Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Hip Echo Bi-Metric MP FP SO Femoral Stem Sz 10 193010 [3642633]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642633
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 SO Femoral Stem Sz 10 193010 [3642633]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642633
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 SO Femoral Stem Sz 11 193011 [3641563]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3641563
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 SO Femoral Stem Sz 11 193011 [3641563]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3641563
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 SO Femoral Stem Sz 12 193012 [3641232]

Facility

$20,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3641232
Hospital Revenue Code	278
Min. Negotiated Rate	$11,621.68
Max. Negotiated Rate	$20,130.41
Rate for Payer: Cash Price	$13,489.45
Rate for Payer: Hawaii Western Management Group Commercial	$14,527.10
Rate for Payer: Health Management Network Commercial	$17,640.05
Rate for Payer: MDX Hawaii PPO	$20,130.41
Rate for Payer: University Health Alliance Commercial	$11,621.68

Total Hip Echo Bi Metric MP FP SO Femoral Stem Sz 12 193012 [3641232]

Facility

$20,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3641232
Hospital Revenue Code	278
Min. Negotiated Rate	$10,584.03
Max. Negotiated Rate	$20,130.41
Rate for Payer: Cash Price	$13,489.45
Rate for Payer: Hawaii Western Management Group Commercial	$14,527.10
Rate for Payer: Health Management Network Commercial	$17,640.05
Rate for Payer: Kaiser Permanente Commercial	$13,074.39
Rate for Payer: Kaiser Permanente Medicaid	$10,584.03
Rate for Payer: MDX Hawaii PPO	$20,130.41
Rate for Payer: University Health Alliance Commercial	$11,621.68

Total Hip Echo Bi Metric MP FP SO Femoral Stem Sz 13 193013 [3642442]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642442
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 SO Femoral Stem Sz 13 193013 [3642442]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642442
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 SO Femoral Stem Sz 14 193014 [3643013]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643013
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 SO Femoral Stem Sz 14 193014 [3643013]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3643013
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 SO Femoral Stem Sz 7 193007 [3641365]

Facility

$14,121.25

Service Code	HCPCS C1776
Hospital Charge Code	3641365
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 SO Femoral Stem Sz 7 193007 [3641365]

Facility

$14,121.25

Service Code	HCPCS C1776
Hospital Charge Code	3641365
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 SO Femoral Stem Sz 9 193009 [3641371]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3641371
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 SO Femoral Stem Sz 9 193009 [3641371]

Facility

$13,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3641371
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 G7 Acet Liner +5mm Offset 40mm Sz G 30154007 [3644430]

Facility

$10,428.00

Service Code	HCPCS C1776
Hospital Charge Code	3644430
Hospital Revenue Code	278
Min. Negotiated Rate	$5,839.68
Max. Negotiated Rate	$10,115.16
Rate for Payer: Cash Price	$6,778.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,299.60
Rate for Payer: Health Management Network Commercial	$8,863.80
Rate for Payer: MDX Hawaii PPO	$10,115.16
Rate for Payer: University Health Alliance Commercial	$5,839.68

Total Hip G7 Acet Liner +5mm Offset 40mm Sz G 30154007 [3644430]

Facility

$10,428.00

Service Code	HCPCS C1776
Hospital Charge Code	3644430
Hospital Revenue Code	278
Min. Negotiated Rate	$5,318.28
Max. Negotiated Rate	$10,115.16
Rate for Payer: Cash Price	$6,778.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,299.60
Rate for Payer: Health Management Network Commercial	$8,863.80
Rate for Payer: Kaiser Permanente Commercial	$6,569.64
Rate for Payer: Kaiser Permanente Medicaid	$5,318.28
Rate for Payer: MDX Hawaii PPO	$10,115.16
Rate for Payer: University Health Alliance Commercial	$5,839.68

Total Hip G7 Acet Liner High Wall Vit E 36mm E 30123605 [3644032]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3644032
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner High Wall Vit E 36mm E 30123605 [3644032]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3644032
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.53
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: Kaiser Permanente Commercial	$3,151.89
Rate for Payer: Kaiser Permanente Medicaid	$2,551.53
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner High Wall Vit E Sz F 36mm 30123606 [3643668]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3643668
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.53
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: Kaiser Permanente Commercial	$3,151.89
Rate for Payer: Kaiser Permanente Medicaid	$2,551.53
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner High Wall Vit E Sz F 36mm 30123606 [3643668]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3643668
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner Neutral Vit E 32mm C 30103203 [3642518]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642518
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.53
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: Kaiser Permanente Commercial	$3,151.89
Rate for Payer: Kaiser Permanente Medicaid	$2,551.53
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner Neutral Vit E 32mm C 30103203 [3642518]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642518
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner Neutral Vit E 36mm D 30103604 [3642150]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642150
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.53
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: Kaiser Permanente Commercial	$3,151.89
Rate for Payer: Kaiser Permanente Medicaid	$2,551.53
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner Neutral Vit E 36mm D 30103604 [3642150]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642150
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Total Hip G7 Acet Liner Neutral Vit E 36mm E 30103605 [3642440]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642440
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Know your out-of-pocket cost for care.

All Charges