Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Hip G7 Finned Acet Shell 4H 58mm G 110017106 [3642797]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642797
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 Finned Acet Shell 4H 58mm G 110017106 [3642797]

Facility

$5,003.00

Service Code	HCPCS C1776
Hospital Charge Code	3642797
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 Finned Acet Shell 4H 60mm G 110017107 [3643242]

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	3643242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,425.00
Rate for Payer: Cash Price	$1,625.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,750.00
Rate for Payer: Health Management Network Commercial	$2,125.00
Rate for Payer: Kaiser Permanente Commercial	$1,575.00
Rate for Payer: Kaiser Permanente Medicaid	$1,275.00
Rate for Payer: MDX Hawaii PPO	$2,425.00
Rate for Payer: University Health Alliance Commercial	$1,400.00

Total Hip G7 Finned Acet Shell 4H 60mm G 110017107 [3643242]

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	3643242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,425.00
Rate for Payer: Cash Price	$1,625.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,750.00
Rate for Payer: Health Management Network Commercial	$2,125.00
Rate for Payer: MDX Hawaii PPO	$2,425.00
Rate for Payer: University Health Alliance Commercial	$1,400.00

Total Hip G7 Longevity Neutral Liner 36mm F 20103606 [3642907]

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Charge Code	3642907
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,820.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$1,764.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

Total Hip G7 Longevity Neutral Liner 36mm F 20103606 [3642907]

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Charge Code	3642907
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,820.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

Total Hip G7 Osseo Ti Acet Shell 3 Hole 48mm Sz C 110010242 [3642129]

Facility

$9,170.00

Service Code	HCPCS C1776
Hospital Charge Code	3642129
Hospital Revenue Code	278
Min. Negotiated Rate	$5,135.20
Max. Negotiated Rate	$8,894.90
Rate for Payer: Cash Price	$5,960.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,419.00
Rate for Payer: Health Management Network Commercial	$7,794.50
Rate for Payer: MDX Hawaii PPO	$8,894.90
Rate for Payer: University Health Alliance Commercial	$5,135.20

Total Hip G7 Osseo Ti Acet Shell 3 Hole 48mm Sz C 110010242 [3642129]

Facility

$9,170.00

Service Code	HCPCS C1776
Hospital Charge Code	3642129
Hospital Revenue Code	278
Min. Negotiated Rate	$4,676.70
Max. Negotiated Rate	$8,894.90
Rate for Payer: Cash Price	$5,960.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,419.00
Rate for Payer: Health Management Network Commercial	$7,794.50
Rate for Payer: Kaiser Permanente Commercial	$5,777.10
Rate for Payer: Kaiser Permanente Medicaid	$4,676.70
Rate for Payer: MDX Hawaii PPO	$8,894.90
Rate for Payer: University Health Alliance Commercial	$5,135.20

Total Hip G7 Osseo Ti Acet Shell 3 Hole 50mm Sz D 110010243 [3641364]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641364
Hospital Revenue Code	278
Min. Negotiated Rate	$5,369.28
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 3 Hole 50mm Sz D 110010243 [3641364]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641364
Hospital Revenue Code	278
Min. Negotiated Rate	$4,889.88
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: Kaiser Permanente Commercial	$6,040.44
Rate for Payer: Kaiser Permanente Medicaid	$4,889.88
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 3 Hole 52mm Sz E 110010244 [3641761]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641761
Hospital Revenue Code	278
Min. Negotiated Rate	$5,369.28
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 3 Hole 52mm Sz E 110010244 [3641761]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641761
Hospital Revenue Code	278
Min. Negotiated Rate	$4,889.88
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: Kaiser Permanente Commercial	$6,040.44
Rate for Payer: Kaiser Permanente Medicaid	$4,889.88
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseoti Acet Shell 4H 58mm G 110010247 [3641229]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641229
Hospital Revenue Code	278
Min. Negotiated Rate	$5,369.28
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseoti Acet Shell 4H 58mm G 110010247 [3641229]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641229
Hospital Revenue Code	278
Min. Negotiated Rate	$4,889.88
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: Kaiser Permanente Commercial	$6,040.44
Rate for Payer: Kaiser Permanente Medicaid	$4,889.88
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 4 Hole 54mm Sz F 110010245 [3641651]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641651
Hospital Revenue Code	278
Min. Negotiated Rate	$5,369.28
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 4 Hole 54mm Sz F 110010245 [3641651]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641651
Hospital Revenue Code	278
Min. Negotiated Rate	$4,889.88
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: Kaiser Permanente Commercial	$6,040.44
Rate for Payer: Kaiser Permanente Medicaid	$4,889.88
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 4 Hole 56mm Sz F 110010246 [3641442]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641442
Hospital Revenue Code	278
Min. Negotiated Rate	$4,889.88
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: Kaiser Permanente Commercial	$6,040.44
Rate for Payer: Kaiser Permanente Medicaid	$4,889.88
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 4 Hole 56mm Sz F 110010246 [3641442]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641442
Hospital Revenue Code	278
Min. Negotiated Rate	$5,369.28
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 4 Hole 60mm Sz G 110010248 [3641369]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641369
Hospital Revenue Code	278
Min. Negotiated Rate	$4,889.88
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: Kaiser Permanente Commercial	$6,040.44
Rate for Payer: Kaiser Permanente Medicaid	$4,889.88
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell 4 Hole 60mm Sz G 110010248 [3641369]

Facility

$9,588.00

Service Code	HCPCS C1776
Hospital Charge Code	3641369
Hospital Revenue Code	278
Min. Negotiated Rate	$5,369.28
Max. Negotiated Rate	$9,300.36
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,711.60
Rate for Payer: Health Management Network Commercial	$8,149.80
Rate for Payer: MDX Hawaii PPO	$9,300.36
Rate for Payer: University Health Alliance Commercial	$5,369.28

Total Hip G7 Osseo Ti Acet Shell MLT HL 68mm Sz I 110010272 [3644951]

Facility

$13,053.00

Service Code	HCPCS C1776
Hospital Charge Code	3644951
Hospital Revenue Code	278
Min. Negotiated Rate	$6,657.03
Max. Negotiated Rate	$12,661.41
Rate for Payer: Cash Price	$8,484.45
Rate for Payer: Hawaii Western Management Group Commercial	$9,137.10
Rate for Payer: Health Management Network Commercial	$11,095.05
Rate for Payer: Kaiser Permanente Commercial	$8,223.39
Rate for Payer: Kaiser Permanente Medicaid	$6,657.03
Rate for Payer: MDX Hawaii PPO	$12,661.41
Rate for Payer: University Health Alliance Commercial	$7,309.68

Total Hip G7 Osseo Ti Acet Shell MLT HL 68mm Sz I 110010272 [3644951]

Facility

$13,053.00

Service Code	HCPCS C1776
Hospital Charge Code	3644951
Hospital Revenue Code	278
Min. Negotiated Rate	$7,309.68
Max. Negotiated Rate	$12,661.41
Rate for Payer: Cash Price	$8,484.45
Rate for Payer: Hawaii Western Management Group Commercial	$9,137.10
Rate for Payer: Health Management Network Commercial	$11,095.05
Rate for Payer: MDX Hawaii PPO	$12,661.41
Rate for Payer: University Health Alliance Commercial	$7,309.68

Total Hip G7 Screw 6.5mmx15mm 010000996 [3643422]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3643422
Hospital Revenue Code	278
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Total Hip G7 Screw 6.5mmx15mm 010000996 [3643422]

Facility

$308.75

Service Code	HCPCS C1713
Hospital Charge Code	3643422
Hospital Revenue Code	278
Min. Negotiated Rate	$157.46
Max. Negotiated Rate	$299.49
Rate for Payer: Cash Price	$200.69
Rate for Payer: Hawaii Western Management Group Commercial	$216.12
Rate for Payer: Health Management Network Commercial	$262.44
Rate for Payer: Kaiser Permanente Commercial	$194.51
Rate for Payer: Kaiser Permanente Medicaid	$157.46
Rate for Payer: MDX Hawaii PPO	$299.49
Rate for Payer: University Health Alliance Commercial	$172.90

Total Hip G7 Screw 6.5mm x 20mm 010000997 [3641560]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3641560
Hospital Revenue Code	278
Min. Negotiated Rate	$259.14
Max. Negotiated Rate	$448.87
Rate for Payer: Cash Price	$300.79
Rate for Payer: Hawaii Western Management Group Commercial	$323.93
Rate for Payer: Health Management Network Commercial	$393.34
Rate for Payer: MDX Hawaii PPO	$448.87
Rate for Payer: University Health Alliance Commercial	$259.14

Know your out-of-pocket cost for care.

All Charges