Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Suturelasso SD Wire Loop AR-4068-05SD [3643911]

Facility

$356.25

Hospital Charge Code	3643911
Hospital Revenue Code	272
Min. Negotiated Rate	$181.69
Max. Negotiated Rate	$345.56
Rate for Payer: Cash Price	$231.56
Rate for Payer: Hawaii Western Management Group Commercial	$338.44
Rate for Payer: Health Management Network Commercial	$302.81
Rate for Payer: Kaiser Permanente Commercial	$224.44
Rate for Payer: Kaiser Permanente Medicaid	$181.69
Rate for Payer: MDX Hawaii PPO	$345.56
Rate for Payer: University Health Alliance Commercial	$259.67

Suture Maxon 1 630972 [3600944]

Facility

$43.13

Hospital Charge Code	3600944
Hospital Revenue Code	272
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$41.84
Rate for Payer: Cash Price	$28.03
Rate for Payer: Hawaii Western Management Group Commercial	$40.97
Rate for Payer: Health Management Network Commercial	$36.66
Rate for Payer: Kaiser Permanente Commercial	$27.17
Rate for Payer: Kaiser Permanente Medicaid	$22.00
Rate for Payer: MDX Hawaii PPO	$41.84
Rate for Payer: University Health Alliance Commercial	$31.44

Suture Maxon 1 630972 [3600944]

Facility

$43.13

Hospital Charge Code	3600944
Hospital Revenue Code	272
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$41.84
Rate for Payer: Cash Price	$28.03
Rate for Payer: Health Management Network Commercial	$36.66
Rate for Payer: MDX Hawaii PPO	$41.84

Suture Monosof 9-0 N2532 [3607529]

Facility

$163.04

Hospital Charge Code	3607529
Hospital Revenue Code	272
Min. Negotiated Rate	$83.15
Max. Negotiated Rate	$158.15
Rate for Payer: Cash Price	$105.98
Rate for Payer: Hawaii Western Management Group Commercial	$154.89
Rate for Payer: Health Management Network Commercial	$138.58
Rate for Payer: Kaiser Permanente Commercial	$102.72
Rate for Payer: Kaiser Permanente Medicaid	$83.15
Rate for Payer: MDX Hawaii PPO	$158.15
Rate for Payer: University Health Alliance Commercial	$118.84

Suture Monosof 9-0 N2532 [3607529]

Facility

$163.04

Hospital Charge Code	3607529
Hospital Revenue Code	272
Min. Negotiated Rate	$138.58
Max. Negotiated Rate	$158.15
Rate for Payer: Cash Price	$105.98
Rate for Payer: Health Management Network Commercial	$138.58
Rate for Payer: MDX Hawaii PPO	$158.15

Suture Nylon 10-0 AA2674N/A9061N [3607124]

Facility

$133.44

Hospital Charge Code	3607124
Hospital Revenue Code	272
Min. Negotiated Rate	$113.42
Max. Negotiated Rate	$129.44
Rate for Payer: Cash Price	$86.74
Rate for Payer: Health Management Network Commercial	$113.42
Rate for Payer: MDX Hawaii PPO	$129.44

Suture Nylon 10-0 AA2674N/A9061N [3607124]

Facility

$133.44

Hospital Charge Code	3607124
Hospital Revenue Code	272
Min. Negotiated Rate	$68.05
Max. Negotiated Rate	$129.44
Rate for Payer: Cash Price	$86.74
Rate for Payer: Hawaii Western Management Group Commercial	$126.77
Rate for Payer: Health Management Network Commercial	$113.42
Rate for Payer: Kaiser Permanente Commercial	$84.07
Rate for Payer: Kaiser Permanente Medicaid	$68.05
Rate for Payer: MDX Hawaii PPO	$129.44
Rate for Payer: University Health Alliance Commercial	$97.26

SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIRECT CLOSURE; FULL THICKNESS

Facility

$6,183.00

Service Code	CPT 67935
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,808.63
Rate for Payer: AlohaCare Medicare	$2,808.63
Rate for Payer: Devoted Health Medicare	$3,089.49
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,808.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,808.63
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,808.63
Rate for Payer: Ohana Health Plan Medicaid	$3,089.49
Rate for Payer: Ohana Health Plan Medicare	$2,808.63
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,808.63
Rate for Payer: University Health Alliance Commercial	$5,160.40

Suture Passer Hewson 71111579 [3600294]

Facility

$1,251.55

Hospital Charge Code	3600294
Hospital Revenue Code	272
Min. Negotiated Rate	$1,063.82
Max. Negotiated Rate	$1,214.00
Rate for Payer: Cash Price	$813.51
Rate for Payer: Health Management Network Commercial	$1,063.82
Rate for Payer: MDX Hawaii PPO	$1,214.00

Suture Passer Hewson 71111579 [3600294]

Facility

$1,251.55

Hospital Charge Code	3600294
Hospital Revenue Code	272
Min. Negotiated Rate	$638.29
Max. Negotiated Rate	$1,214.00
Rate for Payer: Cash Price	$813.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,188.97
Rate for Payer: Health Management Network Commercial	$1,063.82
Rate for Payer: Kaiser Permanente Commercial	$788.48
Rate for Payer: Kaiser Permanente Medicaid	$638.29
Rate for Payer: MDX Hawaii PPO	$1,214.00
Rate for Payer: University Health Alliance Commercial	$912.25

Suture Permasilk 6-0 TG140-8 1732G [3607290]

Facility

$136.00

Hospital Charge Code	3607290
Hospital Revenue Code	272
Min. Negotiated Rate	$69.36
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$85.68
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: University Health Alliance Commercial	$99.13

Suture Permasilk 6-0 TG140-8 1732G [3607290]

Facility

$136.00

Hospital Charge Code	3607290
Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: MDX Hawaii PPO	$131.92

Suture Plain Gut 5-0 PC-1 1915G [2707723]

Facility

$73.02

Hospital Charge Code	2707723
Hospital Revenue Code	272
Min. Negotiated Rate	$37.24
Max. Negotiated Rate	$70.83
Rate for Payer: Cash Price	$47.46
Rate for Payer: Hawaii Western Management Group Commercial	$69.37
Rate for Payer: Health Management Network Commercial	$62.07
Rate for Payer: Kaiser Permanente Commercial	$46.00
Rate for Payer: Kaiser Permanente Medicaid	$37.24
Rate for Payer: MDX Hawaii PPO	$70.83
Rate for Payer: University Health Alliance Commercial	$53.22

Suture Plain Gut 5-0 PC-1 1915G [2707723]

Facility

$73.02

Hospital Charge Code	2707723
Hospital Revenue Code	272
Min. Negotiated Rate	$62.07
Max. Negotiated Rate	$70.83
Rate for Payer: Cash Price	$47.46
Rate for Payer: Health Management Network Commercial	$62.07
Rate for Payer: MDX Hawaii PPO	$70.83

Suture Polysorb 0 CL5M [3640405]

Facility

$87.30

Hospital Charge Code	3640405
Hospital Revenue Code	272
Min. Negotiated Rate	$74.20
Max. Negotiated Rate	$84.68
Rate for Payer: Cash Price	$56.74
Rate for Payer: Health Management Network Commercial	$74.20
Rate for Payer: MDX Hawaii PPO	$84.68

Suture Polysorb 0 CL5M [3640405]

Facility

$87.30

Hospital Charge Code	3640405
Hospital Revenue Code	272
Min. Negotiated Rate	$44.52
Max. Negotiated Rate	$84.68
Rate for Payer: Cash Price	$56.74
Rate for Payer: Hawaii Western Management Group Commercial	$82.94
Rate for Payer: Health Management Network Commercial	$74.20
Rate for Payer: Kaiser Permanente Commercial	$55.00
Rate for Payer: Kaiser Permanente Medicaid	$44.52
Rate for Payer: MDX Hawaii PPO	$84.68
Rate for Payer: University Health Alliance Commercial	$63.63

Suture Polysorb 3-0 EL440 [3640246]

Facility

$148.40

Hospital Charge Code	3640246
Hospital Revenue Code	272
Min. Negotiated Rate	$75.68
Max. Negotiated Rate	$143.95
Rate for Payer: Cash Price	$96.46
Rate for Payer: Hawaii Western Management Group Commercial	$140.98
Rate for Payer: Health Management Network Commercial	$126.14
Rate for Payer: Kaiser Permanente Commercial	$93.49
Rate for Payer: Kaiser Permanente Medicaid	$75.68
Rate for Payer: MDX Hawaii PPO	$143.95
Rate for Payer: University Health Alliance Commercial	$108.17

Suture Polysorb 3-0 EL440 [3640246]

Facility

$148.40

Hospital Charge Code	3640246
Hospital Revenue Code	272
Min. Negotiated Rate	$126.14
Max. Negotiated Rate	$143.95
Rate for Payer: Cash Price	$96.46
Rate for Payer: Health Management Network Commercial	$126.14
Rate for Payer: MDX Hawaii PPO	$143.95

Suture Prolene 7-0 BV-1 DA 8701H [3607373]

Facility

$197.12

Hospital Charge Code	3607373
Hospital Revenue Code	272
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$191.21
Rate for Payer: Cash Price	$128.13
Rate for Payer: Health Management Network Commercial	$167.55
Rate for Payer: MDX Hawaii PPO	$191.21

Suture Prolene 7-0 BV-1 DA 8701H [3607373]

Facility

$197.12

Hospital Charge Code	3607373
Hospital Revenue Code	272
Min. Negotiated Rate	$100.53
Max. Negotiated Rate	$191.21
Rate for Payer: Cash Price	$128.13
Rate for Payer: Hawaii Western Management Group Commercial	$187.26
Rate for Payer: Health Management Network Commercial	$167.55
Rate for Payer: Kaiser Permanente Commercial	$124.19
Rate for Payer: Kaiser Permanente Medicaid	$100.53
Rate for Payer: MDX Hawaii PPO	$191.21
Rate for Payer: University Health Alliance Commercial	$143.68

Suture Prolene Blue 1 TP-1 Looped D9487 [3642902]

Facility

$354.03

Hospital Charge Code	3642902
Hospital Revenue Code	272
Min. Negotiated Rate	$180.56
Max. Negotiated Rate	$343.41
Rate for Payer: Cash Price	$230.12
Rate for Payer: Hawaii Western Management Group Commercial	$336.33
Rate for Payer: Health Management Network Commercial	$300.93
Rate for Payer: Kaiser Permanente Commercial	$223.04
Rate for Payer: Kaiser Permanente Medicaid	$180.56
Rate for Payer: MDX Hawaii PPO	$343.41
Rate for Payer: University Health Alliance Commercial	$258.05

Suture Prolene Blue 1 TP-1 Looped D9487 [3642902]

Facility

$354.03

Hospital Charge Code	3642902
Hospital Revenue Code	272
Min. Negotiated Rate	$300.93
Max. Negotiated Rate	$343.41
Rate for Payer: Cash Price	$230.12
Rate for Payer: Health Management Network Commercial	$300.93
Rate for Payer: MDX Hawaii PPO	$343.41

Suture Prolene Blue 5-0 C-1 DA EPH8720H [3642535]

Facility

$374.68

Hospital Charge Code	3642535
Hospital Revenue Code	272
Min. Negotiated Rate	$191.09
Max. Negotiated Rate	$363.44
Rate for Payer: Cash Price	$243.54
Rate for Payer: Hawaii Western Management Group Commercial	$355.95
Rate for Payer: Health Management Network Commercial	$318.48
Rate for Payer: Kaiser Permanente Commercial	$236.05
Rate for Payer: Kaiser Permanente Medicaid	$191.09
Rate for Payer: MDX Hawaii PPO	$363.44
Rate for Payer: University Health Alliance Commercial	$273.10

Suture Prolene Blue 5-0 C-1 DA EPH8720H [3642535]

Facility

$374.68

Hospital Charge Code	3642535
Hospital Revenue Code	272
Min. Negotiated Rate	$318.48
Max. Negotiated Rate	$363.44
Rate for Payer: Cash Price	$243.54
Rate for Payer: Health Management Network Commercial	$318.48
Rate for Payer: MDX Hawaii PPO	$363.44

Suture Prolene Blue 6-0 C-1 DA EP8726H [3642567]

Facility

$225.98

Hospital Charge Code	3642567
Hospital Revenue Code	272
Min. Negotiated Rate	$192.08
Max. Negotiated Rate	$219.20
Rate for Payer: Cash Price	$146.89
Rate for Payer: Health Management Network Commercial	$192.08
Rate for Payer: MDX Hawaii PPO	$219.20

Know your out-of-pocket cost for care.

All Charges