Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CATHETER COUDE 12FR 0168L12 [2700359]

Facility

$73.53

Service Code	HCPCS A4340
Hospital Charge Code	2700359
Hospital Revenue Code	272
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$71.32
Rate for Payer: Cash Price	$47.79
Rate for Payer: Health Management Network Commercial	$62.50
Rate for Payer: MDX Hawaii PPO	$71.32

CATHETER COUDE 12FR 0168L12 [2700359]

Facility

$73.53

Service Code	HCPCS A4340
Hospital Charge Code	2700359
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$71.32
Rate for Payer: Cash Price	$47.79
Rate for Payer: Cash Price	$47.79
Rate for Payer: Hawaii Western Management Group Commercial	$69.85
Rate for Payer: Health Management Network Commercial	$62.50
Rate for Payer: Kaiser Permanente Commercial	$46.32
Rate for Payer: Kaiser Permanente Medicaid	$37.50
Rate for Payer: MDX Hawaii PPO	$71.32
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$53.60

CATHETER COUDE 14FR 0168L14 [2700360]

Facility

$70.21

Service Code	HCPCS A4340
Hospital Charge Code	2700360
Hospital Revenue Code	272
Min. Negotiated Rate	$59.68
Max. Negotiated Rate	$68.10
Rate for Payer: Cash Price	$45.64
Rate for Payer: Health Management Network Commercial	$59.68
Rate for Payer: MDX Hawaii PPO	$68.10

CATHETER COUDE 14FR 0168L14 [2700360]

Facility

$70.21

Service Code	HCPCS A4340
Hospital Charge Code	2700360
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$68.10
Rate for Payer: Cash Price	$45.64
Rate for Payer: Cash Price	$45.64
Rate for Payer: Hawaii Western Management Group Commercial	$66.70
Rate for Payer: Health Management Network Commercial	$59.68
Rate for Payer: Kaiser Permanente Commercial	$44.23
Rate for Payer: Kaiser Permanente Medicaid	$35.81
Rate for Payer: MDX Hawaii PPO	$68.10
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$51.18

CATHETER COUDE 16FR 0168L16 [2700361]

Facility

$70.21

Service Code	HCPCS A4340
Hospital Charge Code	2700361
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$68.10
Rate for Payer: Cash Price	$45.64
Rate for Payer: Cash Price	$45.64
Rate for Payer: Hawaii Western Management Group Commercial	$66.70
Rate for Payer: Health Management Network Commercial	$59.68
Rate for Payer: Kaiser Permanente Commercial	$44.23
Rate for Payer: Kaiser Permanente Medicaid	$35.81
Rate for Payer: MDX Hawaii PPO	$68.10
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$51.18

CATHETER COUDE 16FR 0168L16 [2700361]

Facility

$70.21

Service Code	HCPCS A4340
Hospital Charge Code	2700361
Hospital Revenue Code	272
Min. Negotiated Rate	$59.68
Max. Negotiated Rate	$68.10
Rate for Payer: Cash Price	$45.64
Rate for Payer: Health Management Network Commercial	$59.68
Rate for Payer: MDX Hawaii PPO	$68.10

CATHETER COUDE 18F 0168L18 [2700362]

Facility

$73.19

Service Code	HCPCS A4340
Hospital Charge Code	2700362
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$70.99
Rate for Payer: Cash Price	$47.57
Rate for Payer: Cash Price	$47.57
Rate for Payer: Hawaii Western Management Group Commercial	$69.53
Rate for Payer: Health Management Network Commercial	$62.21
Rate for Payer: Kaiser Permanente Commercial	$46.11
Rate for Payer: Kaiser Permanente Medicaid	$37.33
Rate for Payer: MDX Hawaii PPO	$70.99
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$53.35

CATHETER COUDE 18F 0168L18 [2700362]

Facility

$73.19

Service Code	HCPCS A4340
Hospital Charge Code	2700362
Hospital Revenue Code	272
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$70.99
Rate for Payer: Cash Price	$47.57
Rate for Payer: Health Management Network Commercial	$62.21
Rate for Payer: MDX Hawaii PPO	$70.99

CATHETER COUDE 20FR 0168L20 [2700363]

Facility

$73.53

Service Code	HCPCS A4340
Hospital Charge Code	2700363
Hospital Revenue Code	272
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$71.32
Rate for Payer: Cash Price	$47.79
Rate for Payer: Health Management Network Commercial	$62.50
Rate for Payer: MDX Hawaii PPO	$71.32

CATHETER COUDE 20FR 0168L20 [2700363]

Facility

$73.53

Service Code	HCPCS A4340
Hospital Charge Code	2700363
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$71.32
Rate for Payer: Cash Price	$47.79
Rate for Payer: Cash Price	$47.79
Rate for Payer: Hawaii Western Management Group Commercial	$69.85
Rate for Payer: Health Management Network Commercial	$62.50
Rate for Payer: Kaiser Permanente Commercial	$46.32
Rate for Payer: Kaiser Permanente Medicaid	$37.50
Rate for Payer: MDX Hawaii PPO	$71.32
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$53.60

Catheter Council 16fr 2way 0196L16 [2702271]

Facility

$105.49

Service Code	HCPCS C1769
Hospital Charge Code	2702271
Hospital Revenue Code	272
Min. Negotiated Rate	$53.80
Max. Negotiated Rate	$102.33
Rate for Payer: Cash Price	$68.57
Rate for Payer: Hawaii Western Management Group Commercial	$100.22
Rate for Payer: Health Management Network Commercial	$89.67
Rate for Payer: Kaiser Permanente Commercial	$66.46
Rate for Payer: Kaiser Permanente Medicaid	$53.80
Rate for Payer: MDX Hawaii PPO	$102.33
Rate for Payer: University Health Alliance Commercial	$76.89

Catheter Council 16fr 2way 0196L16 [2702271]

Facility

$105.49

Service Code	HCPCS C1769
Hospital Charge Code	2702271
Hospital Revenue Code	272
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$102.33
Rate for Payer: Cash Price	$68.57
Rate for Payer: Health Management Network Commercial	$89.67
Rate for Payer: MDX Hawaii PPO	$102.33

Catheter Council 18fr 2way [2702272]

Facility

$105.49

Service Code	HCPCS C1769
Hospital Charge Code	2702272
Hospital Revenue Code	272
Min. Negotiated Rate	$53.80
Max. Negotiated Rate	$102.33
Rate for Payer: Cash Price	$68.57
Rate for Payer: Hawaii Western Management Group Commercial	$100.22
Rate for Payer: Health Management Network Commercial	$89.67
Rate for Payer: Kaiser Permanente Commercial	$66.46
Rate for Payer: Kaiser Permanente Medicaid	$53.80
Rate for Payer: MDX Hawaii PPO	$102.33
Rate for Payer: University Health Alliance Commercial	$76.89

Catheter Council 18fr 2way [2702272]

Facility

$105.49

Service Code	HCPCS C1769
Hospital Charge Code	2702272
Hospital Revenue Code	272
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$102.33
Rate for Payer: Cash Price	$68.57
Rate for Payer: Health Management Network Commercial	$89.67
Rate for Payer: MDX Hawaii PPO	$102.33

Catheter Drn Centesis Needle Yueh 5fr 7cm [2709886]

Facility

$189.68

Service Code	HCPCS C1729
Hospital Charge Code	2709886
Hospital Revenue Code	272
Min. Negotiated Rate	$161.23
Max. Negotiated Rate	$183.99
Rate for Payer: Cash Price	$123.29
Rate for Payer: Health Management Network Commercial	$161.23
Rate for Payer: MDX Hawaii PPO	$183.99

Catheter Drn Centesis Needle Yueh 5fr 7cm [2709886]

Facility

$189.68

Service Code	HCPCS C1729
Hospital Charge Code	2709886
Hospital Revenue Code	272
Min. Negotiated Rate	$96.74
Max. Negotiated Rate	$183.99
Rate for Payer: Cash Price	$123.29
Rate for Payer: Hawaii Western Management Group Commercial	$180.20
Rate for Payer: Health Management Network Commercial	$161.23
Rate for Payer: Kaiser Permanente Commercial	$119.50
Rate for Payer: Kaiser Permanente Medicaid	$96.74
Rate for Payer: MDX Hawaii PPO	$183.99
Rate for Payer: University Health Alliance Commercial	$138.26

Catheter External Small [2707816]

Facility

$7.57

Service Code	HCPCS A4349
Hospital Charge Code	2707816
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$7.34
Rate for Payer: Cash Price	$4.92
Rate for Payer: Cash Price	$4.92
Rate for Payer: Hawaii Western Management Group Commercial	$7.19
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Kaiser Permanente Commercial	$4.77
Rate for Payer: Kaiser Permanente Medicaid	$3.86
Rate for Payer: MDX Hawaii PPO	$7.34
Rate for Payer: UnitedHealthcare Medicaid	$1.87
Rate for Payer: University Health Alliance Commercial	$5.52

Catheter External Small [2707816]

Facility

$7.57

Service Code	HCPCS A4349
Hospital Charge Code	2707816
Hospital Revenue Code	272
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$7.34
Rate for Payer: Cash Price	$4.92
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: MDX Hawaii PPO	$7.34

CATHETER FOLEY 12FR 2WAY 5CC LF 165812 [2707823]

Facility

$28.05

Service Code	HCPCS A4344
Hospital Charge Code	2707823
Hospital Revenue Code	272
Min. Negotiated Rate	$23.84
Max. Negotiated Rate	$27.21
Rate for Payer: Cash Price	$18.23
Rate for Payer: Health Management Network Commercial	$23.84
Rate for Payer: MDX Hawaii PPO	$27.21

CATHETER FOLEY 12FR 2WAY 5CC LF 165812 [2707823]

Facility

$28.05

Service Code	HCPCS A4344
Hospital Charge Code	2707823
Hospital Revenue Code	272
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$27.21
Rate for Payer: Cash Price	$18.23
Rate for Payer: Cash Price	$18.23
Rate for Payer: Hawaii Western Management Group Commercial	$26.65
Rate for Payer: Health Management Network Commercial	$23.84
Rate for Payer: Kaiser Permanente Commercial	$17.67
Rate for Payer: Kaiser Permanente Medicaid	$14.31
Rate for Payer: MDX Hawaii PPO	$27.21
Rate for Payer: UnitedHealthcare Medicaid	$11.56
Rate for Payer: University Health Alliance Commercial	$20.45

CATHETER FOLEY 14FR 2WAY 5CC LF 165814 [2707824]

Facility

$28.05

Service Code	HCPCS A4344
Hospital Charge Code	2707824
Hospital Revenue Code	272
Min. Negotiated Rate	$23.84
Max. Negotiated Rate	$27.21
Rate for Payer: Cash Price	$18.23
Rate for Payer: Health Management Network Commercial	$23.84
Rate for Payer: MDX Hawaii PPO	$27.21

CATHETER FOLEY 14FR 2WAY 5CC LF 165814 [2707824]

Facility

$28.05

Service Code	HCPCS A4344
Hospital Charge Code	2707824
Hospital Revenue Code	272
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$27.21
Rate for Payer: Cash Price	$18.23
Rate for Payer: Cash Price	$18.23
Rate for Payer: Hawaii Western Management Group Commercial	$26.65
Rate for Payer: Health Management Network Commercial	$23.84
Rate for Payer: Kaiser Permanente Commercial	$17.67
Rate for Payer: Kaiser Permanente Medicaid	$14.31
Rate for Payer: MDX Hawaii PPO	$27.21
Rate for Payer: UnitedHealthcare Medicaid	$11.56
Rate for Payer: University Health Alliance Commercial	$20.45

CATHETER FOLEY 16FR 3WAY 30CC 0167SI16 [2700411]

Facility

$99.71

Hospital Charge Code	2700411
Hospital Revenue Code	272
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$96.72
Rate for Payer: Cash Price	$64.81
Rate for Payer: Health Management Network Commercial	$84.75
Rate for Payer: MDX Hawaii PPO	$96.72

CATHETER FOLEY 16FR 3WAY 30CC 0167SI16 [2700411]

Facility

$99.71

Hospital Charge Code	2700411
Hospital Revenue Code	272
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$96.72
Rate for Payer: Cash Price	$64.81
Rate for Payer: Hawaii Western Management Group Commercial	$94.72
Rate for Payer: Health Management Network Commercial	$84.75
Rate for Payer: Kaiser Permanente Commercial	$62.82
Rate for Payer: Kaiser Permanente Medicaid	$50.85
Rate for Payer: MDX Hawaii PPO	$96.72
Rate for Payer: University Health Alliance Commercial	$72.68

Catheter Foley 18fr 3way 30cc 0167SI18 [2700412]

Facility

$99.71

Service Code	HCPCS A4346
Hospital Charge Code	2700412
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$96.72
Rate for Payer: Cash Price	$64.81
Rate for Payer: Cash Price	$64.81
Rate for Payer: Hawaii Western Management Group Commercial	$94.72
Rate for Payer: Health Management Network Commercial	$84.75
Rate for Payer: Kaiser Permanente Commercial	$62.82
Rate for Payer: Kaiser Permanente Medicaid	$50.85
Rate for Payer: MDX Hawaii PPO	$96.72
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$72.68

Know your out-of-pocket cost for care.

All Charges