Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Cautery Ball Electrode 5" ENT 0009 [3600568]

Facility

$72.08

Hospital Charge Code	3600568
Hospital Revenue Code	272
Min. Negotiated Rate	$36.76
Max. Negotiated Rate	$69.92
Rate for Payer: Cash Price	$46.85
Rate for Payer: Hawaii Western Management Group Commercial	$68.48
Rate for Payer: Health Management Network Commercial	$61.27
Rate for Payer: Kaiser Permanente Commercial	$45.41
Rate for Payer: Kaiser Permanente Medicaid	$36.76
Rate for Payer: MDX Hawaii PPO	$69.92
Rate for Payer: University Health Alliance Commercial	$52.54

Cautery Ball Electrode 5" ENT 0009 [3600568]

Facility

$72.08

Hospital Charge Code	3600568
Hospital Revenue Code	272
Min. Negotiated Rate	$61.27
Max. Negotiated Rate	$69.92
Rate for Payer: Cash Price	$46.85
Rate for Payer: Health Management Network Commercial	$61.27
Rate for Payer: MDX Hawaii PPO	$69.92

CAUTERY FINE TIP DISP [2707812]

Facility

$137.60

Hospital Charge Code	2707812
Hospital Revenue Code	272
Min. Negotiated Rate	$116.96
Max. Negotiated Rate	$133.47
Rate for Payer: Cash Price	$89.44
Rate for Payer: Health Management Network Commercial	$116.96
Rate for Payer: MDX Hawaii PPO	$133.47

CAUTERY FINE TIP DISP [2707812]

Facility

$137.60

Hospital Charge Code	2707812
Hospital Revenue Code	272
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$133.47
Rate for Payer: Cash Price	$89.44
Rate for Payer: Hawaii Western Management Group Commercial	$130.72
Rate for Payer: Health Management Network Commercial	$116.96
Rate for Payer: Kaiser Permanente Commercial	$86.69
Rate for Payer: Kaiser Permanente Medicaid	$70.18
Rate for Payer: MDX Hawaii PPO	$133.47
Rate for Payer: University Health Alliance Commercial	$100.30

Cautery Ligasure Curved Small Jaw LF1212A [3600543]

Facility

$2,202.79

Hospital Charge Code	3600543
Hospital Revenue Code	272
Min. Negotiated Rate	$1,123.42
Max. Negotiated Rate	$2,136.71
Rate for Payer: Cash Price	$1,431.81
Rate for Payer: Hawaii Western Management Group Commercial	$2,092.65
Rate for Payer: Health Management Network Commercial	$1,872.37
Rate for Payer: Kaiser Permanente Commercial	$1,387.76
Rate for Payer: Kaiser Permanente Medicaid	$1,123.42
Rate for Payer: MDX Hawaii PPO	$2,136.71
Rate for Payer: University Health Alliance Commercial	$1,605.61

Cautery Ligasure Curved Small Jaw LF1212A [3600543]

Facility

$2,202.79

Hospital Charge Code	3600543
Hospital Revenue Code	272
Min. Negotiated Rate	$1,872.37
Max. Negotiated Rate	$2,136.71
Rate for Payer: Cash Price	$1,431.81
Rate for Payer: Health Management Network Commercial	$1,872.37
Rate for Payer: MDX Hawaii PPO	$2,136.71

Cautery Ligasure Impact LF4418 [3600544]

Facility

$3,518.00

Hospital Charge Code	3600544
Hospital Revenue Code	272
Min. Negotiated Rate	$1,794.18
Max. Negotiated Rate	$3,412.46
Rate for Payer: Cash Price	$2,286.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,342.10
Rate for Payer: Health Management Network Commercial	$2,990.30
Rate for Payer: Kaiser Permanente Commercial	$2,216.34
Rate for Payer: Kaiser Permanente Medicaid	$1,794.18
Rate for Payer: MDX Hawaii PPO	$3,412.46
Rate for Payer: University Health Alliance Commercial	$2,564.27

Cautery Ligasure Impact LF4418 [3600544]

Facility

$3,518.00

Hospital Charge Code	3600544
Hospital Revenue Code	272
Min. Negotiated Rate	$2,990.30
Max. Negotiated Rate	$3,412.46
Rate for Payer: Cash Price	$2,286.70
Rate for Payer: Health Management Network Commercial	$2,990.30
Rate for Payer: MDX Hawaii PPO	$3,412.46

Cautery Shear Harmonic Focus HAR9F [3600526]

Facility

$3,238.06

Hospital Charge Code	3600526
Hospital Revenue Code	272
Min. Negotiated Rate	$1,651.41
Max. Negotiated Rate	$3,140.92
Rate for Payer: Cash Price	$2,104.74
Rate for Payer: Hawaii Western Management Group Commercial	$3,076.16
Rate for Payer: Health Management Network Commercial	$2,752.35
Rate for Payer: Kaiser Permanente Commercial	$2,039.98
Rate for Payer: Kaiser Permanente Medicaid	$1,651.41
Rate for Payer: MDX Hawaii PPO	$3,140.92
Rate for Payer: University Health Alliance Commercial	$2,360.22

Cautery Shear Harmonic Focus HAR9F [3600526]

Facility

$3,238.06

Hospital Charge Code	3600526
Hospital Revenue Code	272
Min. Negotiated Rate	$2,752.35
Max. Negotiated Rate	$3,140.92
Rate for Payer: Cash Price	$2,104.74
Rate for Payer: Health Management Network Commercial	$2,752.35
Rate for Payer: MDX Hawaii PPO	$3,140.92

Cautery Shear Harmonic Scalpel HARH36 [3600540]

Facility

$2,174.52

Hospital Charge Code	3600540
Hospital Revenue Code	272
Min. Negotiated Rate	$1,848.34
Max. Negotiated Rate	$2,109.28
Rate for Payer: Cash Price	$1,413.44
Rate for Payer: Health Management Network Commercial	$1,848.34
Rate for Payer: MDX Hawaii PPO	$2,109.28

Cautery Shear Harmonic Scalpel HARH36 [3600540]

Facility

$2,174.52

Hospital Charge Code	3600540
Hospital Revenue Code	272
Min. Negotiated Rate	$1,109.01
Max. Negotiated Rate	$2,109.28
Rate for Payer: Cash Price	$1,413.44
Rate for Payer: Hawaii Western Management Group Commercial	$2,065.79
Rate for Payer: Health Management Network Commercial	$1,848.34
Rate for Payer: Kaiser Permanente Commercial	$1,369.95
Rate for Payer: Kaiser Permanente Medicaid	$1,109.01
Rate for Payer: MDX Hawaii PPO	$2,109.28
Rate for Payer: University Health Alliance Commercial	$1,585.01

CEFAZOLIN 1 G (50 MG/ML) RECON.SOLN FOR NON-INJ USE

Facility

$10.93

Service Code	NDC 44567070725
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$10.60
Rate for Payer: Cash Price	$7.10
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: MDX Hawaii PPO	$10.60

CEFAZOLIN 1 G (50 MG/ML) RECON.SOLN FOR NON-INJ USE

Facility

$10.93

Service Code	NDC 44567070725
Hospital Revenue Code	250
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$10.60
Rate for Payer: Cash Price	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$10.38
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: Kaiser Permanente Commercial	$6.89
Rate for Payer: Kaiser Permanente Medicaid	$5.57
Rate for Payer: MDX Hawaii PPO	$10.60
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: University Health Alliance Commercial	$7.97

CEFAZOLIN 1 G (50 MG/ML) RECON.SOLN FOR NON-INJ USE

Facility

$7.56

Service Code	NDC 00143992490
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$7.33
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: MDX Hawaii PPO	$7.33

CEFAZOLIN 1 G (50 MG/ML) RECON.SOLN FOR NON-INJ USE

Facility

$7.56

Service Code	NDC 00143992490
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$7.33
Rate for Payer: Cash Price	$4.91
Rate for Payer: Hawaii Western Management Group Commercial	$7.18
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Kaiser Permanente Commercial	$4.76
Rate for Payer: Kaiser Permanente Medicaid	$3.86
Rate for Payer: MDX Hawaii PPO	$7.33
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: University Health Alliance Commercial	$5.51

CEFAZOLIN 1 GRAM INJ RECON.SOLN.

Facility

$10.93

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$10.60
Rate for Payer: Cash Price	$7.10
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: MDX Hawaii PPO	$7.33
Rate for Payer: MDX Hawaii PPO	$10.60

CEFAZOLIN 1 GRAM INJ RECON.SOLN.

Facility

$7.56

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$7.33
Rate for Payer: Cash Price	$4.91
Rate for Payer: Cash Price	$7.10
Rate for Payer: Cash Price	$7.10
Rate for Payer: Cash Price	$4.91
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$10.38
Rate for Payer: Hawaii Western Management Group Commercial	$7.18
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: Kaiser Permanente Commercial	$4.76
Rate for Payer: Kaiser Permanente Commercial	$6.89
Rate for Payer: Kaiser Permanente Medicaid	$5.57
Rate for Payer: Kaiser Permanente Medicaid	$3.86
Rate for Payer: MDX Hawaii PPO	$10.60
Rate for Payer: MDX Hawaii PPO	$7.33
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: University Health Alliance Commercial	$7.97
Rate for Payer: University Health Alliance Commercial	$5.51

CEFAZOLIN 500 MG INJ RECON.SOLN.

Facility

$11.06

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$10.73
Rate for Payer: Cash Price	$7.19
Rate for Payer: Health Management Network Commercial	$9.40
Rate for Payer: MDX Hawaii PPO	$10.73

CEFAZOLIN 500 MG INJ RECON.SOLN.

Facility

$11.06

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$10.73
Rate for Payer: Cash Price	$7.19
Rate for Payer: Cash Price	$7.19
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$10.51
Rate for Payer: Health Management Network Commercial	$9.40
Rate for Payer: Kaiser Permanente Commercial	$6.97
Rate for Payer: Kaiser Permanente Medicaid	$5.64
Rate for Payer: MDX Hawaii PPO	$10.73
Rate for Payer: UnitedHealthcare Medicaid	$6.64
Rate for Payer: University Health Alliance Commercial	$8.06

CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV IVPB

Facility

$72.32

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$61.47
Max. Negotiated Rate	$70.15
Rate for Payer: Cash Price	$47.01
Rate for Payer: Health Management Network Commercial	$61.47
Rate for Payer: MDX Hawaii PPO	$70.15

CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV IVPB

Facility

$72.32

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$70.15
Rate for Payer: Cash Price	$47.01
Rate for Payer: Cash Price	$47.01
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$68.70
Rate for Payer: Health Management Network Commercial	$61.47
Rate for Payer: Kaiser Permanente Commercial	$45.56
Rate for Payer: Kaiser Permanente Medicaid	$36.88
Rate for Payer: MDX Hawaii PPO	$70.15
Rate for Payer: UnitedHealthcare Medicaid	$43.39
Rate for Payer: University Health Alliance Commercial	$52.71

CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV IVPB

Facility

$79.11

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$76.74
Rate for Payer: Cash Price	$51.42
Rate for Payer: Health Management Network Commercial	$67.24
Rate for Payer: MDX Hawaii PPO	$76.74

CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV IVPB

Facility

$79.11

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$76.74
Rate for Payer: Cash Price	$51.42
Rate for Payer: Cash Price	$51.42
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$75.15
Rate for Payer: Health Management Network Commercial	$67.24
Rate for Payer: Kaiser Permanente Commercial	$49.84
Rate for Payer: Kaiser Permanente Medicaid	$40.35
Rate for Payer: MDX Hawaii PPO	$76.74
Rate for Payer: UnitedHealthcare Medicaid	$47.47
Rate for Payer: University Health Alliance Commercial	$57.66

CEFDINIR 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$275.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$234.48
Max. Negotiated Rate	$267.58
Rate for Payer: Cash Price	$179.31
Rate for Payer: Health Management Network Commercial	$234.48
Rate for Payer: MDX Hawaii PPO	$267.58

Know your out-of-pocket cost for care.

All Charges