Kona Community Hospital

All Charges

Charge

Type

Setting

Price

KLS Blade Screwdriver Angulus II 50-991-20-71 [3643136]

Facility

$1,471.25

Hospital Charge Code	3643136
Hospital Revenue Code	272
Min. Negotiated Rate	$750.34
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,397.69
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: Kaiser Permanente Commercial	$926.89
Rate for Payer: Kaiser Permanente Medicaid	$750.34
Rate for Payer: MDX Hawaii PPO	$1,427.11
Rate for Payer: University Health Alliance Commercial	$1,072.39

KLS Blade Screwdriver Angulus II 50-991-20-71 [3643136]

Facility

$1,471.25

Hospital Charge Code	3643136
Hospital Revenue Code	272
Min. Negotiated Rate	$1,250.56
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: MDX Hawaii PPO	$1,427.11

KLS Plate Rib Locking Xshp 10 hole 24-015-20-71 [3643133]

Facility

$6,238.50

Service Code	HCPCS C1713
Hospital Charge Code	3643133
Hospital Revenue Code	278
Min. Negotiated Rate	$3,181.64
Max. Negotiated Rate	$6,051.35
Rate for Payer: Cash Price	$4,055.02
Rate for Payer: Hawaii Western Management Group Commercial	$4,366.95
Rate for Payer: Health Management Network Commercial	$5,302.73
Rate for Payer: Kaiser Permanente Commercial	$3,930.26
Rate for Payer: Kaiser Permanente Medicaid	$3,181.64
Rate for Payer: MDX Hawaii PPO	$6,051.35
Rate for Payer: University Health Alliance Commercial	$3,493.56

KLS Plate Rib Locking Xshp 10 hole 24-015-20-71 [3643133]

Facility

$6,238.50

Service Code	HCPCS C1713
Hospital Charge Code	3643133
Hospital Revenue Code	278
Min. Negotiated Rate	$3,493.56
Max. Negotiated Rate	$6,051.35
Rate for Payer: Cash Price	$4,055.02
Rate for Payer: Hawaii Western Management Group Commercial	$4,366.95
Rate for Payer: Health Management Network Commercial	$5,302.73
Rate for Payer: MDX Hawaii PPO	$6,051.35
Rate for Payer: University Health Alliance Commercial	$3,493.56

KLS Plate Rib Locking Xshp 20 hole 24-015-22-71 [3643135]

Facility

$7,453.88

Service Code	HCPCS C1713
Hospital Charge Code	3643135
Hospital Revenue Code	278
Min. Negotiated Rate	$4,174.17
Max. Negotiated Rate	$7,230.26
Rate for Payer: Cash Price	$4,845.02
Rate for Payer: Hawaii Western Management Group Commercial	$5,217.72
Rate for Payer: Health Management Network Commercial	$6,335.80
Rate for Payer: MDX Hawaii PPO	$7,230.26
Rate for Payer: University Health Alliance Commercial	$4,174.17

KLS Plate Rib Locking Xshp 20 hole 24-015-22-71 [3643135]

Facility

$7,453.88

Service Code	HCPCS C1713
Hospital Charge Code	3643135
Hospital Revenue Code	278
Min. Negotiated Rate	$3,801.48
Max. Negotiated Rate	$7,230.26
Rate for Payer: Cash Price	$4,845.02
Rate for Payer: Hawaii Western Management Group Commercial	$5,217.72
Rate for Payer: Health Management Network Commercial	$6,335.80
Rate for Payer: Kaiser Permanente Commercial	$4,695.94
Rate for Payer: Kaiser Permanente Medicaid	$3,801.48
Rate for Payer: MDX Hawaii PPO	$7,230.26
Rate for Payer: University Health Alliance Commercial	$4,174.17

Kls Plate Rib Lock Y Shp Long 24-015-27-71 [3643854]

Facility

$9,745.50

Service Code	HCPCS C1713
Hospital Charge Code	3643854
Hospital Revenue Code	278
Min. Negotiated Rate	$4,970.20
Max. Negotiated Rate	$9,453.14
Rate for Payer: Cash Price	$6,334.58
Rate for Payer: Hawaii Western Management Group Commercial	$6,821.85
Rate for Payer: Health Management Network Commercial	$8,283.67
Rate for Payer: Kaiser Permanente Commercial	$6,139.66
Rate for Payer: Kaiser Permanente Medicaid	$4,970.20
Rate for Payer: MDX Hawaii PPO	$9,453.14
Rate for Payer: University Health Alliance Commercial	$5,457.48

Kls Plate Rib Lock Y Shp Long 24-015-27-71 [3643854]

Facility

$9,745.50

Service Code	HCPCS C1713
Hospital Charge Code	3643854
Hospital Revenue Code	278
Min. Negotiated Rate	$5,457.48
Max. Negotiated Rate	$9,453.14
Rate for Payer: Cash Price	$6,334.58
Rate for Payer: Hawaii Western Management Group Commercial	$6,821.85
Rate for Payer: Health Management Network Commercial	$8,283.67
Rate for Payer: MDX Hawaii PPO	$9,453.14
Rate for Payer: University Health Alliance Commercial	$5,457.48

Kls Plate Sternal Y Shp 24-025-52-09 [3643852]

Facility

$2,688.00

Service Code	HCPCS C1713
Hospital Charge Code	3643852
Hospital Revenue Code	278
Min. Negotiated Rate	$1,370.88
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,747.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Kaiser Permanente Commercial	$1,693.44
Rate for Payer: Kaiser Permanente Medicaid	$1,370.88
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

Kls Plate Sternal Y Shp 24-025-52-09 [3643852]

Facility

$2,688.00

Service Code	HCPCS C1713
Hospital Charge Code	3643852
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,747.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

Kls Screw Rib Maxdrive Lock 2.3x7mm 1pk 24-016-07-71 [3643855]

Facility

$739.38

Service Code	HCPCS C1713
Hospital Charge Code	3643855
Hospital Revenue Code	278
Min. Negotiated Rate	$414.05
Max. Negotiated Rate	$717.20
Rate for Payer: Cash Price	$480.60
Rate for Payer: Hawaii Western Management Group Commercial	$517.57
Rate for Payer: Health Management Network Commercial	$628.47
Rate for Payer: MDX Hawaii PPO	$717.20
Rate for Payer: University Health Alliance Commercial	$414.05

Kls Screw Rib Maxdrive Lock 2.3x7mm 1pk 24-016-07-71 [3643855]

Facility

$739.38

Service Code	HCPCS C1713
Hospital Charge Code	3643855
Hospital Revenue Code	278
Min. Negotiated Rate	$377.08
Max. Negotiated Rate	$717.20
Rate for Payer: Cash Price	$480.60
Rate for Payer: Hawaii Western Management Group Commercial	$517.57
Rate for Payer: Health Management Network Commercial	$628.47
Rate for Payer: Kaiser Permanente Commercial	$465.81
Rate for Payer: Kaiser Permanente Medicaid	$377.08
Rate for Payer: MDX Hawaii PPO	$717.20
Rate for Payer: University Health Alliance Commercial	$414.05

KLS Screw Rib Maxdrive Locking 2.3X7mm 4Pk 24-016-07-74 [3643134]

Facility

$3,545.00

Service Code	HCPCS C1713
Hospital Charge Code	3643134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.95
Max. Negotiated Rate	$3,438.65
Rate for Payer: Cash Price	$2,304.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,481.50
Rate for Payer: Health Management Network Commercial	$3,013.25
Rate for Payer: Kaiser Permanente Commercial	$2,233.35
Rate for Payer: Kaiser Permanente Medicaid	$1,807.95
Rate for Payer: MDX Hawaii PPO	$3,438.65
Rate for Payer: University Health Alliance Commercial	$1,985.20

KLS Screw Rib Maxdrive Locking 2.3X7mm 4Pk 24-016-07-74 [3643134]

Facility

$3,545.00

Service Code	HCPCS C1713
Hospital Charge Code	3643134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,985.20
Max. Negotiated Rate	$3,438.65
Rate for Payer: Cash Price	$2,304.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,481.50
Rate for Payer: Health Management Network Commercial	$3,013.25
Rate for Payer: MDX Hawaii PPO	$3,438.65
Rate for Payer: University Health Alliance Commercial	$1,985.20

Kls Screw Sternal Maxdrive Lock 2.3x9mm 1pk 24-023-09-91 [3643853]

Facility

$277.83

Service Code	HCPCS C1713
Hospital Charge Code	3643853
Hospital Revenue Code	278
Min. Negotiated Rate	$155.58
Max. Negotiated Rate	$269.50
Rate for Payer: Cash Price	$180.59
Rate for Payer: Hawaii Western Management Group Commercial	$194.48
Rate for Payer: Health Management Network Commercial	$236.16
Rate for Payer: MDX Hawaii PPO	$269.50
Rate for Payer: University Health Alliance Commercial	$155.58

Kls Screw Sternal Maxdrive Lock 2.3x9mm 1pk 24-023-09-91 [3643853]

Facility

$277.83

Service Code	HCPCS C1713
Hospital Charge Code	3643853
Hospital Revenue Code	278
Min. Negotiated Rate	$141.69
Max. Negotiated Rate	$269.50
Rate for Payer: Cash Price	$180.59
Rate for Payer: Hawaii Western Management Group Commercial	$194.48
Rate for Payer: Health Management Network Commercial	$236.16
Rate for Payer: Kaiser Permanente Commercial	$175.03
Rate for Payer: Kaiser Permanente Medicaid	$141.69
Rate for Payer: MDX Hawaii PPO	$269.50
Rate for Payer: University Health Alliance Commercial	$155.58

Knee Instr Sterile Disp Fluted Headless Pins [3643941]

Facility

$2,019.44

Service Code	HCPCS C1713
Hospital Charge Code	3643941
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.89
Max. Negotiated Rate	$1,958.86
Rate for Payer: Cash Price	$1,312.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,413.61
Rate for Payer: Health Management Network Commercial	$1,716.52
Rate for Payer: MDX Hawaii PPO	$1,958.86
Rate for Payer: University Health Alliance Commercial	$1,130.89

Knee Instr Sterile Disp Fluted Headless Pins [3643941]

Facility

$2,019.44

Service Code	HCPCS C1713
Hospital Charge Code	3643941
Hospital Revenue Code	278
Min. Negotiated Rate	$1,029.91
Max. Negotiated Rate	$1,958.86
Rate for Payer: Cash Price	$1,312.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,413.61
Rate for Payer: Health Management Network Commercial	$1,716.52
Rate for Payer: Kaiser Permanente Commercial	$1,272.25
Rate for Payer: Kaiser Permanente Medicaid	$1,029.91
Rate for Payer: MDX Hawaii PPO	$1,958.86
Rate for Payer: University Health Alliance Commercial	$1,130.89

KNEE JOINT REPLACEMENT

Facility

$8,335.75

Service Code	APR-DRG 3021
Min. Negotiated Rate	$8,335.75
Max. Negotiated Rate	$8,335.75
Rate for Payer: AlohaCare Medicaid	$8,335.75
Rate for Payer: Hawaii Medical Service Association ABD	$8,335.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,335.75
Rate for Payer: Kaiser Permanente Medicaid	$8,335.75
Rate for Payer: Ohana Health Plan Medicaid	$8,335.75
Rate for Payer: UnitedHealthcare Medicaid	$8,335.75

KNEE JOINT REPLACEMENT

Facility

$8,992.30

Service Code	APR-DRG 3022
Min. Negotiated Rate	$8,992.30
Max. Negotiated Rate	$8,992.30
Rate for Payer: AlohaCare Medicaid	$8,992.30
Rate for Payer: Hawaii Medical Service Association ABD	$8,992.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,992.30
Rate for Payer: Kaiser Permanente Medicaid	$8,992.30
Rate for Payer: Ohana Health Plan Medicaid	$8,992.30
Rate for Payer: UnitedHealthcare Medicaid	$8,992.30

KNEE JOINT REPLACEMENT

Facility

$11,894.21

Service Code	APR-DRG 3023
Min. Negotiated Rate	$11,894.21
Max. Negotiated Rate	$11,894.21
Rate for Payer: AlohaCare Medicaid	$11,894.21
Rate for Payer: Hawaii Medical Service Association ABD	$11,894.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,894.21
Rate for Payer: Kaiser Permanente Medicaid	$11,894.21
Rate for Payer: Ohana Health Plan Medicaid	$11,894.21
Rate for Payer: UnitedHealthcare Medicaid	$11,894.21

KNEE JOINT REPLACEMENT

Facility

$17,627.98

Service Code	APR-DRG 3024
Min. Negotiated Rate	$17,627.98
Max. Negotiated Rate	$17,627.98
Rate for Payer: AlohaCare Medicaid	$17,627.98
Rate for Payer: Hawaii Medical Service Association ABD	$17,627.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,627.98
Rate for Payer: Kaiser Permanente Medicaid	$17,627.98
Rate for Payer: Ohana Health Plan Medicaid	$17,627.98
Rate for Payer: UnitedHealthcare Medicaid	$17,627.98

KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$8,332.57

Service Code	APR-DRG 3132
Min. Negotiated Rate	$8,332.57
Max. Negotiated Rate	$8,332.57
Rate for Payer: AlohaCare Medicaid	$8,332.57
Rate for Payer: Hawaii Medical Service Association ABD	$8,332.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,332.57
Rate for Payer: Kaiser Permanente Medicaid	$8,332.57
Rate for Payer: Ohana Health Plan Medicaid	$8,332.57
Rate for Payer: UnitedHealthcare Medicaid	$8,332.57

KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$6,433.62

Service Code	APR-DRG 3131
Min. Negotiated Rate	$6,433.62
Max. Negotiated Rate	$6,433.62
Rate for Payer: AlohaCare Medicaid	$6,433.62
Rate for Payer: Hawaii Medical Service Association ABD	$6,433.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,433.62
Rate for Payer: Kaiser Permanente Medicaid	$6,433.62
Rate for Payer: Ohana Health Plan Medicaid	$6,433.62
Rate for Payer: UnitedHealthcare Medicaid	$6,433.62

KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$11,566.89

Service Code	APR-DRG 3133
Min. Negotiated Rate	$11,566.89
Max. Negotiated Rate	$11,566.89
Rate for Payer: AlohaCare Medicaid	$11,566.89
Rate for Payer: Hawaii Medical Service Association ABD	$11,566.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,566.89
Rate for Payer: Kaiser Permanente Medicaid	$11,566.89
Rate for Payer: Ohana Health Plan Medicaid	$11,566.89
Rate for Payer: UnitedHealthcare Medicaid	$11,566.89

Know your out-of-pocket cost for care.

All Charges