Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Cath Foley 20fr 3way 30cc Coude 2557H20 [3643578]

Facility

$161.36

Hospital Charge Code	3643578
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

Cath Foley 20fr 3way 30cc Coude 2557H20 [3643578]

Facility

$161.36

Hospital Charge Code	3643578
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

Cath Foley 20fr 3way 30cc Silicone 73020L [3643579]

Facility

$88.74

Hospital Charge Code	3643579
Hospital Revenue Code	272
Min. Negotiated Rate	$75.43
Max. Negotiated Rate	$86.08
Rate for Payer: Cash Price	$57.68
Rate for Payer: Health Management Network Commercial	$75.43
Rate for Payer: MDX Hawaii PPO	$86.08

Cath Foley 20fr 3way 30cc Silicone 73020L [3643579]

Facility

$88.74

Hospital Charge Code	3643579
Hospital Revenue Code	272
Min. Negotiated Rate	$45.26
Max. Negotiated Rate	$86.08
Rate for Payer: Cash Price	$57.68
Rate for Payer: Hawaii Western Management Group Commercial	$84.30
Rate for Payer: Health Management Network Commercial	$75.43
Rate for Payer: Kaiser Permanente Commercial	$55.91
Rate for Payer: Kaiser Permanente Medicaid	$45.26
Rate for Payer: MDX Hawaii PPO	$86.08
Rate for Payer: University Health Alliance Commercial	$64.68

Cath Foley 20Fr 3Way 50cc X-Flow Prostatic AB6320 [3643026]

Facility

$156.80

Service Code	HCPCS A4346
Hospital Charge Code	3643026
Hospital Revenue Code	272
Min. Negotiated Rate	$133.28
Max. Negotiated Rate	$152.10
Rate for Payer: Cash Price	$101.92
Rate for Payer: Health Management Network Commercial	$133.28
Rate for Payer: MDX Hawaii PPO	$152.10

Cath Foley 20Fr 3Way 50cc X-Flow Prostatic AB6320 [3643026]

Facility

$156.80

Service Code	HCPCS A4346
Hospital Charge Code	3643026
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$152.10
Rate for Payer: Cash Price	$101.92
Rate for Payer: Cash Price	$101.92
Rate for Payer: Hawaii Western Management Group Commercial	$148.96
Rate for Payer: Health Management Network Commercial	$133.28
Rate for Payer: Kaiser Permanente Commercial	$98.78
Rate for Payer: Kaiser Permanente Medicaid	$79.97
Rate for Payer: MDX Hawaii PPO	$152.10
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$114.29

Cath Foley 22Fr 3Way 30cc Simplistic 570622 [3600698]

Facility

$262.09

Service Code	HCPCS A4346
Hospital Charge Code	3600698
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$254.23
Rate for Payer: Cash Price	$170.36
Rate for Payer: Cash Price	$170.36
Rate for Payer: Hawaii Western Management Group Commercial	$248.99
Rate for Payer: Health Management Network Commercial	$222.78
Rate for Payer: Kaiser Permanente Commercial	$165.12
Rate for Payer: Kaiser Permanente Medicaid	$133.67
Rate for Payer: MDX Hawaii PPO	$254.23
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$191.04

Cath Foley 22Fr 3Way 30cc Simplistic 570622 [3600698]

Facility

$262.09

Service Code	HCPCS A4346
Hospital Charge Code	3600698
Hospital Revenue Code	272
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$254.23
Rate for Payer: Cash Price	$170.36
Rate for Payer: Health Management Network Commercial	$222.78
Rate for Payer: MDX Hawaii PPO	$254.23

Cath Foley 22Fr 3Way 50cc X-Flow Prostatic AB6322 [3643027]

Facility

$156.80

Service Code	HCPCS A4346
Hospital Charge Code	3643027
Hospital Revenue Code	272
Min. Negotiated Rate	$133.28
Max. Negotiated Rate	$152.10
Rate for Payer: Cash Price	$101.92
Rate for Payer: Health Management Network Commercial	$133.28
Rate for Payer: MDX Hawaii PPO	$152.10

Cath Foley 22Fr 3Way 50cc X-Flow Prostatic AB6322 [3643027]

Facility

$156.80

Service Code	HCPCS A4346
Hospital Charge Code	3643027
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$152.10
Rate for Payer: Cash Price	$101.92
Rate for Payer: Cash Price	$101.92
Rate for Payer: Hawaii Western Management Group Commercial	$148.96
Rate for Payer: Health Management Network Commercial	$133.28
Rate for Payer: Kaiser Permanente Commercial	$98.78
Rate for Payer: Kaiser Permanente Medicaid	$79.97
Rate for Payer: MDX Hawaii PPO	$152.10
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$114.29

Cath Foley Coude 20Fr 30cc 3way 1857SI20 [3642483]

Facility

$156.72

Service Code	HCPCS A4346
Hospital Charge Code	3642483
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$152.02
Rate for Payer: Cash Price	$101.87
Rate for Payer: Cash Price	$101.87
Rate for Payer: Hawaii Western Management Group Commercial	$148.88
Rate for Payer: Health Management Network Commercial	$133.21
Rate for Payer: Kaiser Permanente Commercial	$98.73
Rate for Payer: Kaiser Permanente Medicaid	$79.93
Rate for Payer: MDX Hawaii PPO	$152.02
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$114.23

Cath Foley Coude 20Fr 30cc 3way 1857SI20 [3642483]

Facility

$156.72

Service Code	HCPCS A4346
Hospital Charge Code	3642483
Hospital Revenue Code	272
Min. Negotiated Rate	$133.21
Max. Negotiated Rate	$152.02
Rate for Payer: Cash Price	$101.87
Rate for Payer: Health Management Network Commercial	$133.21
Rate for Payer: MDX Hawaii PPO	$152.02

Cath Foley Coude 22Fr 30cc 3way 1857SI22 [3642373]

Facility

$156.72

Service Code	HCPCS A4346
Hospital Charge Code	3642373
Hospital Revenue Code	272
Min. Negotiated Rate	$133.21
Max. Negotiated Rate	$152.02
Rate for Payer: Cash Price	$101.87
Rate for Payer: Health Management Network Commercial	$133.21
Rate for Payer: MDX Hawaii PPO	$152.02

Cath Foley Coude 22Fr 30cc 3way 1857SI22 [3642373]

Facility

$156.72

Service Code	HCPCS A4346
Hospital Charge Code	3642373
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$152.02
Rate for Payer: Cash Price	$101.87
Rate for Payer: Cash Price	$101.87
Rate for Payer: Hawaii Western Management Group Commercial	$148.88
Rate for Payer: Health Management Network Commercial	$133.21
Rate for Payer: Kaiser Permanente Commercial	$98.73
Rate for Payer: Kaiser Permanente Medicaid	$79.93
Rate for Payer: MDX Hawaii PPO	$152.02
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$114.23

Cath Foley Coude 24Fr 30cc 3way 1857SI24 [3642374]

Facility

$149.60

Service Code	HCPCS A4346
Hospital Charge Code	3642374
Hospital Revenue Code	272
Min. Negotiated Rate	$127.16
Max. Negotiated Rate	$145.11
Rate for Payer: Cash Price	$97.24
Rate for Payer: Health Management Network Commercial	$127.16
Rate for Payer: MDX Hawaii PPO	$145.11

Cath Foley Coude 24Fr 30cc 3way 1857SI24 [3642374]

Facility

$149.60

Service Code	HCPCS A4346
Hospital Charge Code	3642374
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$145.11
Rate for Payer: Cash Price	$97.24
Rate for Payer: Cash Price	$97.24
Rate for Payer: Hawaii Western Management Group Commercial	$142.12
Rate for Payer: Health Management Network Commercial	$127.16
Rate for Payer: Kaiser Permanente Commercial	$94.25
Rate for Payer: Kaiser Permanente Medicaid	$76.30
Rate for Payer: MDX Hawaii PPO	$145.11
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: University Health Alliance Commercial	$109.04

Cath Foley Coude Tiemann 16Fr 5cc 2 way 0102L16 [3642849]

Facility

$90.10

Service Code	HCPCS A4340
Hospital Charge Code	3642849
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$87.40
Rate for Payer: Cash Price	$58.56
Rate for Payer: Cash Price	$58.56
Rate for Payer: Hawaii Western Management Group Commercial	$85.59
Rate for Payer: Health Management Network Commercial	$76.58
Rate for Payer: Kaiser Permanente Commercial	$56.76
Rate for Payer: Kaiser Permanente Medicaid	$45.95
Rate for Payer: MDX Hawaii PPO	$87.40
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$65.67

Cath Foley Coude Tiemann 16Fr 5cc 2 way 0102L16 [3642849]

Facility

$90.10

Service Code	HCPCS A4340
Hospital Charge Code	3642849
Hospital Revenue Code	272
Min. Negotiated Rate	$76.58
Max. Negotiated Rate	$87.40
Rate for Payer: Cash Price	$58.56
Rate for Payer: Health Management Network Commercial	$76.58
Rate for Payer: MDX Hawaii PPO	$87.40

Cath Foley Coude Tiemann 18fr 5cc 2way 0102L18 [3643580]

Facility

$90.10

Hospital Charge Code	3643580
Hospital Revenue Code	272
Min. Negotiated Rate	$76.58
Max. Negotiated Rate	$87.40
Rate for Payer: Cash Price	$58.56
Rate for Payer: Health Management Network Commercial	$76.58
Rate for Payer: MDX Hawaii PPO	$87.40

Cath Foley Coude Tiemann 18fr 5cc 2way 0102L18 [3643580]

Facility

$90.10

Hospital Charge Code	3643580
Hospital Revenue Code	272
Min. Negotiated Rate	$45.95
Max. Negotiated Rate	$87.40
Rate for Payer: Cash Price	$58.56
Rate for Payer: Hawaii Western Management Group Commercial	$85.59
Rate for Payer: Health Management Network Commercial	$76.58
Rate for Payer: Kaiser Permanente Commercial	$56.76
Rate for Payer: Kaiser Permanente Medicaid	$45.95
Rate for Payer: MDX Hawaii PPO	$87.40
Rate for Payer: University Health Alliance Commercial	$65.67

Cath Foley Coude Tiemann 20Fr 5cc 2way 0102SI20 [3642999]

Facility

$129.60

Service Code	HCPCS A4340
Hospital Charge Code	3642999
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$125.71
Rate for Payer: Cash Price	$84.24
Rate for Payer: Cash Price	$84.24
Rate for Payer: Hawaii Western Management Group Commercial	$123.12
Rate for Payer: Health Management Network Commercial	$110.16
Rate for Payer: Kaiser Permanente Commercial	$81.65
Rate for Payer: Kaiser Permanente Medicaid	$66.10
Rate for Payer: MDX Hawaii PPO	$125.71
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$94.47

Cath Foley Coude Tiemann 20Fr 5cc 2way 0102SI20 [3642999]

Facility

$129.60

Service Code	HCPCS A4340
Hospital Charge Code	3642999
Hospital Revenue Code	272
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$125.71
Rate for Payer: Cash Price	$84.24
Rate for Payer: Health Management Network Commercial	$110.16
Rate for Payer: MDX Hawaii PPO	$125.71

Cath Foley Coude Tiemann 22Fr 5cc 2way 0102SI22 [3642375]

Facility

$119.43

Service Code	HCPCS A4340
Hospital Charge Code	3642375
Hospital Revenue Code	272
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$115.85
Rate for Payer: Cash Price	$77.63
Rate for Payer: Health Management Network Commercial	$101.52
Rate for Payer: MDX Hawaii PPO	$115.85

Cath Foley Coude Tiemann 22Fr 5cc 2way 0102SI22 [3642375]

Facility

$119.43

Service Code	HCPCS A4340
Hospital Charge Code	3642375
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$115.85
Rate for Payer: Cash Price	$77.63
Rate for Payer: Cash Price	$77.63
Rate for Payer: Hawaii Western Management Group Commercial	$113.46
Rate for Payer: Health Management Network Commercial	$101.52
Rate for Payer: Kaiser Permanente Commercial	$75.24
Rate for Payer: Kaiser Permanente Medicaid	$60.91
Rate for Payer: MDX Hawaii PPO	$115.85
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: University Health Alliance Commercial	$87.05

CATH MIDLINE KIT 1LUM 3FR 20CM [2703500]

Facility

$1,054.27

Service Code	HCPCS C1751
Hospital Charge Code	2703500
Hospital Revenue Code	272
Min. Negotiated Rate	$537.68
Max. Negotiated Rate	$1,022.64
Rate for Payer: Cash Price	$685.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,001.56
Rate for Payer: Health Management Network Commercial	$896.13
Rate for Payer: Kaiser Permanente Commercial	$664.19
Rate for Payer: Kaiser Permanente Medicaid	$537.68
Rate for Payer: MDX Hawaii PPO	$1,022.64
Rate for Payer: University Health Alliance Commercial	$768.46

Know your out-of-pocket cost for care.

All Charges