Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Stapler Skin Rotating Head 35Wide PRW35 [3642675]

Facility

$473.68

Hospital Charge Code	3642675
Hospital Revenue Code	272
Min. Negotiated Rate	$241.58
Max. Negotiated Rate	$459.47
Rate for Payer: Cash Price	$307.89
Rate for Payer: Hawaii Western Management Group Commercial	$450.00
Rate for Payer: Health Management Network Commercial	$402.63
Rate for Payer: Kaiser Permanente Commercial	$298.42
Rate for Payer: Kaiser Permanente Medicaid	$241.58
Rate for Payer: MDX Hawaii PPO	$459.47
Rate for Payer: University Health Alliance Commercial	$345.27

Stapler TA45 3.5Mm TA4535S [3606727]

Facility

$771.10

Hospital Charge Code	3606727
Hospital Revenue Code	272
Min. Negotiated Rate	$655.43
Max. Negotiated Rate	$747.97
Rate for Payer: Cash Price	$501.22
Rate for Payer: Health Management Network Commercial	$655.43
Rate for Payer: MDX Hawaii PPO	$747.97

Stapler TA45 3.5Mm TA4535S [3606727]

Facility

$771.10

Hospital Charge Code	3606727
Hospital Revenue Code	272
Min. Negotiated Rate	$393.26
Max. Negotiated Rate	$747.97
Rate for Payer: Cash Price	$501.22
Rate for Payer: Hawaii Western Management Group Commercial	$732.54
Rate for Payer: Health Management Network Commercial	$655.43
Rate for Payer: Kaiser Permanente Commercial	$485.79
Rate for Payer: Kaiser Permanente Medicaid	$393.26
Rate for Payer: MDX Hawaii PPO	$747.97
Rate for Payer: University Health Alliance Commercial	$562.05

Stapler TA45 4.8Mm TA4548S [3606847]

Facility

$838.73

Hospital Charge Code	3606847
Hospital Revenue Code	272
Min. Negotiated Rate	$427.75
Max. Negotiated Rate	$813.57
Rate for Payer: Cash Price	$545.17
Rate for Payer: Hawaii Western Management Group Commercial	$796.79
Rate for Payer: Health Management Network Commercial	$712.92
Rate for Payer: Kaiser Permanente Commercial	$528.40
Rate for Payer: Kaiser Permanente Medicaid	$427.75
Rate for Payer: MDX Hawaii PPO	$813.57
Rate for Payer: University Health Alliance Commercial	$611.35

Stapler TA45 4.8Mm TA4548S [3606847]

Facility

$838.73

Hospital Charge Code	3606847
Hospital Revenue Code	272
Min. Negotiated Rate	$712.92
Max. Negotiated Rate	$813.57
Rate for Payer: Cash Price	$545.17
Rate for Payer: Health Management Network Commercial	$712.92
Rate for Payer: MDX Hawaii PPO	$813.57

Stapler TA 60mm-3.5mm TA6035S [3641725]

Facility

$576.49

Hospital Charge Code	3641725
Hospital Revenue Code	272
Min. Negotiated Rate	$294.01
Max. Negotiated Rate	$559.20
Rate for Payer: Cash Price	$374.72
Rate for Payer: Hawaii Western Management Group Commercial	$547.67
Rate for Payer: Health Management Network Commercial	$490.02
Rate for Payer: Kaiser Permanente Commercial	$363.19
Rate for Payer: Kaiser Permanente Medicaid	$294.01
Rate for Payer: MDX Hawaii PPO	$559.20
Rate for Payer: University Health Alliance Commercial	$420.20

Stapler TA 60mm-3.5mm TA6035S [3641725]

Facility

$576.49

Hospital Charge Code	3641725
Hospital Revenue Code	272
Min. Negotiated Rate	$490.02
Max. Negotiated Rate	$559.20
Rate for Payer: Cash Price	$374.72
Rate for Payer: Health Management Network Commercial	$490.02
Rate for Payer: MDX Hawaii PPO	$559.20

Stapler TA 60mm-4.8mm TA6048S [3641984]

Facility

$576.49

Hospital Charge Code	3641984
Hospital Revenue Code	272
Min. Negotiated Rate	$294.01
Max. Negotiated Rate	$559.20
Rate for Payer: Cash Price	$374.72
Rate for Payer: Hawaii Western Management Group Commercial	$547.67
Rate for Payer: Health Management Network Commercial	$490.02
Rate for Payer: Kaiser Permanente Commercial	$363.19
Rate for Payer: Kaiser Permanente Medicaid	$294.01
Rate for Payer: MDX Hawaii PPO	$559.20
Rate for Payer: University Health Alliance Commercial	$420.20

Stapler TA 60mm-4.8mm TA6048S [3641984]

Facility

$576.49

Hospital Charge Code	3641984
Hospital Revenue Code	272
Min. Negotiated Rate	$490.02
Max. Negotiated Rate	$559.20
Rate for Payer: Cash Price	$374.72
Rate for Payer: Health Management Network Commercial	$490.02
Rate for Payer: MDX Hawaii PPO	$559.20

Stapler Univ EndoGia 12MM EGIAUSTND [3607641]

Facility

$884.36

Hospital Charge Code	3607641
Hospital Revenue Code	272
Min. Negotiated Rate	$451.02
Max. Negotiated Rate	$857.83
Rate for Payer: Cash Price	$574.83
Rate for Payer: Hawaii Western Management Group Commercial	$840.14
Rate for Payer: Health Management Network Commercial	$751.71
Rate for Payer: Kaiser Permanente Commercial	$557.15
Rate for Payer: Kaiser Permanente Medicaid	$451.02
Rate for Payer: MDX Hawaii PPO	$857.83
Rate for Payer: University Health Alliance Commercial	$644.61

Stapler Univ EndoGia 12MM EGIAUSTND [3607641]

Facility

$884.36

Hospital Charge Code	3607641
Hospital Revenue Code	272
Min. Negotiated Rate	$751.71
Max. Negotiated Rate	$857.83
Rate for Payer: Cash Price	$574.83
Rate for Payer: Health Management Network Commercial	$751.71
Rate for Payer: MDX Hawaii PPO	$857.83

Stapler Univ Gia Short EGIAUSHORT [3607639]

Facility

$489.60

Hospital Charge Code	3607639
Hospital Revenue Code	272
Min. Negotiated Rate	$249.70
Max. Negotiated Rate	$474.91
Rate for Payer: Cash Price	$318.24
Rate for Payer: Hawaii Western Management Group Commercial	$465.12
Rate for Payer: Health Management Network Commercial	$416.16
Rate for Payer: Kaiser Permanente Commercial	$308.45
Rate for Payer: Kaiser Permanente Medicaid	$249.70
Rate for Payer: MDX Hawaii PPO	$474.91
Rate for Payer: University Health Alliance Commercial	$356.87

Stapler Univ Gia Short EGIAUSHORT [3607639]

Facility

$489.60

Hospital Charge Code	3607639
Hospital Revenue Code	272
Min. Negotiated Rate	$416.16
Max. Negotiated Rate	$474.91
Rate for Payer: Cash Price	$318.24
Rate for Payer: Health Management Network Commercial	$416.16
Rate for Payer: MDX Hawaii PPO	$474.91

Staple SuperMX Comp 18W x 18L AR-8719MX-1818 [3645000]

Facility

$13,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3645000
Hospital Revenue Code	278
Min. Negotiated Rate	$7,686.00
Max. Negotiated Rate	$13,313.25
Rate for Payer: Cash Price	$8,921.25
Rate for Payer: Hawaii Western Management Group Commercial	$9,607.50
Rate for Payer: Health Management Network Commercial	$11,666.25
Rate for Payer: MDX Hawaii PPO	$13,313.25
Rate for Payer: University Health Alliance Commercial	$7,686.00

Staple SuperMX Comp 18W x 18L AR-8719MX-1818 [3645000]

Facility

$13,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3645000
Hospital Revenue Code	278
Min. Negotiated Rate	$6,999.75
Max. Negotiated Rate	$13,313.25
Rate for Payer: Cash Price	$8,921.25
Rate for Payer: Hawaii Western Management Group Commercial	$9,607.50
Rate for Payer: Health Management Network Commercial	$11,666.25
Rate for Payer: Kaiser Permanente Commercial	$8,646.75
Rate for Payer: Kaiser Permanente Medicaid	$6,999.75
Rate for Payer: MDX Hawaii PPO	$13,313.25
Rate for Payer: University Health Alliance Commercial	$7,686.00

Staple SuperMX Nitinol w/Instr 15W x 15L AR-8719MXDS-1515 [3645001]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3645001
Hospital Revenue Code	278
Min. Negotiated Rate	$8,993.32
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Nitinol w/Instr 15W x 15L AR-8719MXDS-1515 [3645001]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3645001
Hospital Revenue Code	278
Min. Negotiated Rate	$8,190.35
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: Kaiser Permanente Commercial	$10,117.49
Rate for Payer: Kaiser Permanente Medicaid	$8,190.35
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Nitinol w/ Instr 18W x 15L AR-8719MXDS-1815 [3645002]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3645002
Hospital Revenue Code	278
Min. Negotiated Rate	$8,190.35
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: Kaiser Permanente Commercial	$10,117.49
Rate for Payer: Kaiser Permanente Medicaid	$8,190.35
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Nitinol w/ Instr 18W x 15L AR-8719MXDS-1815 [3645002]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3645002
Hospital Revenue Code	278
Min. Negotiated Rate	$8,993.32
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Nitinol w/Instr 25W x 20L AR-8719MXDS-2520 [3645003]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3645003
Hospital Revenue Code	278
Min. Negotiated Rate	$8,993.32
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Nitinol w/Instr 25W x 20L AR-8719MXDS-2520 [3645003]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3645003
Hospital Revenue Code	278
Min. Negotiated Rate	$8,190.35
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: Kaiser Permanente Commercial	$10,117.49
Rate for Payer: Kaiser Permanente Medicaid	$8,190.35
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Niti W/Instr 18W x18L AR-8719MXDS-1818 [3644974]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3644974
Hospital Revenue Code	278
Min. Negotiated Rate	$8,190.35
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: Kaiser Permanente Commercial	$10,117.49
Rate for Payer: Kaiser Permanente Medicaid	$8,190.35
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Niti W/Instr 18W x18L AR-8719MXDS-1818 [3644974]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3644974
Hospital Revenue Code	278
Min. Negotiated Rate	$8,993.32
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Niti W/Instr 20W x 20L AR-8719MXDS-2020 [3644975]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3644975
Hospital Revenue Code	278
Min. Negotiated Rate	$8,190.35
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: Kaiser Permanente Commercial	$10,117.49
Rate for Payer: Kaiser Permanente Medicaid	$8,190.35
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Staple SuperMX Niti W/Instr 20W x 20L AR-8719MXDS-2020 [3644975]

Facility

$16,059.50

Service Code	HCPCS C1713
Hospital Charge Code	3644975
Hospital Revenue Code	278
Min. Negotiated Rate	$8,993.32
Max. Negotiated Rate	$15,577.72
Rate for Payer: Cash Price	$10,438.68
Rate for Payer: Hawaii Western Management Group Commercial	$11,241.65
Rate for Payer: Health Management Network Commercial	$13,650.58
Rate for Payer: MDX Hawaii PPO	$15,577.72
Rate for Payer: University Health Alliance Commercial	$8,993.32

Know your out-of-pocket cost for care.

All Charges