Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NP CEPHALEXIN 500 MG #4 CAP (WHR)

Facility

$26.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$26.18
Rate for Payer: Cash Price	$17.54
Rate for Payer: Hawaii Western Management Group Commercial	$25.64
Rate for Payer: Health Management Network Commercial	$22.94
Rate for Payer: Kaiser Permanente Commercial	$17.00
Rate for Payer: Kaiser Permanente Medicaid	$13.76
Rate for Payer: MDX Hawaii PPO	$26.18
Rate for Payer: UnitedHealthcare Medicaid	$16.19
Rate for Payer: University Health Alliance Commercial	$19.67

NP CEPHALEXIN 500 MG #4 CAP (WHR)

Facility

$26.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$26.18
Rate for Payer: Cash Price	$17.54
Rate for Payer: Health Management Network Commercial	$22.94
Rate for Payer: MDX Hawaii PPO	$26.18

NP CIPROFLOXACIN 500 MG #2 TAB (WHR)

Facility

$3.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.31
Rate for Payer: Cash Price	$2.22
Rate for Payer: Hawaii Western Management Group Commercial	$3.24
Rate for Payer: Health Management Network Commercial	$2.90
Rate for Payer: Kaiser Permanente Commercial	$2.15
Rate for Payer: Kaiser Permanente Medicaid	$1.74
Rate for Payer: MDX Hawaii PPO	$3.31
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: University Health Alliance Commercial	$2.49

NP CIPROFLOXACIN 500 MG #2 TAB (WHR)

Facility

$3.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$3.31
Rate for Payer: Cash Price	$2.22
Rate for Payer: Health Management Network Commercial	$2.90
Rate for Payer: MDX Hawaii PPO	$3.31

NP CLINDAMYCIN 150 MG #8 CAP (WHR)

Facility

$27.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$26.86
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$23.54
Rate for Payer: MDX Hawaii PPO	$26.86

NP CLINDAMYCIN 150 MG #8 CAP (WHR)

Facility

$27.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.12
Max. Negotiated Rate	$26.86
Rate for Payer: Cash Price	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$26.31
Rate for Payer: Health Management Network Commercial	$23.54
Rate for Payer: Kaiser Permanente Commercial	$17.44
Rate for Payer: Kaiser Permanente Medicaid	$14.12
Rate for Payer: MDX Hawaii PPO	$26.86
Rate for Payer: UnitedHealthcare Medicaid	$16.61
Rate for Payer: University Health Alliance Commercial	$20.18

NP CLINDAMYCIN 300 MG #4 CAP (WHR)

Facility

$28.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$27.80
Rate for Payer: Cash Price	$18.63
Rate for Payer: Hawaii Western Management Group Commercial	$27.23
Rate for Payer: Health Management Network Commercial	$24.36
Rate for Payer: Kaiser Permanente Commercial	$18.06
Rate for Payer: Kaiser Permanente Medicaid	$14.62
Rate for Payer: MDX Hawaii PPO	$27.80
Rate for Payer: UnitedHealthcare Medicaid	$17.20
Rate for Payer: University Health Alliance Commercial	$20.89

NP CLINDAMYCIN 300 MG #4 CAP (WHR)

Facility

$28.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$27.80
Rate for Payer: Cash Price	$18.63
Rate for Payer: Health Management Network Commercial	$24.36
Rate for Payer: MDX Hawaii PPO	$27.80

NP CYCLOBENZAPRINE 10 MG #3 TAB (WHR)

Facility

$3.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.44
Rate for Payer: Cash Price	$2.31
Rate for Payer: Health Management Network Commercial	$3.02
Rate for Payer: MDX Hawaii PPO	$3.44

NP CYCLOBENZAPRINE 10 MG #3 TAB (WHR)

Facility

$3.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$3.44
Rate for Payer: Cash Price	$2.31
Rate for Payer: Hawaii Western Management Group Commercial	$3.37
Rate for Payer: Health Management Network Commercial	$3.02
Rate for Payer: Kaiser Permanente Commercial	$2.24
Rate for Payer: Kaiser Permanente Medicaid	$1.81
Rate for Payer: MDX Hawaii PPO	$3.44
Rate for Payer: UnitedHealthcare Medicaid	$2.13
Rate for Payer: University Health Alliance Commercial	$2.59

NP DIAZEPAM 5 MG #5 TAB (WHR)

Facility

$8.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$5.76
Rate for Payer: Hawaii Western Management Group Commercial	$8.42
Rate for Payer: Health Management Network Commercial	$7.53
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: Kaiser Permanente Medicaid	$4.52
Rate for Payer: MDX Hawaii PPO	$8.59
Rate for Payer: UnitedHealthcare Medicaid	$5.32
Rate for Payer: University Health Alliance Commercial	$6.46

NP DIAZEPAM 5 MG #5 TAB (WHR)

Facility

$8.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$5.76
Rate for Payer: Health Management Network Commercial	$7.53
Rate for Payer: MDX Hawaii PPO	$8.59

NP DIPHENHYDRAMINE 25 MG #4 CAP (WHR)

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

NP DIPHENHYDRAMINE 25 MG #4 CAP (WHR)

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

NP DIPHENHYDRAMINE 50 MG #4 CAP (WHR)

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

NP DIPHENHYDRAMINE 50 MG #4 CAP (WHR)

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

NP DOXYCYCLINE 100 MG #2 TAB (WHR)

Facility

$64.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$54.63
Max. Negotiated Rate	$62.34
Rate for Payer: Cash Price	$41.78
Rate for Payer: Health Management Network Commercial	$54.63
Rate for Payer: MDX Hawaii PPO	$62.34

NP DOXYCYCLINE 100 MG #2 TAB (WHR)

Facility

$64.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$62.34
Rate for Payer: Cash Price	$41.78
Rate for Payer: Hawaii Western Management Group Commercial	$61.06
Rate for Payer: Health Management Network Commercial	$54.63
Rate for Payer: Kaiser Permanente Commercial	$40.49
Rate for Payer: Kaiser Permanente Medicaid	$32.78
Rate for Payer: MDX Hawaii PPO	$62.34
Rate for Payer: UnitedHealthcare Medicaid	$38.56
Rate for Payer: University Health Alliance Commercial	$46.85

NP EPINEPHRINE 0.15 MG/0.15 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$1,075.73
Max. Negotiated Rate	$1,227.60
Rate for Payer: Cash Price	$822.62
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: MDX Hawaii PPO	$1,227.60

NP EPINEPHRINE 0.15 MG/0.15 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1,227.60
Rate for Payer: Cash Price	$822.62
Rate for Payer: Cash Price	$822.62
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,202.29
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: Kaiser Permanente Commercial	$797.31
Rate for Payer: Kaiser Permanente Medicaid	$645.44
Rate for Payer: MDX Hawaii PPO	$1,227.60
Rate for Payer: UnitedHealthcare Medicaid	$759.34
Rate for Payer: University Health Alliance Commercial	$922.47

NP EPINEPHRINE 0.3 MG/0.3 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1,227.60
Rate for Payer: Cash Price	$822.62
Rate for Payer: Cash Price	$822.62
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,202.29
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: Kaiser Permanente Commercial	$797.31
Rate for Payer: Kaiser Permanente Medicaid	$645.44
Rate for Payer: MDX Hawaii PPO	$1,227.60
Rate for Payer: UnitedHealthcare Medicaid	$759.34
Rate for Payer: University Health Alliance Commercial	$922.47

NP EPINEPHRINE 0.3 MG/0.3 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$1,075.73
Max. Negotiated Rate	$1,227.60
Rate for Payer: Cash Price	$822.62
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: MDX Hawaii PPO	$1,227.60

NP HYDROCODONE-ACETAMINOPHEN 5-325 MG #5 TAB (WHR)

Facility

$21.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$21.29
Rate for Payer: Cash Price	$14.27
Rate for Payer: Hawaii Western Management Group Commercial	$20.85
Rate for Payer: Health Management Network Commercial	$18.66
Rate for Payer: Kaiser Permanente Commercial	$13.83
Rate for Payer: Kaiser Permanente Medicaid	$11.19
Rate for Payer: MDX Hawaii PPO	$21.29
Rate for Payer: UnitedHealthcare Medicaid	$13.17
Rate for Payer: University Health Alliance Commercial	$16.00

NP HYDROCODONE-ACETAMINOPHEN 5-325 MG #5 TAB (WHR)

Facility

$21.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.66
Max. Negotiated Rate	$21.29
Rate for Payer: Cash Price	$14.27
Rate for Payer: Health Management Network Commercial	$18.66
Rate for Payer: MDX Hawaii PPO	$21.29

NP HYDROXYZINE HCL 25 MG #8 TAB (WHR)

Facility

$11.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$10.84
Rate for Payer: Cash Price	$7.27
Rate for Payer: Hawaii Western Management Group Commercial	$10.62
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Kaiser Permanente Commercial	$7.04
Rate for Payer: Kaiser Permanente Medicaid	$5.70
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: UnitedHealthcare Medicaid	$6.71
Rate for Payer: University Health Alliance Commercial	$8.15

Know your out-of-pocket cost for care.

All Charges