Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Knee PSN FEM CR CMT CCR STD Sz5 RT 42502605802 [3641095]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3641095
Hospital Revenue Code	278
Min. Negotiated Rate	$2,741.25
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: Kaiser Permanente Commercial	$3,386.25
Rate for Payer: Kaiser Permanente Medicaid	$2,741.25
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Total Knee PSN FEM CR CMT CCR STD sz7 LT 42502606201 [3641037]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3641037
Hospital Revenue Code	278
Min. Negotiated Rate	$3,010.00
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Total Knee PSN FEM CR CMT CCR STD sz7 LT 42502606201 [3641037]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3641037
Hospital Revenue Code	278
Min. Negotiated Rate	$2,741.25
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: Kaiser Permanente Commercial	$3,386.25
Rate for Payer: Kaiser Permanente Medicaid	$2,741.25
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Total Knee PSN FEM CR CMT CCR STD sz7 RT 42502606202 [3641464]

Facility

$8,678.00

Service Code	HCPCS C1776
Hospital Charge Code	3641464
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.78
Max. Negotiated Rate	$8,417.66
Rate for Payer: Cash Price	$5,640.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.60
Rate for Payer: Health Management Network Commercial	$7,376.30
Rate for Payer: Kaiser Permanente Commercial	$5,467.14
Rate for Payer: Kaiser Permanente Medicaid	$4,425.78
Rate for Payer: MDX Hawaii PPO	$8,417.66
Rate for Payer: University Health Alliance Commercial	$4,859.68

Total Knee PSN FEM CR CMT CCR STD sz7 RT 42502606202 [3641464]

Facility

$8,678.00

Service Code	HCPCS C1776
Hospital Charge Code	3641464
Hospital Revenue Code	278
Min. Negotiated Rate	$4,859.68
Max. Negotiated Rate	$8,417.66
Rate for Payer: Cash Price	$5,640.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.60
Rate for Payer: Health Management Network Commercial	$7,376.30
Rate for Payer: MDX Hawaii PPO	$8,417.66
Rate for Payer: University Health Alliance Commercial	$4,859.68

Total Knee PSN FEM CR CMT CCR STD Sz8 LT 42502606401 [3641176]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3641176
Hospital Revenue Code	278
Min. Negotiated Rate	$3,010.00
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Total Knee PSN FEM CR CMT CCR STD Sz8 LT 42502606401 [3641176]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3641176
Hospital Revenue Code	278
Min. Negotiated Rate	$2,741.25
Max. Negotiated Rate	$5,213.75
Rate for Payer: Cash Price	$3,493.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,762.50
Rate for Payer: Health Management Network Commercial	$4,568.75
Rate for Payer: Kaiser Permanente Commercial	$3,386.25
Rate for Payer: Kaiser Permanente Medicaid	$2,741.25
Rate for Payer: MDX Hawaii PPO	$5,213.75
Rate for Payer: University Health Alliance Commercial	$3,010.00

Total Knee PSN FEM CR CMT CCR STD Sz9 LT 42-5026-066-01 [3640828]

Facility

$8,678.00

Service Code	HCPCS C1776
Hospital Charge Code	3640828
Hospital Revenue Code	278
Min. Negotiated Rate	$4,859.68
Max. Negotiated Rate	$8,417.66
Rate for Payer: Cash Price	$5,640.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.60
Rate for Payer: Health Management Network Commercial	$7,376.30
Rate for Payer: MDX Hawaii PPO	$8,417.66
Rate for Payer: University Health Alliance Commercial	$4,859.68

Total Knee PSN FEM CR CMT CCR STD Sz9 LT 42-5026-066-01 [3640828]

Facility

$8,678.00

Service Code	HCPCS C1776
Hospital Charge Code	3640828
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.78
Max. Negotiated Rate	$8,417.66
Rate for Payer: Cash Price	$5,640.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.60
Rate for Payer: Health Management Network Commercial	$7,376.30
Rate for Payer: Kaiser Permanente Commercial	$5,467.14
Rate for Payer: Kaiser Permanente Medicaid	$4,425.78
Rate for Payer: MDX Hawaii PPO	$8,417.66
Rate for Payer: University Health Alliance Commercial	$4,859.68

Total Knee Psn Fem Cr Por Ccr Std Sz 12 Lt 42-5028-074-01 [3643468]

Facility

$10,603.00

Service Code	HCPCS C1713
Hospital Charge Code	3643468
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Por Ccr Std Sz 12 Lt 42-5028-074-01 [3643468]

Facility

$10,603.00

Service Code	HCPCS C1713
Hospital Charge Code	3643468
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Por Ccr Std Sz12 Rt 42-5028-074-02 [3643262]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643262
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Por Ccr Std Sz12 Rt 42-5028-074-02 [3643262]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643262
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz10 Lt 42-5080-068-01 [3643268]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643268
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz10 Lt 42-5080-068-01 [3643268]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643268
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz 10 Rt 42-5080-068-02 [3643427]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643427
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz 10 Rt 42-5080-068-02 [3643427]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643427
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee PSN Fem CR PPS CCR NRW Sz 11 Lt 42-5080-070-01 [3644839]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644839
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee PSN Fem CR PPS CCR NRW Sz 11 Lt 42-5080-070-01 [3644839]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644839
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz 11 Rt 42-5080-070-02 [3643892]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643892
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz 11 Rt 42-5080-070-02 [3643892]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643892
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz6 Lt 42-5080-060-01 [3643649]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643649
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz6 Lt 42-5080-060-01 [3643649]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643649
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz6 Rt 42-5080-060-02 [3644113]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644113
Hospital Revenue Code	278
Min. Negotiated Rate	$5,407.53
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: Kaiser Permanente Commercial	$6,679.89
Rate for Payer: Kaiser Permanente Medicaid	$5,407.53
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Total Knee Psn Fem Cr Pps Ccr Nrw Sz6 Rt 42-5080-060-02 [3644113]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644113
Hospital Revenue Code	278
Min. Negotiated Rate	$5,937.68
Max. Negotiated Rate	$10,284.91
Rate for Payer: Cash Price	$6,891.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,422.10
Rate for Payer: Health Management Network Commercial	$9,012.55
Rate for Payer: MDX Hawaii PPO	$10,284.91
Rate for Payer: University Health Alliance Commercial	$5,937.68

Know your out-of-pocket cost for care.

All Charges