Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Total Shoulder Comp Steinmann Pin 9" 405800 [3641567]

Facility

$903.48

Hospital Charge Code	3641567
Hospital Revenue Code	272
Min. Negotiated Rate	$460.77
Max. Negotiated Rate	$876.38
Rate for Payer: Cash Price	$587.26
Rate for Payer: Hawaii Western Management Group Commercial	$858.31
Rate for Payer: Health Management Network Commercial	$767.96
Rate for Payer: Kaiser Permanente Commercial	$569.19
Rate for Payer: Kaiser Permanente Medicaid	$460.77
Rate for Payer: MDX Hawaii PPO	$876.38
Rate for Payer: University Health Alliance Commercial	$658.55

Total Shoulder Comp Ti Std Taper Adaptor 118001 [3641227]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3641227
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Total Shoulder Comp Ti Std Taper Adaptor 118001 [3641227]

Facility

$1,727.50

Service Code	HCPCS C1776
Hospital Charge Code	3641227
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Total Shoulder Drill Bit 3.0mm MGS Sterile AR-9628S [3642766]

Facility

$2,711.50

Hospital Charge Code	3642766
Hospital Revenue Code	272
Min. Negotiated Rate	$1,382.87
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,575.93
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: Kaiser Permanente Commercial	$1,708.24
Rate for Payer: Kaiser Permanente Medicaid	$1,382.87
Rate for Payer: MDX Hawaii PPO	$2,630.16
Rate for Payer: University Health Alliance Commercial	$1,976.41

Total Shoulder Drill Bit 3.0mm MGS Sterile AR-9628S [3642766]

Facility

$2,711.50

Hospital Charge Code	3642766
Hospital Revenue Code	272
Min. Negotiated Rate	$2,304.78
Max. Negotiated Rate	$2,630.16
Rate for Payer: Cash Price	$1,762.48
Rate for Payer: Health Management Network Commercial	$2,304.78
Rate for Payer: MDX Hawaii PPO	$2,630.16

Total Shoulder Humeral Insert S/36 +3 to fit in 36 Cup AR9503S03 [3642759]

Facility

$2,537.50

Service Code	HCPCS C1776
Hospital Charge Code	3642759
Hospital Revenue Code	278
Min. Negotiated Rate	$1,294.12
Max. Negotiated Rate	$2,461.38
Rate for Payer: Cash Price	$1,649.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,776.25
Rate for Payer: Health Management Network Commercial	$2,156.88
Rate for Payer: Kaiser Permanente Commercial	$1,598.62
Rate for Payer: Kaiser Permanente Medicaid	$1,294.12
Rate for Payer: MDX Hawaii PPO	$2,461.38
Rate for Payer: University Health Alliance Commercial	$1,421.00

Total Shoulder Humeral Insert S/36 +3 to fit in 36 Cup AR9503S03 [3642759]

Facility

$2,537.50

Service Code	HCPCS C1776
Hospital Charge Code	3642759
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.00
Max. Negotiated Rate	$2,461.38
Rate for Payer: Cash Price	$1,649.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,776.25
Rate for Payer: Health Management Network Commercial	$2,156.88
Rate for Payer: MDX Hawaii PPO	$2,461.38
Rate for Payer: University Health Alliance Commercial	$1,421.00

Total Shoulder Humeral Stem & Neck Kit Sz 2 21mm 520-08-021 [3642459]

Facility

$24,788.50

Service Code	HCPCS C1776
Hospital Charge Code	3642459
Hospital Revenue Code	278
Min. Negotiated Rate	$12,642.14
Max. Negotiated Rate	$24,044.85
Rate for Payer: Cash Price	$16,112.53
Rate for Payer: Hawaii Western Management Group Commercial	$17,351.95
Rate for Payer: Health Management Network Commercial	$21,070.22
Rate for Payer: Kaiser Permanente Commercial	$15,616.75
Rate for Payer: Kaiser Permanente Medicaid	$12,642.14
Rate for Payer: MDX Hawaii PPO	$24,044.85
Rate for Payer: University Health Alliance Commercial	$13,881.56

Total Shoulder Humeral Stem & Neck Kit Sz 2 21mm 520-08-021 [3642459]

Facility

$24,788.50

Service Code	HCPCS C1776
Hospital Charge Code	3642459
Hospital Revenue Code	278
Min. Negotiated Rate	$13,881.56
Max. Negotiated Rate	$24,044.85
Rate for Payer: Cash Price	$16,112.53
Rate for Payer: Hawaii Western Management Group Commercial	$17,351.95
Rate for Payer: Health Management Network Commercial	$21,070.22
Rate for Payer: MDX Hawaii PPO	$24,044.85
Rate for Payer: University Health Alliance Commercial	$13,881.56

Total Shoulder Humeral Stem & Neck Kit Sz 3 24mm 52008024 [3642607]

Facility

$24,788.50

Service Code	HCPCS C1776
Hospital Charge Code	3642607
Hospital Revenue Code	278
Min. Negotiated Rate	$13,881.56
Max. Negotiated Rate	$24,044.85
Rate for Payer: Cash Price	$16,112.53
Rate for Payer: Hawaii Western Management Group Commercial	$17,351.95
Rate for Payer: Health Management Network Commercial	$21,070.22
Rate for Payer: MDX Hawaii PPO	$24,044.85
Rate for Payer: University Health Alliance Commercial	$13,881.56

Total Shoulder Humeral Stem & Neck Kit Sz 3 24mm 52008024 [3642607]

Facility

$24,788.50

Service Code	HCPCS C1776
Hospital Charge Code	3642607
Hospital Revenue Code	278
Min. Negotiated Rate	$12,642.14
Max. Negotiated Rate	$24,044.85
Rate for Payer: Cash Price	$16,112.53
Rate for Payer: Hawaii Western Management Group Commercial	$17,351.95
Rate for Payer: Health Management Network Commercial	$21,070.22
Rate for Payer: Kaiser Permanente Commercial	$15,616.75
Rate for Payer: Kaiser Permanente Medicaid	$12,642.14
Rate for Payer: MDX Hawaii PPO	$24,044.85
Rate for Payer: University Health Alliance Commercial	$13,881.56

Total Shoulder Humeral Stem Rev 10mm x 108mm 53010108 [3641269]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3641269
Hospital Revenue Code	278
Min. Negotiated Rate	$13,865.88
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev 10mm x 108mm 53010108 [3641269]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3641269
Hospital Revenue Code	278
Min. Negotiated Rate	$12,627.85
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: Kaiser Permanente Commercial	$15,599.11
Rate for Payer: Kaiser Permanente Medicaid	$12,627.85
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev 12mm x 108mm 53012108 [3641266]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3641266
Hospital Revenue Code	278
Min. Negotiated Rate	$13,865.88
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev 12mm x 108mm 53012108 [3641266]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3641266
Hospital Revenue Code	278
Min. Negotiated Rate	$12,627.85
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: Kaiser Permanente Commercial	$15,599.11
Rate for Payer: Kaiser Permanente Medicaid	$12,627.85
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev 14mm x 108mm 53014108 [3641208]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3641208
Hospital Revenue Code	278
Min. Negotiated Rate	$12,627.85
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: Kaiser Permanente Commercial	$15,599.11
Rate for Payer: Kaiser Permanente Medicaid	$12,627.85
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev 14mm x 108mm 53014108 [3641208]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3641208
Hospital Revenue Code	278
Min. Negotiated Rate	$13,865.88
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev 16mm x 108mm 53016108 [3641392]

Facility

$28,500.00

Service Code	HCPCS C1776
Hospital Charge Code	3641392
Hospital Revenue Code	278
Min. Negotiated Rate	$14,535.00
Max. Negotiated Rate	$27,645.00
Rate for Payer: Cash Price	$18,525.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,950.00
Rate for Payer: Health Management Network Commercial	$24,225.00
Rate for Payer: Kaiser Permanente Commercial	$17,955.00
Rate for Payer: Kaiser Permanente Medicaid	$14,535.00
Rate for Payer: MDX Hawaii PPO	$27,645.00
Rate for Payer: University Health Alliance Commercial	$15,960.00

Total Shoulder Humeral Stem Rev 16mm x 108mm 53016108 [3641392]

Facility

$28,500.00

Service Code	HCPCS C1776
Hospital Charge Code	3641392
Hospital Revenue Code	278
Min. Negotiated Rate	$15,960.00
Max. Negotiated Rate	$27,645.00
Rate for Payer: Cash Price	$18,525.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,950.00
Rate for Payer: Health Management Network Commercial	$24,225.00
Rate for Payer: MDX Hawaii PPO	$27,645.00
Rate for Payer: University Health Alliance Commercial	$15,960.00

Total Shoulder Humeral Stem Rev Small Shell 12x108mm 533-12-108 [3643260]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3643260
Hospital Revenue Code	278
Min. Negotiated Rate	$12,627.85
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: Kaiser Permanente Commercial	$15,599.11
Rate for Payer: Kaiser Permanente Medicaid	$12,627.85
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Rev Small Shell 12x108mm 533-12-108 [3643260]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3643260
Hospital Revenue Code	278
Min. Negotiated Rate	$13,865.88
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Small Shell 8mmX108mm 533-08-108 [3643108]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3643108
Hospital Revenue Code	278
Min. Negotiated Rate	$13,865.88
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Small Shell 8mmX108mm 533-08-108 [3643108]

Facility

$24,760.50

Service Code	HCPCS C1776
Hospital Charge Code	3643108
Hospital Revenue Code	278
Min. Negotiated Rate	$12,627.85
Max. Negotiated Rate	$24,017.69
Rate for Payer: Cash Price	$16,094.32
Rate for Payer: Hawaii Western Management Group Commercial	$17,332.35
Rate for Payer: Health Management Network Commercial	$21,046.42
Rate for Payer: Kaiser Permanente Commercial	$15,599.11
Rate for Payer: Kaiser Permanente Medicaid	$12,627.85
Rate for Payer: MDX Hawaii PPO	$24,017.69
Rate for Payer: University Health Alliance Commercial	$13,865.88

Total Shoulder Humeral Stem Small Shell Short 10mmX48mm 533-10-048 [3643215]

Facility

$30,514.50

Service Code	HCPCS C1776
Hospital Charge Code	3643215
Hospital Revenue Code	278
Min. Negotiated Rate	$15,562.40
Max. Negotiated Rate	$29,599.06
Rate for Payer: Cash Price	$19,834.42
Rate for Payer: Hawaii Western Management Group Commercial	$21,360.15
Rate for Payer: Health Management Network Commercial	$25,937.33
Rate for Payer: Kaiser Permanente Commercial	$19,224.13
Rate for Payer: Kaiser Permanente Medicaid	$15,562.40
Rate for Payer: MDX Hawaii PPO	$29,599.06
Rate for Payer: University Health Alliance Commercial	$17,088.12

Total Shoulder Humeral Stem Small Shell Short 10mmX48mm 533-10-048 [3643215]

Facility

$30,514.50

Service Code	HCPCS C1776
Hospital Charge Code	3643215
Hospital Revenue Code	278
Min. Negotiated Rate	$17,088.12
Max. Negotiated Rate	$29,599.06
Rate for Payer: Cash Price	$19,834.42
Rate for Payer: Hawaii Western Management Group Commercial	$21,360.15
Rate for Payer: Health Management Network Commercial	$25,937.33
Rate for Payer: MDX Hawaii PPO	$29,599.06
Rate for Payer: University Health Alliance Commercial	$17,088.12

Know your out-of-pocket cost for care.

All Charges