Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$2,035.15
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 Delta Cer Femoral Head 28mm +3mm T1 6501157 [3643012]

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	3643012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.50
Max. Negotiated Rate	$3,055.50
Rate for Payer: Cash Price	$2,047.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.00
Rate for Payer: Health Management Network Commercial	$2,677.50
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,606.50
Rate for Payer: MDX Hawaii PPO	$3,055.50
Rate for Payer: University Health Alliance Commercial	$1,764.00

Total Hip Delta Cer Femoral Head 28mm +3mm T1 6501157 [3643012]

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	3643012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.00
Max. Negotiated Rate	$3,055.50
Rate for Payer: Cash Price	$2,047.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.00
Rate for Payer: Health Management Network Commercial	$2,677.50
Rate for Payer: MDX Hawaii PPO	$3,055.50
Rate for Payer: University Health Alliance Commercial	$1,764.00

Total Hip Delta Cer Femoral Head 28mm -3mm T1 650-1159 [3643319]

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	3643319
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.50
Max. Negotiated Rate	$3,055.50
Rate for Payer: Cash Price	$2,047.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.00
Rate for Payer: Health Management Network Commercial	$2,677.50
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,606.50
Rate for Payer: MDX Hawaii PPO	$3,055.50
Rate for Payer: University Health Alliance Commercial	$1,764.00

Total Hip Delta Cer Femoral Head 28mm -3mm T1 650-1159 [3643319]

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	3643319
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.00
Max. Negotiated Rate	$3,055.50
Rate for Payer: Cash Price	$2,047.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.00
Rate for Payer: Health Management Network Commercial	$2,677.50
Rate for Payer: MDX Hawaii PPO	$3,055.50
Rate for Payer: University Health Alliance Commercial	$1,764.00

Total Hip Drill Bit 3.2mmX20mm Rnglc+Acet 31-323220 [3641561]

Facility

$463.13

Hospital Charge Code	3641561
Hospital Revenue Code	272
Min. Negotiated Rate	$393.66
Max. Negotiated Rate	$449.24
Rate for Payer: Cash Price	$301.03
Rate for Payer: Health Management Network Commercial	$393.66
Rate for Payer: MDX Hawaii PPO	$449.24

Total Hip Drill Bit 3.2mmX20mm Rnglc+Acet 31-323220 [3641561]

Facility

$463.13

Hospital Charge Code	3641561
Hospital Revenue Code	272
Min. Negotiated Rate	$236.20
Max. Negotiated Rate	$449.24
Rate for Payer: Cash Price	$301.03
Rate for Payer: Hawaii Western Management Group Commercial	$439.97
Rate for Payer: Health Management Network Commercial	$393.66
Rate for Payer: Kaiser Permanente Commercial	$291.77
Rate for Payer: Kaiser Permanente Medicaid	$236.20
Rate for Payer: MDX Hawaii PPO	$449.24
Rate for Payer: University Health Alliance Commercial	$337.58

Total Hip Drill Bit 3.2mmX30mm Rnglc+Acet 31-323230 [3641650]

Facility

$649.63

Hospital Charge Code	3641650
Hospital Revenue Code	272
Min. Negotiated Rate	$331.31
Max. Negotiated Rate	$630.14
Rate for Payer: Cash Price	$422.26
Rate for Payer: Hawaii Western Management Group Commercial	$617.15
Rate for Payer: Health Management Network Commercial	$552.19
Rate for Payer: Kaiser Permanente Commercial	$409.27
Rate for Payer: Kaiser Permanente Medicaid	$331.31
Rate for Payer: MDX Hawaii PPO	$630.14
Rate for Payer: University Health Alliance Commercial	$473.52

Total Hip Drill Bit 3.2mmX30mm Rnglc+Acet 31-323230 [3641650]

Facility

$649.63

Hospital Charge Code	3641650
Hospital Revenue Code	272
Min. Negotiated Rate	$552.19
Max. Negotiated Rate	$630.14
Rate for Payer: Cash Price	$422.26
Rate for Payer: Health Management Network Commercial	$552.19
Rate for Payer: MDX Hawaii PPO	$630.14

Total Hip Drill Bit 3.2mmX40mm Rnglc+Acet 31-323240 [3641562]

Facility

$683.92

Hospital Charge Code	3641562
Hospital Revenue Code	272
Min. Negotiated Rate	$348.80
Max. Negotiated Rate	$663.40
Rate for Payer: Cash Price	$444.55
Rate for Payer: Hawaii Western Management Group Commercial	$649.72
Rate for Payer: Health Management Network Commercial	$581.33
Rate for Payer: Kaiser Permanente Commercial	$430.87
Rate for Payer: Kaiser Permanente Medicaid	$348.80
Rate for Payer: MDX Hawaii PPO	$663.40
Rate for Payer: University Health Alliance Commercial	$498.51

Total Hip Drill Bit 3.2mmX40mm Rnglc+Acet 31-323240 [3641562]

Facility

$683.92

Hospital Charge Code	3641562
Hospital Revenue Code	272
Min. Negotiated Rate	$581.33
Max. Negotiated Rate	$663.40
Rate for Payer: Cash Price	$444.55
Rate for Payer: Health Management Network Commercial	$581.33
Rate for Payer: MDX Hawaii PPO	$663.40

Total Hip Drill Bit RNGLC +ACET 3.2mm x 50mm 31-323250 [3643862]

Facility

$683.92

Hospital Charge Code	3643862
Hospital Revenue Code	272
Min. Negotiated Rate	$348.80
Max. Negotiated Rate	$663.40
Rate for Payer: Cash Price	$444.55
Rate for Payer: Hawaii Western Management Group Commercial	$649.72
Rate for Payer: Health Management Network Commercial	$581.33
Rate for Payer: Kaiser Permanente Commercial	$430.87
Rate for Payer: Kaiser Permanente Medicaid	$348.80
Rate for Payer: MDX Hawaii PPO	$663.40
Rate for Payer: University Health Alliance Commercial	$498.51

Total Hip Drill Bit RNGLC +ACET 3.2mm x 50mm 31-323250 [3643862]

Facility

$683.92

Hospital Charge Code	3643862
Hospital Revenue Code	272
Min. Negotiated Rate	$581.33
Max. Negotiated Rate	$663.40
Rate for Payer: Cash Price	$444.55
Rate for Payer: Health Management Network Commercial	$581.33
Rate for Payer: MDX Hawaii PPO	$663.40

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 10 193110 [3642151]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642151
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 10 193110 [3642151]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642151
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 11 193111 [3642776]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 11 193111 [3642776]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 12 193112 [3642916]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3642916
Hospital Revenue Code	278
Min. Negotiated Rate	$4,515.03
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: Kaiser Permanente Commercial	$5,577.39
Rate for Payer: Kaiser Permanente Medicaid	$4,515.03
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 12 193112 [3642916]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3642916
Hospital Revenue Code	278
Min. Negotiated Rate	$4,957.68
Max. Negotiated Rate	$8,587.41
Rate for Payer: Cash Price	$5,754.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,197.10
Rate for Payer: Health Management Network Commercial	$7,525.05
Rate for Payer: MDX Hawaii PPO	$8,587.41
Rate for Payer: University Health Alliance Commercial	$4,957.68

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 13 193113 [3642908]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642908
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 13 193113 [3642908]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642908
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 14 193114 [3642613]

Facility

$14,121.25

Service Code	HCPCS C1776
Hospital Charge Code	3642613
Hospital Revenue Code	278
Min. Negotiated Rate	$7,201.84
Max. Negotiated Rate	$13,697.61
Rate for Payer: Cash Price	$9,178.81
Rate for Payer: Hawaii Western Management Group Commercial	$9,884.88
Rate for Payer: Health Management Network Commercial	$12,003.06
Rate for Payer: Kaiser Permanente Commercial	$8,896.39
Rate for Payer: Kaiser Permanente Medicaid	$7,201.84
Rate for Payer: MDX Hawaii PPO	$13,697.61
Rate for Payer: University Health Alliance Commercial	$7,907.90

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 14 193114 [3642613]

Facility

$14,121.25

Service Code	HCPCS C1776
Hospital Charge Code	3642613
Hospital Revenue Code	278
Min. Negotiated Rate	$7,907.90
Max. Negotiated Rate	$13,697.61
Rate for Payer: Cash Price	$9,178.81
Rate for Payer: Hawaii Western Management Group Commercial	$9,884.88
Rate for Payer: Health Management Network Commercial	$12,003.06
Rate for Payer: MDX Hawaii PPO	$13,697.61
Rate for Payer: University Health Alliance Commercial	$7,907.90

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 9 193109 [3642130]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642130
Hospital Revenue Code	278
Min. Negotiated Rate	$7,700.00
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Total Hip Echo Bi-Metric MP FP HO Femoral Stem Sz 9 193109 [3642130]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642130
Hospital Revenue Code	278
Min. Negotiated Rate	$7,012.50
Max. Negotiated Rate	$13,337.50
Rate for Payer: Cash Price	$8,937.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,625.00
Rate for Payer: Health Management Network Commercial	$11,687.50
Rate for Payer: Kaiser Permanente Commercial	$8,662.50
Rate for Payer: Kaiser Permanente Medicaid	$7,012.50
Rate for Payer: MDX Hawaii PPO	$13,337.50
Rate for Payer: University Health Alliance Commercial	$7,700.00

Know your out-of-pocket cost for care.

All Charges