Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Mesh Phasix ST 7 x 10cm 1200710 [3640926]

Facility

$5,052.50

Service Code	HCPCS C1781
Hospital Charge Code	3640926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,829.40
Max. Negotiated Rate	$4,900.93
Rate for Payer: Cash Price	$3,284.12
Rate for Payer: Hawaii Western Management Group Commercial	$3,536.75
Rate for Payer: Health Management Network Commercial	$4,294.62
Rate for Payer: MDX Hawaii PPO	$4,900.93
Rate for Payer: University Health Alliance Commercial	$2,829.40

Mesh Polypropylene 10X14 0112660 [3603302]

Facility

$874.02

Service Code	HCPCS C1781
Hospital Charge Code	3603302
Hospital Revenue Code	278
Min. Negotiated Rate	$445.75
Max. Negotiated Rate	$847.80
Rate for Payer: Cash Price	$568.11
Rate for Payer: Hawaii Western Management Group Commercial	$611.81
Rate for Payer: Health Management Network Commercial	$742.92
Rate for Payer: Kaiser Permanente Commercial	$550.63
Rate for Payer: Kaiser Permanente Medicaid	$445.75
Rate for Payer: MDX Hawaii PPO	$847.80
Rate for Payer: University Health Alliance Commercial	$489.45

Mesh Polypropylene 10X14 0112660 [3603302]

Facility

$874.02

Service Code	HCPCS C1781
Hospital Charge Code	3603302
Hospital Revenue Code	278
Min. Negotiated Rate	$489.45
Max. Negotiated Rate	$847.80
Rate for Payer: Cash Price	$568.11
Rate for Payer: Hawaii Western Management Group Commercial	$611.81
Rate for Payer: Health Management Network Commercial	$742.92
Rate for Payer: MDX Hawaii PPO	$847.80
Rate for Payer: University Health Alliance Commercial	$489.45

Mesh Polypropylene 1X4 0112640 [3603300]

Facility

$358.28

Service Code	HCPCS C1781
Hospital Charge Code	3603300
Hospital Revenue Code	278
Min. Negotiated Rate	$182.72
Max. Negotiated Rate	$347.53
Rate for Payer: Cash Price	$232.88
Rate for Payer: Hawaii Western Management Group Commercial	$250.80
Rate for Payer: Health Management Network Commercial	$304.54
Rate for Payer: Kaiser Permanente Commercial	$225.72
Rate for Payer: Kaiser Permanente Medicaid	$182.72
Rate for Payer: MDX Hawaii PPO	$347.53
Rate for Payer: University Health Alliance Commercial	$200.64

Mesh Polypropylene 1X4 0112640 [3603300]

Facility

$358.28

Service Code	HCPCS C1781
Hospital Charge Code	3603300
Hospital Revenue Code	278
Min. Negotiated Rate	$200.64
Max. Negotiated Rate	$347.53
Rate for Payer: Cash Price	$232.88
Rate for Payer: Hawaii Western Management Group Commercial	$250.80
Rate for Payer: Health Management Network Commercial	$304.54
Rate for Payer: MDX Hawaii PPO	$347.53
Rate for Payer: University Health Alliance Commercial	$200.64

Mesh Polypropylene 6X6 0112720 [3603321]

Facility

$1,522.50

Service Code	HCPCS C1781
Hospital Charge Code	3603321
Hospital Revenue Code	278
Min. Negotiated Rate	$776.48
Max. Negotiated Rate	$1,476.83
Rate for Payer: Cash Price	$989.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,065.75
Rate for Payer: Health Management Network Commercial	$1,294.12
Rate for Payer: Kaiser Permanente Commercial	$959.17
Rate for Payer: Kaiser Permanente Medicaid	$776.48
Rate for Payer: MDX Hawaii PPO	$1,476.83
Rate for Payer: University Health Alliance Commercial	$852.60

Mesh Polypropylene 6X6 0112720 [3603321]

Facility

$1,522.50

Service Code	HCPCS C1781
Hospital Charge Code	3603321
Hospital Revenue Code	278
Min. Negotiated Rate	$852.60
Max. Negotiated Rate	$1,476.83
Rate for Payer: Cash Price	$989.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,065.75
Rate for Payer: Health Management Network Commercial	$1,294.12
Rate for Payer: MDX Hawaii PPO	$1,476.83
Rate for Payer: University Health Alliance Commercial	$852.60

Mesh Symbotex Composite 15cm SYM15 [3642093]

Facility

$4,949.32

Service Code	HCPCS C1781
Hospital Charge Code	3642093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,524.15
Max. Negotiated Rate	$4,800.84
Rate for Payer: Cash Price	$3,217.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,464.52
Rate for Payer: Health Management Network Commercial	$4,206.92
Rate for Payer: Kaiser Permanente Commercial	$3,118.07
Rate for Payer: Kaiser Permanente Medicaid	$2,524.15
Rate for Payer: MDX Hawaii PPO	$4,800.84
Rate for Payer: University Health Alliance Commercial	$2,771.62

Mesh Symbotex Composite 15cm SYM15 [3642093]

Facility

$4,949.32

Service Code	HCPCS C1781
Hospital Charge Code	3642093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,771.62
Max. Negotiated Rate	$4,800.84
Rate for Payer: Cash Price	$3,217.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,464.52
Rate for Payer: Health Management Network Commercial	$4,206.92
Rate for Payer: MDX Hawaii PPO	$4,800.84
Rate for Payer: University Health Alliance Commercial	$2,771.62

Mesh Symbotex Composite 15x10cm SYM1510 [3640349]

Facility

$3,591.17

Service Code	HCPCS C1781
Hospital Charge Code	3640349
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.06
Max. Negotiated Rate	$3,483.43
Rate for Payer: Cash Price	$2,334.26
Rate for Payer: Hawaii Western Management Group Commercial	$2,513.82
Rate for Payer: Health Management Network Commercial	$3,052.49
Rate for Payer: MDX Hawaii PPO	$3,483.43
Rate for Payer: University Health Alliance Commercial	$2,011.06

Mesh Symbotex Composite 15x10cm SYM1510 [3640349]

Facility

$3,591.17

Service Code	HCPCS C1781
Hospital Charge Code	3640349
Hospital Revenue Code	278
Min. Negotiated Rate	$1,831.50
Max. Negotiated Rate	$3,483.43
Rate for Payer: Cash Price	$2,334.26
Rate for Payer: Hawaii Western Management Group Commercial	$2,513.82
Rate for Payer: Health Management Network Commercial	$3,052.49
Rate for Payer: Kaiser Permanente Commercial	$2,262.44
Rate for Payer: Kaiser Permanente Medicaid	$1,831.50
Rate for Payer: MDX Hawaii PPO	$3,483.43
Rate for Payer: University Health Alliance Commercial	$2,011.06

Mesh Symbotex Composite 20cm SYM20 [3642094]

Facility

$6,589.06

Service Code	HCPCS C1781
Hospital Charge Code	3642094
Hospital Revenue Code	278
Min. Negotiated Rate	$3,360.42
Max. Negotiated Rate	$6,391.39
Rate for Payer: Cash Price	$4,282.89
Rate for Payer: Hawaii Western Management Group Commercial	$4,612.34
Rate for Payer: Health Management Network Commercial	$5,600.70
Rate for Payer: Kaiser Permanente Commercial	$4,151.11
Rate for Payer: Kaiser Permanente Medicaid	$3,360.42
Rate for Payer: MDX Hawaii PPO	$6,391.39
Rate for Payer: University Health Alliance Commercial	$3,689.87

Mesh Symbotex Composite 20cm SYM20 [3642094]

Facility

$6,589.06

Service Code	HCPCS C1781
Hospital Charge Code	3642094
Hospital Revenue Code	278
Min. Negotiated Rate	$3,689.87
Max. Negotiated Rate	$6,391.39
Rate for Payer: Cash Price	$4,282.89
Rate for Payer: Hawaii Western Management Group Commercial	$4,612.34
Rate for Payer: Health Management Network Commercial	$5,600.70
Rate for Payer: MDX Hawaii PPO	$6,391.39
Rate for Payer: University Health Alliance Commercial	$3,689.87

Mesh Symbotex Composite 20x15cm SYM2015 [3642095]

Facility

$5,356.08

Service Code	HCPCS C1781
Hospital Charge Code	3642095
Hospital Revenue Code	278
Min. Negotiated Rate	$2,731.60
Max. Negotiated Rate	$5,195.40
Rate for Payer: Kaiser Permanente Medicaid	$2,731.60
Rate for Payer: Cash Price	$3,481.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,749.26
Rate for Payer: Health Management Network Commercial	$4,552.67
Rate for Payer: Kaiser Permanente Commercial	$3,374.33
Rate for Payer: MDX Hawaii PPO	$5,195.40
Rate for Payer: University Health Alliance Commercial	$2,999.40

Mesh Symbotex Composite 20x15cm SYM2015 [3642095]

Facility

$5,356.08

Service Code	HCPCS C1781
Hospital Charge Code	3642095
Hospital Revenue Code	278
Min. Negotiated Rate	$2,999.40
Max. Negotiated Rate	$5,195.40
Rate for Payer: Cash Price	$3,481.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,749.26
Rate for Payer: Health Management Network Commercial	$4,552.67
Rate for Payer: MDX Hawaii PPO	$5,195.40
Rate for Payer: University Health Alliance Commercial	$2,999.40

Mesh Symbotex Composite 30x20cm SYM3020 [3642096]

Facility

$9,909.69

Service Code	HCPCS C1781
Hospital Charge Code	3642096
Hospital Revenue Code	278
Min. Negotiated Rate	$5,053.94
Max. Negotiated Rate	$9,612.40
Rate for Payer: Cash Price	$6,441.30
Rate for Payer: Hawaii Western Management Group Commercial	$6,936.78
Rate for Payer: Health Management Network Commercial	$8,423.24
Rate for Payer: Kaiser Permanente Commercial	$6,243.10
Rate for Payer: Kaiser Permanente Medicaid	$5,053.94
Rate for Payer: MDX Hawaii PPO	$9,612.40
Rate for Payer: University Health Alliance Commercial	$5,549.43

Mesh Symbotex Composite 30x20cm SYM3020 [3642096]

Facility

$9,909.69

Service Code	HCPCS C1781
Hospital Charge Code	3642096
Hospital Revenue Code	278
Min. Negotiated Rate	$5,549.43
Max. Negotiated Rate	$9,612.40
Rate for Payer: Cash Price	$6,441.30
Rate for Payer: Hawaii Western Management Group Commercial	$6,936.78
Rate for Payer: Health Management Network Commercial	$8,423.24
Rate for Payer: MDX Hawaii PPO	$9,612.40
Rate for Payer: University Health Alliance Commercial	$5,549.43

Mesh Ventralex ST LG 5950009 [3603343]

Facility

$3,367.70

Service Code	HCPCS C1781
Hospital Charge Code	3603343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,885.91
Max. Negotiated Rate	$3,266.67
Rate for Payer: Cash Price	$2,189.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,357.39
Rate for Payer: Health Management Network Commercial	$2,862.55
Rate for Payer: MDX Hawaii PPO	$3,266.67
Rate for Payer: University Health Alliance Commercial	$1,885.91

Mesh Ventralex ST LG 5950009 [3603343]

Facility

$3,367.70

Service Code	HCPCS C1781
Hospital Charge Code	3603343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.53
Max. Negotiated Rate	$3,266.67
Rate for Payer: Cash Price	$2,189.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,357.39
Rate for Payer: Health Management Network Commercial	$2,862.55
Rate for Payer: Kaiser Permanente Commercial	$2,121.65
Rate for Payer: Kaiser Permanente Medicaid	$1,717.53
Rate for Payer: MDX Hawaii PPO	$3,266.67
Rate for Payer: University Health Alliance Commercial	$1,885.91

Mesh Ventralex ST MED 5950008 [3603342]

Facility

$4,313.60

Service Code	HCPCS C1781
Hospital Charge Code	3603342
Hospital Revenue Code	278
Min. Negotiated Rate	$2,199.94
Max. Negotiated Rate	$4,184.19
Rate for Payer: Cash Price	$2,803.84
Rate for Payer: Hawaii Western Management Group Commercial	$3,019.52
Rate for Payer: Health Management Network Commercial	$3,666.56
Rate for Payer: Kaiser Permanente Commercial	$2,717.57
Rate for Payer: Kaiser Permanente Medicaid	$2,199.94
Rate for Payer: MDX Hawaii PPO	$4,184.19
Rate for Payer: University Health Alliance Commercial	$2,415.62

Mesh Ventralex ST MED 5950008 [3603342]

Facility

$4,313.60

Service Code	HCPCS C1781
Hospital Charge Code	3603342
Hospital Revenue Code	278
Min. Negotiated Rate	$2,415.62
Max. Negotiated Rate	$4,184.19
Rate for Payer: Cash Price	$2,803.84
Rate for Payer: Hawaii Western Management Group Commercial	$3,019.52
Rate for Payer: Health Management Network Commercial	$3,666.56
Rate for Payer: MDX Hawaii PPO	$4,184.19
Rate for Payer: University Health Alliance Commercial	$2,415.62

Mesh Ventralex ST SM 5950007 [3603341]

Facility

$3,688.10

Service Code	HCPCS C1781
Hospital Charge Code	3603341
Hospital Revenue Code	278
Min. Negotiated Rate	$2,065.34
Max. Negotiated Rate	$3,577.46
Rate for Payer: Cash Price	$2,397.26
Rate for Payer: Hawaii Western Management Group Commercial	$2,581.67
Rate for Payer: Health Management Network Commercial	$3,134.89
Rate for Payer: MDX Hawaii PPO	$3,577.46
Rate for Payer: University Health Alliance Commercial	$2,065.34

Mesh Ventralex ST SM 5950007 [3603341]

Facility

$3,688.10

Service Code	HCPCS C1781
Hospital Charge Code	3603341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,880.93
Max. Negotiated Rate	$3,577.46
Rate for Payer: Cash Price	$2,397.26
Rate for Payer: Hawaii Western Management Group Commercial	$2,581.67
Rate for Payer: Health Management Network Commercial	$3,134.89
Rate for Payer: Kaiser Permanente Commercial	$2,323.50
Rate for Payer: Kaiser Permanente Medicaid	$1,880.93
Rate for Payer: MDX Hawaii PPO	$3,577.46
Rate for Payer: University Health Alliance Commercial	$2,065.34

Mesh Ventralight ST 4.5 x11.4 5954450 [3603344]

Facility

$5,039.75

Service Code	HCPCS C1781
Hospital Charge Code	3603344
Hospital Revenue Code	278
Min. Negotiated Rate	$2,570.27
Max. Negotiated Rate	$4,888.56
Rate for Payer: Cash Price	$3,275.84
Rate for Payer: Hawaii Western Management Group Commercial	$3,527.82
Rate for Payer: Health Management Network Commercial	$4,283.79
Rate for Payer: Kaiser Permanente Commercial	$3,175.04
Rate for Payer: Kaiser Permanente Medicaid	$2,570.27
Rate for Payer: MDX Hawaii PPO	$4,888.56
Rate for Payer: University Health Alliance Commercial	$2,822.26

Mesh Ventralight ST 4.5 x11.4 5954450 [3603344]

Facility

$5,039.75

Service Code	HCPCS C1781
Hospital Charge Code	3603344
Hospital Revenue Code	278
Min. Negotiated Rate	$2,822.26
Max. Negotiated Rate	$4,888.56
Rate for Payer: Cash Price	$3,275.84
Rate for Payer: Hawaii Western Management Group Commercial	$3,527.82
Rate for Payer: Health Management Network Commercial	$4,283.79
Rate for Payer: MDX Hawaii PPO	$4,888.56
Rate for Payer: University Health Alliance Commercial	$2,822.26

Know your out-of-pocket cost for care.

All Charges