Kona Community Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$35,869.65

Service Code	MSDRG 511
Min. Negotiated Rate	$23,576.65
Max. Negotiated Rate	$35,869.65
Rate for Payer: AlohaCare Medicare	$27,349.86
Rate for Payer: Devoted Health Medicare	$30,084.85
Rate for Payer: Hawaii Medical Service Association Commercial	$23,576.65
Rate for Payer: Hawaii Medical Service Association Medicare	$27,349.86
Rate for Payer: Humana Medicare	$27,349.86
Rate for Payer: Kaiser Permanente Commercial	$35,869.65
Rate for Payer: Kaiser Permanente Medicare	$27,349.86
Rate for Payer: Ohana Health Plan Medicare	$27,349.86
Rate for Payer: UnitedHealthcare Medicare	$27,349.86

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$52,103.62

Service Code	MSDRG 510
Min. Negotiated Rate	$23,576.65
Max. Negotiated Rate	$52,103.62
Rate for Payer: AlohaCare Medicare	$39,727.94
Rate for Payer: Devoted Health Medicare	$43,700.73
Rate for Payer: Hawaii Medical Service Association Commercial	$23,576.65
Rate for Payer: Hawaii Medical Service Association Medicare	$39,727.94
Rate for Payer: Humana Medicare	$39,727.94
Rate for Payer: Kaiser Permanente Commercial	$52,103.62
Rate for Payer: Kaiser Permanente Medicare	$39,727.94
Rate for Payer: Ohana Health Plan Medicare	$39,727.94
Rate for Payer: UnitedHealthcare Medicare	$39,727.94

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$28,555.65

Service Code	MSDRG 512
Min. Negotiated Rate	$21,773.09
Max. Negotiated Rate	$28,555.65
Rate for Payer: AlohaCare Medicare	$21,773.09
Rate for Payer: Devoted Health Medicare	$23,950.40
Rate for Payer: Hawaii Medical Service Association Commercial	$22,154.33
Rate for Payer: Hawaii Medical Service Association Medicare	$21,773.09
Rate for Payer: Humana Medicare	$21,773.09
Rate for Payer: Kaiser Permanente Commercial	$28,555.65
Rate for Payer: Kaiser Permanente Medicare	$21,773.09
Rate for Payer: Ohana Health Plan Medicare	$21,773.09
Rate for Payer: UnitedHealthcare Medicare	$21,773.09

SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$10,470.31

Service Code	APR-DRG 3153
Min. Negotiated Rate	$10,470.31
Max. Negotiated Rate	$10,470.31
Rate for Payer: AlohaCare Medicaid	$10,470.31
Rate for Payer: Hawaii Medical Service Association ABD	$10,470.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,470.31
Rate for Payer: Kaiser Permanente Medicaid	$10,470.31
Rate for Payer: Ohana Health Plan Medicaid	$10,470.31
Rate for Payer: UnitedHealthcare Medicaid	$10,470.31

SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$17,032.57

Service Code	APR-DRG 3154
Min. Negotiated Rate	$17,032.57
Max. Negotiated Rate	$17,032.57
Rate for Payer: AlohaCare Medicaid	$17,032.57
Rate for Payer: Hawaii Medical Service Association ABD	$17,032.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,032.57
Rate for Payer: Kaiser Permanente Medicaid	$17,032.57
Rate for Payer: Ohana Health Plan Medicaid	$17,032.57
Rate for Payer: UnitedHealthcare Medicaid	$17,032.57

SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$4,374.84

Service Code	APR-DRG 3151
Min. Negotiated Rate	$4,374.84
Max. Negotiated Rate	$4,374.84
Rate for Payer: AlohaCare Medicaid	$4,374.84
Rate for Payer: Hawaii Medical Service Association ABD	$4,374.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,374.84
Rate for Payer: Kaiser Permanente Medicaid	$4,374.84
Rate for Payer: Ohana Health Plan Medicaid	$4,374.84
Rate for Payer: UnitedHealthcare Medicaid	$4,374.84

SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$7,183.14

Service Code	APR-DRG 3152
Min. Negotiated Rate	$7,183.14
Max. Negotiated Rate	$7,183.14
Rate for Payer: AlohaCare Medicaid	$7,183.14
Rate for Payer: Hawaii Medical Service Association ABD	$7,183.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,183.14
Rate for Payer: Kaiser Permanente Medicaid	$7,183.14
Rate for Payer: Ohana Health Plan Medicaid	$7,183.14
Rate for Payer: UnitedHealthcare Medicaid	$7,183.14

Shukla Blade Cupped 14mm x 11cm Single Use SBLDCUP-3 [3644212]

Facility

$1,117.68

Hospital Charge Code	3644212
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Cupped 14mm x 11cm Single Use SBLDCUP-3 [3644212]

Facility

$1,117.68

Hospital Charge Code	3644212
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Curved For Medial Hip 12mm x 11cm Single SBLDCURVE-3 [3644217]

Facility

$1,117.68

Hospital Charge Code	3644217
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Curved For Medial Hip 12mm x 11cm Single SBLDCURVE-3 [3644217]

Facility

$1,117.68

Hospital Charge Code	3644217
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat 10mm x 11cm Single Use SBLDFLAT-4 [3644204]

Facility

$1,117.68

Hospital Charge Code	3644204
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat 10mm x 11cm Single Use SBLDFLAT-4 [3644204]

Facility

$1,117.68

Hospital Charge Code	3644204
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Flat 10mm x 5cm Single Use SBLDFLAT-3 [3644169]

Facility

$1,117.68

Hospital Charge Code	3644169
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat 10mm x 5cm Single Use SBLDFLAT-3 [3644169]

Facility

$1,117.68

Hospital Charge Code	3644169
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Flat 12mm x 5cm Single Use SBLDFLAT-5 [3643975]

Facility

$1,117.68

Hospital Charge Code	3643975
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Flat 12mm x 5cm Single Use SBLDFLAT-5 [3643975]

Facility

$1,117.68

Hospital Charge Code	3643975
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat 6mm x 9cm Single Use SBLDFLAT-10 [3644209]

Facility

$1,117.68

Hospital Charge Code	3644209
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Flat 6mm x 9cm Single Use SBLDFLAT-10 [3644209]

Facility

$1,117.68

Hospital Charge Code	3644209
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat 8mm x 11cm Single Use SBLDFLAT-2 [3644203]

Facility

$1,117.68

Hospital Charge Code	3644203
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade Flat 8mm x 11cm Single Use SBLDFLAT-2 [3644203]

Facility

$1,117.68

Hospital Charge Code	3644203
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat Round Tip 12mm x 5cm Single Use SBLDFLAT-6 [3644205]

Facility

$1,117.68

Hospital Charge Code	3644205
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Shukla Blade Flat Round Tip 12mm x 5cm Single Use SBLDFLAT-6 [3644205]

Facility

$1,117.68

Hospital Charge Code	3644205
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade For Calcar 8mm x 3cm Single Use SBLDCALC-1 [3644220]

Facility

$1,117.68

Hospital Charge Code	3644220
Hospital Revenue Code	272
Min. Negotiated Rate	$570.02
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.80
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: Kaiser Permanente Commercial	$704.14
Rate for Payer: Kaiser Permanente Medicaid	$570.02
Rate for Payer: MDX Hawaii PPO	$1,084.15
Rate for Payer: University Health Alliance Commercial	$814.68

Shukla Blade For Calcar 8mm x 3cm Single Use SBLDCALC-1 [3644220]

Facility

$1,117.68

Hospital Charge Code	3644220
Hospital Revenue Code	272
Min. Negotiated Rate	$950.03
Max. Negotiated Rate	$1,084.15
Rate for Payer: Cash Price	$726.49
Rate for Payer: Health Management Network Commercial	$950.03
Rate for Payer: MDX Hawaii PPO	$1,084.15

Know your out-of-pocket cost for care.

All Charges