Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT

Facility

$24,500.00

Service Code	CPT 27130
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$18,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,102.18
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, ANKLE; WITH IMPLANT (TOTAL ANKLE)

Facility

$35,260.10

Service Code	CPT 27702
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$35,260.10
Rate for Payer: AlohaCare Medicaid	$32,054.64
Rate for Payer: AlohaCare Medicare	$32,054.64
Rate for Payer: Devoted Health Medicare	$35,260.10
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$18,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$32,054.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,102.18
Rate for Payer: Humana Medicare	$32,054.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$32,054.64
Rate for Payer: Ohana Health Plan Medicaid	$35,260.10
Rate for Payer: Ohana Health Plan Medicare	$32,054.64
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$32,054.64
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT

Facility

$25,891.85

Service Code	CPT 24361
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$25,891.85
Rate for Payer: AlohaCare Medicaid	$20,713.48
Rate for Payer: AlohaCare Medicare	$20,713.48
Rate for Payer: Devoted Health Medicare	$22,784.83
Rate for Payer: Hawaii Medical Service Association Commercial	$25,891.85
Rate for Payer: Hawaii Medical Service Association Medicare	$20,713.48
Rate for Payer: Humana Medicare	$20,713.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$20,713.48
Rate for Payer: Ohana Health Plan Medicaid	$22,784.83
Rate for Payer: Ohana Health Plan Medicare	$20,713.48
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$20,713.48
Rate for Payer: University Health Alliance Commercial	$11,157.19

ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY

Facility

$24,500.00

Service Code	CPT 23470
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$17,484.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,902.37
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))

Facility

$24,500.00

Service Code	CPT 23472
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$20,713.48
Rate for Payer: AlohaCare Medicare	$20,713.48
Rate for Payer: Devoted Health Medicare	$22,784.83
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$18,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20,713.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,102.18
Rate for Payer: Humana Medicare	$20,713.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$20,713.48
Rate for Payer: Ohana Health Plan Medicaid	$22,784.83
Rate for Payer: Ohana Health Plan Medicare	$20,713.48
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$20,713.48
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)

Facility

$24,500.00

Service Code	CPT 27447
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$17,484.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,902.37
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT

Facility

$20,300.00

Service Code	CPT 27446
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$20,300.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$17,484.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,902.37
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$20,300.00

ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT

Facility

$16,683.60

Service Code	CPT 24366
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$16,683.60
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$11,157.19

ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

Facility

$17,484.00

Service Code	CPT 29888
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$17,484.00
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$17,484.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,902.37
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

Facility

$16,683.60

Service Code	CPT 29889
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$16,683.60
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE

Facility

$9,416.00

Service Code	CPT 29898
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY

Facility

$9,416.00

Service Code	CPT 29894
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$6,743.44

Arthroscopy Blade 3.5Mm Agg Plus 0375-534-000 [3600269]

Facility

$410.94

Hospital Charge Code	3600269
Hospital Revenue Code	272
Min. Negotiated Rate	$349.30
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: MDX Hawaii PPO	$398.61

Arthroscopy Blade 3.5Mm Agg Plus 0375-534-000 [3600269]

Facility

$410.94

Hospital Charge Code	3600269
Hospital Revenue Code	272
Min. Negotiated Rate	$209.58
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Hawaii Western Management Group Commercial	$390.39
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: Kaiser Permanente Commercial	$258.89
Rate for Payer: Kaiser Permanente Medicaid	$209.58
Rate for Payer: MDX Hawaii PPO	$398.61
Rate for Payer: University Health Alliance Commercial	$299.53

Arthroscopy Blade 3.5Mm Resector 375532000 [3600268]

Facility

$410.94

Hospital Charge Code	3600268
Hospital Revenue Code	272
Min. Negotiated Rate	$209.58
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Hawaii Western Management Group Commercial	$390.39
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: Kaiser Permanente Commercial	$258.89
Rate for Payer: Kaiser Permanente Medicaid	$209.58
Rate for Payer: MDX Hawaii PPO	$398.61
Rate for Payer: University Health Alliance Commercial	$299.53

Arthroscopy Blade 3.5Mm Resector 375532000 [3600268]

Facility

$410.94

Hospital Charge Code	3600268
Hospital Revenue Code	272
Min. Negotiated Rate	$349.30
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: MDX Hawaii PPO	$398.61

Arthroscopy Blade 4.0Mm Agg Plus 375544000 [3600271]

Facility

$410.95

Hospital Charge Code	3600271
Hospital Revenue Code	272
Min. Negotiated Rate	$349.31
Max. Negotiated Rate	$398.62
Rate for Payer: Cash Price	$267.12
Rate for Payer: Health Management Network Commercial	$349.31
Rate for Payer: MDX Hawaii PPO	$398.62

Arthroscopy Blade 4.0Mm Agg Plus 375544000 [3600271]

Facility

$410.95

Hospital Charge Code	3600271
Hospital Revenue Code	272
Min. Negotiated Rate	$209.58
Max. Negotiated Rate	$398.62
Rate for Payer: Cash Price	$267.12
Rate for Payer: Hawaii Western Management Group Commercial	$390.40
Rate for Payer: Health Management Network Commercial	$349.31
Rate for Payer: Kaiser Permanente Commercial	$258.90
Rate for Payer: Kaiser Permanente Medicaid	$209.58
Rate for Payer: MDX Hawaii PPO	$398.62
Rate for Payer: University Health Alliance Commercial	$299.54

Arthroscopy Blade 4.0Mm Barrel Bur 0375-941-000 [3600337]

Facility

$429.06

Hospital Charge Code	3600337
Hospital Revenue Code	272
Min. Negotiated Rate	$218.82
Max. Negotiated Rate	$416.19
Rate for Payer: Cash Price	$278.89
Rate for Payer: Hawaii Western Management Group Commercial	$407.61
Rate for Payer: Health Management Network Commercial	$364.70
Rate for Payer: Kaiser Permanente Commercial	$270.31
Rate for Payer: Kaiser Permanente Medicaid	$218.82
Rate for Payer: MDX Hawaii PPO	$416.19
Rate for Payer: University Health Alliance Commercial	$312.74

Arthroscopy Blade 4.0Mm Barrel Bur 0375-941-000 [3600337]

Facility

$429.06

Hospital Charge Code	3600337
Hospital Revenue Code	272
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$416.19
Rate for Payer: Cash Price	$278.89
Rate for Payer: Health Management Network Commercial	$364.70
Rate for Payer: MDX Hawaii PPO	$416.19

Arthroscopy Blade 4.0Mm Rd Bur 375940000 [3600289]

Facility

$429.06

Hospital Charge Code	3600289
Hospital Revenue Code	272
Min. Negotiated Rate	$218.82
Max. Negotiated Rate	$416.19
Rate for Payer: Cash Price	$278.89
Rate for Payer: Hawaii Western Management Group Commercial	$407.61
Rate for Payer: Health Management Network Commercial	$364.70
Rate for Payer: Kaiser Permanente Commercial	$270.31
Rate for Payer: Kaiser Permanente Medicaid	$218.82
Rate for Payer: MDX Hawaii PPO	$416.19
Rate for Payer: University Health Alliance Commercial	$312.74

Arthroscopy Blade 4.0Mm Rd Bur 375940000 [3600289]

Facility

$429.06

Hospital Charge Code	3600289
Hospital Revenue Code	272
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$416.19
Rate for Payer: Cash Price	$278.89
Rate for Payer: Health Management Network Commercial	$364.70
Rate for Payer: MDX Hawaii PPO	$416.19

Arthroscopy Blade 4.0Mm Resector 0375-542-000 [3600273]

Facility

$410.94

Hospital Charge Code	3600273
Hospital Revenue Code	272
Min. Negotiated Rate	$209.58
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Hawaii Western Management Group Commercial	$390.39
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: Kaiser Permanente Commercial	$258.89
Rate for Payer: Kaiser Permanente Medicaid	$209.58
Rate for Payer: MDX Hawaii PPO	$398.61
Rate for Payer: University Health Alliance Commercial	$299.53

Arthroscopy Blade 4.0Mm Resector 0375-542-000 [3600273]

Facility

$410.94

Hospital Charge Code	3600273
Hospital Revenue Code	272
Min. Negotiated Rate	$349.30
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: MDX Hawaii PPO	$398.61

Arthroscopy Blade 4.0Mm Tomcat 0375-545-000 [3600276]

Facility

$410.94

Hospital Charge Code	3600276
Hospital Revenue Code	272
Min. Negotiated Rate	$209.58
Max. Negotiated Rate	$398.61
Rate for Payer: Cash Price	$267.11
Rate for Payer: Hawaii Western Management Group Commercial	$390.39
Rate for Payer: Health Management Network Commercial	$349.30
Rate for Payer: Kaiser Permanente Commercial	$258.89
Rate for Payer: Kaiser Permanente Medicaid	$209.58
Rate for Payer: MDX Hawaii PPO	$398.61
Rate for Payer: University Health Alliance Commercial	$299.53

Know your out-of-pocket cost for care.

All Charges