Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$5,407.53
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 Sz9 Rt 42-5086-066-02 [3643344]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643344
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 Rt 42-5086-066-02 [3643344]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643344
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 Cocr Nrw Sz3 Rt 42-5080-054-02 [3644554]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644554
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 Cocr Nrw Sz3 Rt 42-5080-054-02 [3644554]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644554
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 Cocr Nrw Sz 7 Lt 42-5080-062-01 [3643817]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643817
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 Cocr Nrw Sz 7 Lt 42-5080-062-01 [3643817]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643817
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 Cocr Nrw Sz7 Rt 42-5080-062-02 [3643914]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643914
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 Cocr Nrw Sz7 Rt 42-5080-062-02 [3643914]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643914
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 Cocr Nrw Sz8 Lt 42-5080-064-01 [3643401]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643401
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 Cocr Nrw Sz8 Lt 42-5080-064-01 [3643401]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643401
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 Cocr Nrw Sz8 Rt 42-5080-064-02 [3643625]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643625
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 Cocr Nrw Sz8 Rt 42-5080-064-02 [3643625]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643625
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 Cocr Std Sz 12 LT 42-5086-074-01 [3644867]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644867
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 Cocr Std Sz 12 LT 42-5086-074-01 [3644867]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644867
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 COCR STD Sz12 Rt 42-5086-074-02 [3644243]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644243
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 COCR STD Sz12 Rt 42-5086-074-02 [3644243]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3644243
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 Cocr Std Sz8 Rt 42-5086-064-02 [3643600]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643600
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 Cocr Std Sz8 Rt 42-5086-064-02 [3643600]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643600
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 Ps Ccr Std Sz 8 Lt 42-5086-064-01 [3643674]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643674
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 Ps Ccr Std Sz 8 Lt 42-5086-064-01 [3643674]

Facility

$10,603.00

Service Code	HCPCS C1776
Hospital Charge Code	3643674
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 Ps Cmt Ccr Std Sz 10 Rt [3643667]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3643667
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 Ps Cmt Ccr Std Sz 10 Rt [3643667]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3643667
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 Ps Cmt Ccr Std Sz8 Rt 42-5006-064-02 [3643955]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3643955
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 Ps Cmt Ccr Std Sz8 Rt 42-5006-064-02 [3643955]

Facility

$5,375.00

Service Code	HCPCS C1776
Hospital Charge Code	3643955
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

Know your out-of-pocket cost for care.

All Charges