Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Suture Stratafix PDS Plus 3-0 70cm CT-2 SXPP1B425 [3643199]

Facility

$18.87

Hospital Charge Code	3643199
Hospital Revenue Code	272
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$18.30
Rate for Payer: Cash Price	$12.27
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$16.04
Rate for Payer: Kaiser Permanente Commercial	$11.89
Rate for Payer: Kaiser Permanente Medicaid	$9.62
Rate for Payer: MDX Hawaii PPO	$18.30
Rate for Payer: University Health Alliance Commercial	$13.75

Suture Stratafix PDS Plus 3-0 70cm CT-2 SXPP1B425 [3643199]

Facility

$18.87

Hospital Charge Code	3643199
Hospital Revenue Code	272
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$18.30
Rate for Payer: Cash Price	$12.27
Rate for Payer: Health Management Network Commercial	$16.04
Rate for Payer: MDX Hawaii PPO	$18.30

Suture Stratafix PDS+ UNI VIO 24" 1 SXPP1A443 [3641387]

Facility

$221.66

Hospital Charge Code	3641387
Hospital Revenue Code	272
Min. Negotiated Rate	$188.41
Max. Negotiated Rate	$215.01
Rate for Payer: Cash Price	$144.08
Rate for Payer: Health Management Network Commercial	$188.41
Rate for Payer: MDX Hawaii PPO	$215.01

Suture Stratafix PDS+ UNI VIO 24" 1 SXPP1A443 [3641387]

Facility

$221.66

Hospital Charge Code	3641387
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$215.01
Rate for Payer: Cash Price	$144.08
Rate for Payer: Hawaii Western Management Group Commercial	$210.58
Rate for Payer: Health Management Network Commercial	$188.41
Rate for Payer: Kaiser Permanente Commercial	$139.65
Rate for Payer: Kaiser Permanente Medicaid	$113.05
Rate for Payer: MDX Hawaii PPO	$215.01
Rate for Payer: University Health Alliance Commercial	$161.57

Suture Stratafix PDS+ UNI VIO 24" O SXPP1A440 [3641386]

Facility

$220.98

Hospital Charge Code	3641386
Hospital Revenue Code	272
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$214.35
Rate for Payer: Cash Price	$143.64
Rate for Payer: Hawaii Western Management Group Commercial	$209.93
Rate for Payer: Health Management Network Commercial	$187.83
Rate for Payer: Kaiser Permanente Commercial	$139.22
Rate for Payer: Kaiser Permanente Medicaid	$112.70
Rate for Payer: MDX Hawaii PPO	$214.35
Rate for Payer: University Health Alliance Commercial	$161.07

Suture Stratafix PDS+ UNI VIO 24" O SXPP1A440 [3641386]

Facility

$220.98

Hospital Charge Code	3641386
Hospital Revenue Code	272
Min. Negotiated Rate	$187.83
Max. Negotiated Rate	$214.35
Rate for Payer: Cash Price	$143.64
Rate for Payer: Health Management Network Commercial	$187.83
Rate for Payer: MDX Hawaii PPO	$214.35

Suture Stratafix PDS+ VIO 18" 2-O SXPP1A403 [3641402]

Facility

$168.40

Hospital Charge Code	3641402
Hospital Revenue Code	272
Min. Negotiated Rate	$85.88
Max. Negotiated Rate	$163.35
Rate for Payer: Cash Price	$109.46
Rate for Payer: Hawaii Western Management Group Commercial	$159.98
Rate for Payer: Health Management Network Commercial	$143.14
Rate for Payer: Kaiser Permanente Commercial	$106.09
Rate for Payer: Kaiser Permanente Medicaid	$85.88
Rate for Payer: MDX Hawaii PPO	$163.35
Rate for Payer: University Health Alliance Commercial	$122.75

Suture Stratafix PDS+ VIO 18" 2-O SXPP1A403 [3641402]

Facility

$168.40

Hospital Charge Code	3641402
Hospital Revenue Code	272
Min. Negotiated Rate	$143.14
Max. Negotiated Rate	$163.35
Rate for Payer: Cash Price	$109.46
Rate for Payer: Health Management Network Commercial	$143.14
Rate for Payer: MDX Hawaii PPO	$163.35

Suture Surgigut 2-0 UG778 [3607182]

Facility

$20.15

Hospital Charge Code	3607182
Hospital Revenue Code	272
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$13.10
Rate for Payer: Hawaii Western Management Group Commercial	$19.14
Rate for Payer: Health Management Network Commercial	$17.13
Rate for Payer: Kaiser Permanente Commercial	$12.69
Rate for Payer: Kaiser Permanente Medicaid	$10.28
Rate for Payer: MDX Hawaii PPO	$19.55
Rate for Payer: University Health Alliance Commercial	$14.69

Suture Surgigut 2-0 UG778 [3607182]

Facility

$20.15

Hospital Charge Code	3607182
Hospital Revenue Code	272
Min. Negotiated Rate	$17.13
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$13.10
Rate for Payer: Health Management Network Commercial	$17.13
Rate for Payer: MDX Hawaii PPO	$19.55

Suture Surgipro 1 GS26 CP834L [3642631]

Facility

$101.15

Hospital Charge Code	3642631
Hospital Revenue Code	272
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$98.12
Rate for Payer: Cash Price	$65.75
Rate for Payer: Hawaii Western Management Group Commercial	$96.09
Rate for Payer: Health Management Network Commercial	$85.98
Rate for Payer: Kaiser Permanente Commercial	$63.72
Rate for Payer: Kaiser Permanente Medicaid	$51.59
Rate for Payer: MDX Hawaii PPO	$98.12
Rate for Payer: University Health Alliance Commercial	$73.73

Suture Surgipro 1 GS26 CP834L [3642631]

Facility

$101.15

Hospital Charge Code	3642631
Hospital Revenue Code	272
Min. Negotiated Rate	$85.98
Max. Negotiated Rate	$98.12
Rate for Payer: Cash Price	$65.75
Rate for Payer: Health Management Network Commercial	$85.98
Rate for Payer: MDX Hawaii PPO	$98.12

Suturetak Biocomp 3.0mm Dl W/Suturetape AR-1934BCT-2 [3644416]

Facility

$3,203.00

Service Code	HCPCS C1713
Hospital Charge Code	3644416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,633.53
Max. Negotiated Rate	$3,106.91
Rate for Payer: Cash Price	$2,081.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,242.10
Rate for Payer: Health Management Network Commercial	$2,722.55
Rate for Payer: Kaiser Permanente Commercial	$2,017.89
Rate for Payer: Kaiser Permanente Medicaid	$1,633.53
Rate for Payer: MDX Hawaii PPO	$3,106.91
Rate for Payer: University Health Alliance Commercial	$1,793.68

Suturetak Biocomp 3.0mm Dl W/Suturetape AR-1934BCT-2 [3644416]

Facility

$3,203.00

Service Code	HCPCS C1713
Hospital Charge Code	3644416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,793.68
Max. Negotiated Rate	$3,106.91
Rate for Payer: Cash Price	$2,081.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,242.10
Rate for Payer: Health Management Network Commercial	$2,722.55
Rate for Payer: MDX Hawaii PPO	$3,106.91
Rate for Payer: University Health Alliance Commercial	$1,793.68

Suturetape 1.3mm Black/White w/ Needle AR-7506T [3643432]

Facility

$390.88

Hospital Charge Code	3643432
Hospital Revenue Code	272
Min. Negotiated Rate	$199.35
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Hawaii Western Management Group Commercial	$371.34
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: Kaiser Permanente Commercial	$246.25
Rate for Payer: Kaiser Permanente Medicaid	$199.35
Rate for Payer: MDX Hawaii PPO	$379.15
Rate for Payer: University Health Alliance Commercial	$284.91

Suturetape 1.3mm Black/White w/ Needle AR-7506T [3643432]

Facility

$390.88

Hospital Charge Code	3643432
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: MDX Hawaii PPO	$379.15

SutureTape 1.3mm White/Blue w/Taper Needle AR-7500 [3641213]

Facility

$275.25

Hospital Charge Code	3641213
Hospital Revenue Code	272
Min. Negotiated Rate	$233.96
Max. Negotiated Rate	$266.99
Rate for Payer: Cash Price	$178.91
Rate for Payer: Health Management Network Commercial	$233.96
Rate for Payer: MDX Hawaii PPO	$266.99

SutureTape 1.3mm White/Blue w/Taper Needle AR-7500 [3641213]

Facility

$275.25

Hospital Charge Code	3641213
Hospital Revenue Code	272
Min. Negotiated Rate	$140.38
Max. Negotiated Rate	$266.99
Rate for Payer: Cash Price	$178.91
Rate for Payer: Hawaii Western Management Group Commercial	$261.49
Rate for Payer: Health Management Network Commercial	$233.96
Rate for Payer: Kaiser Permanente Commercial	$173.41
Rate for Payer: Kaiser Permanente Medicaid	$140.38
Rate for Payer: MDX Hawaii PPO	$266.99
Rate for Payer: University Health Alliance Commercial	$200.63

Suturetape 1.3mm W/taper Ndle AR-7506 [3643431]

Facility

$390.88

Hospital Charge Code	3643431
Hospital Revenue Code	272
Min. Negotiated Rate	$199.35
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Hawaii Western Management Group Commercial	$371.34
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: Kaiser Permanente Commercial	$246.25
Rate for Payer: Kaiser Permanente Medicaid	$199.35
Rate for Payer: MDX Hawaii PPO	$379.15
Rate for Payer: University Health Alliance Commercial	$284.91

Suturetape 1.3mm W/taper Ndle AR-7506 [3643431]

Facility

$390.88

Hospital Charge Code	3643431
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$379.15
Rate for Payer: Cash Price	$254.07
Rate for Payer: Health Management Network Commercial	$332.25
Rate for Payer: MDX Hawaii PPO	$379.15

SutureTape FiberLink 1.3mm White/Blue AR-7535 [3642237]

Facility

$577.75

Hospital Charge Code	3642237
Hospital Revenue Code	272
Min. Negotiated Rate	$294.65
Max. Negotiated Rate	$560.42
Rate for Payer: Cash Price	$375.54
Rate for Payer: Hawaii Western Management Group Commercial	$548.86
Rate for Payer: Health Management Network Commercial	$491.09
Rate for Payer: Kaiser Permanente Commercial	$363.98
Rate for Payer: Kaiser Permanente Medicaid	$294.65
Rate for Payer: MDX Hawaii PPO	$560.42
Rate for Payer: University Health Alliance Commercial	$421.12

SutureTape FiberLink 1.3mm White/Blue AR-7535 [3642237]

Facility

$577.75

Hospital Charge Code	3642237
Hospital Revenue Code	272
Min. Negotiated Rate	$491.09
Max. Negotiated Rate	$560.42
Rate for Payer: Cash Price	$375.54
Rate for Payer: Health Management Network Commercial	$491.09
Rate for Payer: MDX Hawaii PPO	$560.42

Suture Vicryl 8-0 Tg160-8 J574g [3643321]

Facility

$161.36

Hospital Charge Code	3643321
Hospital Revenue Code	272
Min. Negotiated Rate	$82.29
Max. Negotiated Rate	$156.52
Rate for Payer: Cash Price	$104.88
Rate for Payer: Hawaii Western Management Group Commercial	$153.29
Rate for Payer: Health Management Network Commercial	$137.16
Rate for Payer: Kaiser Permanente Commercial	$101.66
Rate for Payer: Kaiser Permanente Medicaid	$82.29
Rate for Payer: MDX Hawaii PPO	$156.52
Rate for Payer: University Health Alliance Commercial	$117.62

Suture Vicryl 8-0 Tg160-8 J574g [3643321]

Facility

$161.36

Hospital Charge Code	3643321
Hospital Revenue Code	272
Min. Negotiated Rate	$137.16
Max. Negotiated Rate	$156.52
Rate for Payer: Cash Price	$104.88
Rate for Payer: Health Management Network Commercial	$137.16
Rate for Payer: MDX Hawaii PPO	$156.52

Suture Vicryl Plus 0 CT-1 CR VCPP31D [3642566]

Facility

$143.04

Hospital Charge Code	3642566
Hospital Revenue Code	272
Min. Negotiated Rate	$72.95
Max. Negotiated Rate	$138.75
Rate for Payer: Cash Price	$92.98
Rate for Payer: Hawaii Western Management Group Commercial	$135.89
Rate for Payer: Health Management Network Commercial	$121.58
Rate for Payer: Kaiser Permanente Commercial	$90.12
Rate for Payer: Kaiser Permanente Medicaid	$72.95
Rate for Payer: MDX Hawaii PPO	$138.75
Rate for Payer: University Health Alliance Commercial	$104.26

Know your out-of-pocket cost for care.

All Charges