Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CEFTRIAXONE 1 GRAM INJ RECON.SOLN.

Facility

$8.41

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$5.47
Rate for Payer: Cash Price	$8.61
Rate for Payer: Cash Price	$7.18
Rate for Payer: Health Management Network Commercial	$7.15
Rate for Payer: Health Management Network Commercial	$9.38
Rate for Payer: Health Management Network Commercial	$11.26
Rate for Payer: MDX Hawaii PPO	$8.16
Rate for Payer: MDX Hawaii PPO	$12.85
Rate for Payer: MDX Hawaii PPO	$10.71

CEFTRIAXONE 1 GRAM INJ RECON.SOLN.

Facility

$13.25

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$12.85
Rate for Payer: Cash Price	$8.61
Rate for Payer: Cash Price	$5.47
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$5.47
Rate for Payer: Cash Price	$8.61
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$10.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.59
Rate for Payer: Hawaii Western Management Group Commercial	$7.99
Rate for Payer: Health Management Network Commercial	$7.15
Rate for Payer: Health Management Network Commercial	$9.38
Rate for Payer: Health Management Network Commercial	$11.26
Rate for Payer: Kaiser Permanente Commercial	$5.30
Rate for Payer: Kaiser Permanente Commercial	$8.35
Rate for Payer: Kaiser Permanente Commercial	$6.96
Rate for Payer: Kaiser Permanente Medicaid	$5.63
Rate for Payer: Kaiser Permanente Medicaid	$6.76
Rate for Payer: Kaiser Permanente Medicaid	$4.29
Rate for Payer: MDX Hawaii PPO	$10.71
Rate for Payer: MDX Hawaii PPO	$12.85
Rate for Payer: MDX Hawaii PPO	$8.16
Rate for Payer: UnitedHealthcare Medicaid	$7.95
Rate for Payer: UnitedHealthcare Medicaid	$5.05
Rate for Payer: UnitedHealthcare Medicaid	$6.62
Rate for Payer: University Health Alliance Commercial	$8.05
Rate for Payer: University Health Alliance Commercial	$9.66
Rate for Payer: University Health Alliance Commercial	$6.13

CEFTRIAXONE 250 MG INJ RECON.SOLN.

Facility

$4.21

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cash Price	$2.74
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.00
Rate for Payer: Health Management Network Commercial	$3.58
Rate for Payer: Kaiser Permanente Commercial	$2.65
Rate for Payer: Kaiser Permanente Medicaid	$2.15
Rate for Payer: MDX Hawaii PPO	$4.08
Rate for Payer: UnitedHealthcare Medicaid	$2.53
Rate for Payer: University Health Alliance Commercial	$3.07

CEFTRIAXONE 250 MG INJ RECON.SOLN.

Facility

$4.21

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$4.08
Rate for Payer: Cash Price	$2.74
Rate for Payer: Health Management Network Commercial	$3.58
Rate for Payer: MDX Hawaii PPO	$4.08

CEFTRIAXONE 2 GRAM INJ RECON.SOLN.

Facility

$415.16

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$352.89
Max. Negotiated Rate	$402.71
Rate for Payer: Cash Price	$269.85
Rate for Payer: Health Management Network Commercial	$352.89
Rate for Payer: MDX Hawaii PPO	$402.71

CEFTRIAXONE 2 GRAM INJ RECON.SOLN.

Facility

$415.16

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$402.71
Rate for Payer: Cash Price	$269.85
Rate for Payer: Cash Price	$269.85
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$394.40
Rate for Payer: Health Management Network Commercial	$352.89
Rate for Payer: Kaiser Permanente Commercial	$261.55
Rate for Payer: Kaiser Permanente Medicaid	$211.73
Rate for Payer: MDX Hawaii PPO	$402.71
Rate for Payer: UnitedHealthcare Medicaid	$249.10
Rate for Payer: University Health Alliance Commercial	$302.61

CEFTRIAXONE 500 MG INJ RECON.SOLN.

Facility

$6.90

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$4.49
Rate for Payer: Cash Price	$4.49
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cash Price	$3.46
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$5.06
Rate for Payer: Hawaii Western Management Group Commercial	$6.55
Rate for Payer: Health Management Network Commercial	$4.53
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: Kaiser Permanente Commercial	$4.35
Rate for Payer: Kaiser Permanente Commercial	$3.36
Rate for Payer: Kaiser Permanente Medicaid	$3.52
Rate for Payer: Kaiser Permanente Medicaid	$2.72
Rate for Payer: MDX Hawaii PPO	$5.17
Rate for Payer: MDX Hawaii PPO	$6.69
Rate for Payer: UnitedHealthcare Medicaid	$4.14
Rate for Payer: UnitedHealthcare Medicaid	$3.20
Rate for Payer: University Health Alliance Commercial	$3.89
Rate for Payer: University Health Alliance Commercial	$5.03

CEFTRIAXONE 500 MG INJ RECON.SOLN.

Facility

$5.33

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$5.17
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cash Price	$4.49
Rate for Payer: Health Management Network Commercial	$4.53
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: MDX Hawaii PPO	$5.17
Rate for Payer: MDX Hawaii PPO	$6.69

CEFTRIAXONE-DEXTROSE (ISO-OSM) 1 G/50 ML IV IVPB PREMIX

Facility

$99.48

Service Code	HCPCS J0696
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

CEFTRIAXONE-DEXTROSE (ISO-OSM) 1 G/50 ML IV IVPB PREMIX

Facility

$99.48

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
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	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
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

CEFTRIAXONE IN DEXTROSE,ISO-OS 2 GRAM/50 ML IV IVPB

Facility

$126.64

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$122.84
Rate for Payer: Cash Price	$82.32
Rate for Payer: Cash Price	$82.32
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$120.31
Rate for Payer: Health Management Network Commercial	$107.64
Rate for Payer: Kaiser Permanente Commercial	$79.78
Rate for Payer: Kaiser Permanente Medicaid	$64.59
Rate for Payer: MDX Hawaii PPO	$122.84
Rate for Payer: UnitedHealthcare Medicaid	$75.98
Rate for Payer: University Health Alliance Commercial	$92.31

CEFTRIAXONE IN DEXTROSE,ISO-OS 2 GRAM/50 ML IV IVPB

Facility

$126.64

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$107.64
Max. Negotiated Rate	$122.84
Rate for Payer: Cash Price	$82.32
Rate for Payer: Health Management Network Commercial	$107.64
Rate for Payer: MDX Hawaii PPO	$122.84

CEFUROXIME AXETIL 250 MG PO TABLET

Facility

$24.29

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$23.56
Rate for Payer: Cash Price	$15.79
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$20.65
Rate for Payer: Health Management Network Commercial	$26.68
Rate for Payer: MDX Hawaii PPO	$23.56
Rate for Payer: MDX Hawaii PPO	$30.45
Rate for Payer: MDX Hawaii PPO	$22.09

CEFUROXIME AXETIL 250 MG PO TABLET

Facility

$22.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$22.09
Rate for Payer: Cash Price	$14.80
Rate for Payer: Cash Price	$15.79
Rate for Payer: Cash Price	$20.40
Rate for Payer: Hawaii Western Management Group Commercial	$23.08
Rate for Payer: Hawaii Western Management Group Commercial	$21.63
Rate for Payer: Hawaii Western Management Group Commercial	$29.82
Rate for Payer: Health Management Network Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$26.68
Rate for Payer: Health Management Network Commercial	$20.65
Rate for Payer: Kaiser Permanente Commercial	$14.35
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$19.78
Rate for Payer: Kaiser Permanente Medicaid	$16.01
Rate for Payer: Kaiser Permanente Medicaid	$11.61
Rate for Payer: Kaiser Permanente Medicaid	$12.39
Rate for Payer: MDX Hawaii PPO	$22.09
Rate for Payer: MDX Hawaii PPO	$23.56
Rate for Payer: MDX Hawaii PPO	$30.45
Rate for Payer: UnitedHealthcare Medicaid	$13.66
Rate for Payer: UnitedHealthcare Medicaid	$14.57
Rate for Payer: UnitedHealthcare Medicaid	$18.83
Rate for Payer: University Health Alliance Commercial	$22.88
Rate for Payer: University Health Alliance Commercial	$17.70
Rate for Payer: University Health Alliance Commercial	$16.60

CELECOXIB 100 MG PO CAP

Facility

$25.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$24.73
Rate for Payer: Cash Price	$16.58
Rate for Payer: Hawaii Western Management Group Commercial	$24.23
Rate for Payer: Health Management Network Commercial	$21.68
Rate for Payer: Kaiser Permanente Commercial	$16.07
Rate for Payer: Kaiser Permanente Medicaid	$13.01
Rate for Payer: MDX Hawaii PPO	$24.73
Rate for Payer: UnitedHealthcare Medicaid	$15.30
Rate for Payer: University Health Alliance Commercial	$18.59

CELECOXIB 100 MG PO CAP

Facility

$25.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.68
Max. Negotiated Rate	$24.73
Rate for Payer: Cash Price	$16.58
Rate for Payer: Health Management Network Commercial	$21.68
Rate for Payer: MDX Hawaii PPO	$24.73

CELECOXIB 200 MG PO CAP

Facility

$46.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$44.84
Rate for Payer: Cash Price	$30.05
Rate for Payer: Cash Price	$8.72
Rate for Payer: Health Management Network Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$39.30
Rate for Payer: MDX Hawaii PPO	$44.84
Rate for Payer: MDX Hawaii PPO	$13.01

CELECOXIB 200 MG PO CAP

Facility

$13.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.01
Rate for Payer: Cash Price	$8.72
Rate for Payer: Cash Price	$30.05
Rate for Payer: Hawaii Western Management Group Commercial	$12.74
Rate for Payer: Hawaii Western Management Group Commercial	$43.92
Rate for Payer: Health Management Network Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$39.30
Rate for Payer: Kaiser Permanente Commercial	$8.45
Rate for Payer: Kaiser Permanente Commercial	$29.12
Rate for Payer: Kaiser Permanente Medicaid	$6.84
Rate for Payer: Kaiser Permanente Medicaid	$23.58
Rate for Payer: MDX Hawaii PPO	$13.01
Rate for Payer: MDX Hawaii PPO	$44.84
Rate for Payer: UnitedHealthcare Medicaid	$27.74
Rate for Payer: UnitedHealthcare Medicaid	$8.05
Rate for Payer: University Health Alliance Commercial	$9.77
Rate for Payer: University Health Alliance Commercial	$33.70

Cell Saver A&A Line Assy 00208 [3602015]

Facility

$249.33

Hospital Charge Code	3602015
Hospital Revenue Code	272
Min. Negotiated Rate	$127.16
Max. Negotiated Rate	$241.85
Rate for Payer: Cash Price	$162.06
Rate for Payer: Hawaii Western Management Group Commercial	$236.86
Rate for Payer: Health Management Network Commercial	$211.93
Rate for Payer: Kaiser Permanente Commercial	$157.08
Rate for Payer: Kaiser Permanente Medicaid	$127.16
Rate for Payer: MDX Hawaii PPO	$241.85
Rate for Payer: University Health Alliance Commercial	$181.74

Cell Saver A&A Line Assy 00208 [3602015]

Facility

$249.33

Hospital Charge Code	3602015
Hospital Revenue Code	272
Min. Negotiated Rate	$211.93
Max. Negotiated Rate	$241.85
Rate for Payer: Cash Price	$162.06
Rate for Payer: Health Management Network Commercial	$211.93
Rate for Payer: MDX Hawaii PPO	$241.85

Cell Saver Bowl Kit 125ML 00261 [3602014]

Facility

$908.40

Hospital Charge Code	3602014
Hospital Revenue Code	272
Min. Negotiated Rate	$463.28
Max. Negotiated Rate	$881.15
Rate for Payer: Cash Price	$590.46
Rate for Payer: Hawaii Western Management Group Commercial	$862.98
Rate for Payer: Health Management Network Commercial	$772.14
Rate for Payer: Kaiser Permanente Commercial	$572.29
Rate for Payer: Kaiser Permanente Medicaid	$463.28
Rate for Payer: MDX Hawaii PPO	$881.15
Rate for Payer: University Health Alliance Commercial	$662.13

Cell Saver Bowl Kit 125ML 00261 [3602014]

Facility

$908.40

Hospital Charge Code	3602014
Hospital Revenue Code	272
Min. Negotiated Rate	$772.14
Max. Negotiated Rate	$881.15
Rate for Payer: Cash Price	$590.46
Rate for Payer: Health Management Network Commercial	$772.14
Rate for Payer: MDX Hawaii PPO	$881.15

Cell Saver Collection Reservoir 3L 00205 [3602016]

Facility

$525.77

Hospital Charge Code	3602016
Hospital Revenue Code	272
Min. Negotiated Rate	$446.90
Max. Negotiated Rate	$510.00
Rate for Payer: Cash Price	$341.75
Rate for Payer: Health Management Network Commercial	$446.90
Rate for Payer: MDX Hawaii PPO	$510.00

Cell Saver Collection Reservoir 3L 00205 [3602016]

Facility

$525.77

Hospital Charge Code	3602016
Hospital Revenue Code	272
Min. Negotiated Rate	$268.14
Max. Negotiated Rate	$510.00
Rate for Payer: Cash Price	$341.75
Rate for Payer: Hawaii Western Management Group Commercial	$499.48
Rate for Payer: Health Management Network Commercial	$446.90
Rate for Payer: Kaiser Permanente Commercial	$331.24
Rate for Payer: Kaiser Permanente Medicaid	$268.14
Rate for Payer: MDX Hawaii PPO	$510.00
Rate for Payer: University Health Alliance Commercial	$383.23

CELLULITIS & OTHER SKIN INFECTIONS

Facility

$2,246.00

Service Code	APR-DRG 3831
Min. Negotiated Rate	$2,246.00
Max. Negotiated Rate	$2,246.00
Rate for Payer: AlohaCare Medicaid	$2,246.00
Rate for Payer: Hawaii Medical Service Association ABD	$2,246.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,246.00
Rate for Payer: Kaiser Permanente Medicaid	$2,246.00
Rate for Payer: Ohana Health Plan Medicaid	$2,246.00
Rate for Payer: UnitedHealthcare Medicaid	$2,246.00

Know your out-of-pocket cost for care.

All Charges