Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Staple Endo Gia Ii 45 2.5 Dlu 030425 [3607633]

Facility

$610.47

Hospital Charge Code	3607633
Hospital Revenue Code	272
Min. Negotiated Rate	$518.90
Max. Negotiated Rate	$592.16
Rate for Payer: Cash Price	$396.81
Rate for Payer: Health Management Network Commercial	$518.90
Rate for Payer: MDX Hawaii PPO	$592.16

Staple GIA 100-3.8 Single Use Load Unit GIA10038L [3643868]

Facility

$455.19

Hospital Charge Code	3643868
Hospital Revenue Code	272
Min. Negotiated Rate	$232.15
Max. Negotiated Rate	$441.53
Rate for Payer: Cash Price	$295.87
Rate for Payer: Hawaii Western Management Group Commercial	$432.43
Rate for Payer: Health Management Network Commercial	$386.91
Rate for Payer: Kaiser Permanente Commercial	$286.77
Rate for Payer: Kaiser Permanente Medicaid	$232.15
Rate for Payer: MDX Hawaii PPO	$441.53
Rate for Payer: University Health Alliance Commercial	$331.79

Staple GIA 100-3.8 Single Use Load Unit GIA10038L [3643868]

Facility

$455.19

Hospital Charge Code	3643868
Hospital Revenue Code	272
Min. Negotiated Rate	$386.91
Max. Negotiated Rate	$441.53
Rate for Payer: Cash Price	$295.87
Rate for Payer: Health Management Network Commercial	$386.91
Rate for Payer: MDX Hawaii PPO	$441.53

Staple GIA 45MM Articu Load Unit Vas/Med EGIA45AVM [3603170]

Facility

$1,038.90

Hospital Charge Code	3603170
Hospital Revenue Code	272
Min. Negotiated Rate	$883.07
Max. Negotiated Rate	$1,007.73
Rate for Payer: Cash Price	$675.29
Rate for Payer: Health Management Network Commercial	$883.07
Rate for Payer: MDX Hawaii PPO	$1,007.73

Staple GIA 45MM Articu Load Unit Vas/Med EGIA45AVM [3603170]

Facility

$1,038.90

Hospital Charge Code	3603170
Hospital Revenue Code	272
Min. Negotiated Rate	$529.84
Max. Negotiated Rate	$1,007.73
Rate for Payer: Cash Price	$675.29
Rate for Payer: Hawaii Western Management Group Commercial	$986.96
Rate for Payer: Health Management Network Commercial	$883.07
Rate for Payer: Kaiser Permanente Commercial	$654.51
Rate for Payer: Kaiser Permanente Medicaid	$529.84
Rate for Payer: MDX Hawaii PPO	$1,007.73
Rate for Payer: University Health Alliance Commercial	$757.25

Staple GIA 45MM Articu Load Unit Vas/Thick EGIA45AMT [3603180]

Facility

$1,034.35

Hospital Charge Code	3603180
Hospital Revenue Code	272
Min. Negotiated Rate	$527.52
Max. Negotiated Rate	$1,003.32
Rate for Payer: Cash Price	$672.33
Rate for Payer: Hawaii Western Management Group Commercial	$982.63
Rate for Payer: Health Management Network Commercial	$879.20
Rate for Payer: Kaiser Permanente Commercial	$651.64
Rate for Payer: Kaiser Permanente Medicaid	$527.52
Rate for Payer: MDX Hawaii PPO	$1,003.32
Rate for Payer: University Health Alliance Commercial	$753.94

Staple GIA 45MM Articu Load Unit Vas/Thick EGIA45AMT [3603180]

Facility

$1,034.35

Hospital Charge Code	3603180
Hospital Revenue Code	272
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,003.32
Rate for Payer: Cash Price	$672.33
Rate for Payer: Health Management Network Commercial	$879.20
Rate for Payer: MDX Hawaii PPO	$1,003.32

Staple GIA 60MM Articu Load Unit ExThick SIG60AXT [3625832]

Facility

$1,767.48

Hospital Charge Code	3625832
Hospital Revenue Code	272
Min. Negotiated Rate	$1,502.36
Max. Negotiated Rate	$1,714.46
Rate for Payer: Cash Price	$1,148.86
Rate for Payer: Health Management Network Commercial	$1,502.36
Rate for Payer: MDX Hawaii PPO	$1,714.46

Staple GIA 60MM Articu Load Unit ExThick SIG60AXT [3625832]

Facility

$1,767.48

Hospital Charge Code	3625832
Hospital Revenue Code	272
Min. Negotiated Rate	$901.41
Max. Negotiated Rate	$1,714.46
Rate for Payer: Cash Price	$1,148.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,679.11
Rate for Payer: Health Management Network Commercial	$1,502.36
Rate for Payer: Kaiser Permanente Commercial	$1,113.51
Rate for Payer: Kaiser Permanente Medicaid	$901.41
Rate for Payer: MDX Hawaii PPO	$1,714.46
Rate for Payer: University Health Alliance Commercial	$1,288.32

Staple GIA 60MM Articu Load Unit Med/Thick EGIA60AMT [3603171]

Facility

$1,372.63

Hospital Charge Code	3603171
Hospital Revenue Code	272
Min. Negotiated Rate	$700.04
Max. Negotiated Rate	$1,331.45
Rate for Payer: Cash Price	$892.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.00
Rate for Payer: Health Management Network Commercial	$1,166.74
Rate for Payer: Kaiser Permanente Commercial	$864.76
Rate for Payer: Kaiser Permanente Medicaid	$700.04
Rate for Payer: MDX Hawaii PPO	$1,331.45
Rate for Payer: University Health Alliance Commercial	$1,000.51

Staple GIA 60MM Articu Load Unit Med/Thick EGIA60AMT [3603171]

Facility

$1,372.63

Hospital Charge Code	3603171
Hospital Revenue Code	272
Min. Negotiated Rate	$1,166.74
Max. Negotiated Rate	$1,331.45
Rate for Payer: Cash Price	$892.21
Rate for Payer: Health Management Network Commercial	$1,166.74
Rate for Payer: MDX Hawaii PPO	$1,331.45

Staple GIA 60MM Articu Load Unit Vas/Med EGIA60AVM [3603172]

Facility

$1,319.67

Hospital Charge Code	3603172
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.72
Max. Negotiated Rate	$1,280.08
Rate for Payer: Cash Price	$857.79
Rate for Payer: Health Management Network Commercial	$1,121.72
Rate for Payer: MDX Hawaii PPO	$1,280.08

Staple GIA 60MM Articu Load Unit Vas/Med EGIA60AVM [3603172]

Facility

$1,319.67

Hospital Charge Code	3603172
Hospital Revenue Code	272
Min. Negotiated Rate	$673.03
Max. Negotiated Rate	$1,280.08
Rate for Payer: Cash Price	$857.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,253.69
Rate for Payer: Health Management Network Commercial	$1,121.72
Rate for Payer: Kaiser Permanente Commercial	$831.39
Rate for Payer: Kaiser Permanente Medicaid	$673.03
Rate for Payer: MDX Hawaii PPO	$1,280.08
Rate for Payer: University Health Alliance Commercial	$961.91

Staple Multifire Gia 60 3.8 Dlu GIA6038L [3606681]

Facility

$270.71

Hospital Charge Code	3606681
Hospital Revenue Code	272
Min. Negotiated Rate	$138.06
Max. Negotiated Rate	$262.59
Rate for Payer: Cash Price	$175.96
Rate for Payer: Hawaii Western Management Group Commercial	$257.17
Rate for Payer: Health Management Network Commercial	$230.10
Rate for Payer: Kaiser Permanente Commercial	$170.55
Rate for Payer: Kaiser Permanente Medicaid	$138.06
Rate for Payer: MDX Hawaii PPO	$262.59
Rate for Payer: University Health Alliance Commercial	$197.32

Staple Multifire Gia 60 3.8 Dlu GIA6038L [3606681]

Facility

$270.71

Hospital Charge Code	3606681
Hospital Revenue Code	272
Min. Negotiated Rate	$230.10
Max. Negotiated Rate	$262.59
Rate for Payer: Cash Price	$175.96
Rate for Payer: Health Management Network Commercial	$230.10
Rate for Payer: MDX Hawaii PPO	$262.59

Staple Nitinol Kit 10mm x 10mm Fuseforce FFNS1010 [3644429]

Facility

$6,366.81

Service Code	HCPCS C1713
Hospital Charge Code	3644429
Hospital Revenue Code	278
Min. Negotiated Rate	$3,565.41
Max. Negotiated Rate	$6,175.81
Rate for Payer: Cash Price	$4,138.43
Rate for Payer: Hawaii Western Management Group Commercial	$4,456.77
Rate for Payer: Health Management Network Commercial	$5,411.79
Rate for Payer: MDX Hawaii PPO	$6,175.81
Rate for Payer: University Health Alliance Commercial	$3,565.41

Staple Nitinol Kit 10mm x 10mm Fuseforce FFNS1010 [3644429]

Facility

$6,366.81

Service Code	HCPCS C1713
Hospital Charge Code	3644429
Hospital Revenue Code	278
Min. Negotiated Rate	$3,247.07
Max. Negotiated Rate	$6,175.81
Rate for Payer: Cash Price	$4,138.43
Rate for Payer: Hawaii Western Management Group Commercial	$4,456.77
Rate for Payer: Health Management Network Commercial	$5,411.79
Rate for Payer: Kaiser Permanente Commercial	$4,011.09
Rate for Payer: Kaiser Permanente Medicaid	$3,247.07
Rate for Payer: MDX Hawaii PPO	$6,175.81
Rate for Payer: University Health Alliance Commercial	$3,565.41

Stapler 75mm Reloadable Ethicon NTLC75 [3642959]

Facility

$1,457.13

Hospital Charge Code	3642959
Hospital Revenue Code	272
Min. Negotiated Rate	$1,238.56
Max. Negotiated Rate	$1,413.42
Rate for Payer: Cash Price	$947.13
Rate for Payer: Health Management Network Commercial	$1,238.56
Rate for Payer: MDX Hawaii PPO	$1,413.42

Stapler 75mm Reloadable Ethicon NTLC75 [3642959]

Facility

$1,457.13

Hospital Charge Code	3642959
Hospital Revenue Code	272
Min. Negotiated Rate	$743.14
Max. Negotiated Rate	$1,413.42
Rate for Payer: Cash Price	$947.13
Rate for Payer: Hawaii Western Management Group Commercial	$1,384.27
Rate for Payer: Health Management Network Commercial	$1,238.56
Rate for Payer: Kaiser Permanente Commercial	$917.99
Rate for Payer: Kaiser Permanente Medicaid	$743.14
Rate for Payer: MDX Hawaii PPO	$1,413.42
Rate for Payer: University Health Alliance Commercial	$1,062.10

Stapler 80mm Med Thk Tristp Purple GIA80MTS [3644072]

Facility

$888.53

Hospital Charge Code	3644072
Hospital Revenue Code	272
Min. Negotiated Rate	$453.15
Max. Negotiated Rate	$861.87
Rate for Payer: Cash Price	$577.54
Rate for Payer: Hawaii Western Management Group Commercial	$844.10
Rate for Payer: Health Management Network Commercial	$755.25
Rate for Payer: Kaiser Permanente Commercial	$559.77
Rate for Payer: Kaiser Permanente Medicaid	$453.15
Rate for Payer: MDX Hawaii PPO	$861.87
Rate for Payer: University Health Alliance Commercial	$647.65

Stapler 80mm Med Thk Tristp Purple GIA80MTS [3644072]

Facility

$888.53

Hospital Charge Code	3644072
Hospital Revenue Code	272
Min. Negotiated Rate	$755.25
Max. Negotiated Rate	$861.87
Rate for Payer: Cash Price	$577.54
Rate for Payer: Health Management Network Commercial	$755.25
Rate for Payer: MDX Hawaii PPO	$861.87

Stapler Anvil EEA 21mm EEAORVIL21A [3640445]

Facility

$546.53

Hospital Charge Code	3640445
Hospital Revenue Code	272
Min. Negotiated Rate	$464.55
Max. Negotiated Rate	$530.13
Rate for Payer: Cash Price	$355.24
Rate for Payer: Health Management Network Commercial	$464.55
Rate for Payer: MDX Hawaii PPO	$530.13

Stapler Anvil EEA 21mm EEAORVIL21A [3640445]

Facility

$546.53

Hospital Charge Code	3640445
Hospital Revenue Code	272
Min. Negotiated Rate	$278.73
Max. Negotiated Rate	$530.13
Rate for Payer: Cash Price	$355.24
Rate for Payer: Hawaii Western Management Group Commercial	$519.20
Rate for Payer: Health Management Network Commercial	$464.55
Rate for Payer: Kaiser Permanente Commercial	$344.31
Rate for Payer: Kaiser Permanente Medicaid	$278.73
Rate for Payer: MDX Hawaii PPO	$530.13
Rate for Payer: University Health Alliance Commercial	$398.37

Stapler Contour CVD Cutter Blue CS40B [3601167]

Facility

$2,891.96

Hospital Charge Code	3601167
Hospital Revenue Code	272
Min. Negotiated Rate	$1,474.90
Max. Negotiated Rate	$2,805.20
Rate for Payer: Cash Price	$1,879.77
Rate for Payer: Hawaii Western Management Group Commercial	$2,747.36
Rate for Payer: Health Management Network Commercial	$2,458.17
Rate for Payer: Kaiser Permanente Commercial	$1,821.93
Rate for Payer: Kaiser Permanente Medicaid	$1,474.90
Rate for Payer: MDX Hawaii PPO	$2,805.20
Rate for Payer: University Health Alliance Commercial	$2,107.95

Stapler Contour CVD Cutter Blue CS40B [3601167]

Facility

$2,891.96

Hospital Charge Code	3601167
Hospital Revenue Code	272
Min. Negotiated Rate	$2,458.17
Max. Negotiated Rate	$2,805.20
Rate for Payer: Cash Price	$1,879.77
Rate for Payer: Health Management Network Commercial	$2,458.17
Rate for Payer: MDX Hawaii PPO	$2,805.20

Know your out-of-pocket cost for care.

All Charges