Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Knee Psn Fem Cr Pps Ccr Nrw Sz 9 Lt 42-5080-066-01 [3643672]

Facility

$10,603.00

Service Code	HCPCS C1713
Hospital Charge Code	3643672
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 9 Lt 42-5080-066-01 [3643672]

Facility

$10,603.00

Service Code	HCPCS C1713
Hospital Charge Code	3643672
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 Std Sz10 Lt 42-5086-068-01 [3643841]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643841
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 Std Sz10 Lt 42-5086-068-01 [3643841]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643841
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 Std Sz10 Rt 42-5086-068-02 [3643266]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643266
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 Std Sz10 Rt 42-5086-068-02 [3643266]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643266
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 Std Sz11 Lt 42-5086-070-01 [3643313]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643313
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 Std Sz11 Lt 42-5086-070-01 [3643313]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643313
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 Std Sz11 Rt 42-5086-070-02 [3643693]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643693
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 Std Sz11 Rt 42-5086-070-02 [3643693]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643693
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 Std Sz4 Lt 42-5086-056-01 [3644068]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644068
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 Std Sz4 Lt 42-5086-056-01 [3644068]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644068
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 Std Sz5 Lt 42-5086-058-01 [3643978]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643978
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 Std Sz5 Lt 42-5086-058-01 [3643978]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643978
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 Std Sz5 Rt 42-5086-058-02 [3643335]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643335
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 Std Sz5 Rt 42-5086-058-02 [3643335]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643335
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 Std Sz6 Lt 42-5086-060-01 [3643682]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643682
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 Std Sz6 Lt 42-5086-060-01 [3643682]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643682
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 Std Sz6 Rt 42-5086-060-02 [3643297]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643297
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 Std Sz6 Rt 42-5086-060-02 [3643297]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643297
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 Std Sz7 Lt 42-5086-062-01 [3644031]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644031
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 Std Sz7 Lt 42-5086-062-01 [3644031]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644031
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 Std Sz 7 Rt 42-5086-062-02 [3643675]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643675
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 Std Sz 7 Rt 42-5086-062-02 [3643675]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643675
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 Std Sz9 Lt 42-5086-066-01 [3643365]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643365
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