Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE ETHILON 3-0 FS-1 BX/36

Facility

$4.00

Hospital Charge Code	8311
Hospital Revenue Code	270
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.68
Rate for Payer: Cash Price	$2.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.68
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.68
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.68
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.68
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.68
Rate for Payer: Ohana Health Plan Medicare	$1.68
Rate for Payer: UnitedHealthcare Medicare	$1.68
Rate for Payer: University Health Alliance Commercial	$2.92

SUTURE ETHILON 4-0 FS-1

Facility

$18.00

Hospital Charge Code	8312
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

SUTURE ETHILON 4-0 FS-1

Facility

$18.00

Hospital Charge Code	8312
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$7.56
Rate for Payer: Cash Price	$11.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.56
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$7.56
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$7.56
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$7.56
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$7.56
Rate for Payer: Ohana Health Plan Medicare	$7.56
Rate for Payer: UnitedHealthcare Medicare	$7.56
Rate for Payer: University Health Alliance Commercial	$13.12

SUTURE ETHILON 4-0 FS-2

Facility

$18.00

Hospital Charge Code	8313
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

SUTURE ETHILON 4-0 FS-2

Facility

$18.00

Hospital Charge Code	8313
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$7.56
Rate for Payer: Cash Price	$11.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.56
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$7.56
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$7.56
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$7.56
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$7.56
Rate for Payer: Ohana Health Plan Medicare	$7.56
Rate for Payer: UnitedHealthcare Medicare	$7.56
Rate for Payer: University Health Alliance Commercial	$13.12

SUTURE ETHILON 4-0 PC-3 BOX 12

Facility

$5.00

Hospital Charge Code	8575
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$3.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.60
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.64

SUTURE ETHILON 4-0 PC-3 BOX 12

Facility

$5.00

Hospital Charge Code	8575
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

SUTURE ETHILON 5-0 C-3 BOX 12

Facility

$180.00

Hospital Charge Code	8577
Hospital Revenue Code	270
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: MDX Hawaii PPO	$174.60

SUTURE ETHILON 5-0 C-3 BOX 12

Facility

$180.00

Hospital Charge Code	8577
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$90.00
Rate for Payer: AlohaCare Medicare	$75.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$165.60
Rate for Payer: Devoted Health Medicare	$75.60
Rate for Payer: Hawaii Medical Service Association Medicare	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$171.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$75.60
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$75.60
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$75.60
Rate for Payer: Ohana Health Plan Medicare	$75.60
Rate for Payer: UnitedHealthcare Medicare	$75.60
Rate for Payer: University Health Alliance Commercial	$131.20

SUTURE ETHILON 5-0 FS-2 BX/24

Facility

$37.00

Hospital Charge Code	8314
Hospital Revenue Code	270
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

SUTURE ETHILON 5-0 FS-2 BX/24

Facility

$37.00

Hospital Charge Code	8314
Hospital Revenue Code	270
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$15.54
Rate for Payer: Cash Price	$24.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.04
Rate for Payer: Devoted Health Medicare	$15.54
Rate for Payer: Hawaii Medical Service Association Medicare	$15.54
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$15.54
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$15.54
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$15.54
Rate for Payer: Ohana Health Plan Medicare	$15.54
Rate for Payer: UnitedHealthcare Medicare	$15.54
Rate for Payer: University Health Alliance Commercial	$26.97

SUTURE ETHILON 5-0 FS-2 BX/36

Facility

$34.00

Hospital Charge Code	8315
Hospital Revenue Code	270
Min. Negotiated Rate	$14.28
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$14.28
Rate for Payer: Cash Price	$22.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$31.28
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$14.28
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$14.28
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$14.28
Rate for Payer: Ohana Health Plan Medicare	$14.28
Rate for Payer: UnitedHealthcare Medicare	$14.28
Rate for Payer: University Health Alliance Commercial	$24.78

SUTURE ETHILON 5-0 FS-2 BX/36

Facility

$34.00

Hospital Charge Code	8315
Hospital Revenue Code	270
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

SUTURE ETHILON 5-0 P-3

Facility

$32.00

Hospital Charge Code	8316
Hospital Revenue Code	270
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

SUTURE ETHILON 5-0 P-3

Facility

$32.00

Hospital Charge Code	8316
Hospital Revenue Code	270
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$20.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$29.44
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$13.44
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$23.32

SUTURE ETHILON 5-0 PC-3 BOX 12

Facility

$2.00

Hospital Charge Code	8576
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

SUTURE ETHILON 5-0 PC-3 BOX 12

Facility

$2.00

Hospital Charge Code	8576
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

SUTURE ETHILON 6-0 P-1

Facility

$39.00

Hospital Charge Code	8317
Hospital Revenue Code	270
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$25.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

SUTURE ETHILON 6-0 P-1

Facility

$39.00

Hospital Charge Code	8317
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$25.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.88
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$16.38
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$28.43

SUTURE ETHILON 6-0 P-3

Facility

$39.00

Hospital Charge Code	8318
Hospital Revenue Code	270
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$25.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

SUTURE ETHILON 6-0 P-3

Facility

$39.00

Hospital Charge Code	8318
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$25.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.88
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$16.38
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$28.43

SUTURE FAST ABSORBING PLAIN GUT

Facility

$23.00

Hospital Charge Code	8802
Hospital Revenue Code	270
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$14.95
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

SUTURE FAST ABSORBING PLAIN GUT

Facility

$23.00

Hospital Charge Code	8802
Hospital Revenue Code	270
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$9.66
Rate for Payer: Cash Price	$14.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21.16
Rate for Payer: Devoted Health Medicare	$9.66
Rate for Payer: Hawaii Medical Service Association Medicare	$9.66
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$9.66
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$9.66
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$9.66
Rate for Payer: Ohana Health Plan Medicare	$9.66
Rate for Payer: UnitedHealthcare Medicare	$9.66
Rate for Payer: University Health Alliance Commercial	$16.76

SUTURE FAST ABSORBING PLAIN GUT 6-0 PC-1

Facility

$39.00

Hospital Charge Code	8319
Hospital Revenue Code	270
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$25.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

SUTURE FAST ABSORBING PLAIN GUT 6-0 PC-1

Facility

$39.00

Hospital Charge Code	8319
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$25.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.88
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$16.38
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$28.43

Know your out-of-pocket cost for care.

All Charges