Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Knee PSN REV 6mm Offset Stem Ext 22 x 135mm 42-5606-135-22 [3644395]

Facility

$7,922.00

Service Code	HCPCS C1776
Hospital Charge Code	3644395
Hospital Revenue Code	278
Min. Negotiated Rate	$4,040.22
Max. Negotiated Rate	$7,684.34
Rate for Payer: Cash Price	$5,149.30
Rate for Payer: Hawaii Western Management Group Commercial	$5,545.40
Rate for Payer: Health Management Network Commercial	$6,733.70
Rate for Payer: Kaiser Permanente Commercial	$4,990.86
Rate for Payer: Kaiser Permanente Medicaid	$4,040.22
Rate for Payer: MDX Hawaii PPO	$7,684.34
Rate for Payer: University Health Alliance Commercial	$4,436.32

Total Knee PSN REV CCK ART SURF VE 10mm RT 7-9+ GH 42-5228-009-10 [3644361]

Facility

$9,290.50

Service Code	HCPCS C1776
Hospital Charge Code	3644361
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.15
Max. Negotiated Rate	$9,011.78
Rate for Payer: Cash Price	$6,038.82
Rate for Payer: Hawaii Western Management Group Commercial	$6,503.35
Rate for Payer: Health Management Network Commercial	$7,896.93
Rate for Payer: Kaiser Permanente Commercial	$5,853.02
Rate for Payer: Kaiser Permanente Medicaid	$4,738.15
Rate for Payer: MDX Hawaii PPO	$9,011.78
Rate for Payer: University Health Alliance Commercial	$5,202.68

Total Knee PSN REV CCK ART SURF VE 10mm RT 7-9+ GH 42-5228-009-10 [3644361]

Facility

$9,290.50

Service Code	HCPCS C1776
Hospital Charge Code	3644361
Hospital Revenue Code	278
Min. Negotiated Rate	$5,202.68
Max. Negotiated Rate	$9,011.78
Rate for Payer: Cash Price	$6,038.82
Rate for Payer: Hawaii Western Management Group Commercial	$6,503.35
Rate for Payer: Health Management Network Commercial	$7,896.93
Rate for Payer: MDX Hawaii PPO	$9,011.78
Rate for Payer: University Health Alliance Commercial	$5,202.68

Total Knee PSN REV FEM CMT CCR PLS Sz5 RT 42-5046-058-12 [3643169]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3643169
Hospital Revenue Code	278
Min. Negotiated Rate	$13,718.88
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV FEM CMT CCR PLS Sz5 RT 42-5046-058-12 [3643169]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3643169
Hospital Revenue Code	278
Min. Negotiated Rate	$12,493.98
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: Kaiser Permanente Commercial	$15,433.74
Rate for Payer: Kaiser Permanente Medicaid	$12,493.98
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV Fem CMT COCR PLS Sz 11 L 42-5046-070-11 [3644394]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644394
Hospital Revenue Code	278
Min. Negotiated Rate	$13,718.88
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV Fem CMT COCR PLS Sz 11 L 42-5046-070-11 [3644394]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644394
Hospital Revenue Code	278
Min. Negotiated Rate	$12,493.98
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: Kaiser Permanente Commercial	$15,433.74
Rate for Payer: Kaiser Permanente Medicaid	$12,493.98
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN Rev Fem CMT Cocr Pls Sz 11 RT 42-5046-070-12 [3644571]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644571
Hospital Revenue Code	278
Min. Negotiated Rate	$12,493.98
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: Kaiser Permanente Commercial	$15,433.74
Rate for Payer: Kaiser Permanente Medicaid	$12,493.98
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN Rev Fem CMT Cocr Pls Sz 11 RT 42-5046-070-12 [3644571]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644571
Hospital Revenue Code	278
Min. Negotiated Rate	$13,718.88
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV FEM CMT COCR PLS Sz7 Lt 42-5046-062-11 [3644432]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644432
Hospital Revenue Code	278
Min. Negotiated Rate	$13,718.88
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV FEM CMT COCR PLS Sz7 Lt 42-5046-062-11 [3644432]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644432
Hospital Revenue Code	278
Min. Negotiated Rate	$12,493.98
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: Kaiser Permanente Commercial	$15,433.74
Rate for Payer: Kaiser Permanente Medicaid	$12,493.98
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee Psn Rev Fem Cmt Cocr Pls Sz7 Rt 42-5046-062-12 [3643918]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3643918
Hospital Revenue Code	278
Min. Negotiated Rate	$12,493.98
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: Kaiser Permanente Commercial	$15,433.74
Rate for Payer: Kaiser Permanente Medicaid	$12,493.98
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee Psn Rev Fem Cmt Cocr Pls Sz7 Rt 42-5046-062-12 [3643918]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3643918
Hospital Revenue Code	278
Min. Negotiated Rate	$13,718.88
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV FEM CMT COCR PLS Sz 9 RT 42-5046-066-12 [3644453]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644453
Hospital Revenue Code	278
Min. Negotiated Rate	$13,718.88
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV FEM CMT COCR PLS Sz 9 RT 42-5046-066-12 [3644453]

Facility

$24,498.00

Service Code	HCPCS C1776
Hospital Charge Code	3644453
Hospital Revenue Code	278
Min. Negotiated Rate	$12,493.98
Max. Negotiated Rate	$23,763.06
Rate for Payer: Cash Price	$15,923.70
Rate for Payer: Hawaii Western Management Group Commercial	$17,148.60
Rate for Payer: Health Management Network Commercial	$20,823.30
Rate for Payer: Kaiser Permanente Commercial	$15,433.74
Rate for Payer: Kaiser Permanente Medicaid	$12,493.98
Rate for Payer: MDX Hawaii PPO	$23,763.06
Rate for Payer: University Health Alliance Commercial	$13,718.88

Total Knee PSN REV Fem Distal Aug Sz 11 5mm 42-5566-070-05 [3644393]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3644393
Hospital Revenue Code	278
Min. Negotiated Rate	$3,193.68
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN REV Fem Distal Aug Sz 11 5mm 42-5566-070-05 [3644393]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3644393
Hospital Revenue Code	278
Min. Negotiated Rate	$2,908.53
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: Kaiser Permanente Commercial	$3,592.89
Rate for Payer: Kaiser Permanente Medicaid	$2,908.53
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN REV FEM Distal AUG Sz5 x 5mm 42-5566-058-05 [3643166]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3643166
Hospital Revenue Code	278
Min. Negotiated Rate	$2,908.53
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: Kaiser Permanente Commercial	$3,592.89
Rate for Payer: Kaiser Permanente Medicaid	$2,908.53
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN REV FEM Distal AUG Sz5 x 5mm 42-5566-058-05 [3643166]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3643166
Hospital Revenue Code	278
Min. Negotiated Rate	$3,193.68
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN Rev Fem Distal Aug Sz7 5mm 42-5566-062-05 [3644431]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3644431
Hospital Revenue Code	278
Min. Negotiated Rate	$3,193.68
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN Rev Fem Distal Aug Sz7 5mm 42-5566-062-05 [3644431]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3644431
Hospital Revenue Code	278
Min. Negotiated Rate	$2,908.53
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: Kaiser Permanente Commercial	$3,592.89
Rate for Payer: Kaiser Permanente Medicaid	$2,908.53
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee Psn Rev Fem Distal Aug Sz7x10mm 42-5566-062-10 [3643921]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3643921
Hospital Revenue Code	278
Min. Negotiated Rate	$2,908.53
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: Kaiser Permanente Commercial	$3,592.89
Rate for Payer: Kaiser Permanente Medicaid	$2,908.53
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee Psn Rev Fem Distal Aug Sz7x10mm 42-5566-062-10 [3643921]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3643921
Hospital Revenue Code	278
Min. Negotiated Rate	$3,193.68
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN REV Fem Post Aug Sz 11 5mm 42-5568-070-05 [3644392]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3644392
Hospital Revenue Code	278
Min. Negotiated Rate	$2,908.53
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: Kaiser Permanente Commercial	$3,592.89
Rate for Payer: Kaiser Permanente Medicaid	$2,908.53
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Total Knee PSN REV Fem Post Aug Sz 11 5mm 42-5568-070-05 [3644392]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3644392
Hospital Revenue Code	278
Min. Negotiated Rate	$3,193.68
Max. Negotiated Rate	$5,531.91
Rate for Payer: Cash Price	$3,706.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,992.10
Rate for Payer: Health Management Network Commercial	$4,847.55
Rate for Payer: MDX Hawaii PPO	$5,531.91
Rate for Payer: University Health Alliance Commercial	$3,193.68

Know your out-of-pocket cost for care.

All Charges