Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

EPOETIN ALFA-EPBX ESRD 10000 UNITS/ML INJ SOLN

Facility

$468.99

Service Code	HCPCS Q5105
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 ESRD 10000 UNITS/ML INJ SOLN

Facility

$468.99

Service Code	HCPCS Q5105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$454.92
Rate for Payer: Cash Price	$304.84
Rate for Payer: Cash Price	$304.84
Rate for Payer: Hawaii Medical Service Association ABD	$0.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$445.54
Rate for Payer: Health Management Network Commercial	$398.64
Rate for Payer: Kaiser Permanente Commercial	$295.46
Rate for Payer: Kaiser Permanente Medicaid	$239.18
Rate for Payer: MDX Hawaii PPO	$454.92
Rate for Payer: UnitedHealthcare Medicaid	$281.39
Rate for Payer: University Health Alliance Commercial	$341.85

EPOETIN ALFA-EPBX ESRD 40000 UNITS/ML INJ SOLN

Facility

$1,155.94

Service Code	HCPCS Q5105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1,121.26
Rate for Payer: Cash Price	$751.36
Rate for Payer: Cash Price	$751.36
Rate for Payer: Hawaii Medical Service Association ABD	$0.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.14
Rate for Payer: Health Management Network Commercial	$982.55
Rate for Payer: Kaiser Permanente Commercial	$728.24
Rate for Payer: Kaiser Permanente Medicaid	$589.53
Rate for Payer: MDX Hawaii PPO	$1,121.26
Rate for Payer: UnitedHealthcare Medicaid	$693.56
Rate for Payer: University Health Alliance Commercial	$842.56

EPOETIN ALFA-EPBX ESRD 40000 UNITS/ML INJ SOLN

Facility

$1,155.94

Service Code	HCPCS Q5105
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

EPTIFIBATIDE 0.75 MG/ML IV SOLN

Facility

$1,458.41

Service Code	HCPCS J1327
Hospital Revenue Code	636
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$1,414.66
Rate for Payer: AlohaCare Medicaid	$3.26
Rate for Payer: AlohaCare Medicare	$3.26
Rate for Payer: Cash Price	$947.97
Rate for Payer: Cash Price	$947.97
Rate for Payer: Devoted Health Medicare	$3.59
Rate for Payer: Hawaii Medical Service Association Commercial	$4.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,385.49
Rate for Payer: Health Management Network Commercial	$1,239.65
Rate for Payer: Humana Medicare	$3.26
Rate for Payer: Kaiser Permanente Commercial	$918.80
Rate for Payer: Kaiser Permanente Medicaid	$743.79
Rate for Payer: Kaiser Permanente Medicare	$3.26
Rate for Payer: MDX Hawaii PPO	$1,414.66
Rate for Payer: Ohana Health Plan Medicaid	$3.59
Rate for Payer: Ohana Health Plan Medicare	$3.26
Rate for Payer: UnitedHealthcare Medicaid	$875.05
Rate for Payer: UnitedHealthcare Medicare	$3.26
Rate for Payer: University Health Alliance Commercial	$1,063.04

EPTIFIBATIDE 0.75 MG/ML IV SOLN

Facility

$1,458.41

Service Code	HCPCS J1327
Hospital Revenue Code	250
Min. Negotiated Rate	$1,239.65
Max. Negotiated Rate	$1,414.66
Rate for Payer: Cash Price	$947.97
Rate for Payer: Health Management Network Commercial	$1,239.65
Rate for Payer: MDX Hawaii PPO	$1,414.66

EPTIFIBATIDE 2 MG/ML IV SOLN

Facility

$629.34

Service Code	HCPCS J1327
Hospital Revenue Code	636
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$610.46
Rate for Payer: AlohaCare Medicaid	$3.26
Rate for Payer: AlohaCare Medicare	$3.26
Rate for Payer: Cash Price	$409.07
Rate for Payer: Cash Price	$409.07
Rate for Payer: Devoted Health Medicare	$3.59
Rate for Payer: Hawaii Medical Service Association Commercial	$4.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3.26
Rate for Payer: Hawaii Western Management Group Commercial	$597.87
Rate for Payer: Health Management Network Commercial	$534.94
Rate for Payer: Humana Medicare	$3.26
Rate for Payer: Kaiser Permanente Commercial	$396.48
Rate for Payer: Kaiser Permanente Medicaid	$320.96
Rate for Payer: Kaiser Permanente Medicare	$3.26
Rate for Payer: MDX Hawaii PPO	$610.46
Rate for Payer: Ohana Health Plan Medicaid	$3.59
Rate for Payer: Ohana Health Plan Medicare	$3.26
Rate for Payer: UnitedHealthcare Medicaid	$377.60
Rate for Payer: UnitedHealthcare Medicare	$3.26
Rate for Payer: University Health Alliance Commercial	$458.73

EPTIFIBATIDE 2 MG/ML IV SOLN

Facility

$629.34

Service Code	HCPCS J1327
Hospital Revenue Code	250
Min. Negotiated Rate	$534.94
Max. Negotiated Rate	$610.46
Rate for Payer: Cash Price	$409.07
Rate for Payer: Health Management Network Commercial	$534.94
Rate for Payer: MDX Hawaii PPO	$610.46

ERAVACYCLINE 100 MG IV RECON.SOLN.

Facility

$482.21

Service Code	HCPCS J0122
Hospital Revenue Code	250
Min. Negotiated Rate	$409.88
Max. Negotiated Rate	$467.74
Rate for Payer: Cash Price	$313.44
Rate for Payer: Health Management Network Commercial	$409.88
Rate for Payer: MDX Hawaii PPO	$467.74

ERAVACYCLINE 100 MG IV RECON.SOLN.

Facility

$482.21

Service Code	HCPCS J0122
Hospital Revenue Code	636
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$467.74
Rate for Payer: AlohaCare Medicaid	$1.29
Rate for Payer: AlohaCare Medicare	$1.29
Rate for Payer: Cash Price	$313.44
Rate for Payer: Cash Price	$313.44
Rate for Payer: Devoted Health Medicare	$1.42
Rate for Payer: Hawaii Medical Service Association ABD	$1.29
Rate for Payer: Hawaii Medical Service Association Commercial	$1.61
Rate for Payer: Hawaii Medical Service Association Medicare	$1.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.29
Rate for Payer: Hawaii Western Management Group Commercial	$458.10
Rate for Payer: Health Management Network Commercial	$409.88
Rate for Payer: Humana Medicare	$1.29
Rate for Payer: Kaiser Permanente Commercial	$303.79
Rate for Payer: Kaiser Permanente Medicaid	$245.93
Rate for Payer: Kaiser Permanente Medicare	$1.29
Rate for Payer: MDX Hawaii PPO	$467.74
Rate for Payer: Ohana Health Plan Medicaid	$1.42
Rate for Payer: Ohana Health Plan Medicare	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$289.33
Rate for Payer: UnitedHealthcare Medicare	$1.29
Rate for Payer: University Health Alliance Commercial	$351.48

ERAVACYCLINE 50 MG IV RECON.SOLN.

Facility

$331.44

Service Code	HCPCS J0122
Hospital Revenue Code	250
Min. Negotiated Rate	$281.72
Max. Negotiated Rate	$321.50
Rate for Payer: Cash Price	$215.44
Rate for Payer: Health Management Network Commercial	$281.72
Rate for Payer: MDX Hawaii PPO	$321.50

ERAVACYCLINE 50 MG IV RECON.SOLN.

Facility

$331.44

Service Code	HCPCS J0122
Hospital Revenue Code	636
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$321.50
Rate for Payer: AlohaCare Medicaid	$1.29
Rate for Payer: AlohaCare Medicare	$1.29
Rate for Payer: Cash Price	$215.44
Rate for Payer: Cash Price	$215.44
Rate for Payer: Devoted Health Medicare	$1.42
Rate for Payer: Hawaii Medical Service Association ABD	$1.29
Rate for Payer: Hawaii Medical Service Association Commercial	$1.61
Rate for Payer: Hawaii Medical Service Association Medicare	$1.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.29
Rate for Payer: Hawaii Western Management Group Commercial	$314.87
Rate for Payer: Health Management Network Commercial	$281.72
Rate for Payer: Humana Medicare	$1.29
Rate for Payer: Kaiser Permanente Commercial	$208.81
Rate for Payer: Kaiser Permanente Medicaid	$169.03
Rate for Payer: Kaiser Permanente Medicare	$1.29
Rate for Payer: MDX Hawaii PPO	$321.50
Rate for Payer: Ohana Health Plan Medicaid	$1.42
Rate for Payer: Ohana Health Plan Medicare	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$198.86
Rate for Payer: UnitedHealthcare Medicare	$1.29
Rate for Payer: University Health Alliance Commercial	$241.59

ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) PO CAP

Facility

$10.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$10.28
Rate for Payer: Cash Price	$6.89
Rate for Payer: Cash Price	$2.58
Rate for Payer: Health Management Network Commercial	$9.01
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: MDX Hawaii PPO	$10.28
Rate for Payer: MDX Hawaii PPO	$3.85

ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) PO CAP

Facility

$3.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$3.85
Rate for Payer: Cash Price	$2.58
Rate for Payer: Cash Price	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$10.07
Rate for Payer: Hawaii Western Management Group Commercial	$3.77
Rate for Payer: Health Management Network Commercial	$9.01
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Kaiser Permanente Commercial	$2.50
Rate for Payer: Kaiser Permanente Commercial	$6.68
Rate for Payer: Kaiser Permanente Medicaid	$2.02
Rate for Payer: Kaiser Permanente Medicaid	$5.41
Rate for Payer: MDX Hawaii PPO	$10.28
Rate for Payer: MDX Hawaii PPO	$3.85
Rate for Payer: UnitedHealthcare Medicaid	$6.36
Rate for Payer: UnitedHealthcare Medicaid	$2.38
Rate for Payer: University Health Alliance Commercial	$2.89
Rate for Payer: University Health Alliance Commercial	$7.73

ERTAPENEM 1 GRAM INJ RECON.SOLN.

Facility

$585.78

Service Code	HCPCS J1335
Hospital Revenue Code	250
Min. Negotiated Rate	$497.91
Max. Negotiated Rate	$568.21
Rate for Payer: Cash Price	$380.76
Rate for Payer: Cash Price	$226.49
Rate for Payer: Cash Price	$65.52
Rate for Payer: Health Management Network Commercial	$497.91
Rate for Payer: Health Management Network Commercial	$85.68
Rate for Payer: Health Management Network Commercial	$296.17
Rate for Payer: MDX Hawaii PPO	$568.21
Rate for Payer: MDX Hawaii PPO	$337.99
Rate for Payer: MDX Hawaii PPO	$97.78

ERTAPENEM 1 GRAM INJ RECON.SOLN.

Facility

$348.44

Service Code	HCPCS J1335
Hospital Revenue Code	636
Min. Negotiated Rate	$59.71
Max. Negotiated Rate	$337.99
Rate for Payer: Cash Price	$226.49
Rate for Payer: Cash Price	$380.76
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$380.76
Rate for Payer: Cash Price	$226.49
Rate for Payer: Hawaii Medical Service Association ABD	$59.71
Rate for Payer: Hawaii Medical Service Association ABD	$59.71
Rate for Payer: Hawaii Medical Service Association ABD	$59.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.71
Rate for Payer: Hawaii Western Management Group Commercial	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$331.02
Rate for Payer: Hawaii Western Management Group Commercial	$556.49
Rate for Payer: Health Management Network Commercial	$497.91
Rate for Payer: Health Management Network Commercial	$85.68
Rate for Payer: Health Management Network Commercial	$296.17
Rate for Payer: Kaiser Permanente Commercial	$369.04
Rate for Payer: Kaiser Permanente Commercial	$219.52
Rate for Payer: Kaiser Permanente Commercial	$63.50
Rate for Payer: Kaiser Permanente Medicaid	$51.41
Rate for Payer: Kaiser Permanente Medicaid	$177.70
Rate for Payer: Kaiser Permanente Medicaid	$298.75
Rate for Payer: MDX Hawaii PPO	$97.78
Rate for Payer: MDX Hawaii PPO	$337.99
Rate for Payer: MDX Hawaii PPO	$568.21
Rate for Payer: UnitedHealthcare Medicaid	$209.06
Rate for Payer: UnitedHealthcare Medicaid	$351.47
Rate for Payer: UnitedHealthcare Medicaid	$60.48
Rate for Payer: University Health Alliance Commercial	$73.47
Rate for Payer: University Health Alliance Commercial	$253.98
Rate for Payer: University Health Alliance Commercial	$426.98

ERYTHROMYCIN 250 MG PO TABLET

Facility

$72.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$37.11
Max. Negotiated Rate	$70.59
Rate for Payer: Cash Price	$47.30
Rate for Payer: Hawaii Western Management Group Commercial	$69.13
Rate for Payer: Health Management Network Commercial	$61.85
Rate for Payer: Kaiser Permanente Commercial	$45.85
Rate for Payer: Kaiser Permanente Medicaid	$37.11
Rate for Payer: MDX Hawaii PPO	$70.59
Rate for Payer: UnitedHealthcare Medicaid	$43.66
Rate for Payer: University Health Alliance Commercial	$53.04

ERYTHROMYCIN 250 MG PO TABLET

Facility

$72.77

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$61.85
Max. Negotiated Rate	$70.59
Rate for Payer: Cash Price	$47.30
Rate for Payer: Health Management Network Commercial	$61.85
Rate for Payer: MDX Hawaii PPO	$70.59

ERYTHROMYCIN 5 MG/G OPHT OINT 1G UNIT DOSE TUBE

Facility

$69.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$35.39
Max. Negotiated Rate	$67.32
Rate for Payer: Cash Price	$45.11
Rate for Payer: Hawaii Western Management Group Commercial	$65.93
Rate for Payer: Health Management Network Commercial	$58.99
Rate for Payer: Kaiser Permanente Commercial	$43.72
Rate for Payer: Kaiser Permanente Medicaid	$35.39
Rate for Payer: MDX Hawaii PPO	$67.32
Rate for Payer: UnitedHealthcare Medicaid	$41.64
Rate for Payer: University Health Alliance Commercial	$50.59

ERYTHROMYCIN 5 MG/G OPHT OINT 1G UNIT DOSE TUBE

Facility

$69.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$58.99
Max. Negotiated Rate	$67.32
Rate for Payer: Cash Price	$45.11
Rate for Payer: Health Management Network Commercial	$58.99
Rate for Payer: MDX Hawaii PPO	$67.32

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$1,050.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$893.08
Max. Negotiated Rate	$1,019.16
Rate for Payer: Cash Price	$682.94
Rate for Payer: Cash Price	$703.05
Rate for Payer: Health Management Network Commercial	$919.38
Rate for Payer: Health Management Network Commercial	$893.08
Rate for Payer: MDX Hawaii PPO	$1,019.16
Rate for Payer: MDX Hawaii PPO	$1,049.17

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$1,050.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$535.85
Max. Negotiated Rate	$1,019.16
Rate for Payer: Cash Price	$682.94
Rate for Payer: Cash Price	$703.05
Rate for Payer: Hawaii Western Management Group Commercial	$998.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,027.54
Rate for Payer: Health Management Network Commercial	$893.08
Rate for Payer: Health Management Network Commercial	$919.38
Rate for Payer: Kaiser Permanente Commercial	$661.93
Rate for Payer: Kaiser Permanente Commercial	$681.42
Rate for Payer: Kaiser Permanente Medicaid	$535.85
Rate for Payer: Kaiser Permanente Medicaid	$551.63
Rate for Payer: MDX Hawaii PPO	$1,019.16
Rate for Payer: MDX Hawaii PPO	$1,049.17
Rate for Payer: UnitedHealthcare Medicaid	$648.97
Rate for Payer: UnitedHealthcare Medicaid	$630.41
Rate for Payer: University Health Alliance Commercial	$765.84
Rate for Payer: University Health Alliance Commercial	$788.39

ERYTHROMYCIN LACTOBIONATE 500 MG IV RECON.SOLN.

Facility

$467.83

Service Code	HCPCS J1364
Hospital Revenue Code	636
Min. Negotiated Rate	$75.05
Max. Negotiated Rate	$453.80
Rate for Payer: Cash Price	$304.09
Rate for Payer: Cash Price	$304.09
Rate for Payer: Hawaii Medical Service Association ABD	$75.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.05
Rate for Payer: Hawaii Western Management Group Commercial	$444.44
Rate for Payer: Health Management Network Commercial	$397.66
Rate for Payer: Kaiser Permanente Commercial	$294.73
Rate for Payer: Kaiser Permanente Medicaid	$238.59
Rate for Payer: MDX Hawaii PPO	$453.80
Rate for Payer: UnitedHealthcare Medicaid	$280.70
Rate for Payer: University Health Alliance Commercial	$341.00

ERYTHROMYCIN LACTOBIONATE 500 MG IV RECON.SOLN.

Facility

$467.83

Service Code	HCPCS J1364
Hospital Revenue Code	250
Min. Negotiated Rate	$397.66
Max. Negotiated Rate	$453.80
Rate for Payer: Cash Price	$304.09
Rate for Payer: Health Management Network Commercial	$397.66
Rate for Payer: MDX Hawaii PPO	$453.80

Know your out-of-pocket cost for care.

All Charges