Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$896.13
Max. Negotiated Rate	$1,022.64
Rate for Payer: Cash Price	$685.28
Rate for Payer: Health Management Network Commercial	$896.13
Rate for Payer: MDX Hawaii PPO	$1,022.64

CATH MIDLINE KIT 2LUM 4FR 20CM [2703501]

Facility

$3,135.50

Service Code	HCPCS C1751
Hospital Charge Code	2703501
Hospital Revenue Code	272
Min. Negotiated Rate	$2,665.18
Max. Negotiated Rate	$3,041.43
Rate for Payer: Cash Price	$2,038.08
Rate for Payer: Health Management Network Commercial	$2,665.18
Rate for Payer: MDX Hawaii PPO	$3,041.43

CATH MIDLINE KIT 2LUM 4FR 20CM [2703501]

Facility

$3,135.50

Service Code	HCPCS C1751
Hospital Charge Code	2703501
Hospital Revenue Code	272
Min. Negotiated Rate	$1,599.11
Max. Negotiated Rate	$3,041.43
Rate for Payer: Cash Price	$2,038.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,978.72
Rate for Payer: Health Management Network Commercial	$2,665.18
Rate for Payer: Kaiser Permanente Commercial	$1,975.37
Rate for Payer: Kaiser Permanente Medicaid	$1,599.11
Rate for Payer: MDX Hawaii PPO	$3,041.43
Rate for Payer: University Health Alliance Commercial	$2,285.47

Cath Nottingham Ureteral Dilator Hydrogel M0062301010 [3600421]

Facility

$787.33

Service Code	HCPCS C1726
Hospital Charge Code	3600421
Hospital Revenue Code	272
Min. Negotiated Rate	$669.23
Max. Negotiated Rate	$763.71
Rate for Payer: Cash Price	$511.76
Rate for Payer: Health Management Network Commercial	$669.23
Rate for Payer: MDX Hawaii PPO	$763.71

Cath Nottingham Ureteral Dilator Hydrogel M0062301010 [3600421]

Facility

$787.33

Service Code	HCPCS C1726
Hospital Charge Code	3600421
Hospital Revenue Code	272
Min. Negotiated Rate	$401.54
Max. Negotiated Rate	$763.71
Rate for Payer: Cash Price	$511.76
Rate for Payer: Hawaii Western Management Group Commercial	$747.96
Rate for Payer: Health Management Network Commercial	$669.23
Rate for Payer: Kaiser Permanente Commercial	$496.02
Rate for Payer: Kaiser Permanente Medicaid	$401.54
Rate for Payer: MDX Hawaii PPO	$763.71
Rate for Payer: University Health Alliance Commercial	$573.88

CATH PACE BIPOLAR/BALLOON [2707025]

Facility

$1,187.29

Service Code	HCPCS C1726
Hospital Charge Code	2707025
Hospital Revenue Code	272
Min. Negotiated Rate	$605.52
Max. Negotiated Rate	$1,151.67
Rate for Payer: Cash Price	$771.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.93
Rate for Payer: Health Management Network Commercial	$1,009.20
Rate for Payer: Kaiser Permanente Commercial	$747.99
Rate for Payer: Kaiser Permanente Medicaid	$605.52
Rate for Payer: MDX Hawaii PPO	$1,151.67
Rate for Payer: University Health Alliance Commercial	$865.42

CATH PACE BIPOLAR/BALLOON [2707025]

Facility

$1,187.29

Service Code	HCPCS C1726
Hospital Charge Code	2707025
Hospital Revenue Code	272
Min. Negotiated Rate	$1,009.20
Max. Negotiated Rate	$1,151.67
Rate for Payer: Cash Price	$771.74
Rate for Payer: Health Management Network Commercial	$1,009.20
Rate for Payer: MDX Hawaii PPO	$1,151.67

Cath Port Powerport 8Fr Grosh 1808561 [3640966]

Facility

$1,676.25

Service Code	HCPCS C1788
Hospital Charge Code	3640966
Hospital Revenue Code	278
Min. Negotiated Rate	$854.89
Max. Negotiated Rate	$1,625.96
Rate for Payer: Cash Price	$1,089.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.38
Rate for Payer: Health Management Network Commercial	$1,424.81
Rate for Payer: Kaiser Permanente Commercial	$1,056.04
Rate for Payer: Kaiser Permanente Medicaid	$854.89
Rate for Payer: MDX Hawaii PPO	$1,625.96
Rate for Payer: University Health Alliance Commercial	$938.70

Cath Port Powerport 8Fr Grosh 1808561 [3640966]

Facility

$1,676.25

Service Code	HCPCS C1788
Hospital Charge Code	3640966
Hospital Revenue Code	278
Min. Negotiated Rate	$938.70
Max. Negotiated Rate	$1,625.96
Rate for Payer: Cash Price	$1,089.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.38
Rate for Payer: Health Management Network Commercial	$1,424.81
Rate for Payer: MDX Hawaii PPO	$1,625.96
Rate for Payer: University Health Alliance Commercial	$938.70

Cath Port Powerport 8Fr Slim 1718500 [3641682]

Facility

$1,676.25

Service Code	HCPCS C1788
Hospital Charge Code	3641682
Hospital Revenue Code	278
Min. Negotiated Rate	$854.89
Max. Negotiated Rate	$1,625.96
Rate for Payer: Cash Price	$1,089.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.38
Rate for Payer: Health Management Network Commercial	$1,424.81
Rate for Payer: Kaiser Permanente Commercial	$1,056.04
Rate for Payer: Kaiser Permanente Medicaid	$854.89
Rate for Payer: MDX Hawaii PPO	$1,625.96
Rate for Payer: University Health Alliance Commercial	$938.70

Cath Port Powerport 8Fr Slim 1718500 [3641682]

Facility

$1,676.25

Service Code	HCPCS C1788
Hospital Charge Code	3641682
Hospital Revenue Code	278
Min. Negotiated Rate	$938.70
Max. Negotiated Rate	$1,625.96
Rate for Payer: Cash Price	$1,089.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.38
Rate for Payer: Health Management Network Commercial	$1,424.81
Rate for Payer: MDX Hawaii PPO	$1,625.96
Rate for Payer: University Health Alliance Commercial	$938.70

Cath Powerport ClearVUE 8fr ISP 1608062 [3642858]

Facility

$2,163.13

Service Code	HCPCS C1788
Hospital Charge Code	3642858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.20
Max. Negotiated Rate	$2,098.24
Rate for Payer: Cash Price	$1,406.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.19
Rate for Payer: Health Management Network Commercial	$1,838.66
Rate for Payer: Kaiser Permanente Commercial	$1,362.77
Rate for Payer: Kaiser Permanente Medicaid	$1,103.20
Rate for Payer: MDX Hawaii PPO	$2,098.24
Rate for Payer: University Health Alliance Commercial	$1,211.35

Cath Powerport ClearVUE 8fr ISP 1608062 [3642858]

Facility

$2,163.13

Service Code	HCPCS C1788
Hospital Charge Code	3642858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.35
Max. Negotiated Rate	$2,098.24
Rate for Payer: Cash Price	$1,406.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.19
Rate for Payer: Health Management Network Commercial	$1,838.66
Rate for Payer: MDX Hawaii PPO	$2,098.24
Rate for Payer: University Health Alliance Commercial	$1,211.35

CATH UMBILICAL ART 3.5F [2700508]

Facility

$93.93

Hospital Charge Code	2700508
Hospital Revenue Code	272
Min. Negotiated Rate	$47.90
Max. Negotiated Rate	$91.11
Rate for Payer: Cash Price	$61.05
Rate for Payer: Hawaii Western Management Group Commercial	$89.23
Rate for Payer: Health Management Network Commercial	$79.84
Rate for Payer: Kaiser Permanente Commercial	$59.18
Rate for Payer: Kaiser Permanente Medicaid	$47.90
Rate for Payer: MDX Hawaii PPO	$91.11
Rate for Payer: University Health Alliance Commercial	$68.47

CATH UMBILICAL ART 3.5F [2700508]

Facility

$93.93

Hospital Charge Code	2700508
Hospital Revenue Code	272
Min. Negotiated Rate	$79.84
Max. Negotiated Rate	$91.11
Rate for Payer: Cash Price	$61.05
Rate for Payer: Health Management Network Commercial	$79.84
Rate for Payer: MDX Hawaii PPO	$91.11

CATH UMBILICAL ART 5F [2700509]

Facility

$128.64

Hospital Charge Code	2700509
Hospital Revenue Code	272
Min. Negotiated Rate	$109.34
Max. Negotiated Rate	$124.78
Rate for Payer: Cash Price	$83.62
Rate for Payer: Health Management Network Commercial	$109.34
Rate for Payer: MDX Hawaii PPO	$124.78

CATH UMBILICAL ART 5F [2700509]

Facility

$128.64

Hospital Charge Code	2700509
Hospital Revenue Code	272
Min. Negotiated Rate	$65.61
Max. Negotiated Rate	$124.78
Rate for Payer: Cash Price	$83.62
Rate for Payer: Hawaii Western Management Group Commercial	$122.21
Rate for Payer: Health Management Network Commercial	$109.34
Rate for Payer: Kaiser Permanente Commercial	$81.04
Rate for Payer: Kaiser Permanente Medicaid	$65.61
Rate for Payer: MDX Hawaii PPO	$124.78
Rate for Payer: University Health Alliance Commercial	$93.77

Cath Ureteral 10 FR DBL Lumen M0064051000 [3601727]

Facility

$477.87

Service Code	HCPCS C1758
Hospital Charge Code	3601727
Hospital Revenue Code	272
Min. Negotiated Rate	$243.71
Max. Negotiated Rate	$463.53
Rate for Payer: Cash Price	$310.62
Rate for Payer: Hawaii Western Management Group Commercial	$453.98
Rate for Payer: Health Management Network Commercial	$406.19
Rate for Payer: Kaiser Permanente Commercial	$301.06
Rate for Payer: Kaiser Permanente Medicaid	$243.71
Rate for Payer: MDX Hawaii PPO	$463.53
Rate for Payer: University Health Alliance Commercial	$348.32

Cath Ureteral 10 FR DBL Lumen M0064051000 [3601727]

Facility

$477.87

Service Code	HCPCS C1758
Hospital Charge Code	3601727
Hospital Revenue Code	272
Min. Negotiated Rate	$406.19
Max. Negotiated Rate	$463.53
Rate for Payer: Cash Price	$310.62
Rate for Payer: Health Management Network Commercial	$406.19
Rate for Payer: MDX Hawaii PPO	$463.53

Cath Ureteral 5FR Cone Tip Flexima M0064002110 [3642088]

Facility

$79.82

Service Code	HCPCS C1758
Hospital Charge Code	3642088
Hospital Revenue Code	272
Min. Negotiated Rate	$40.71
Max. Negotiated Rate	$77.43
Rate for Payer: Cash Price	$51.88
Rate for Payer: Hawaii Western Management Group Commercial	$75.83
Rate for Payer: Health Management Network Commercial	$67.85
Rate for Payer: Kaiser Permanente Commercial	$50.29
Rate for Payer: Kaiser Permanente Medicaid	$40.71
Rate for Payer: MDX Hawaii PPO	$77.43
Rate for Payer: University Health Alliance Commercial	$58.18

Cath Ureteral 5FR Cone Tip Flexima M0064002110 [3642088]

Facility

$79.82

Service Code	HCPCS C1758
Hospital Charge Code	3642088
Hospital Revenue Code	272
Min. Negotiated Rate	$67.85
Max. Negotiated Rate	$77.43
Rate for Payer: Cash Price	$51.88
Rate for Payer: Health Management Network Commercial	$67.85
Rate for Payer: MDX Hawaii PPO	$77.43

Cath Ureteral 5Fr Open End Flexima M0064002010 [3601728]

Facility

$79.82

Service Code	HCPCS C1758
Hospital Charge Code	3601728
Hospital Revenue Code	272
Min. Negotiated Rate	$67.85
Max. Negotiated Rate	$77.43
Rate for Payer: Cash Price	$51.88
Rate for Payer: Health Management Network Commercial	$67.85
Rate for Payer: MDX Hawaii PPO	$77.43

Cath Ureteral 5Fr Open End Flexima M0064002010 [3601728]

Facility

$79.82

Service Code	HCPCS C1758
Hospital Charge Code	3601728
Hospital Revenue Code	272
Min. Negotiated Rate	$40.71
Max. Negotiated Rate	$77.43
Rate for Payer: Cash Price	$51.88
Rate for Payer: Hawaii Western Management Group Commercial	$75.83
Rate for Payer: Health Management Network Commercial	$67.85
Rate for Payer: Kaiser Permanente Commercial	$50.29
Rate for Payer: Kaiser Permanente Medicaid	$40.71
Rate for Payer: MDX Hawaii PPO	$77.43
Rate for Payer: University Health Alliance Commercial	$58.18

Cautery ABC GI Probe 2.3mmX270cm 133327 [3641634]

Facility

$2,961.80

Hospital Charge Code	3641634
Hospital Revenue Code	272
Min. Negotiated Rate	$1,510.52
Max. Negotiated Rate	$2,872.95
Rate for Payer: Cash Price	$1,925.17
Rate for Payer: Hawaii Western Management Group Commercial	$2,813.71
Rate for Payer: Health Management Network Commercial	$2,517.53
Rate for Payer: Kaiser Permanente Commercial	$1,865.93
Rate for Payer: Kaiser Permanente Medicaid	$1,510.52
Rate for Payer: MDX Hawaii PPO	$2,872.95
Rate for Payer: University Health Alliance Commercial	$2,158.86

Cautery ABC GI Probe 2.3mmX270cm 133327 [3641634]

Facility

$2,961.80

Hospital Charge Code	3641634
Hospital Revenue Code	272
Min. Negotiated Rate	$2,517.53
Max. Negotiated Rate	$2,872.95
Rate for Payer: Cash Price	$1,925.17
Rate for Payer: Health Management Network Commercial	$2,517.53
Rate for Payer: MDX Hawaii PPO	$2,872.95

Know your out-of-pocket cost for care.

All Charges