Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Knee PSN ASF MC VE 11mm LT 6-7 CD 42-5121-004-11 [3643218]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643218
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm LT 6-7 CD 42-5121-004-11 [3643218]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643218
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm LT 6-7 EF 42-5121-007-11 [3642598]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642598
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm LT 6-7 EF 42-5121-007-11 [3642598]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642598
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm LT 8-11 EF 42-5121-008-11 [3643032]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643032
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm LT 8-11 EF 42-5121-008-11 [3643032]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643032
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 11mm Lt 8-11 Gh 42-5121-009-11 [3643315]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643315
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 11mm Lt 8-11 Gh 42-5121-009-11 [3643315]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643315
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF Mc Ve 11mm Rt 4-5 Cd 42-5221-003-11 [3643651]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643651
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.75
Max. Negotiated Rate	$3,225.25
Rate for Payer: MDX Hawaii PPO	$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: University Health Alliance Commercial	$1,862.00

Total Knee PSN ASF Mc Ve 11mm Rt 4-5 Cd 42-5221-003-11 [3643651]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3643651
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 PSN ASF MC VE 11mm RT 6-7 CD 42-5221-004-11 [3642819]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642819
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm RT 6-7 CD 42-5221-004-11 [3642819]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642819
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm Rt 6-7 EF 42-5221-007-11 [3644314]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644314
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm Rt 6-7 EF 42-5221-007-11 [3644314]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644314
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF Mc Ve 11mm Rt 8-11 Ef 42-5221-008-11 [3643677]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643677
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF Mc Ve 11mm Rt 8-11 Ef 42-5221-008-11 [3643677]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643677
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm RT 8-11 GH 42-5221-009-11 [3643044]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643044
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 11mm RT 8-11 GH 42-5221-009-11 [3643044]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643044
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 12mm LT 12 GH 42-5121-010-12 [3643035]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee PSN ASF MC VE 12mm LT 12 GH 42-5121-010-12 [3643035]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 12mm Lt 4-5 EF 42-5121-006-12 [3644197]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644197
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 12mm Lt 4-5 EF 42-5121-006-12 [3644197]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644197
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 12mm Lt 6-7 Cd 42-5121-004-12 [3643683]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 12mm Lt 6-7 Cd 42-5121-004-12 [3643683]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Total Knee Psn Asf Mc Ve 12mm Lt 6-7 Ef 42-5121-007-12 [3643816]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643816
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Know your out-of-pocket cost for care.

All Charges