
Hospital Charge Code	3640122
Hospital Revenue Code	278
Min. Negotiated Rate	$282.25
Max. Negotiated Rate	$536.84
Rate for Payer: Cash Price	$359.74
Rate for Payer: Hawaii Western Management Group Commercial	$387.41
Rate for Payer: Health Management Network Commercial	$470.42
Rate for Payer: Kaiser Permanente Commercial	$348.67
Rate for Payer: Kaiser Permanente Medicaid	$282.25
Rate for Payer: MDX Hawaii PPO	$536.84
Rate for Payer: University Health Alliance Commercial	$309.93

Total Hip Bone Screw ST 6.5 x 20mm 00625006520 [3640122]

Facility

$553.44

Service Code	HCPCS C1713
Hospital Charge Code	3640122
Hospital Revenue Code	278
Min. Negotiated Rate	$309.93
Max. Negotiated Rate	$536.84
Rate for Payer: Cash Price	$359.74
Rate for Payer: Hawaii Western Management Group Commercial	$387.41
Rate for Payer: Health Management Network Commercial	$470.42
Rate for Payer: MDX Hawaii PPO	$536.84
Rate for Payer: University Health Alliance Commercial	$309.93

Total Hip Bone Screw ST 6.5 x 40mm 00-6250-065-40 [3642802]

Facility

$275.25

Service Code	HCPCS C1713
Hospital Charge Code	3642802
Hospital Revenue Code	278
Min. Negotiated Rate	$140.38
Max. Negotiated Rate	$266.99
Rate for Payer: Cash Price	$178.91
Rate for Payer: Hawaii Western Management Group Commercial	$192.68
Rate for Payer: Health Management Network Commercial	$233.96
Rate for Payer: Kaiser Permanente Commercial	$173.41
Rate for Payer: Kaiser Permanente Medicaid	$140.38
Rate for Payer: MDX Hawaii PPO	$266.99
Rate for Payer: University Health Alliance Commercial	$154.14

Total Hip Bone Screw ST 6.5 x 40mm 00-6250-065-40 [3642802]

Facility

$275.25

Service Code	HCPCS C1713
Hospital Charge Code	3642802
Hospital Revenue Code	278
Min. Negotiated Rate	$154.14
Max. Negotiated Rate	$266.99
Rate for Payer: Cash Price	$178.91
Rate for Payer: Hawaii Western Management Group Commercial	$192.68
Rate for Payer: Health Management Network Commercial	$233.96
Rate for Payer: MDX Hawaii PPO	$266.99
Rate for Payer: University Health Alliance Commercial	$154.14

Total Hip Cable Assy Cerclage SST 1.8mm X 559mm 00-2232-001-18 [3641368]

Facility

$2,421.94

Service Code	HCPCS C1776
Hospital Charge Code	3641368
Hospital Revenue Code	278
Min. Negotiated Rate	$1,235.19
Max. Negotiated Rate	$2,349.28
Rate for Payer: Cash Price	$1,574.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,695.36
Rate for Payer: Health Management Network Commercial	$2,058.65
Rate for Payer: Kaiser Permanente Commercial	$1,525.82
Rate for Payer: Kaiser Permanente Medicaid	$1,235.19
Rate for Payer: MDX Hawaii PPO	$2,349.28
Rate for Payer: University Health Alliance Commercial	$1,356.29

Total Hip Cable Assy Cerclage SST 1.8mm X 559mm 00-2232-001-18 [3641368]

Facility

$2,421.94

Service Code	HCPCS C1776
Hospital Charge Code	3641368
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.29
Max. Negotiated Rate	$2,349.28
Rate for Payer: Cash Price	$1,574.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,695.36
Rate for Payer: Health Management Network Commercial	$2,058.65
Rate for Payer: MDX Hawaii PPO	$2,349.28
Rate for Payer: University Health Alliance Commercial	$1,356.29

Total Hip C Taper Head Lfit 28mm +7.5 S-1400-HH84 [3644230]

Facility

$3,458.78

Service Code	HCPCS C1776
Hospital Charge Code	3644230
Hospital Revenue Code	278
Min. Negotiated Rate	$1,763.98
Max. Negotiated Rate	$3,355.02
Rate for Payer: Cash Price	$2,248.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,421.15
Rate for Payer: Health Management Network Commercial	$2,939.96
Rate for Payer: Kaiser Permanente Commercial	$2,179.03
Rate for Payer: Kaiser Permanente Medicaid	$1,763.98
Rate for Payer: MDX Hawaii PPO	$3,355.02
Rate for Payer: University Health Alliance Commercial	$1,936.92

Total Hip C Taper Head Lfit 28mm +7.5 S-1400-HH84 [3644230]

Facility

$3,458.78

Service Code	HCPCS C1776
Hospital Charge Code	3644230
Hospital Revenue Code	278
Min. Negotiated Rate	$1,936.92
Max. Negotiated Rate	$3,355.02
Rate for Payer: Cash Price	$2,248.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,421.15
Rate for Payer: Health Management Network Commercial	$2,939.96
Rate for Payer: MDX Hawaii PPO	$3,355.02
Rate for Payer: University Health Alliance Commercial	$1,936.92

Total Hip Delta Cer Femoral Head 28mm 0mm T1 650-1158 [3643217]

Facility

$3,990.50

Service Code	HCPCS C1776
Hospital Charge Code	3643217
Hospital Revenue Code	278
Min. Negotiated Rate	$2,234.68
Max. Negotiated Rate	$3,870.78
Rate for Payer: Cash Price	$2,593.83
Rate for Payer: Hawaii Western Management Group Commercial	$2,793.35
Rate for Payer: Health Management Network Commercial	$3,391.93
Rate for Payer: MDX Hawaii PPO	$3,870.78
Rate for Payer: University Health Alliance Commercial	$2,234.68

Know your out-of-pocket cost for care.

All Charges