Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Knee MIS Headed Screw 48MM 00598304048 [3627424]

Facility

$658.25

Service Code	HCPCS C1713
Hospital Charge Code	3627424
Hospital Revenue Code	278
Min. Negotiated Rate	$368.62
Max. Negotiated Rate	$638.50
Rate for Payer: Cash Price	$427.86
Rate for Payer: Hawaii Western Management Group Commercial	$460.77
Rate for Payer: Health Management Network Commercial	$559.51
Rate for Payer: MDX Hawaii PPO	$638.50
Rate for Payer: University Health Alliance Commercial	$368.62

Total Knee Nexgen LPS All-Poly Tib Stem Sz 8 Blue GH 14mm 00-5996-008-14 [3644757]

Facility

$4,665.50

Service Code	HCPCS C1776
Hospital Charge Code	3644757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,612.68
Max. Negotiated Rate	$4,525.53
Rate for Payer: Cash Price	$3,032.58
Rate for Payer: Hawaii Western Management Group Commercial	$3,265.85
Rate for Payer: Health Management Network Commercial	$3,965.68
Rate for Payer: MDX Hawaii PPO	$4,525.53
Rate for Payer: University Health Alliance Commercial	$2,612.68

Total Knee Nexgen LPS All-Poly Tib Stem Sz 8 Blue GH 14mm 00-5996-008-14 [3644757]

Facility

$4,665.50

Service Code	HCPCS C1776
Hospital Charge Code	3644757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,379.41
Max. Negotiated Rate	$4,525.53
Rate for Payer: Cash Price	$3,032.58
Rate for Payer: Hawaii Western Management Group Commercial	$3,265.85
Rate for Payer: Health Management Network Commercial	$3,965.68
Rate for Payer: Kaiser Permanente Commercial	$2,939.26
Rate for Payer: Kaiser Permanente Medicaid	$2,379.41
Rate for Payer: MDX Hawaii PPO	$4,525.53
Rate for Payer: University Health Alliance Commercial	$2,612.68

Total Knee Nexgen Lps Poly Tib Stem Sz5 Green 17mm Ef 00-5996-005-17 [3643956]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643956
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.75
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: Kaiser Permanente Commercial	$2,094.75
Rate for Payer: Kaiser Permanente Medicaid	$1,695.75
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Total Knee Nexgen Lps Poly Tib Stem Sz5 Green 17mm Ef 00-5996-005-17 [3643956]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643956
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.00
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Total Knee Nexgen Por Tm Patella 10mm x 29mm 00-5878-065-29 [3643298]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643298
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.03
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$1,863.03
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mm x 29mm 00-5878-065-29 [3643298]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643298
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.68
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mmx32mm 00-5878-065-32 [3643312]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643312
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.68
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mmx32mm 00-5878-065-32 [3643312]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643312
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.03
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$1,863.03
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mmx35mm 00-5878-065-35 [3643366]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643366
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.68
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mmx35mm 00-5878-065-35 [3643366]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.03
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$1,863.03
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mmx41mm 00-5878-065-41 [3643429]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643429
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.03
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$1,863.03
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nexgen Por Tm Patella 10mmx41mm 00-5878-065-41 [3643429]

Facility

$3,653.00

Service Code	HCPCS C1776
Hospital Charge Code	3643429
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.68
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Total Knee Nex Lps Stem Tib Com Sz7 Blue Ef [3643602]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643602
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.75
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: Kaiser Permanente Commercial	$2,094.75
Rate for Payer: Kaiser Permanente Medicaid	$1,695.75
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Total Knee Nex Lps Stem Tib Com Sz7 Blue Ef [3643602]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643602
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.00
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Total Knee Oxford Anat Brg RT MD Sz 5 PMA 159577 [3644756]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3644756
Hospital Revenue Code	278
Min. Negotiated Rate	$2,092.53
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: Kaiser Permanente Commercial	$2,584.89
Rate for Payer: Kaiser Permanente Medicaid	$2,092.53
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Total Knee Oxford Anat Brg RT MD Sz 5 PMA 159577 [3644756]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3644756
Hospital Revenue Code	278
Min. Negotiated Rate	$2,297.68
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Total Knee Psn All Poly Patella Ve 32x8.5mm 42-5402-000-32 [3643680]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3643680
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.03
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: Kaiser Permanente Commercial	$1,734.39
Rate for Payer: Kaiser Permanente Medicaid	$1,404.03
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Total Knee Psn All Poly Patella Ve 32x8.5mm 42-5402-000-32 [3643680]

Facility

$2,753.00

Service Code	HCPCS C1776
Hospital Charge Code	3643680
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.68
Max. Negotiated Rate	$2,670.41
Rate for Payer: Cash Price	$1,789.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.10
Rate for Payer: Health Management Network Commercial	$2,340.05
Rate for Payer: MDX Hawaii PPO	$2,670.41
Rate for Payer: University Health Alliance Commercial	$1,541.68

Total Knee PSN ALL Poly Pat PLY 26mmX7.5mm 42-5400-000-26 [3643042]

Facility

$1,983.75

Service Code	HCPCS C1776
Hospital Charge Code	3643042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,110.90
Max. Negotiated Rate	$1,924.24
Rate for Payer: Cash Price	$1,289.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,388.62
Rate for Payer: Health Management Network Commercial	$1,686.19
Rate for Payer: MDX Hawaii PPO	$1,924.24
Rate for Payer: University Health Alliance Commercial	$1,110.90

Total Knee PSN ALL Poly Pat PLY 26mmX7.5mm 42-5400-000-26 [3643042]

Facility

$1,983.75

Service Code	HCPCS C1776
Hospital Charge Code	3643042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.71
Max. Negotiated Rate	$1,924.24
Rate for Payer: Cash Price	$1,289.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,388.62
Rate for Payer: Health Management Network Commercial	$1,686.19
Rate for Payer: Kaiser Permanente Commercial	$1,249.76
Rate for Payer: Kaiser Permanente Medicaid	$1,011.71
Rate for Payer: MDX Hawaii PPO	$1,924.24
Rate for Payer: University Health Alliance Commercial	$1,110.90

Total Knee PSN ALL Poly Pat PLY 29mmX8.0mm 42540000029 [3642627]

Facility

$1,443.75

Service Code	HCPCS C1776
Hospital Charge Code	3642627
Hospital Revenue Code	278
Min. Negotiated Rate	$736.31
Max. Negotiated Rate	$1,400.44
Rate for Payer: Cash Price	$938.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,010.62
Rate for Payer: Health Management Network Commercial	$1,227.19
Rate for Payer: Kaiser Permanente Commercial	$909.56
Rate for Payer: Kaiser Permanente Medicaid	$736.31
Rate for Payer: MDX Hawaii PPO	$1,400.44
Rate for Payer: University Health Alliance Commercial	$808.50

Total Knee PSN ALL Poly Pat PLY 29mmX8.0mm 42540000029 [3642627]

Facility

$1,443.75

Service Code	HCPCS C1776
Hospital Charge Code	3642627
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,400.44
Rate for Payer: Cash Price	$938.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,010.62
Rate for Payer: Health Management Network Commercial	$1,227.19
Rate for Payer: MDX Hawaii PPO	$1,400.44
Rate for Payer: University Health Alliance Commercial	$808.50

Total Knee PSN ALL Poly Pat PLY 32mmX8.5mm 42540000032 [3641279]

Facility

$1,443.75

Service Code	HCPCS C1776
Hospital Charge Code	3641279
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,400.44
Rate for Payer: Cash Price	$938.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,010.62
Rate for Payer: Health Management Network Commercial	$1,227.19
Rate for Payer: MDX Hawaii PPO	$1,400.44
Rate for Payer: University Health Alliance Commercial	$808.50

Total Knee PSN ALL Poly Pat PLY 32mmX8.5mm 42540000032 [3641279]

Facility

$1,443.75

Service Code	HCPCS C1776
Hospital Charge Code	3641279
Hospital Revenue Code	278
Min. Negotiated Rate	$736.31
Max. Negotiated Rate	$1,400.44
Rate for Payer: Cash Price	$938.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,010.62
Rate for Payer: Health Management Network Commercial	$1,227.19
Rate for Payer: Kaiser Permanente Commercial	$909.56
Rate for Payer: Kaiser Permanente Medicaid	$736.31
Rate for Payer: MDX Hawaii PPO	$1,400.44
Rate for Payer: University Health Alliance Commercial	$808.50

Know your out-of-pocket cost for care.

All Charges