Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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 PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$26,282.10

Service Code	MSDRG 488
Min. Negotiated Rate	$23,265.93
Max. Negotiated Rate	$26,282.10
Rate for Payer: AlohaCare Medicare	$23,265.93
Rate for Payer: Devoted Health Medicare	$25,592.52
Rate for Payer: Hawaii Medical Service Association Commercial	$25,360.56
Rate for Payer: Hawaii Medical Service Association Medicare	$23,265.93
Rate for Payer: Humana Medicare	$23,265.93
Rate for Payer: Kaiser Permanente Commercial	$26,282.10
Rate for Payer: Kaiser Permanente Medicare	$23,265.93
Rate for Payer: Ohana Health Plan Medicare	$23,265.93
Rate for Payer: UnitedHealthcare Medicare	$23,265.93

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$25,360.56

Service Code	MSDRG 489
Min. Negotiated Rate	$14,689.02
Max. Negotiated Rate	$25,360.56
Rate for Payer: AlohaCare Medicare	$14,689.02
Rate for Payer: Devoted Health Medicare	$16,157.92
Rate for Payer: Hawaii Medical Service Association Commercial	$25,360.56
Rate for Payer: Hawaii Medical Service Association Medicare	$14,689.02
Rate for Payer: Humana Medicare	$14,689.02
Rate for Payer: Kaiser Permanente Commercial	$19,264.80
Rate for Payer: Kaiser Permanente Medicare	$14,689.02
Rate for Payer: Ohana Health Plan Medicare	$14,689.02
Rate for Payer: UnitedHealthcare Medicare	$14,689.02

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$44,911.34

Service Code	MSDRG 486
Min. Negotiated Rate	$27,503.74
Max. Negotiated Rate	$44,911.34
Rate for Payer: AlohaCare Medicare	$27,503.74
Rate for Payer: Devoted Health Medicare	$30,254.11
Rate for Payer: Hawaii Medical Service Association Commercial	$44,911.34
Rate for Payer: Hawaii Medical Service Association Medicare	$27,503.74
Rate for Payer: Humana Medicare	$27,503.74
Rate for Payer: Kaiser Permanente Commercial	$36,071.47
Rate for Payer: Kaiser Permanente Medicare	$27,503.74
Rate for Payer: Ohana Health Plan Medicare	$27,503.74
Rate for Payer: UnitedHealthcare Medicare	$27,503.74

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$55,667.47

Service Code	MSDRG 485
Min. Negotiated Rate	$42,445.30
Max. Negotiated Rate	$55,667.47
Rate for Payer: AlohaCare Medicare	$42,445.30
Rate for Payer: Devoted Health Medicare	$46,689.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,911.34
Rate for Payer: Hawaii Medical Service Association Medicare	$42,445.30
Rate for Payer: Humana Medicare	$42,445.30
Rate for Payer: Kaiser Permanente Commercial	$55,667.47
Rate for Payer: Kaiser Permanente Medicare	$42,445.30
Rate for Payer: Ohana Health Plan Medicare	$42,445.30
Rate for Payer: UnitedHealthcare Medicare	$42,445.30

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$32,086.42

Service Code	MSDRG 487
Min. Negotiated Rate	$20,599.86
Max. Negotiated Rate	$32,086.42
Rate for Payer: AlohaCare Medicare	$20,599.86
Rate for Payer: Devoted Health Medicare	$22,659.85
Rate for Payer: Hawaii Medical Service Association Commercial	$32,086.42
Rate for Payer: Hawaii Medical Service Association Medicare	$20,599.86
Rate for Payer: Humana Medicare	$20,599.86
Rate for Payer: Kaiser Permanente Commercial	$27,016.95
Rate for Payer: Kaiser Permanente Medicare	$20,599.86
Rate for Payer: Ohana Health Plan Medicare	$20,599.86
Rate for Payer: UnitedHealthcare Medicare	$20,599.86

Knee Rev OSS Poly Lock Pin 150478 [3642661]

Facility

$1,206.56

Service Code	HCPCS C1713
Hospital Charge Code	3642661
Hospital Revenue Code	278
Min. Negotiated Rate	$615.35
Max. Negotiated Rate	$1,170.36
Rate for Payer: Cash Price	$784.26
Rate for Payer: Hawaii Western Management Group Commercial	$844.59
Rate for Payer: Health Management Network Commercial	$1,025.58
Rate for Payer: Kaiser Permanente Commercial	$760.13
Rate for Payer: Kaiser Permanente Medicaid	$615.35
Rate for Payer: MDX Hawaii PPO	$1,170.36
Rate for Payer: University Health Alliance Commercial	$675.67

Knee Rev OSS Poly Lock Pin 150478 [3642661]

Facility

$1,206.56

Service Code	HCPCS C1713
Hospital Charge Code	3642661
Hospital Revenue Code	278
Min. Negotiated Rate	$675.67
Max. Negotiated Rate	$1,170.36
Rate for Payer: Cash Price	$784.26
Rate for Payer: Hawaii Western Management Group Commercial	$844.59
Rate for Payer: Health Management Network Commercial	$1,025.58
Rate for Payer: MDX Hawaii PPO	$1,170.36
Rate for Payer: University Health Alliance Commercial	$675.67

Knee Rev OSS Poly Tibial Bushing 150476 [3642662]

Facility

$1,639.69

Service Code	HCPCS C1776
Hospital Charge Code	3642662
Hospital Revenue Code	278
Min. Negotiated Rate	$836.24
Max. Negotiated Rate	$1,590.50
Rate for Payer: Cash Price	$1,065.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,147.78
Rate for Payer: Health Management Network Commercial	$1,393.74
Rate for Payer: Kaiser Permanente Commercial	$1,033.00
Rate for Payer: Kaiser Permanente Medicaid	$836.24
Rate for Payer: MDX Hawaii PPO	$1,590.50
Rate for Payer: University Health Alliance Commercial	$918.23

Knee Rev OSS Poly Tibial Bushing 150476 [3642662]

Facility

$1,639.69

Service Code	HCPCS C1776
Hospital Charge Code	3642662
Hospital Revenue Code	278
Min. Negotiated Rate	$918.23
Max. Negotiated Rate	$1,590.50
Rate for Payer: Cash Price	$1,065.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,147.78
Rate for Payer: Health Management Network Commercial	$1,393.74
Rate for Payer: MDX Hawaii PPO	$1,590.50
Rate for Payer: University Health Alliance Commercial	$918.23

Knee Rev OSS Yoke 150493 [3642660]

Facility

$3,487.50

Service Code	HCPCS C1776
Hospital Charge Code	3642660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,778.62
Max. Negotiated Rate	$3,382.88
Rate for Payer: Cash Price	$2,266.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,441.25
Rate for Payer: Health Management Network Commercial	$2,964.38
Rate for Payer: Kaiser Permanente Commercial	$2,197.12
Rate for Payer: Kaiser Permanente Medicaid	$1,778.62
Rate for Payer: MDX Hawaii PPO	$3,382.88
Rate for Payer: University Health Alliance Commercial	$1,953.00

Knee Rev OSS Yoke 150493 [3642660]

Facility

$3,487.50

Service Code	HCPCS C1776
Hospital Charge Code	3642660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$3,382.88
Rate for Payer: Cash Price	$2,266.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,441.25
Rate for Payer: Health Management Network Commercial	$2,964.38
Rate for Payer: MDX Hawaii PPO	$3,382.88
Rate for Payer: University Health Alliance Commercial	$1,953.00

Knotless Ac Tightrope Open Repair Implant Ar-2372blo [3644559]

Facility

$11,684.50

Service Code	HCPCS C1713
Hospital Charge Code	3644559
Hospital Revenue Code	278
Min. Negotiated Rate	$5,959.10
Max. Negotiated Rate	$11,333.97
Rate for Payer: Cash Price	$7,594.92
Rate for Payer: Hawaii Western Management Group Commercial	$8,179.15
Rate for Payer: Health Management Network Commercial	$9,931.83
Rate for Payer: Kaiser Permanente Commercial	$7,361.23
Rate for Payer: Kaiser Permanente Medicaid	$5,959.10
Rate for Payer: MDX Hawaii PPO	$11,333.97
Rate for Payer: University Health Alliance Commercial	$6,543.32

Knotless Ac Tightrope Open Repair Implant Ar-2372blo [3644559]

Facility

$11,684.50

Service Code	HCPCS C1713
Hospital Charge Code	3644559
Hospital Revenue Code	278
Min. Negotiated Rate	$6,543.32
Max. Negotiated Rate	$11,333.97
Rate for Payer: Cash Price	$7,594.92
Rate for Payer: Hawaii Western Management Group Commercial	$8,179.15
Rate for Payer: Health Management Network Commercial	$9,931.83
Rate for Payer: MDX Hawaii PPO	$11,333.97
Rate for Payer: University Health Alliance Commercial	$6,543.32

Knotless Ac Tightrope Repair System Ar-2371bl [3643910]

Facility

$12,440.50

Service Code	HCPCS C1713
Hospital Charge Code	3643910
Hospital Revenue Code	278
Min. Negotiated Rate	$6,966.68
Max. Negotiated Rate	$12,067.28
Rate for Payer: Cash Price	$8,086.33
Rate for Payer: Hawaii Western Management Group Commercial	$8,708.35
Rate for Payer: Health Management Network Commercial	$10,574.42
Rate for Payer: MDX Hawaii PPO	$12,067.28
Rate for Payer: University Health Alliance Commercial	$6,966.68

Knotless Ac Tightrope Repair System Ar-2371bl [3643910]

Facility

$12,440.50

Service Code	HCPCS C1713
Hospital Charge Code	3643910
Hospital Revenue Code	278
Min. Negotiated Rate	$6,344.65
Max. Negotiated Rate	$12,067.28
Rate for Payer: Cash Price	$8,086.33
Rate for Payer: Hawaii Western Management Group Commercial	$8,708.35
Rate for Payer: Health Management Network Commercial	$10,574.42
Rate for Payer: Kaiser Permanente Commercial	$7,837.52
Rate for Payer: Kaiser Permanente Medicaid	$6,344.65
Rate for Payer: MDX Hawaii PPO	$12,067.28
Rate for Payer: University Health Alliance Commercial	$6,966.68

Knotless Dis Clav Plate Button Tightrope AR-2658TR [3644562]

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	3644562
Hospital Revenue Code	278
Min. Negotiated Rate	$3,697.50
Max. Negotiated Rate	$7,032.50
Rate for Payer: Cash Price	$4,712.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,075.00
Rate for Payer: Health Management Network Commercial	$6,162.50
Rate for Payer: Kaiser Permanente Commercial	$4,567.50
Rate for Payer: Kaiser Permanente Medicaid	$3,697.50
Rate for Payer: MDX Hawaii PPO	$7,032.50
Rate for Payer: University Health Alliance Commercial	$4,060.00

Knotless Dis Clav Plate Button Tightrope AR-2658TR [3644562]

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	3644562
Hospital Revenue Code	278
Min. Negotiated Rate	$4,060.00
Max. Negotiated Rate	$7,032.50
Rate for Payer: Cash Price	$4,712.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,075.00
Rate for Payer: Health Management Network Commercial	$6,162.50
Rate for Payer: MDX Hawaii PPO	$7,032.50
Rate for Payer: University Health Alliance Commercial	$4,060.00

Knotless Fibertak w/ #2 Suture AR-3638 [3643488]

Facility

$2,450.00

Service Code	HCPCS C1713
Hospital Charge Code	3643488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,592.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

Knotless Fibertak w/ #2 Suture AR-3638 [3643488]

Facility

$2,450.00

Service Code	HCPCS C1713
Hospital Charge Code	3643488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,592.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: Kaiser Permanente Commercial	$1,543.50
Rate for Payer: Kaiser Permanente Medicaid	$1,249.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

Knot Pusher/ Suture Cutter For #2-0 FW AR-4515 [3644269]

Facility

$1,246.20

Hospital Charge Code	3644269
Hospital Revenue Code	272
Min. Negotiated Rate	$1,059.27
Max. Negotiated Rate	$1,208.81
Rate for Payer: Cash Price	$810.03
Rate for Payer: Health Management Network Commercial	$1,059.27
Rate for Payer: MDX Hawaii PPO	$1,208.81

Knot Pusher/ Suture Cutter For #2-0 FW AR-4515 [3644269]

Facility

$1,246.20

Hospital Charge Code	3644269
Hospital Revenue Code	272
Min. Negotiated Rate	$635.56
Max. Negotiated Rate	$1,208.81
Rate for Payer: Cash Price	$810.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,183.89
Rate for Payer: Health Management Network Commercial	$1,059.27
Rate for Payer: Kaiser Permanente Commercial	$785.11
Rate for Payer: Kaiser Permanente Medicaid	$635.56
Rate for Payer: MDX Hawaii PPO	$1,208.81
Rate for Payer: University Health Alliance Commercial	$908.36

Knot Pusher/Suture Cutter Slotted Cannula Set 4721 [3640866]

Facility

$1,064.66

Hospital Charge Code	3640866
Hospital Revenue Code	272
Min. Negotiated Rate	$542.98
Max. Negotiated Rate	$1,032.72
Rate for Payer: Cash Price	$692.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,011.43
Rate for Payer: Health Management Network Commercial	$904.96
Rate for Payer: Kaiser Permanente Commercial	$670.74
Rate for Payer: Kaiser Permanente Medicaid	$542.98
Rate for Payer: MDX Hawaii PPO	$1,032.72
Rate for Payer: University Health Alliance Commercial	$776.03

Knot Pusher/Suture Cutter Slotted Cannula Set 4721 [3640866]

Facility

$1,064.66

Hospital Charge Code	3640866
Hospital Revenue Code	272
Min. Negotiated Rate	$904.96
Max. Negotiated Rate	$1,032.72
Rate for Payer: Cash Price	$692.03
Rate for Payer: Health Management Network Commercial	$904.96
Rate for Payer: MDX Hawaii PPO	$1,032.72

Knot Pusher/Suture Cutter w/Portal Skid AR-5845 [3643064]

Facility

$2,070.88

Hospital Charge Code	3643064
Hospital Revenue Code	272
Min. Negotiated Rate	$1,760.25
Max. Negotiated Rate	$2,008.75
Rate for Payer: Cash Price	$1,346.07
Rate for Payer: Health Management Network Commercial	$1,760.25
Rate for Payer: MDX Hawaii PPO	$2,008.75

Know your out-of-pocket cost for care.

All Charges