Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$2,675.68
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 8-11 EF 42-5121-008-12 [3642877]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642877
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 8-11 EF 42-5121-008-12 [3642877]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642877
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 8-11 GH 42-5121-009-12 [3642898]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642898
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 8-11 GH 42-5121-009-12 [3642898]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642898
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 VE12mm Rt 12 GH 42-5221-010-12 [3644279]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644279
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 VE12mm Rt 12 GH 42-5221-010-12 [3644279]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644279
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 RT 4-5 EF 42-5221-006-12 [3642887]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642887
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 RT 4-5 EF 42-5221-006-12 [3642887]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642887
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 Rt 6-7 Ef 42-5221-007-12 [3643676]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643676
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 Rt 6-7 Ef 42-5221-007-12 [3643676]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3643676
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 RT 8-11 EF 42-5221-008-12 [3642795]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642795
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 RT 8-11 EF 42-5221-008-12 [3642795]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642795
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 Rt 8-11 Gh 42-5221-009-12 [3644173]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644173
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 Rt 8-11 Gh 42-5221-009-12 [3644173]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644173
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 13mm LT 6-7 CD 42512100413 [3642800]

Facility

$4,606.25

Service Code	HCPCS C1776
Hospital Charge Code	3642800
Hospital Revenue Code	278
Min. Negotiated Rate	$2,579.50
Max. Negotiated Rate	$4,468.06
Rate for Payer: Cash Price	$2,994.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,224.38
Rate for Payer: Health Management Network Commercial	$3,915.31
Rate for Payer: MDX Hawaii PPO	$4,468.06
Rate for Payer: University Health Alliance Commercial	$2,579.50

Total Knee PSN ASF MC VE 13mm LT 6-7 CD 42512100413 [3642800]

Facility

$4,606.25

Service Code	HCPCS C1776
Hospital Charge Code	3642800
Hospital Revenue Code	278
Min. Negotiated Rate	$2,349.19
Max. Negotiated Rate	$4,468.06
Rate for Payer: Cash Price	$2,994.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,224.38
Rate for Payer: Health Management Network Commercial	$3,915.31
Rate for Payer: Kaiser Permanente Commercial	$2,901.94
Rate for Payer: Kaiser Permanente Medicaid	$2,349.19
Rate for Payer: MDX Hawaii PPO	$4,468.06
Rate for Payer: University Health Alliance Commercial	$2,579.50

Total Knee PSN ASF MC VE 13mm LT 8-11 EF 42-5121-008-13 [3642801]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642801
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 13mm LT 8-11 EF 42-5121-008-13 [3642801]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642801
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 13mm Lt 8-11 Gh 42-5121-009-13 [3642861]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3642861
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 Psn Asf Mc Ve 13mm Lt 8-11 Gh 42-5121-009-13 [3642861]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3642861
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 13mm RT 6-7 EF 42-5221-007-13 [3644419]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644419
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 13mm RT 6-7 EF 42-5221-007-13 [3644419]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3644419
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 13mm RT 8-11 GH 42-5221-009-13 [3642699]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642699
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 13mm RT 8-11 GH 42-5221-009-13 [3642699]

Facility

$4,778.00

Service Code	HCPCS C1776
Hospital Charge Code	3642699
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

Know your out-of-pocket cost for care.

All Charges