Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYR

Facility

$20.32

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$19.71
Rate for Payer: Cash Price	$13.21
Rate for Payer: Cash Price	$33.08
Rate for Payer: Cash Price	$33.08
Rate for Payer: Cash Price	$13.21
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$19.30
Rate for Payer: Hawaii Western Management Group Commercial	$48.35
Rate for Payer: Health Management Network Commercial	$43.27
Rate for Payer: Health Management Network Commercial	$17.27
Rate for Payer: Kaiser Permanente Commercial	$12.80
Rate for Payer: Kaiser Permanente Commercial	$32.07
Rate for Payer: Kaiser Permanente Medicaid	$25.96
Rate for Payer: Kaiser Permanente Medicaid	$10.36
Rate for Payer: MDX Hawaii PPO	$19.71
Rate for Payer: MDX Hawaii PPO	$49.37
Rate for Payer: UnitedHealthcare Medicaid	$12.19
Rate for Payer: UnitedHealthcare Medicaid	$30.54
Rate for Payer: University Health Alliance Commercial	$14.81
Rate for Payer: University Health Alliance Commercial	$37.10

ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYR

Facility

$53.13

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cash Price	$56.82
Rate for Payer: Cash Price	$56.82
Rate for Payer: Cash Price	$34.53
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$50.47
Rate for Payer: Hawaii Western Management Group Commercial	$28.17
Rate for Payer: Hawaii Western Management Group Commercial	$83.04
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Health Management Network Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$74.30
Rate for Payer: Kaiser Permanente Commercial	$18.68
Rate for Payer: Kaiser Permanente Commercial	$33.47
Rate for Payer: Kaiser Permanente Commercial	$55.07
Rate for Payer: Kaiser Permanente Medicaid	$15.12
Rate for Payer: Kaiser Permanente Medicaid	$27.10
Rate for Payer: Kaiser Permanente Medicaid	$44.58
Rate for Payer: MDX Hawaii PPO	$84.79
Rate for Payer: MDX Hawaii PPO	$28.76
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: UnitedHealthcare Medicaid	$17.79
Rate for Payer: UnitedHealthcare Medicaid	$52.45
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: University Health Alliance Commercial	$63.71
Rate for Payer: University Health Alliance Commercial	$21.61
Rate for Payer: University Health Alliance Commercial	$38.73

ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYR

Facility

$87.41

Service Code	HCPCS J1650
Hospital Revenue Code	250
Min. Negotiated Rate	$74.30
Max. Negotiated Rate	$84.79
Rate for Payer: Cash Price	$56.82
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cash Price	$34.53
Rate for Payer: Health Management Network Commercial	$25.20
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Health Management Network Commercial	$74.30
Rate for Payer: MDX Hawaii PPO	$28.76
Rate for Payer: MDX Hawaii PPO	$84.79
Rate for Payer: MDX Hawaii PPO	$51.54

ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYR

Facility

$45.39

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$44.03
Rate for Payer: Cash Price	$29.50
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$29.50
Rate for Payer: Cash Price	$43.99
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$64.30
Rate for Payer: Hawaii Western Management Group Commercial	$43.12
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Health Management Network Commercial	$38.58
Rate for Payer: Kaiser Permanente Commercial	$42.64
Rate for Payer: Kaiser Permanente Commercial	$28.60
Rate for Payer: Kaiser Permanente Medicaid	$23.15
Rate for Payer: Kaiser Permanente Medicaid	$34.52
Rate for Payer: MDX Hawaii PPO	$44.03
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: UnitedHealthcare Medicaid	$40.61
Rate for Payer: UnitedHealthcare Medicaid	$27.23
Rate for Payer: University Health Alliance Commercial	$33.08
Rate for Payer: University Health Alliance Commercial	$49.33

ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYR

Facility

$45.39

Service Code	HCPCS J1650
Hospital Revenue Code	250
Min. Negotiated Rate	$38.58
Max. Negotiated Rate	$44.03
Rate for Payer: Cash Price	$29.50
Rate for Payer: Cash Price	$43.99
Rate for Payer: Health Management Network Commercial	$38.58
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: MDX Hawaii PPO	$44.03
Rate for Payer: MDX Hawaii PPO	$65.65

EPHEDRINE SULFATE 50 MG/ML IV SOLN

Facility

$138.23

Service Code	NDC 42023021601
Hospital Revenue Code	250
Min. Negotiated Rate	$117.50
Max. Negotiated Rate	$134.08
Rate for Payer: Cash Price	$89.85
Rate for Payer: Health Management Network Commercial	$117.50
Rate for Payer: MDX Hawaii PPO	$134.08

EPHEDRINE SULFATE 50 MG/ML IV SOLN

Facility

$138.23

Service Code	NDC 42023021601
Hospital Revenue Code	250
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$134.08
Rate for Payer: Cash Price	$89.85
Rate for Payer: Hawaii Western Management Group Commercial	$131.32
Rate for Payer: Health Management Network Commercial	$117.50
Rate for Payer: Kaiser Permanente Commercial	$87.08
Rate for Payer: Kaiser Permanente Medicaid	$70.50
Rate for Payer: MDX Hawaii PPO	$134.08
Rate for Payer: UnitedHealthcare Medicaid	$82.94
Rate for Payer: University Health Alliance Commercial	$100.76

EPHEDRINE SULFATE 50 MG/ML IV SOLN

Facility

$138.23

Service Code	NDC 42023021625
Hospital Revenue Code	250
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$134.08
Rate for Payer: Cash Price	$89.85
Rate for Payer: Hawaii Western Management Group Commercial	$131.32
Rate for Payer: Health Management Network Commercial	$117.50
Rate for Payer: Kaiser Permanente Commercial	$87.08
Rate for Payer: Kaiser Permanente Medicaid	$70.50
Rate for Payer: MDX Hawaii PPO	$134.08
Rate for Payer: UnitedHealthcare Medicaid	$82.94
Rate for Payer: University Health Alliance Commercial	$100.76

EPHEDRINE SULFATE 50 MG/ML IV SOLN

Facility

$138.23

Service Code	NDC 42023021625
Hospital Revenue Code	250
Min. Negotiated Rate	$117.50
Max. Negotiated Rate	$134.08
Rate for Payer: Cash Price	$89.85
Rate for Payer: Health Management Network Commercial	$117.50
Rate for Payer: MDX Hawaii PPO	$134.08

Epidural Kit Perifix CE18TKA (Braun) [3703041]

Facility

$193.20

Hospital Charge Code	3703041
Hospital Revenue Code	272
Min. Negotiated Rate	$98.53
Max. Negotiated Rate	$187.40
Rate for Payer: Cash Price	$125.58
Rate for Payer: Hawaii Western Management Group Commercial	$183.54
Rate for Payer: Health Management Network Commercial	$164.22
Rate for Payer: Kaiser Permanente Commercial	$121.72
Rate for Payer: Kaiser Permanente Medicaid	$98.53
Rate for Payer: MDX Hawaii PPO	$187.40
Rate for Payer: University Health Alliance Commercial	$140.82

Epidural Kit Perifix CE18TKA (Braun) [3703041]

Facility

$193.20

Hospital Charge Code	3703041
Hospital Revenue Code	272
Min. Negotiated Rate	$164.22
Max. Negotiated Rate	$187.40
Rate for Payer: Cash Price	$125.58
Rate for Payer: Health Management Network Commercial	$164.22
Rate for Payer: MDX Hawaii PPO	$187.40

EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN

Facility

$752.79

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$730.21
Rate for Payer: Cash Price	$489.31
Rate for Payer: Cash Price	$489.31
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	$715.15
Rate for Payer: Health Management Network Commercial	$639.87
Rate for Payer: Kaiser Permanente Commercial	$474.26
Rate for Payer: Kaiser Permanente Medicaid	$383.92
Rate for Payer: MDX Hawaii PPO	$730.21
Rate for Payer: UnitedHealthcare Medicaid	$451.67
Rate for Payer: University Health Alliance Commercial	$548.71

EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN

Facility

$752.79

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$639.87
Max. Negotiated Rate	$730.21
Rate for Payer: Cash Price	$489.31
Rate for Payer: Health Management Network Commercial	$639.87
Rate for Payer: MDX Hawaii PPO	$730.21

EPINEPHRINE 0.1 MG/ML INJ SYR

Facility

$74.89

Service Code	HCPCS J0168
Hospital Revenue Code	250
Min. Negotiated Rate	$63.66
Max. Negotiated Rate	$72.64
Rate for Payer: Cash Price	$48.68
Rate for Payer: Health Management Network Commercial	$63.66
Rate for Payer: MDX Hawaii PPO	$72.64

EPINEPHRINE 0.1 MG/ML INJ SYR

Facility

$74.89

Service Code	HCPCS J0168
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$72.64
Rate for Payer: Cash Price	$48.68
Rate for Payer: Cash Price	$48.68
Rate for Payer: Hawaii Medical Service Association ABD	$2.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.18
Rate for Payer: Hawaii Western Management Group Commercial	$71.15
Rate for Payer: Health Management Network Commercial	$63.66
Rate for Payer: Kaiser Permanente Commercial	$47.18
Rate for Payer: Kaiser Permanente Medicaid	$38.19
Rate for Payer: MDX Hawaii PPO	$72.64
Rate for Payer: UnitedHealthcare Medicaid	$44.93
Rate for Payer: University Health Alliance Commercial	$54.59

EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN

Facility

$752.79

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$730.21
Rate for Payer: Cash Price	$489.31
Rate for Payer: Cash Price	$489.31
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	$715.15
Rate for Payer: Health Management Network Commercial	$639.87
Rate for Payer: Kaiser Permanente Commercial	$474.26
Rate for Payer: Kaiser Permanente Medicaid	$383.92
Rate for Payer: MDX Hawaii PPO	$730.21
Rate for Payer: UnitedHealthcare Medicaid	$451.67
Rate for Payer: University Health Alliance Commercial	$548.71

EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN

Facility

$752.79

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$639.87
Max. Negotiated Rate	$730.21
Rate for Payer: Cash Price	$489.31
Rate for Payer: Health Management Network Commercial	$639.87
Rate for Payer: MDX Hawaii PPO	$730.21

EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN

Facility

$49.26

Service Code	HCPCS J0169
Hospital Revenue Code	250
Min. Negotiated Rate	$41.87
Max. Negotiated Rate	$47.78
Rate for Payer: Cash Price	$32.02
Rate for Payer: Health Management Network Commercial	$41.87
Rate for Payer: MDX Hawaii PPO	$47.78

EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN

Facility

$49.26

Service Code	HCPCS J0169
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$47.78
Rate for Payer: Cash Price	$32.02
Rate for Payer: Cash Price	$32.02
Rate for Payer: Hawaii Medical Service Association ABD	$1.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.32
Rate for Payer: Hawaii Western Management Group Commercial	$46.80
Rate for Payer: Health Management Network Commercial	$41.87
Rate for Payer: Kaiser Permanente Commercial	$31.03
Rate for Payer: Kaiser Permanente Medicaid	$25.12
Rate for Payer: MDX Hawaii PPO	$47.78
Rate for Payer: UnitedHealthcare Medicaid	$29.56
Rate for Payer: University Health Alliance Commercial	$35.91

EPINEPHRINE 1 MG/ML INJ SOLN

Facility

$438.33

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$425.18
Rate for Payer: Cash Price	$284.91
Rate for Payer: Cash Price	$284.91
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	$416.41
Rate for Payer: Health Management Network Commercial	$372.58
Rate for Payer: Kaiser Permanente Commercial	$276.15
Rate for Payer: Kaiser Permanente Medicaid	$223.55
Rate for Payer: MDX Hawaii PPO	$425.18
Rate for Payer: UnitedHealthcare Medicaid	$263.00
Rate for Payer: University Health Alliance Commercial	$319.50

EPINEPHRINE 1 MG/ML INJ SOLN

Facility

$707.10

Service Code	HCPCS J0168
Hospital Revenue Code	250
Min. Negotiated Rate	$601.03
Max. Negotiated Rate	$685.89
Rate for Payer: Cash Price	$459.62
Rate for Payer: Health Management Network Commercial	$601.03
Rate for Payer: MDX Hawaii PPO	$685.89

EPINEPHRINE 1 MG/ML INJ SOLN

Facility

$707.10

Service Code	HCPCS J0168
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$685.89
Rate for Payer: Cash Price	$459.62
Rate for Payer: Cash Price	$459.62
Rate for Payer: Hawaii Medical Service Association ABD	$2.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.18
Rate for Payer: Hawaii Western Management Group Commercial	$671.75
Rate for Payer: Health Management Network Commercial	$601.03
Rate for Payer: Kaiser Permanente Commercial	$445.47
Rate for Payer: Kaiser Permanente Medicaid	$360.62
Rate for Payer: MDX Hawaii PPO	$685.89
Rate for Payer: UnitedHealthcare Medicaid	$424.26
Rate for Payer: University Health Alliance Commercial	$515.41

EPINEPHRINE 1 MG/ML INJ SOLN

Facility

$438.33

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$372.58
Max. Negotiated Rate	$425.18
Rate for Payer: Cash Price	$284.91
Rate for Payer: Health Management Network Commercial	$372.58
Rate for Payer: MDX Hawaii PPO	$425.18

EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN

Facility

$90.45

Service Code	HCPCS J0166
Hospital Revenue Code	250
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$87.74
Rate for Payer: Cash Price	$58.79
Rate for Payer: Health Management Network Commercial	$76.88
Rate for Payer: MDX Hawaii PPO	$87.74

EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN

Facility

$90.45

Service Code	HCPCS J0166
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$87.74
Rate for Payer: Cash Price	$58.79
Rate for Payer: Cash Price	$58.79
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$85.93
Rate for Payer: Health Management Network Commercial	$76.88
Rate for Payer: Kaiser Permanente Commercial	$56.98
Rate for Payer: Kaiser Permanente Medicaid	$46.13
Rate for Payer: MDX Hawaii PPO	$87.74
Rate for Payer: UnitedHealthcare Medicaid	$54.27
Rate for Payer: University Health Alliance Commercial	$65.93

Know your out-of-pocket cost for care.

All Charges