Kona Community Hospital

All Charges

Charge

Type

Setting

Price

TRAY CATHETER FOLEY 2W BAG 14F A303314A [2701992]

Facility

$171.04

Hospital Charge Code	2701992
Hospital Revenue Code	272
Min. Negotiated Rate	$145.38
Max. Negotiated Rate	$165.91
Rate for Payer: Cash Price	$111.18
Rate for Payer: Health Management Network Commercial	$145.38
Rate for Payer: MDX Hawaii PPO	$165.91

TRAY CATHETER FOLEY 2W BAG 16F A303316A [2701993]

Facility

$171.04

Hospital Charge Code	2701993
Hospital Revenue Code	272
Min. Negotiated Rate	$145.38
Max. Negotiated Rate	$165.91
Rate for Payer: Cash Price	$111.18
Rate for Payer: Health Management Network Commercial	$145.38
Rate for Payer: MDX Hawaii PPO	$165.91

TRAY CATHETER FOLEY 2W BAG 16F A303316A [2701993]

Facility

$171.04

Hospital Charge Code	2701993
Hospital Revenue Code	272
Min. Negotiated Rate	$87.23
Max. Negotiated Rate	$165.91
Rate for Payer: Cash Price	$111.18
Rate for Payer: Hawaii Western Management Group Commercial	$162.49
Rate for Payer: Health Management Network Commercial	$145.38
Rate for Payer: Kaiser Permanente Commercial	$107.76
Rate for Payer: Kaiser Permanente Medicaid	$87.23
Rate for Payer: MDX Hawaii PPO	$165.91
Rate for Payer: University Health Alliance Commercial	$124.67

TRAY CATHETER FOLEY 2W BAG 16FR LF A303416A [2707813]

Facility

$178.64

Hospital Charge Code	2707813
Hospital Revenue Code	272
Min. Negotiated Rate	$151.84
Max. Negotiated Rate	$173.28
Rate for Payer: Cash Price	$116.12
Rate for Payer: Health Management Network Commercial	$151.84
Rate for Payer: MDX Hawaii PPO	$173.28

TRAY CATHETER FOLEY 2W BAG 16FR LF A303416A [2707813]

Facility

$178.64

Hospital Charge Code	2707813
Hospital Revenue Code	272
Min. Negotiated Rate	$91.11
Max. Negotiated Rate	$173.28
Rate for Payer: Cash Price	$116.12
Rate for Payer: Hawaii Western Management Group Commercial	$169.71
Rate for Payer: Health Management Network Commercial	$151.84
Rate for Payer: Kaiser Permanente Commercial	$112.54
Rate for Payer: Kaiser Permanente Medicaid	$91.11
Rate for Payer: MDX Hawaii PPO	$173.28
Rate for Payer: University Health Alliance Commercial	$130.21

TRAY CATHETER FOLEY 2W BAG 18F A303318A [2701994]

Facility

$167.12

Hospital Charge Code	2701994
Hospital Revenue Code	272
Min. Negotiated Rate	$142.05
Max. Negotiated Rate	$162.11
Rate for Payer: Cash Price	$108.63
Rate for Payer: Health Management Network Commercial	$142.05
Rate for Payer: MDX Hawaii PPO	$162.11

TRAY CATHETER FOLEY 2W BAG 18F A303318A [2701994]

Facility

$167.12

Hospital Charge Code	2701994
Hospital Revenue Code	272
Min. Negotiated Rate	$85.23
Max. Negotiated Rate	$162.11
Rate for Payer: Cash Price	$108.63
Rate for Payer: Hawaii Western Management Group Commercial	$158.76
Rate for Payer: Health Management Network Commercial	$142.05
Rate for Payer: Kaiser Permanente Commercial	$105.29
Rate for Payer: Kaiser Permanente Medicaid	$85.23
Rate for Payer: MDX Hawaii PPO	$162.11
Rate for Payer: University Health Alliance Commercial	$121.81

Tray Cath Uretheral Straight [2701996]

Facility

$24.31

Hospital Charge Code	2701996
Hospital Revenue Code	272
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$23.58
Rate for Payer: Cash Price	$15.80
Rate for Payer: Hawaii Western Management Group Commercial	$23.09
Rate for Payer: Health Management Network Commercial	$20.66
Rate for Payer: Kaiser Permanente Commercial	$15.32
Rate for Payer: Kaiser Permanente Medicaid	$12.40
Rate for Payer: MDX Hawaii PPO	$23.58
Rate for Payer: University Health Alliance Commercial	$17.72

Tray Cath Uretheral Straight [2701996]

Facility

$24.31

Hospital Charge Code	2701996
Hospital Revenue Code	272
Min. Negotiated Rate	$20.66
Max. Negotiated Rate	$23.58
Rate for Payer: Cash Price	$15.80
Rate for Payer: Health Management Network Commercial	$20.66
Rate for Payer: MDX Hawaii PPO	$23.58

TRAY CENTRAL LINE DRESSING [2707269]

Facility

$92.06

Hospital Charge Code	2707269
Hospital Revenue Code	272
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$89.30
Rate for Payer: Cash Price	$59.84
Rate for Payer: Hawaii Western Management Group Commercial	$87.46
Rate for Payer: Health Management Network Commercial	$78.25
Rate for Payer: Kaiser Permanente Commercial	$58.00
Rate for Payer: Kaiser Permanente Medicaid	$46.95
Rate for Payer: MDX Hawaii PPO	$89.30
Rate for Payer: University Health Alliance Commercial	$67.10

TRAY CENTRAL LINE DRESSING [2707269]

Facility

$92.06

Hospital Charge Code	2707269
Hospital Revenue Code	272
Min. Negotiated Rate	$78.25
Max. Negotiated Rate	$89.30
Rate for Payer: Cash Price	$59.84
Rate for Payer: Health Management Network Commercial	$78.25
Rate for Payer: MDX Hawaii PPO	$89.30

Tray Chest Tube 10fr [2707842]

Facility

$1,306.71

Hospital Charge Code	2707842
Hospital Revenue Code	272
Min. Negotiated Rate	$1,110.70
Max. Negotiated Rate	$1,267.51
Rate for Payer: Cash Price	$849.36
Rate for Payer: Health Management Network Commercial	$1,110.70
Rate for Payer: MDX Hawaii PPO	$1,267.51

Tray Chest Tube 10fr [2707842]

Facility

$1,306.71

Hospital Charge Code	2707842
Hospital Revenue Code	272
Min. Negotiated Rate	$666.42
Max. Negotiated Rate	$1,267.51
Rate for Payer: Cash Price	$849.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,241.37
Rate for Payer: Health Management Network Commercial	$1,110.70
Rate for Payer: Kaiser Permanente Commercial	$823.23
Rate for Payer: Kaiser Permanente Medicaid	$666.42
Rate for Payer: MDX Hawaii PPO	$1,267.51
Rate for Payer: University Health Alliance Commercial	$952.46

Tray Chest Tube 8fr [2707841]

Facility

$1,095.24

Hospital Charge Code	2707841
Hospital Revenue Code	272
Min. Negotiated Rate	$558.57
Max. Negotiated Rate	$1,062.38
Rate for Payer: Cash Price	$711.91
Rate for Payer: Hawaii Western Management Group Commercial	$1,040.48
Rate for Payer: Health Management Network Commercial	$930.95
Rate for Payer: Kaiser Permanente Commercial	$690.00
Rate for Payer: Kaiser Permanente Medicaid	$558.57
Rate for Payer: MDX Hawaii PPO	$1,062.38
Rate for Payer: University Health Alliance Commercial	$798.32

Tray Chest Tube 8fr [2707841]

Facility

$1,095.24

Hospital Charge Code	2707841
Hospital Revenue Code	272
Min. Negotiated Rate	$930.95
Max. Negotiated Rate	$1,062.38
Rate for Payer: Cash Price	$711.91
Rate for Payer: Health Management Network Commercial	$930.95
Rate for Payer: MDX Hawaii PPO	$1,062.38

TRAY CIRCUMCISION DISPOSABLE [2701999]

Facility

$62.90

Hospital Charge Code	2701999
Hospital Revenue Code	272
Min. Negotiated Rate	$53.47
Max. Negotiated Rate	$61.01
Rate for Payer: Cash Price	$40.88
Rate for Payer: Health Management Network Commercial	$53.47
Rate for Payer: MDX Hawaii PPO	$61.01

TRAY CIRCUMCISION DISPOSABLE [2701999]

Facility

$62.90

Hospital Charge Code	2701999
Hospital Revenue Code	272
Min. Negotiated Rate	$32.08
Max. Negotiated Rate	$61.01
Rate for Payer: Cash Price	$40.88
Rate for Payer: Hawaii Western Management Group Commercial	$59.76
Rate for Payer: Health Management Network Commercial	$53.47
Rate for Payer: Kaiser Permanente Commercial	$39.63
Rate for Payer: Kaiser Permanente Medicaid	$32.08
Rate for Payer: MDX Hawaii PPO	$61.01
Rate for Payer: University Health Alliance Commercial	$45.85

Tray Dressing Change Picc [2707561]

Facility

$179.20

Hospital Charge Code	2707561
Hospital Revenue Code	272
Min. Negotiated Rate	$152.32
Max. Negotiated Rate	$173.82
Rate for Payer: Cash Price	$116.48
Rate for Payer: Health Management Network Commercial	$152.32
Rate for Payer: MDX Hawaii PPO	$173.82

Tray Dressing Change Picc [2707561]

Facility

$179.20

Hospital Charge Code	2707561
Hospital Revenue Code	272
Min. Negotiated Rate	$91.39
Max. Negotiated Rate	$173.82
Rate for Payer: Cash Price	$116.48
Rate for Payer: Hawaii Western Management Group Commercial	$170.24
Rate for Payer: Health Management Network Commercial	$152.32
Rate for Payer: Kaiser Permanente Commercial	$112.90
Rate for Payer: Kaiser Permanente Medicaid	$91.39
Rate for Payer: MDX Hawaii PPO	$173.82
Rate for Payer: University Health Alliance Commercial	$130.62

Tray Dressing Change Port 20gx.75 [2707563]

Facility

$152.00

Hospital Charge Code	2707563
Hospital Revenue Code	272
Min. Negotiated Rate	$77.52
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$95.76
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: University Health Alliance Commercial	$110.79

Tray Dressing Change Port 20gx.75 [2707563]

Facility

$152.00

Hospital Charge Code	2707563
Hospital Revenue Code	272
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

TRAY LACERATION ER [2702023]

Facility

$171.84

Hospital Charge Code	2702023
Hospital Revenue Code	272
Min. Negotiated Rate	$146.06
Max. Negotiated Rate	$166.68
Rate for Payer: Cash Price	$111.70
Rate for Payer: Health Management Network Commercial	$146.06
Rate for Payer: MDX Hawaii PPO	$166.68

TRAY LACERATION ER [2702023]

Facility

$171.84

Hospital Charge Code	2702023
Hospital Revenue Code	272
Min. Negotiated Rate	$87.64
Max. Negotiated Rate	$166.68
Rate for Payer: Cash Price	$111.70
Rate for Payer: Hawaii Western Management Group Commercial	$163.25
Rate for Payer: Health Management Network Commercial	$146.06
Rate for Payer: Kaiser Permanente Commercial	$108.26
Rate for Payer: Kaiser Permanente Medicaid	$87.64
Rate for Payer: MDX Hawaii PPO	$166.68
Rate for Payer: University Health Alliance Commercial	$125.25

TRAY LUMBAR PUNCTURE W/MANO 20GAX3.5 [2702020]

Facility

$255.34

Hospital Charge Code	2702020
Hospital Revenue Code	272
Min. Negotiated Rate	$130.22
Max. Negotiated Rate	$247.68
Rate for Payer: Cash Price	$165.97
Rate for Payer: Hawaii Western Management Group Commercial	$242.57
Rate for Payer: Health Management Network Commercial	$217.04
Rate for Payer: Kaiser Permanente Commercial	$160.86
Rate for Payer: Kaiser Permanente Medicaid	$130.22
Rate for Payer: MDX Hawaii PPO	$247.68
Rate for Payer: University Health Alliance Commercial	$186.12

TRAY LUMBAR PUNCTURE W/MANO 20GAX3.5 [2702020]

Facility

$255.34

Hospital Charge Code	2702020
Hospital Revenue Code	272
Min. Negotiated Rate	$217.04
Max. Negotiated Rate	$247.68
Rate for Payer: Cash Price	$165.97
Rate for Payer: Health Management Network Commercial	$217.04
Rate for Payer: MDX Hawaii PPO	$247.68

Know your out-of-pocket cost for care.

All Charges