Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

Catheter Foley 20fr 3way 30cc 0167SI20 [2700413]

Facility

$102.17

Service Code	HCPCS A4346
Hospital Charge Code	2700413
Hospital Revenue Code	272
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$66.41
Rate for Payer: Health Management Network Commercial	$86.84
Rate for Payer: MDX Hawaii PPO	$99.10

Catheter Foley 20fr 3way 30cc 0167SI20 [2700413]

Facility

$102.17

Service Code	HCPCS A4346
Hospital Charge Code	2700413
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$66.41
Rate for Payer: Cash Price	$66.41
Rate for Payer: Hawaii Western Management Group Commercial	$97.06
Rate for Payer: Health Management Network Commercial	$86.84
Rate for Payer: Kaiser Permanente Commercial	$64.37
Rate for Payer: Kaiser Permanente Medicaid	$52.11
Rate for Payer: MDX Hawaii PPO	$99.10
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$74.47

Catheter Foley 22fr 3way 30cc 0167SI22 [2700414]

Facility

$102.17

Service Code	HCPCS A4346
Hospital Charge Code	2700414
Hospital Revenue Code	272
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$66.41
Rate for Payer: Health Management Network Commercial	$86.84
Rate for Payer: MDX Hawaii PPO	$99.10

Catheter Foley 22fr 3way 30cc 0167SI22 [2700414]

Facility

$102.17

Service Code	HCPCS A4346
Hospital Charge Code	2700414
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$66.41
Rate for Payer: Cash Price	$66.41
Rate for Payer: Hawaii Western Management Group Commercial	$97.06
Rate for Payer: Health Management Network Commercial	$86.84
Rate for Payer: Kaiser Permanente Commercial	$64.37
Rate for Payer: Kaiser Permanente Medicaid	$52.11
Rate for Payer: MDX Hawaii PPO	$99.10
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$74.47

CATHETER FOLEY 24FR 3WAY 30CC 0167SI24 [2700415]

Facility

$99.71

Hospital Charge Code	2700415
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 24FR 3WAY 30CC 0167SI24 [2700415]

Facility

$99.71

Hospital Charge Code	2700415
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 26fr 3way 30cc 0167SI26 [2700416]

Facility

$87.98

Service Code	HCPCS A4346
Hospital Charge Code	2700416
Hospital Revenue Code	272
Min. Negotiated Rate	$74.78
Max. Negotiated Rate	$85.34
Rate for Payer: Cash Price	$57.19
Rate for Payer: Health Management Network Commercial	$74.78
Rate for Payer: MDX Hawaii PPO	$85.34

Catheter Foley 26fr 3way 30cc 0167SI26 [2700416]

Facility

$87.98

Service Code	HCPCS A4346
Hospital Charge Code	2700416
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$85.34
Rate for Payer: Cash Price	$57.19
Rate for Payer: Cash Price	$57.19
Rate for Payer: Hawaii Western Management Group Commercial	$83.58
Rate for Payer: Health Management Network Commercial	$74.78
Rate for Payer: Kaiser Permanente Commercial	$55.43
Rate for Payer: Kaiser Permanente Medicaid	$44.87
Rate for Payer: MDX Hawaii PPO	$85.34
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$64.13

CATHETER KIT CENTRAL VEIN [2700344]

Facility

$167.37

Service Code	HCPCS C1751
Hospital Charge Code	2700344
Hospital Revenue Code	272
Min. Negotiated Rate	$142.26
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$108.79
Rate for Payer: Health Management Network Commercial	$142.26
Rate for Payer: MDX Hawaii PPO	$162.35

CATHETER KIT CENTRAL VEIN [2700344]

Facility

$167.37

Service Code	HCPCS C1751
Hospital Charge Code	2700344
Hospital Revenue Code	272
Min. Negotiated Rate	$85.36
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$108.79
Rate for Payer: Hawaii Western Management Group Commercial	$159.00
Rate for Payer: Health Management Network Commercial	$142.26
Rate for Payer: Kaiser Permanente Commercial	$105.44
Rate for Payer: Kaiser Permanente Medicaid	$85.36
Rate for Payer: MDX Hawaii PPO	$162.35
Rate for Payer: University Health Alliance Commercial	$122.00

CATHETER KIT TRIPLE-LUMEN PEDIATRIC AAK-15553 [2700425]

Facility

$381.27

Service Code	HCPCS C1751
Hospital Charge Code	2700425
Hospital Revenue Code	272
Min. Negotiated Rate	$194.45
Max. Negotiated Rate	$369.83
Rate for Payer: Cash Price	$247.83
Rate for Payer: Hawaii Western Management Group Commercial	$362.21
Rate for Payer: Health Management Network Commercial	$324.08
Rate for Payer: Kaiser Permanente Commercial	$240.20
Rate for Payer: Kaiser Permanente Medicaid	$194.45
Rate for Payer: MDX Hawaii PPO	$369.83
Rate for Payer: University Health Alliance Commercial	$277.91

CATHETER KIT TRIPLE-LUMEN PEDIATRIC AAK-15553 [2700425]

Facility

$381.27

Service Code	HCPCS C1751
Hospital Charge Code	2700425
Hospital Revenue Code	272
Min. Negotiated Rate	$324.08
Max. Negotiated Rate	$369.83
Rate for Payer: Cash Price	$247.83
Rate for Payer: Health Management Network Commercial	$324.08
Rate for Payer: MDX Hawaii PPO	$369.83

CATHETER ROBINSON 12FR DC9412 [2700441]

Facility

$5.27

Hospital Charge Code	2700441
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$5.11
Rate for Payer: Cash Price	$3.43
Rate for Payer: Hawaii Western Management Group Commercial	$5.01
Rate for Payer: Health Management Network Commercial	$4.48
Rate for Payer: Kaiser Permanente Commercial	$3.32
Rate for Payer: Kaiser Permanente Medicaid	$2.69
Rate for Payer: MDX Hawaii PPO	$5.11
Rate for Payer: University Health Alliance Commercial	$3.84

CATHETER ROBINSON 12FR DC9412 [2700441]

Facility

$5.27

Hospital Charge Code	2700441
Hospital Revenue Code	272
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$5.11
Rate for Payer: Cash Price	$3.43
Rate for Payer: Health Management Network Commercial	$4.48
Rate for Payer: MDX Hawaii PPO	$5.11

Catheter Robinson 18fr [2700444]

Facility

$4.51

Service Code	HCPCS A4351
Hospital Charge Code	2700444
Hospital Revenue Code	272
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$4.37
Rate for Payer: Cash Price	$2.93
Rate for Payer: Health Management Network Commercial	$3.83
Rate for Payer: MDX Hawaii PPO	$4.37

Catheter Robinson 18fr [2700444]

Facility

$4.51

Service Code	HCPCS A4351
Hospital Charge Code	2700444
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.37
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cash Price	$2.93
Rate for Payer: Hawaii Western Management Group Commercial	$4.28
Rate for Payer: Health Management Network Commercial	$3.83
Rate for Payer: Kaiser Permanente Commercial	$2.84
Rate for Payer: Kaiser Permanente Medicaid	$2.30
Rate for Payer: MDX Hawaii PPO	$4.37
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: University Health Alliance Commercial	$3.29

Catheter Suction Kit 14fr [2700470]

Facility

$5.61

Service Code	HCPCS A4624
Hospital Charge Code	2700470
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$5.44
Rate for Payer: Cash Price	$3.65
Rate for Payer: Cash Price	$3.65
Rate for Payer: Hawaii Western Management Group Commercial	$5.33
Rate for Payer: Health Management Network Commercial	$4.77
Rate for Payer: Kaiser Permanente Commercial	$3.53
Rate for Payer: Kaiser Permanente Medicaid	$2.86
Rate for Payer: MDX Hawaii PPO	$5.44
Rate for Payer: UnitedHealthcare Medicaid	$2.60
Rate for Payer: University Health Alliance Commercial	$4.09

Catheter Suction Kit 14fr [2700470]

Facility

$5.61

Service Code	HCPCS A4624
Hospital Charge Code	2700470
Hospital Revenue Code	272
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$5.44
Rate for Payer: Cash Price	$3.65
Rate for Payer: Health Management Network Commercial	$4.77
Rate for Payer: MDX Hawaii PPO	$5.44

Catheter Suction Kit 16fr [2700471]

Facility

$7.06

Service Code	HCPCS A4624
Hospital Charge Code	2700471
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cash Price	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$6.71
Rate for Payer: Health Management Network Commercial	$6.00
Rate for Payer: Kaiser Permanente Commercial	$4.45
Rate for Payer: Kaiser Permanente Medicaid	$3.60
Rate for Payer: MDX Hawaii PPO	$6.85
Rate for Payer: UnitedHealthcare Medicaid	$2.60
Rate for Payer: University Health Alliance Commercial	$5.15

Catheter Suction Kit 16fr [2700471]

Facility

$7.06

Service Code	HCPCS A4624
Hospital Charge Code	2700471
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$4.59
Rate for Payer: Health Management Network Commercial	$6.00
Rate for Payer: MDX Hawaii PPO	$6.85

CATHETER TEMP SENSOR 16FR COUDE 117416 [2702285]

Facility

$99.54

Service Code	HCPCS A4340
Hospital Charge Code	2702285
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$96.55
Rate for Payer: Cash Price	$64.70
Rate for Payer: Cash Price	$64.70
Rate for Payer: Hawaii Western Management Group Commercial	$94.56
Rate for Payer: Health Management Network Commercial	$84.61
Rate for Payer: Kaiser Permanente Commercial	$62.71
Rate for Payer: Kaiser Permanente Medicaid	$50.77
Rate for Payer: MDX Hawaii PPO	$96.55
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$72.55

CATHETER TEMP SENSOR 16FR COUDE 117416 [2702285]

Facility

$99.54

Service Code	HCPCS A4340
Hospital Charge Code	2702285
Hospital Revenue Code	272
Min. Negotiated Rate	$84.61
Max. Negotiated Rate	$96.55
Rate for Payer: Cash Price	$64.70
Rate for Payer: Health Management Network Commercial	$84.61
Rate for Payer: MDX Hawaii PPO	$96.55

Catheter Wayne Pneumothorax Set G56535 [2709871]

Facility

$1,415.95

Service Code	HCPCS C1729
Hospital Charge Code	2709871
Hospital Revenue Code	272
Min. Negotiated Rate	$1,203.56
Max. Negotiated Rate	$1,373.47
Rate for Payer: Cash Price	$920.37
Rate for Payer: Health Management Network Commercial	$1,203.56
Rate for Payer: MDX Hawaii PPO	$1,373.47

Catheter Wayne Pneumothorax Set G56535 [2709871]

Facility

$1,415.95

Service Code	HCPCS C1729
Hospital Charge Code	2709871
Hospital Revenue Code	272
Min. Negotiated Rate	$722.13
Max. Negotiated Rate	$1,373.47
Rate for Payer: Cash Price	$920.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,345.15
Rate for Payer: Health Management Network Commercial	$1,203.56
Rate for Payer: Kaiser Permanente Commercial	$892.05
Rate for Payer: Kaiser Permanente Medicaid	$722.13
Rate for Payer: MDX Hawaii PPO	$1,373.47
Rate for Payer: University Health Alliance Commercial	$1,032.09

Know your out-of-pocket cost for care.

All Charges