Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE FAST ABSORBING PLAIN GUT PC-1 BOX 12

Facility

$23.00

Hospital Charge Code	8581
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 PC-1 BOX 12

Facility

$23.00

Hospital Charge Code	8581
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 MONOCRYL 4-0

Facility

$133.00

Hospital Charge Code	8801
Hospital Revenue Code	270
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

SUTURE MONOCRYL 4-0

Facility

$133.00

Hospital Charge Code	8801
Hospital Revenue Code	270
Min. Negotiated Rate	$55.86
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$55.86
Rate for Payer: Cash Price	$86.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$122.36
Rate for Payer: Devoted Health Medicare	$55.86
Rate for Payer: Hawaii Medical Service Association Medicare	$55.86
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$55.86
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$55.86
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$55.86
Rate for Payer: Ohana Health Plan Medicare	$55.86
Rate for Payer: UnitedHealthcare Medicare	$55.86
Rate for Payer: University Health Alliance Commercial	$96.94

SUTURE MONOCRYL 4-0 P-3 BOX 12

Facility

$97.00

Hospital Charge Code	8580
Hospital Revenue Code	270
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$40.74
Rate for Payer: Cash Price	$63.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$89.24
Rate for Payer: Devoted Health Medicare	$40.74
Rate for Payer: Hawaii Medical Service Association Medicare	$40.74
Rate for Payer: Hawaii Western Management Group Commercial	$92.15
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$40.74
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$40.74
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$40.74
Rate for Payer: Ohana Health Plan Medicare	$40.74
Rate for Payer: UnitedHealthcare Medicare	$40.74
Rate for Payer: University Health Alliance Commercial	$70.70

SUTURE MONOCRYL 4-0 P-3 BOX 12

Facility

$97.00

Hospital Charge Code	8580
Hospital Revenue Code	270
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

SUTURE MONOCRYL 4-0 PS-2

Facility

$69.00

Hospital Charge Code	8320
Hospital Revenue Code	270
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

SUTURE MONOCRYL 4-0 PS-2

Facility

$69.00

Hospital Charge Code	8320
Hospital Revenue Code	270
Min. Negotiated Rate	$28.98
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$65.55
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$50.29

SUTURE MONOCRYL 5-0 P-1 BOX 12

Facility

$4.00

Hospital Charge Code	8578
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 MONOCRYL 5-0 P-1 BOX 12

Facility

$4.00

Hospital Charge Code	8578
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

SUTURE MONOCRYL 6-0 P-1 BOX 12

Facility

$3.00

Hospital Charge Code	8579
Hospital Revenue Code	270
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

SUTURE MONOCRYL 6-0 P-1 BOX 12

Facility

$3.00

Hospital Charge Code	8579
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

SUTURE PERMA-HAND SILK 2-0

Facility

$2.00

Hospital Charge Code	8804
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 PERMA-HAND SILK 2-0

Facility

$2.00

Hospital Charge Code	8804
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 PERMA-HAND SILK 2-0 SH BOX 36

Facility

$2.00

Hospital Charge Code	8803
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 PERMA-HAND SILK 2-0 SH BOX 36

Facility

$2.00

Hospital Charge Code	8803
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 PROLENE 4-0

Facility

$25.00

Hospital Charge Code	8809
Hospital Revenue Code	270
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

SUTURE PROLENE 4-0

Facility

$25.00

Hospital Charge Code	8809
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$23.00
Rate for Payer: Devoted Health Medicare	$10.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$10.50
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$18.22

SUTURE PROLENE 4-0 PS-2

Facility

$79.00

Hospital Charge Code	8322
Hospital Revenue Code	270
Min. Negotiated Rate	$33.18
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$33.18
Rate for Payer: Cash Price	$51.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$72.68
Rate for Payer: Devoted Health Medicare	$33.18
Rate for Payer: Hawaii Medical Service Association Medicare	$33.18
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$33.18
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$33.18
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$33.18
Rate for Payer: Ohana Health Plan Medicare	$33.18
Rate for Payer: UnitedHealthcare Medicare	$33.18
Rate for Payer: University Health Alliance Commercial	$57.58

SUTURE PROLENE 4-0 PS-2

Facility

$79.00

Hospital Charge Code	8322
Hospital Revenue Code	270
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$51.35
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

SUTURE PROLENE 5-0 PS-5

Facility

$70.00

Hospital Charge Code	8323
Hospital Revenue Code	270
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$29.40
Rate for Payer: Cash Price	$45.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$64.40
Rate for Payer: Devoted Health Medicare	$29.40
Rate for Payer: Hawaii Medical Service Association Medicare	$29.40
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$29.40
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$29.40
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$29.40
Rate for Payer: Ohana Health Plan Medicare	$29.40
Rate for Payer: UnitedHealthcare Medicare	$29.40
Rate for Payer: University Health Alliance Commercial	$51.02

SUTURE PROLENE 5-0 PS-5

Facility

$70.00

Hospital Charge Code	8323
Hospital Revenue Code	270
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$45.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

SUTURE REMOVAL TRAY

Facility

$125.00

Hospital Charge Code	8324
Hospital Revenue Code	270
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

SUTURE REMOVAL TRAY

Facility

$125.00

Hospital Charge Code	8324
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$52.50
Rate for Payer: Cash Price	$81.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$115.00
Rate for Payer: Devoted Health Medicare	$52.50
Rate for Payer: Hawaii Medical Service Association Medicare	$52.50
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$52.50
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$52.50
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$52.50
Rate for Payer: Ohana Health Plan Medicare	$52.50
Rate for Payer: UnitedHealthcare Medicare	$52.50
Rate for Payer: University Health Alliance Commercial	$91.11

SUTURE VICRYL 5-0 P-1

Facility

$434.00

Hospital Charge Code	8325
Hospital Revenue Code	270
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$282.10
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: MDX Hawaii PPO	$420.98

Know your out-of-pocket cost for care.

All Charges