Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$236.00
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: Kaiser Permanente Commercial	$291.53
Rate for Payer: Kaiser Permanente Medicaid	$236.00
Rate for Payer: MDX Hawaii PPO	$448.87
Rate for Payer: University Health Alliance Commercial	$259.14

Total Hip G7 Screw 6.5mmX25mm 010000998 [3641653]

Facility

$673.75

Service Code	HCPCS C1713
Hospital Charge Code	3641653
Hospital Revenue Code	278
Min. Negotiated Rate	$343.61
Max. Negotiated Rate	$653.54
Rate for Payer: Cash Price	$437.94
Rate for Payer: Hawaii Western Management Group Commercial	$471.62
Rate for Payer: Health Management Network Commercial	$572.69
Rate for Payer: Kaiser Permanente Commercial	$424.46
Rate for Payer: Kaiser Permanente Medicaid	$343.61
Rate for Payer: MDX Hawaii PPO	$653.54
Rate for Payer: University Health Alliance Commercial	$377.30

Total Hip G7 Screw 6.5mmX25mm 010000998 [3641653]

Facility

$673.75

Service Code	HCPCS C1713
Hospital Charge Code	3641653
Hospital Revenue Code	278
Min. Negotiated Rate	$377.30
Max. Negotiated Rate	$653.54
Rate for Payer: Cash Price	$437.94
Rate for Payer: Hawaii Western Management Group Commercial	$471.62
Rate for Payer: Health Management Network Commercial	$572.69
Rate for Payer: MDX Hawaii PPO	$653.54
Rate for Payer: University Health Alliance Commercial	$377.30

Total Hip G7 Screw 6.5mmX30mm 010000999 [3641692]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3641692
Hospital Revenue Code	278
Min. Negotiated Rate	$236.00
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: Kaiser Permanente Commercial	$291.53
Rate for Payer: Kaiser Permanente Medicaid	$236.00
Rate for Payer: MDX Hawaii PPO	$448.87
Rate for Payer: University Health Alliance Commercial	$259.14

Total Hip G7 Screw 6.5mmX30mm 010000999 [3641692]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3641692
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

Total Hip G7 Screw 6.5mmX35mm 010001000 [3642480]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3642480
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

Total Hip G7 Screw 6.5mmX35mm 010001000 [3642480]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3642480
Hospital Revenue Code	278
Min. Negotiated Rate	$236.00
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: Kaiser Permanente Commercial	$291.53
Rate for Payer: Kaiser Permanente Medicaid	$236.00
Rate for Payer: MDX Hawaii PPO	$448.87
Rate for Payer: University Health Alliance Commercial	$259.14

Total Hip G7 Screw 6.5mmX50mm 010001003 [3642897]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3642897
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

Total Hip G7 Screw 6.5mmX50mm 010001003 [3642897]

Facility

$462.75

Service Code	HCPCS C1713
Hospital Charge Code	3642897
Hospital Revenue Code	278
Min. Negotiated Rate	$236.00
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: Kaiser Permanente Commercial	$291.53
Rate for Payer: Kaiser Permanente Medicaid	$236.00
Rate for Payer: MDX Hawaii PPO	$448.87
Rate for Payer: University Health Alliance Commercial	$259.14

Total Hip Longevity Dm Bearing 28x46mm 110031001 [3644225]

Facility

$5,353.00

Service Code	HCPCS C1776
Hospital Charge Code	3644225
Hospital Revenue Code	278
Min. Negotiated Rate	$2,730.03
Max. Negotiated Rate	$5,192.41
Rate for Payer: Cash Price	$3,479.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,747.10
Rate for Payer: Health Management Network Commercial	$4,550.05
Rate for Payer: Kaiser Permanente Commercial	$3,372.39
Rate for Payer: Kaiser Permanente Medicaid	$2,730.03
Rate for Payer: MDX Hawaii PPO	$5,192.41
Rate for Payer: University Health Alliance Commercial	$2,997.68

Total Hip Longevity Dm Bearing 28x46mm 110031001 [3644225]

Facility

$5,353.00

Service Code	HCPCS C1776
Hospital Charge Code	3644225
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.68
Max. Negotiated Rate	$5,192.41
Rate for Payer: Cash Price	$3,479.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,747.10
Rate for Payer: Health Management Network Commercial	$4,550.05
Rate for Payer: MDX Hawaii PPO	$5,192.41
Rate for Payer: University Health Alliance Commercial	$2,997.68

Total Hip Pinnacle Altrx Acet Liner Neut 40ID x 60OD 1221-40-060 [3641205]

Facility

$12,443.48

Service Code	HCPCS C1776
Hospital Charge Code	3641205
Hospital Revenue Code	278
Min. Negotiated Rate	$6,346.17
Max. Negotiated Rate	$12,070.18
Rate for Payer: Cash Price	$8,088.26
Rate for Payer: Hawaii Western Management Group Commercial	$8,710.44
Rate for Payer: Health Management Network Commercial	$10,576.96
Rate for Payer: Kaiser Permanente Commercial	$7,839.39
Rate for Payer: Kaiser Permanente Medicaid	$6,346.17
Rate for Payer: MDX Hawaii PPO	$12,070.18
Rate for Payer: University Health Alliance Commercial	$6,968.35

Total Hip Pinnacle Altrx Acet Liner Neut 40ID x 60OD 1221-40-060 [3641205]

Facility

$12,443.48

Service Code	HCPCS C1776
Hospital Charge Code	3641205
Hospital Revenue Code	278
Min. Negotiated Rate	$6,968.35
Max. Negotiated Rate	$12,070.18
Rate for Payer: Cash Price	$8,088.26
Rate for Payer: Hawaii Western Management Group Commercial	$8,710.44
Rate for Payer: Health Management Network Commercial	$10,576.96
Rate for Payer: MDX Hawaii PPO	$12,070.18
Rate for Payer: University Health Alliance Commercial	$6,968.35

Total Hip Taperloc Com MP T1 PPS HO 11 x 107.5mm 51-107110 [3644257]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644257
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 Taperloc Com MP T1 PPS HO 11 x 107.5mm 51-107110 [3644257]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644257
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 Taperloc Com MP T1 PPS SO 16 x 117mm 51-106160 [3644556]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644556
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 Taperloc Com MP T1 PPS SO 16 x 117mm 51-106160 [3644556]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644556
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 Taperloc Com Mp T1 Pps So 6 x 97.5mm 51-108060 [3644258]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644258
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 Taperloc Com Mp T1 Pps So 6 x 97.5mm 51-108060 [3644258]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644258
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 Taperloc Com Mp T1 Pps So 8 x 101mm 51-108080 [3644171]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644171
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 Taperloc Com Mp T1 Pps So 8 x 101mm 51-108080 [3644171]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644171
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 Taperloc Com Rdcd Dis Stem Sz 9 x 102.5mm 51-106090 [3644170]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644170
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 Taperloc Com Rdcd Dis Stem Sz 9 x 102.5mm 51-106090 [3644170]

Facility

$8,853.00

Service Code	HCPCS C1776
Hospital Charge Code	3644170
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 Vivacit E DM Bearing 28X38mm 110031009 [3642131]

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642131
Hospital Revenue Code	278
Min. Negotiated Rate	$3,442.50
Max. Negotiated Rate	$6,547.50
Rate for Payer: Cash Price	$4,387.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,725.00
Rate for Payer: Health Management Network Commercial	$5,737.50
Rate for Payer: Kaiser Permanente Commercial	$4,252.50
Rate for Payer: Kaiser Permanente Medicaid	$3,442.50
Rate for Payer: MDX Hawaii PPO	$6,547.50
Rate for Payer: University Health Alliance Commercial	$3,780.00

Total Hip Vivacit E DM Bearing 28X38mm 110031009 [3642131]

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	3642131
Hospital Revenue Code	278
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$6,547.50
Rate for Payer: Cash Price	$4,387.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,725.00
Rate for Payer: Health Management Network Commercial	$5,737.50
Rate for Payer: MDX Hawaii PPO	$6,547.50
Rate for Payer: University Health Alliance Commercial	$3,780.00

Know your out-of-pocket cost for care.

All Charges