Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz C 42-5350-064-02 [3644555]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3644555
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz C 42-5350-064-02 [3644555]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3644555
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz C Lt 42-5350-064-01 [3643368]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3643368
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 Tib Por 0 Deg Spiked Keel Sz C Lt 42-5350-064-01 [3643368]

Facility

$5,703.00

Service Code	HCPCS C1776
Hospital Charge Code	3643368
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 Tib Por 0 Deg Spiked Keel Sz D Lt 42-5350-067-01 [3643400]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643400
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz D Lt 42-5350-067-01 [3643400]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643400
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz D Rt 42-5350-067-02 [3643299]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643299
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz D Rt 42-5350-067-02 [3643299]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643299
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz E Lt 42-5350-071-01 [3643269]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643269
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz E Lt 42-5350-071-01 [3643269]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643269
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz E Rt 42-5350-071-02 [3643267]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643267
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz E Rt 42-5350-071-02 [3643267]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643267
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz F Lt 42-5350-075-01 [3643650]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643650
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz F Lt 42-5350-075-01 [3643650]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643650
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz F Rt 42-5350-075-02 [3643394]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643394
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz F Rt 42-5350-075-02 [3643394]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643394
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz G Lt 42-5350-079-01 [3643314]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643314
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz G Lt 42-5350-079-01 [3643314]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643314
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz G Rt 42-5350-079-02 [3643428]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643428
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz G Rt 42-5350-079-02 [3643428]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643428
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz H Lt 42-5350-083-01 [3643514]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643514
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz H Lt 42-5350-083-01 [3643514]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643514
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz H Rt 42-5350-083-02 [3643263]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643263
Hospital Revenue Code	278
Min. Negotiated Rate	$3,095.68
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee Psn Tib Por 0 Deg Spiked Keel Sz H Rt 42-5350-083-02 [3643263]

Facility

$5,528.00

Service Code	HCPCS C1776
Hospital Charge Code	3643263
Hospital Revenue Code	278
Min. Negotiated Rate	$2,819.28
Max. Negotiated Rate	$5,362.16
Rate for Payer: Cash Price	$3,593.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,869.60
Rate for Payer: Health Management Network Commercial	$4,698.80
Rate for Payer: Kaiser Permanente Commercial	$3,482.64
Rate for Payer: Kaiser Permanente Medicaid	$2,819.28
Rate for Payer: MDX Hawaii PPO	$5,362.16
Rate for Payer: University Health Alliance Commercial	$3,095.68

Total Knee PSN TIB STM 5 Deg SzC RT 42532006402 [3641072]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3641072
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

Know your out-of-pocket cost for care.

All Charges