Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CEMIPLIMAB-RWLC 50 MG/ML IV SOLN

Facility

$14,719.99

Service Code	HCPCS J9119
Hospital Revenue Code	636
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$14,278.39
Rate for Payer: AlohaCare Medicaid	$29.76
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$9,567.99
Rate for Payer: Cash Price	$9,567.99
Rate for Payer: Devoted Health Medicare	$32.74
Rate for Payer: Hawaii Medical Service Association ABD	$28.70
Rate for Payer: Hawaii Medical Service Association Commercial	$37.20
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.70
Rate for Payer: Hawaii Western Management Group Commercial	$13,983.99
Rate for Payer: Health Management Network Commercial	$12,511.99
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$9,273.59
Rate for Payer: Kaiser Permanente Medicaid	$7,507.19
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$14,278.39
Rate for Payer: Ohana Health Plan Medicaid	$32.74
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicaid	$8,831.99
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$10,729.40

CEMIPLIMAB-RWLC 50 MG/ML IV SOLN

Facility

$14,719.99

Service Code	HCPCS J9119
Hospital Revenue Code	250
Min. Negotiated Rate	$12,511.99
Max. Negotiated Rate	$14,278.39
Rate for Payer: Cash Price	$9,567.99
Rate for Payer: Health Management Network Commercial	$12,511.99
Rate for Payer: MDX Hawaii PPO	$14,278.39

CENTRAL LINE CATHETER KIT THREE LUMEN ADULT CDC-45703-P1A [2700423]

Facility

$709.30

Service Code	HCPCS C1751
Hospital Charge Code	2700423
Hospital Revenue Code	272
Min. Negotiated Rate	$602.90
Max. Negotiated Rate	$688.02
Rate for Payer: Cash Price	$461.04
Rate for Payer: Health Management Network Commercial	$602.90
Rate for Payer: MDX Hawaii PPO	$688.02

CENTRAL LINE CATHETER KIT THREE LUMEN ADULT CDC-45703-P1A [2700423]

Facility

$709.30

Service Code	HCPCS C1751
Hospital Charge Code	2700423
Hospital Revenue Code	272
Min. Negotiated Rate	$361.74
Max. Negotiated Rate	$688.02
Rate for Payer: Cash Price	$461.04
Rate for Payer: Hawaii Western Management Group Commercial	$673.84
Rate for Payer: Health Management Network Commercial	$602.90
Rate for Payer: Kaiser Permanente Commercial	$446.86
Rate for Payer: Kaiser Permanente Medicaid	$361.74
Rate for Payer: MDX Hawaii PPO	$688.02
Rate for Payer: University Health Alliance Commercial	$517.01

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

Facility

$116.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$99.06
Max. Negotiated Rate	$113.04
Rate for Payer: Cash Price	$75.75
Rate for Payer: Health Management Network Commercial	$99.06
Rate for Payer: MDX Hawaii PPO	$113.04

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

Facility

$116.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$59.44
Max. Negotiated Rate	$113.04
Rate for Payer: Cash Price	$75.75
Rate for Payer: Hawaii Western Management Group Commercial	$110.71
Rate for Payer: Health Management Network Commercial	$99.06
Rate for Payer: Kaiser Permanente Commercial	$73.42
Rate for Payer: Kaiser Permanente Medicaid	$59.44
Rate for Payer: MDX Hawaii PPO	$113.04
Rate for Payer: UnitedHealthcare Medicaid	$69.92
Rate for Payer: University Health Alliance Commercial	$84.95

CEPHALEXIN 250 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$112.81

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$57.53
Max. Negotiated Rate	$109.43
Rate for Payer: Cash Price	$73.33
Rate for Payer: Cash Price	$89.21
Rate for Payer: Hawaii Western Management Group Commercial	$107.17
Rate for Payer: Hawaii Western Management Group Commercial	$130.38
Rate for Payer: Health Management Network Commercial	$95.89
Rate for Payer: Health Management Network Commercial	$116.65
Rate for Payer: Kaiser Permanente Commercial	$71.07
Rate for Payer: Kaiser Permanente Commercial	$86.46
Rate for Payer: Kaiser Permanente Medicaid	$57.53
Rate for Payer: Kaiser Permanente Medicaid	$69.99
Rate for Payer: MDX Hawaii PPO	$109.43
Rate for Payer: MDX Hawaii PPO	$133.12
Rate for Payer: UnitedHealthcare Medicaid	$82.34
Rate for Payer: UnitedHealthcare Medicaid	$67.69
Rate for Payer: University Health Alliance Commercial	$82.23
Rate for Payer: University Health Alliance Commercial	$100.03

CEPHALEXIN 250 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$137.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$116.65
Max. Negotiated Rate	$133.12
Rate for Payer: Cash Price	$89.21
Rate for Payer: Cash Price	$73.33
Rate for Payer: Health Management Network Commercial	$95.89
Rate for Payer: Health Management Network Commercial	$116.65
Rate for Payer: MDX Hawaii PPO	$133.12
Rate for Payer: MDX Hawaii PPO	$109.43

CEPHALEXIN 250 MG PO CAP

Facility

$3.84

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$3.72
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cash Price	$2.56
Rate for Payer: Health Management Network Commercial	$3.26
Rate for Payer: Health Management Network Commercial	$3.35
Rate for Payer: MDX Hawaii PPO	$3.72
Rate for Payer: MDX Hawaii PPO	$3.82

CEPHALEXIN 250 MG PO CAP

Facility

$3.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$3.82
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cash Price	$2.50
Rate for Payer: Hawaii Western Management Group Commercial	$3.74
Rate for Payer: Hawaii Western Management Group Commercial	$3.65
Rate for Payer: Health Management Network Commercial	$3.35
Rate for Payer: Health Management Network Commercial	$3.26
Rate for Payer: Kaiser Permanente Commercial	$2.42
Rate for Payer: Kaiser Permanente Commercial	$2.48
Rate for Payer: Kaiser Permanente Medicaid	$2.01
Rate for Payer: Kaiser Permanente Medicaid	$1.96
Rate for Payer: MDX Hawaii PPO	$3.72
Rate for Payer: MDX Hawaii PPO	$3.82
Rate for Payer: UnitedHealthcare Medicaid	$2.30
Rate for Payer: UnitedHealthcare Medicaid	$2.36
Rate for Payer: University Health Alliance Commercial	$2.80
Rate for Payer: University Health Alliance Commercial	$2.87

CEPHALEXIN 500 MG PO CAP

Facility

$12.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$12.37
Rate for Payer: Cash Price	$8.29
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cash Price	$4.39
Rate for Payer: Hawaii Western Management Group Commercial	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$6.41
Rate for Payer: Hawaii Western Management Group Commercial	$12.11
Rate for Payer: Health Management Network Commercial	$6.35
Rate for Payer: Health Management Network Commercial	$10.84
Rate for Payer: Health Management Network Commercial	$5.74
Rate for Payer: Kaiser Permanente Commercial	$8.03
Rate for Payer: Kaiser Permanente Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.71
Rate for Payer: Kaiser Permanente Medicaid	$3.44
Rate for Payer: Kaiser Permanente Medicaid	$6.50
Rate for Payer: Kaiser Permanente Medicaid	$3.81
Rate for Payer: MDX Hawaii PPO	$6.55
Rate for Payer: MDX Hawaii PPO	$12.37
Rate for Payer: MDX Hawaii PPO	$7.25
Rate for Payer: UnitedHealthcare Medicaid	$4.05
Rate for Payer: UnitedHealthcare Medicaid	$7.65
Rate for Payer: UnitedHealthcare Medicaid	$4.48
Rate for Payer: University Health Alliance Commercial	$9.29
Rate for Payer: University Health Alliance Commercial	$4.92
Rate for Payer: University Health Alliance Commercial	$5.44

CEPHALEXIN 500 MG PO CAP

Facility

$7.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$7.25
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cash Price	$8.29
Rate for Payer: Cash Price	$4.39
Rate for Payer: Health Management Network Commercial	$6.35
Rate for Payer: Health Management Network Commercial	$5.74
Rate for Payer: Health Management Network Commercial	$10.84
Rate for Payer: MDX Hawaii PPO	$6.55
Rate for Payer: MDX Hawaii PPO	$12.37
Rate for Payer: MDX Hawaii PPO	$7.25

Cerament Bone Void Filler 10ml A021008 [3642401]

Facility

$11,814.00

Service Code	HCPCS C1713
Hospital Charge Code	3642401
Hospital Revenue Code	278
Min. Negotiated Rate	$6,025.14
Max. Negotiated Rate	$11,459.58
Rate for Payer: Cash Price	$7,679.10
Rate for Payer: Hawaii Western Management Group Commercial	$8,269.80
Rate for Payer: Health Management Network Commercial	$10,041.90
Rate for Payer: Kaiser Permanente Commercial	$7,442.82
Rate for Payer: Kaiser Permanente Medicaid	$6,025.14
Rate for Payer: MDX Hawaii PPO	$11,459.58
Rate for Payer: University Health Alliance Commercial	$6,615.84

Cerament Bone Void Filler 10ml A021008 [3642401]

Facility

$11,814.00

Service Code	HCPCS C1713
Hospital Charge Code	3642401
Hospital Revenue Code	278
Min. Negotiated Rate	$6,615.84
Max. Negotiated Rate	$11,459.58
Rate for Payer: Cash Price	$7,679.10
Rate for Payer: Hawaii Western Management Group Commercial	$8,269.80
Rate for Payer: Health Management Network Commercial	$10,041.90
Rate for Payer: MDX Hawaii PPO	$11,459.58
Rate for Payer: University Health Alliance Commercial	$6,615.84

Cerament Bone Void Filler 10ml W/gent A0450-10 [3643471]

Facility

$27,536.00

Service Code	HCPCS C1713
Hospital Charge Code	3643471
Hospital Revenue Code	272
Min. Negotiated Rate	$23,405.60
Max. Negotiated Rate	$26,709.92
Rate for Payer: Cash Price	$17,898.40
Rate for Payer: Health Management Network Commercial	$23,405.60
Rate for Payer: MDX Hawaii PPO	$26,709.92

Cerament Bone Void Filler 10ml W/gent A0450-10 [3643471]

Facility

$27,536.00

Service Code	HCPCS C1713
Hospital Charge Code	3643471
Hospital Revenue Code	272
Min. Negotiated Rate	$14,043.36
Max. Negotiated Rate	$26,709.92
Rate for Payer: Cash Price	$17,898.40
Rate for Payer: Hawaii Western Management Group Commercial	$26,159.20
Rate for Payer: Health Management Network Commercial	$23,405.60
Rate for Payer: Kaiser Permanente Commercial	$17,347.68
Rate for Payer: Kaiser Permanente Medicaid	$14,043.36
Rate for Payer: MDX Hawaii PPO	$26,709.92
Rate for Payer: University Health Alliance Commercial	$20,070.99

Cerament Bone Void Filler 18ml A021011 [3642423]

Facility

$20,214.00

Service Code	HCPCS C1713
Hospital Charge Code	3642423
Hospital Revenue Code	278
Min. Negotiated Rate	$11,319.84
Max. Negotiated Rate	$19,607.58
Rate for Payer: Cash Price	$13,139.10
Rate for Payer: Hawaii Western Management Group Commercial	$14,149.80
Rate for Payer: Health Management Network Commercial	$17,181.90
Rate for Payer: MDX Hawaii PPO	$19,607.58
Rate for Payer: University Health Alliance Commercial	$11,319.84

Cerament Bone Void Filler 18ml A021011 [3642423]

Facility

$20,214.00

Service Code	HCPCS C1713
Hospital Charge Code	3642423
Hospital Revenue Code	278
Min. Negotiated Rate	$10,309.14
Max. Negotiated Rate	$19,607.58
Rate for Payer: Cash Price	$13,139.10
Rate for Payer: Hawaii Western Management Group Commercial	$14,149.80
Rate for Payer: Health Management Network Commercial	$17,181.90
Rate for Payer: Kaiser Permanente Commercial	$12,734.82
Rate for Payer: Kaiser Permanente Medicaid	$10,309.14
Rate for Payer: MDX Hawaii PPO	$19,607.58
Rate for Payer: University Health Alliance Commercial	$11,319.84

Cerament Bone Void Filler 5ml A021009 [3643161]

Facility

$3,712.50

Service Code	HCPCS C1713
Hospital Charge Code	3643161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.38
Max. Negotiated Rate	$3,601.12
Rate for Payer: Cash Price	$2,413.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,598.75
Rate for Payer: Health Management Network Commercial	$3,155.62
Rate for Payer: Kaiser Permanente Commercial	$2,338.88
Rate for Payer: Kaiser Permanente Medicaid	$1,893.38
Rate for Payer: MDX Hawaii PPO	$3,601.12
Rate for Payer: University Health Alliance Commercial	$2,079.00

Cerament Bone Void Filler 5ml A021009 [3643161]

Facility

$3,712.50

Service Code	HCPCS C1713
Hospital Charge Code	3643161
Hospital Revenue Code	278
Min. Negotiated Rate	$2,079.00
Max. Negotiated Rate	$3,601.12
Rate for Payer: Cash Price	$2,413.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,598.75
Rate for Payer: Health Management Network Commercial	$3,155.62
Rate for Payer: MDX Hawaii PPO	$3,601.12
Rate for Payer: University Health Alliance Commercial	$2,079.00

Cerament G Bone Void Filler 5ml A0535-06 [3645495]

Facility

$15,930.00

Service Code	HCPCS C1602
Hospital Charge Code	3645495
Hospital Revenue Code	278
Min. Negotiated Rate	$8,920.80
Max. Negotiated Rate	$15,452.10
Rate for Payer: Cash Price	$10,354.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,151.00
Rate for Payer: Health Management Network Commercial	$13,540.50
Rate for Payer: MDX Hawaii PPO	$15,452.10
Rate for Payer: University Health Alliance Commercial	$8,920.80

Cerament G Bone Void Filler 5ml A0535-06 [3645495]

Facility

$15,930.00

Service Code	HCPCS C1602
Hospital Charge Code	3645495
Hospital Revenue Code	278
Min. Negotiated Rate	$8,124.30
Max. Negotiated Rate	$15,452.10
Rate for Payer: Cash Price	$10,354.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,151.00
Rate for Payer: Health Management Network Commercial	$13,540.50
Rate for Payer: Kaiser Permanente Commercial	$10,035.90
Rate for Payer: Kaiser Permanente Medicaid	$8,124.30
Rate for Payer: MDX Hawaii PPO	$15,452.10
Rate for Payer: University Health Alliance Commercial	$8,920.80

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$8,739.48

Service Code	APR-DRG 3211
Min. Negotiated Rate	$8,739.48
Max. Negotiated Rate	$8,739.48
Rate for Payer: AlohaCare Medicaid	$8,739.48
Rate for Payer: Hawaii Medical Service Association ABD	$8,739.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,739.48
Rate for Payer: Kaiser Permanente Medicaid	$8,739.48
Rate for Payer: Ohana Health Plan Medicaid	$8,739.48
Rate for Payer: UnitedHealthcare Medicaid	$8,739.48

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$10,517.44

Service Code	APR-DRG 3212
Min. Negotiated Rate	$10,517.44
Max. Negotiated Rate	$10,517.44
Rate for Payer: AlohaCare Medicaid	$10,517.44
Rate for Payer: Hawaii Medical Service Association ABD	$10,517.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,517.44
Rate for Payer: Kaiser Permanente Medicaid	$10,517.44
Rate for Payer: Ohana Health Plan Medicaid	$10,517.44
Rate for Payer: UnitedHealthcare Medicaid	$10,517.44

CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$14,913.93

Service Code	APR-DRG 3213
Min. Negotiated Rate	$14,913.93
Max. Negotiated Rate	$14,913.93
Rate for Payer: AlohaCare Medicaid	$14,913.93
Rate for Payer: Hawaii Medical Service Association ABD	$14,913.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,913.93
Rate for Payer: Kaiser Permanente Medicaid	$14,913.93
Rate for Payer: Ohana Health Plan Medicaid	$14,913.93
Rate for Payer: UnitedHealthcare Medicaid	$14,913.93

Know your out-of-pocket cost for care.

All Charges