Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

CEFDINIR 300 MG PO CAP

Facility

$28.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$27.38
Rate for Payer: Cash Price	$18.35
Rate for Payer: Health Management Network Commercial	$24.00
Rate for Payer: MDX Hawaii PPO	$27.38

CEFDINIR 300 MG PO CAP

Facility

$28.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$27.38
Rate for Payer: Cash Price	$18.35
Rate for Payer: Hawaii Western Management Group Commercial	$26.82
Rate for Payer: Health Management Network Commercial	$24.00
Rate for Payer: Kaiser Permanente Commercial	$17.78
Rate for Payer: Kaiser Permanente Medicaid	$14.40
Rate for Payer: MDX Hawaii PPO	$27.38
Rate for Payer: UnitedHealthcare Medicaid	$16.94
Rate for Payer: University Health Alliance Commercial	$20.58

CEFEPIME 1 GRAM INJ RECON.SOLN.

Facility

$39.06

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$37.89
Rate for Payer: Cash Price	$25.39
Rate for Payer: Cash Price	$66.42
Rate for Payer: Cash Price	$25.39
Rate for Payer: Cash Price	$66.42
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$97.08
Rate for Payer: Hawaii Western Management Group Commercial	$37.11
Rate for Payer: Health Management Network Commercial	$33.20
Rate for Payer: Health Management Network Commercial	$86.86
Rate for Payer: Kaiser Permanente Commercial	$24.61
Rate for Payer: Kaiser Permanente Commercial	$64.38
Rate for Payer: Kaiser Permanente Medicaid	$52.12
Rate for Payer: Kaiser Permanente Medicaid	$19.92
Rate for Payer: MDX Hawaii PPO	$37.89
Rate for Payer: MDX Hawaii PPO	$99.12
Rate for Payer: UnitedHealthcare Medicaid	$61.31
Rate for Payer: UnitedHealthcare Medicaid	$23.44
Rate for Payer: University Health Alliance Commercial	$28.47
Rate for Payer: University Health Alliance Commercial	$74.49

CEFEPIME 1 GRAM INJ RECON.SOLN.

Facility

$39.06

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$37.89
Rate for Payer: Cash Price	$25.39
Rate for Payer: Cash Price	$66.42
Rate for Payer: Health Management Network Commercial	$86.86
Rate for Payer: Health Management Network Commercial	$33.20
Rate for Payer: MDX Hawaii PPO	$99.12
Rate for Payer: MDX Hawaii PPO	$37.89

CEFEPIME 2 GRAM INJ RECON.SOLN.

Facility

$185.08

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$157.32
Max. Negotiated Rate	$179.53
Rate for Payer: Cash Price	$120.30
Rate for Payer: Cash Price	$37.84
Rate for Payer: Health Management Network Commercial	$157.32
Rate for Payer: Health Management Network Commercial	$49.48
Rate for Payer: MDX Hawaii PPO	$179.53
Rate for Payer: MDX Hawaii PPO	$56.46

CEFEPIME 2 GRAM INJ RECON.SOLN.

Facility

$58.21

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$56.46
Rate for Payer: Cash Price	$37.84
Rate for Payer: Cash Price	$120.30
Rate for Payer: Cash Price	$120.30
Rate for Payer: Cash Price	$37.84
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$175.83
Rate for Payer: Hawaii Western Management Group Commercial	$55.30
Rate for Payer: Health Management Network Commercial	$49.48
Rate for Payer: Health Management Network Commercial	$157.32
Rate for Payer: Kaiser Permanente Commercial	$36.67
Rate for Payer: Kaiser Permanente Commercial	$116.60
Rate for Payer: Kaiser Permanente Medicaid	$94.39
Rate for Payer: Kaiser Permanente Medicaid	$29.69
Rate for Payer: MDX Hawaii PPO	$179.53
Rate for Payer: MDX Hawaii PPO	$56.46
Rate for Payer: UnitedHealthcare Medicaid	$34.93
Rate for Payer: UnitedHealthcare Medicaid	$111.05
Rate for Payer: University Health Alliance Commercial	$42.43
Rate for Payer: University Health Alliance Commercial	$134.90

CEFEPIME IN DEXTROSE 5 % 1 GRAM/50 ML IV IVPB

Facility

$99.48

Service Code	HCPCS J0703
Hospital Revenue Code	636
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$96.50
Rate for Payer: Cash Price	$64.66
Rate for Payer: Cash Price	$64.66
Rate for Payer: Hawaii Medical Service Association ABD	$5.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.07
Rate for Payer: Hawaii Western Management Group Commercial	$94.51
Rate for Payer: Health Management Network Commercial	$84.56
Rate for Payer: Kaiser Permanente Commercial	$62.67
Rate for Payer: Kaiser Permanente Medicaid	$50.73
Rate for Payer: MDX Hawaii PPO	$96.50
Rate for Payer: UnitedHealthcare Medicaid	$59.69
Rate for Payer: University Health Alliance Commercial	$72.51

CEFEPIME IN DEXTROSE 5 % 1 GRAM/50 ML IV IVPB

Facility

$99.48

Service Code	HCPCS J0703
Hospital Revenue Code	250
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$96.50
Rate for Payer: Cash Price	$64.66
Rate for Payer: Health Management Network Commercial	$84.56
Rate for Payer: MDX Hawaii PPO	$96.50

CEFEPIME IN DEXTROSE 5 % 2 GRAM/50 ML IV IVPB

Facility

$141.58

Service Code	HCPCS J0703
Hospital Revenue Code	250
Min. Negotiated Rate	$120.34
Max. Negotiated Rate	$137.33
Rate for Payer: Cash Price	$92.03
Rate for Payer: Health Management Network Commercial	$120.34
Rate for Payer: MDX Hawaii PPO	$137.33

CEFEPIME IN DEXTROSE 5 % 2 GRAM/50 ML IV IVPB

Facility

$141.58

Service Code	HCPCS J0703
Hospital Revenue Code	636
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$137.33
Rate for Payer: Cash Price	$92.03
Rate for Payer: Cash Price	$92.03
Rate for Payer: Hawaii Medical Service Association ABD	$5.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.07
Rate for Payer: Hawaii Western Management Group Commercial	$134.50
Rate for Payer: Health Management Network Commercial	$120.34
Rate for Payer: Kaiser Permanente Commercial	$89.20
Rate for Payer: Kaiser Permanente Medicaid	$72.21
Rate for Payer: MDX Hawaii PPO	$137.33
Rate for Payer: UnitedHealthcare Medicaid	$84.95
Rate for Payer: University Health Alliance Commercial	$103.20

CEFOTETAN 1 G INJ RECON.SOLN.

Facility

$118.28

Service Code	HCPCS J0525
Hospital Revenue Code	250
Min. Negotiated Rate	$100.54
Max. Negotiated Rate	$114.73
Rate for Payer: Cash Price	$76.88
Rate for Payer: Health Management Network Commercial	$100.54
Rate for Payer: MDX Hawaii PPO	$114.73

CEFOTETAN 1 G INJ RECON.SOLN.

Facility

$118.28

Service Code	HCPCS J0525
Hospital Revenue Code	636
Min. Negotiated Rate	$60.32
Max. Negotiated Rate	$114.73
Rate for Payer: Cash Price	$76.88
Rate for Payer: Hawaii Western Management Group Commercial	$112.37
Rate for Payer: Health Management Network Commercial	$100.54
Rate for Payer: Kaiser Permanente Commercial	$74.52
Rate for Payer: Kaiser Permanente Medicaid	$60.32
Rate for Payer: MDX Hawaii PPO	$114.73
Rate for Payer: UnitedHealthcare Medicaid	$70.97
Rate for Payer: University Health Alliance Commercial	$86.21

CEFOTETAN 2 G INJ RECON.SOLN.

Facility

$218.55

Service Code	HCPCS J0525
Hospital Revenue Code	636
Min. Negotiated Rate	$111.46
Max. Negotiated Rate	$211.99
Rate for Payer: Cash Price	$142.06
Rate for Payer: Hawaii Western Management Group Commercial	$207.62
Rate for Payer: Health Management Network Commercial	$185.77
Rate for Payer: Kaiser Permanente Commercial	$137.69
Rate for Payer: Kaiser Permanente Medicaid	$111.46
Rate for Payer: MDX Hawaii PPO	$211.99
Rate for Payer: UnitedHealthcare Medicaid	$131.13
Rate for Payer: University Health Alliance Commercial	$159.30

CEFOTETAN 2 G INJ RECON.SOLN.

Facility

$218.55

Service Code	HCPCS J0525
Hospital Revenue Code	250
Min. Negotiated Rate	$185.77
Max. Negotiated Rate	$211.99
Rate for Payer: Cash Price	$142.06
Rate for Payer: Health Management Network Commercial	$185.77
Rate for Payer: MDX Hawaii PPO	$211.99

CEFTAZIDIME 1 G INJ (100 MG/ML) RECON.SOLN. FOR OCULAR DROPS

Facility

$29.81

Service Code	NDC 44567023525
Hospital Revenue Code	250
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$28.92
Rate for Payer: Cash Price	$19.38
Rate for Payer: Hawaii Western Management Group Commercial	$28.32
Rate for Payer: Health Management Network Commercial	$25.34
Rate for Payer: Kaiser Permanente Commercial	$18.78
Rate for Payer: Kaiser Permanente Medicaid	$15.20
Rate for Payer: MDX Hawaii PPO	$28.92
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: University Health Alliance Commercial	$21.73

CEFTAZIDIME 1 G INJ (100 MG/ML) RECON.SOLN. FOR OCULAR DROPS

Facility

$29.81

Service Code	NDC 44567023525
Hospital Revenue Code	250
Min. Negotiated Rate	$25.34
Max. Negotiated Rate	$28.92
Rate for Payer: Cash Price	$19.38
Rate for Payer: Health Management Network Commercial	$25.34
Rate for Payer: MDX Hawaii PPO	$28.92

CEFTAZIDIME 1 GRAM INJ RECON.SOLN.

Facility

$29.81

Service Code	HCPCS J0713
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$28.92
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cash Price	$19.38
Rate for Payer: Hawaii Medical Service Association ABD	$2.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$28.32
Rate for Payer: Health Management Network Commercial	$25.34
Rate for Payer: Kaiser Permanente Commercial	$18.78
Rate for Payer: Kaiser Permanente Medicaid	$15.20
Rate for Payer: MDX Hawaii PPO	$28.92
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: University Health Alliance Commercial	$21.73

CEFTAZIDIME 1 GRAM INJ RECON.SOLN.

Facility

$29.81

Service Code	HCPCS J0713
Hospital Revenue Code	250
Min. Negotiated Rate	$25.34
Max. Negotiated Rate	$28.92
Rate for Payer: Cash Price	$19.38
Rate for Payer: Health Management Network Commercial	$25.34
Rate for Payer: MDX Hawaii PPO	$28.92

CEFTAZIDIME 2 GRAM INJ RECON.SOLN.

Facility

$67.68

Service Code	HCPCS J0713
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$65.65
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$43.99
Rate for Payer: Hawaii Medical Service Association ABD	$2.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$64.30
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Kaiser Permanente Commercial	$42.64
Rate for Payer: Kaiser Permanente Medicaid	$34.52
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: UnitedHealthcare Medicaid	$40.61
Rate for Payer: University Health Alliance Commercial	$49.33

CEFTAZIDIME 2 GRAM INJ RECON.SOLN.

Facility

$67.68

Service Code	HCPCS J0713
Hospital Revenue Code	250
Min. Negotiated Rate	$57.53
Max. Negotiated Rate	$65.65
Rate for Payer: Cash Price	$43.99
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: MDX Hawaii PPO	$65.65

CEFTAZIDIME-AVIBACTAM 2.5 G IV RECON.SOLN.

Facility

$1,102.30

Service Code	HCPCS J0714
Hospital Revenue Code	250
Min. Negotiated Rate	$936.96
Max. Negotiated Rate	$1,069.23
Rate for Payer: Cash Price	$716.50
Rate for Payer: Health Management Network Commercial	$936.96
Rate for Payer: MDX Hawaii PPO	$1,069.23

CEFTAZIDIME-AVIBACTAM 2.5 G IV RECON.SOLN.

Facility

$1,102.30

Service Code	HCPCS J0714
Hospital Revenue Code	636
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$1,069.23
Rate for Payer: AlohaCare Medicaid	$104.75
Rate for Payer: AlohaCare Medicare	$104.75
Rate for Payer: Cash Price	$716.50
Rate for Payer: Cash Price	$716.50
Rate for Payer: Devoted Health Medicare	$115.22
Rate for Payer: Hawaii Medical Service Association ABD	$104.95
Rate for Payer: Hawaii Medical Service Association Commercial	$130.94
Rate for Payer: Hawaii Medical Service Association Medicare	$104.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$104.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.18
Rate for Payer: Health Management Network Commercial	$936.96
Rate for Payer: Humana Medicare	$104.75
Rate for Payer: Kaiser Permanente Commercial	$694.45
Rate for Payer: Kaiser Permanente Medicaid	$562.17
Rate for Payer: Kaiser Permanente Medicare	$104.75
Rate for Payer: MDX Hawaii PPO	$1,069.23
Rate for Payer: Ohana Health Plan Medicaid	$115.22
Rate for Payer: Ohana Health Plan Medicare	$104.75
Rate for Payer: UnitedHealthcare Medicaid	$661.38
Rate for Payer: UnitedHealthcare Medicare	$104.75
Rate for Payer: University Health Alliance Commercial	$803.47

CEFTOLOZANE-TAZOBACTAM 1.5 GRAM IV RECON.SOLN.

Facility

$601.98

Service Code	HCPCS J0695
Hospital Revenue Code	250
Min. Negotiated Rate	$511.68
Max. Negotiated Rate	$583.92
Rate for Payer: Cash Price	$391.29
Rate for Payer: Health Management Network Commercial	$511.68
Rate for Payer: MDX Hawaii PPO	$583.92

CEFTOLOZANE-TAZOBACTAM 1.5 GRAM IV RECON.SOLN.

Facility

$601.98

Service Code	HCPCS J0695
Hospital Revenue Code	636
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$583.92
Rate for Payer: AlohaCare Medicaid	$8.84
Rate for Payer: AlohaCare Medicare	$8.84
Rate for Payer: Cash Price	$391.29
Rate for Payer: Cash Price	$391.29
Rate for Payer: Devoted Health Medicare	$9.72
Rate for Payer: Hawaii Medical Service Association ABD	$9.13
Rate for Payer: Hawaii Medical Service Association Commercial	$11.05
Rate for Payer: Hawaii Medical Service Association Medicare	$8.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.13
Rate for Payer: Hawaii Western Management Group Commercial	$571.88
Rate for Payer: Health Management Network Commercial	$511.68
Rate for Payer: Humana Medicare	$8.84
Rate for Payer: Kaiser Permanente Commercial	$379.25
Rate for Payer: Kaiser Permanente Medicaid	$307.01
Rate for Payer: Kaiser Permanente Medicare	$8.84
Rate for Payer: MDX Hawaii PPO	$583.92
Rate for Payer: Ohana Health Plan Medicaid	$9.72
Rate for Payer: Ohana Health Plan Medicare	$8.84
Rate for Payer: UnitedHealthcare Medicaid	$361.19
Rate for Payer: UnitedHealthcare Medicare	$8.84
Rate for Payer: University Health Alliance Commercial	$438.78

Know your out-of-pocket cost for care.

All Charges