Kona Community Hospital

All Charges

Charge

Type

Setting

Price

EPINEPHRINE IN 0.9 % SOD CHLOR 4 MG/250 ML (16 MCG/ML) IV SOLN

Facility

$183.60

Service Code	HCPCS J0163
Hospital Revenue Code	636
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Hawaii Western Management Group Commercial	$174.42
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: Kaiser Permanente Commercial	$115.67
Rate for Payer: Kaiser Permanente Medicaid	$93.64
Rate for Payer: MDX Hawaii PPO	$178.09
Rate for Payer: UnitedHealthcare Medicaid	$110.16
Rate for Payer: University Health Alliance Commercial	$133.83

EPINEPHRINE IN 0.9 % SOD CHLOR 4 MG/250 ML (16 MCG/ML) IV SOLN

Facility

$183.60

Service Code	HCPCS J0163
Hospital Revenue Code	250
Min. Negotiated Rate	$156.06
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: MDX Hawaii PPO	$178.09

EPISTAXIS WITH MCC

Facility

$22,968.38

Service Code	MSDRG 150
Min. Negotiated Rate	$10,582.97
Max. Negotiated Rate	$22,968.38
Rate for Payer: AlohaCare Medicare	$17,512.91
Rate for Payer: Devoted Health Medicare	$19,264.20
Rate for Payer: Hawaii Medical Service Association Commercial	$10,582.97
Rate for Payer: Hawaii Medical Service Association Medicare	$17,512.91
Rate for Payer: Humana Medicare	$17,512.91
Rate for Payer: Kaiser Permanente Commercial	$22,968.38
Rate for Payer: Kaiser Permanente Medicare	$17,512.91
Rate for Payer: Ohana Health Plan Medicare	$17,512.91
Rate for Payer: UnitedHealthcare Medicare	$17,512.91

EPISTAXIS WITHOUT MCC

Facility

$12,661.50

Service Code	MSDRG 151
Min. Negotiated Rate	$9,654.13
Max. Negotiated Rate	$12,661.50
Rate for Payer: AlohaCare Medicare	$9,654.13
Rate for Payer: Devoted Health Medicare	$10,619.54
Rate for Payer: Hawaii Medical Service Association Commercial	$10,582.97
Rate for Payer: Hawaii Medical Service Association Medicare	$9,654.13
Rate for Payer: Humana Medicare	$9,654.13
Rate for Payer: Kaiser Permanente Commercial	$12,661.50
Rate for Payer: Kaiser Permanente Medicare	$9,654.13
Rate for Payer: Ohana Health Plan Medicare	$9,654.13
Rate for Payer: UnitedHealthcare Medicare	$9,654.13

Epix Lapa Grasper 5mm x 35cm C4130 [3645038]

Facility

$606.50

Hospital Charge Code	3645038
Hospital Revenue Code	272
Min. Negotiated Rate	$515.52
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: MDX Hawaii PPO	$588.30

Epix Lapa Grasper 5mm x 35cm C4130 [3645038]

Facility

$606.50

Hospital Charge Code	3645038
Hospital Revenue Code	272
Min. Negotiated Rate	$309.31
Max. Negotiated Rate	$588.30
Rate for Payer: Cash Price	$394.22
Rate for Payer: Hawaii Western Management Group Commercial	$576.17
Rate for Payer: Health Management Network Commercial	$515.52
Rate for Payer: Kaiser Permanente Commercial	$382.10
Rate for Payer: Kaiser Permanente Medicaid	$309.31
Rate for Payer: MDX Hawaii PPO	$588.30
Rate for Payer: University Health Alliance Commercial	$442.08

Epix Universal Clip Applier CA500 [3645037]

Facility

$1,224.78

Hospital Charge Code	3645037
Hospital Revenue Code	272
Min. Negotiated Rate	$624.64
Max. Negotiated Rate	$1,188.04
Rate for Payer: Cash Price	$796.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.54
Rate for Payer: Health Management Network Commercial	$1,041.06
Rate for Payer: Kaiser Permanente Commercial	$771.61
Rate for Payer: Kaiser Permanente Medicaid	$624.64
Rate for Payer: MDX Hawaii PPO	$1,188.04
Rate for Payer: University Health Alliance Commercial	$892.74

Epix Universal Clip Applier CA500 [3645037]

Facility

$1,224.78

Hospital Charge Code	3645037
Hospital Revenue Code	272
Min. Negotiated Rate	$1,041.06
Max. Negotiated Rate	$1,188.04
Rate for Payer: Cash Price	$796.11
Rate for Payer: Health Management Network Commercial	$1,041.06
Rate for Payer: MDX Hawaii PPO	$1,188.04

EPOETIN ALFA 10000 UNIT/ML INJ SOLN

Facility

$794.80

Service Code	HCPCS J0885
Hospital Revenue Code	250
Min. Negotiated Rate	$675.58
Max. Negotiated Rate	$770.96
Rate for Payer: Cash Price	$516.62
Rate for Payer: Cash Price	$516.63
Rate for Payer: Health Management Network Commercial	$675.60
Rate for Payer: Health Management Network Commercial	$675.58
Rate for Payer: MDX Hawaii PPO	$770.98
Rate for Payer: MDX Hawaii PPO	$770.96

EPOETIN ALFA 10000 UNIT/ML INJ SOLN

Facility

$794.80

Service Code	HCPCS J0885
Hospital Revenue Code	636
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$770.96
Rate for Payer: AlohaCare Medicaid	$7.31
Rate for Payer: AlohaCare Medicaid	$7.31
Rate for Payer: AlohaCare Medicare	$7.31
Rate for Payer: AlohaCare Medicare	$7.31
Rate for Payer: Cash Price	$516.63
Rate for Payer: Cash Price	$516.62
Rate for Payer: Cash Price	$516.62
Rate for Payer: Cash Price	$516.63
Rate for Payer: Devoted Health Medicare	$8.04
Rate for Payer: Devoted Health Medicare	$8.04
Rate for Payer: Hawaii Medical Service Association ABD	$7.68
Rate for Payer: Hawaii Medical Service Association ABD	$7.68
Rate for Payer: Hawaii Medical Service Association Commercial	$9.14
Rate for Payer: Hawaii Medical Service Association Commercial	$9.14
Rate for Payer: Hawaii Medical Service Association Medicare	$7.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.68
Rate for Payer: Hawaii Western Management Group Commercial	$755.06
Rate for Payer: Hawaii Western Management Group Commercial	$755.08
Rate for Payer: Health Management Network Commercial	$675.60
Rate for Payer: Health Management Network Commercial	$675.58
Rate for Payer: Humana Medicare	$7.31
Rate for Payer: Humana Medicare	$7.31
Rate for Payer: Kaiser Permanente Commercial	$500.74
Rate for Payer: Kaiser Permanente Commercial	$500.72
Rate for Payer: Kaiser Permanente Medicaid	$405.35
Rate for Payer: Kaiser Permanente Medicaid	$405.36
Rate for Payer: Kaiser Permanente Medicare	$7.31
Rate for Payer: Kaiser Permanente Medicare	$7.31
Rate for Payer: MDX Hawaii PPO	$770.98
Rate for Payer: MDX Hawaii PPO	$770.96
Rate for Payer: Ohana Health Plan Medicaid	$8.04
Rate for Payer: Ohana Health Plan Medicaid	$8.04
Rate for Payer: Ohana Health Plan Medicare	$7.31
Rate for Payer: Ohana Health Plan Medicare	$7.31
Rate for Payer: UnitedHealthcare Medicaid	$476.88
Rate for Payer: UnitedHealthcare Medicaid	$476.89
Rate for Payer: UnitedHealthcare Medicare	$7.31
Rate for Payer: UnitedHealthcare Medicare	$7.31
Rate for Payer: University Health Alliance Commercial	$579.34
Rate for Payer: University Health Alliance Commercial	$579.33

EPOETIN ALFA 10,000 UNIT/ML INJ SOLN FOR ESRD

Facility

$794.80

Service Code	HCPCS Q4081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$770.96
Rate for Payer: Cash Price	$516.62
Rate for Payer: Cash Price	$477.71
Rate for Payer: Cash Price	$477.71
Rate for Payer: Cash Price	$516.62
Rate for Payer: Hawaii Medical Service Association ABD	$0.77
Rate for Payer: Hawaii Medical Service Association ABD	$0.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.77
Rate for Payer: Hawaii Western Management Group Commercial	$698.19
Rate for Payer: Hawaii Western Management Group Commercial	$755.06
Rate for Payer: Health Management Network Commercial	$675.58
Rate for Payer: Health Management Network Commercial	$624.70
Rate for Payer: Kaiser Permanente Commercial	$500.72
Rate for Payer: Kaiser Permanente Commercial	$463.01
Rate for Payer: Kaiser Permanente Medicaid	$374.82
Rate for Payer: Kaiser Permanente Medicaid	$405.35
Rate for Payer: MDX Hawaii PPO	$712.89
Rate for Payer: MDX Hawaii PPO	$770.96
Rate for Payer: UnitedHealthcare Medicaid	$476.88
Rate for Payer: UnitedHealthcare Medicaid	$440.96
Rate for Payer: University Health Alliance Commercial	$535.70
Rate for Payer: University Health Alliance Commercial	$579.33

EPOETIN ALFA 10,000 UNIT/ML INJ SOLN FOR ESRD

Facility

$734.94

Service Code	HCPCS Q4081
Hospital Revenue Code	250
Min. Negotiated Rate	$624.70
Max. Negotiated Rate	$712.89
Rate for Payer: Cash Price	$477.71
Rate for Payer: Cash Price	$516.62
Rate for Payer: Health Management Network Commercial	$624.70
Rate for Payer: Health Management Network Commercial	$675.58
Rate for Payer: MDX Hawaii PPO	$712.89
Rate for Payer: MDX Hawaii PPO	$770.96

EPOETIN ALFA 20000 UNIT/ML INJ SOLN

Facility

$1,349.63

Service Code	HCPCS J0885
Hospital Revenue Code	250
Min. Negotiated Rate	$1,147.19
Max. Negotiated Rate	$1,309.14
Rate for Payer: Cash Price	$877.26
Rate for Payer: Health Management Network Commercial	$1,147.19
Rate for Payer: MDX Hawaii PPO	$1,309.14

EPOETIN ALFA 20000 UNIT/ML INJ SOLN

Facility

$1,349.63

Service Code	HCPCS J0885
Hospital Revenue Code	636
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$1,309.14
Rate for Payer: AlohaCare Medicaid	$7.31
Rate for Payer: AlohaCare Medicare	$7.31
Rate for Payer: Cash Price	$877.26
Rate for Payer: Cash Price	$877.26
Rate for Payer: Devoted Health Medicare	$8.04
Rate for Payer: Hawaii Medical Service Association ABD	$7.68
Rate for Payer: Hawaii Medical Service Association Commercial	$9.14
Rate for Payer: Hawaii Medical Service Association Medicare	$7.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,282.15
Rate for Payer: Health Management Network Commercial	$1,147.19
Rate for Payer: Humana Medicare	$7.31
Rate for Payer: Kaiser Permanente Commercial	$850.27
Rate for Payer: Kaiser Permanente Medicaid	$688.31
Rate for Payer: Kaiser Permanente Medicare	$7.31
Rate for Payer: MDX Hawaii PPO	$1,309.14
Rate for Payer: Ohana Health Plan Medicaid	$8.04
Rate for Payer: Ohana Health Plan Medicare	$7.31
Rate for Payer: UnitedHealthcare Medicaid	$809.78
Rate for Payer: UnitedHealthcare Medicare	$7.31
Rate for Payer: University Health Alliance Commercial	$983.75

EPOETIN ALFA 20,000 UNIT/ML INJ SOLN FOR ESRD

Facility

$1,349.63

Service Code	HCPCS Q4081
Hospital Revenue Code	250
Min. Negotiated Rate	$1,147.19
Max. Negotiated Rate	$1,309.14
Rate for Payer: MDX Hawaii PPO	$1,309.14
Rate for Payer: Cash Price	$877.26
Rate for Payer: Health Management Network Commercial	$1,147.19

EPOETIN ALFA 20,000 UNIT/ML INJ SOLN FOR ESRD

Facility

$1,349.63

Service Code	HCPCS Q4081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1,309.14
Rate for Payer: Cash Price	$877.26
Rate for Payer: Cash Price	$877.26
Rate for Payer: Hawaii Medical Service Association ABD	$0.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,282.15
Rate for Payer: Health Management Network Commercial	$1,147.19
Rate for Payer: Kaiser Permanente Commercial	$850.27
Rate for Payer: Kaiser Permanente Medicaid	$688.31
Rate for Payer: MDX Hawaii PPO	$1,309.14
Rate for Payer: UnitedHealthcare Medicaid	$809.78
Rate for Payer: University Health Alliance Commercial	$983.75

EPOETIN ALFA 40000 UNIT/ML INJ SOLN

Facility

$2,401.20

Service Code	HCPCS J0885
Hospital Revenue Code	250
Min. Negotiated Rate	$2,041.02
Max. Negotiated Rate	$2,329.16
Rate for Payer: Cash Price	$1,560.78
Rate for Payer: Health Management Network Commercial	$2,041.02
Rate for Payer: MDX Hawaii PPO	$2,329.16

EPOETIN ALFA 40000 UNIT/ML INJ SOLN

Facility

$2,401.20

Service Code	HCPCS J0885
Hospital Revenue Code	636
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$2,329.16
Rate for Payer: AlohaCare Medicaid	$7.31
Rate for Payer: AlohaCare Medicare	$7.31
Rate for Payer: Cash Price	$1,560.78
Rate for Payer: Cash Price	$1,560.78
Rate for Payer: Devoted Health Medicare	$8.04
Rate for Payer: Hawaii Medical Service Association ABD	$7.68
Rate for Payer: Hawaii Medical Service Association Commercial	$9.14
Rate for Payer: Hawaii Medical Service Association Medicare	$7.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,281.14
Rate for Payer: Health Management Network Commercial	$2,041.02
Rate for Payer: Humana Medicare	$7.31
Rate for Payer: Kaiser Permanente Commercial	$1,512.76
Rate for Payer: Kaiser Permanente Medicaid	$1,224.61
Rate for Payer: Kaiser Permanente Medicare	$7.31
Rate for Payer: MDX Hawaii PPO	$2,329.16
Rate for Payer: Ohana Health Plan Medicaid	$8.04
Rate for Payer: Ohana Health Plan Medicare	$7.31
Rate for Payer: UnitedHealthcare Medicaid	$1,440.72
Rate for Payer: UnitedHealthcare Medicare	$7.31
Rate for Payer: University Health Alliance Commercial	$1,750.23

EPOETIN ALFA 40,000 UNIT/ML INJ SOLN FOR ESRD

Facility

$2,401.20

Service Code	HCPCS Q4081
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2,329.16
Rate for Payer: Cash Price	$1,560.78
Rate for Payer: Cash Price	$1,560.78
Rate for Payer: Hawaii Medical Service Association ABD	$0.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.77
Rate for Payer: Hawaii Western Management Group Commercial	$2,281.14
Rate for Payer: Health Management Network Commercial	$2,041.02
Rate for Payer: Kaiser Permanente Commercial	$1,512.76
Rate for Payer: Kaiser Permanente Medicaid	$1,224.61
Rate for Payer: MDX Hawaii PPO	$2,329.16
Rate for Payer: UnitedHealthcare Medicaid	$1,440.72
Rate for Payer: University Health Alliance Commercial	$1,750.23

EPOETIN ALFA 40,000 UNIT/ML INJ SOLN FOR ESRD

Facility

$2,401.20

Service Code	HCPCS Q4081
Hospital Revenue Code	250
Min. Negotiated Rate	$2,041.02
Max. Negotiated Rate	$2,329.16
Rate for Payer: Cash Price	$1,560.78
Rate for Payer: Health Management Network Commercial	$2,041.02
Rate for Payer: MDX Hawaii PPO	$2,329.16

EPOETIN ALFA-EPBX 10000 UNITS/ML INJ SOLN

Facility

$468.99

Service Code	HCPCS Q5106
Hospital Revenue Code	250
Min. Negotiated Rate	$398.64
Max. Negotiated Rate	$454.92
Rate for Payer: Cash Price	$304.84
Rate for Payer: Health Management Network Commercial	$398.64
Rate for Payer: MDX Hawaii PPO	$454.92

EPOETIN ALFA-EPBX 10000 UNITS/ML INJ SOLN

Facility

$468.99

Service Code	HCPCS Q5106
Hospital Revenue Code	250
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$454.92
Rate for Payer: AlohaCare Medicaid	$7.88
Rate for Payer: AlohaCare Medicare	$7.88
Rate for Payer: Cash Price	$304.84
Rate for Payer: Cash Price	$304.84
Rate for Payer: Devoted Health Medicare	$8.67
Rate for Payer: Hawaii Medical Service Association ABD	$7.57
Rate for Payer: Hawaii Medical Service Association Commercial	$9.85
Rate for Payer: Hawaii Medical Service Association Medicare	$7.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.57
Rate for Payer: Hawaii Western Management Group Commercial	$445.54
Rate for Payer: Health Management Network Commercial	$398.64
Rate for Payer: Humana Medicare	$7.88
Rate for Payer: Kaiser Permanente Commercial	$295.46
Rate for Payer: Kaiser Permanente Medicaid	$239.18
Rate for Payer: Kaiser Permanente Medicare	$7.88
Rate for Payer: MDX Hawaii PPO	$454.92
Rate for Payer: Ohana Health Plan Medicaid	$8.67
Rate for Payer: Ohana Health Plan Medicare	$7.88
Rate for Payer: UnitedHealthcare Medicaid	$281.39
Rate for Payer: UnitedHealthcare Medicare	$7.88
Rate for Payer: University Health Alliance Commercial	$341.85

EPOETIN ALFA-EPBX 20000 UNITS/ML INJ SOLN

Facility

$697.97

Service Code	HCPCS Q5106
Hospital Revenue Code	250
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$677.03
Rate for Payer: AlohaCare Medicaid	$7.88
Rate for Payer: AlohaCare Medicare	$7.88
Rate for Payer: Cash Price	$453.68
Rate for Payer: Cash Price	$453.68
Rate for Payer: Devoted Health Medicare	$8.67
Rate for Payer: Hawaii Medical Service Association ABD	$7.57
Rate for Payer: Hawaii Medical Service Association Commercial	$9.85
Rate for Payer: Hawaii Medical Service Association Medicare	$7.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.57
Rate for Payer: Hawaii Western Management Group Commercial	$663.07
Rate for Payer: Health Management Network Commercial	$593.27
Rate for Payer: Humana Medicare	$7.88
Rate for Payer: Kaiser Permanente Commercial	$439.72
Rate for Payer: Kaiser Permanente Medicaid	$355.96
Rate for Payer: Kaiser Permanente Medicare	$7.88
Rate for Payer: MDX Hawaii PPO	$677.03
Rate for Payer: Ohana Health Plan Medicaid	$8.67
Rate for Payer: Ohana Health Plan Medicare	$7.88
Rate for Payer: UnitedHealthcare Medicaid	$418.78
Rate for Payer: UnitedHealthcare Medicare	$7.88
Rate for Payer: University Health Alliance Commercial	$508.75

EPOETIN ALFA-EPBX 20000 UNITS/ML INJ SOLN

Facility

$697.97

Service Code	HCPCS Q5106
Hospital Revenue Code	250
Min. Negotiated Rate	$593.27
Max. Negotiated Rate	$677.03
Rate for Payer: Cash Price	$453.68
Rate for Payer: Health Management Network Commercial	$593.27
Rate for Payer: MDX Hawaii PPO	$677.03

EPOETIN ALFA-EPBX 40000 UNITS/ML INJ SOLN

Facility

$1,155.94

Service Code	HCPCS Q5106
Hospital Revenue Code	250
Min. Negotiated Rate	$982.55
Max. Negotiated Rate	$1,121.26
Rate for Payer: Cash Price	$751.36
Rate for Payer: Health Management Network Commercial	$982.55
Rate for Payer: MDX Hawaii PPO	$1,121.26

Know your out-of-pocket cost for care.

All Charges