Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BUMETANIDE 2 MG PO TABLET

Facility

$11.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.18
Rate for Payer: Cash Price	$7.49
Rate for Payer: Cash Price	$6.36
Rate for Payer: Cash Price	$7.27
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$9.80
Rate for Payer: Health Management Network Commercial	$8.31
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: MDX Hawaii PPO	$9.49
Rate for Payer: MDX Hawaii PPO	$11.18

BUPIVACAINE 0.125 % 50 ML PCA DISCRETE DOSE (WHR)

Facility

$18.22

Service Code	HCPCS J0665
Hospital Revenue Code	250
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$17.67
Rate for Payer: Cash Price	$11.84
Rate for Payer: Health Management Network Commercial	$15.49
Rate for Payer: MDX Hawaii PPO	$17.67

BUPIVACAINE 0.125 % 50 ML PCA DISCRETE DOSE (WHR)

Facility

$18.22

Service Code	HCPCS J0665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$17.67
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cash Price	$11.84
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$17.31
Rate for Payer: Health Management Network Commercial	$15.49
Rate for Payer: Kaiser Permanente Commercial	$11.48
Rate for Payer: Kaiser Permanente Medicaid	$9.29
Rate for Payer: MDX Hawaii PPO	$17.67
Rate for Payer: UnitedHealthcare Medicaid	$10.93
Rate for Payer: University Health Alliance Commercial	$13.28

BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN

Facility

$15.74

Service Code	HCPCS J0665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$15.27
Rate for Payer: Cash Price	$10.23
Rate for Payer: Cash Price	$11.75
Rate for Payer: Cash Price	$26.90
Rate for Payer: Cash Price	$11.75
Rate for Payer: Cash Price	$26.90
Rate for Payer: Cash Price	$10.23
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$17.17
Rate for Payer: Hawaii Western Management Group Commercial	$14.95
Rate for Payer: Hawaii Western Management Group Commercial	$39.31
Rate for Payer: Health Management Network Commercial	$35.17
Rate for Payer: Health Management Network Commercial	$13.38
Rate for Payer: Health Management Network Commercial	$15.36
Rate for Payer: Kaiser Permanente Commercial	$26.07
Rate for Payer: Kaiser Permanente Commercial	$11.38
Rate for Payer: Kaiser Permanente Commercial	$9.92
Rate for Payer: Kaiser Permanente Medicaid	$8.03
Rate for Payer: Kaiser Permanente Medicaid	$21.10
Rate for Payer: Kaiser Permanente Medicaid	$9.22
Rate for Payer: MDX Hawaii PPO	$40.14
Rate for Payer: MDX Hawaii PPO	$17.53
Rate for Payer: MDX Hawaii PPO	$15.27
Rate for Payer: UnitedHealthcare Medicaid	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$10.84
Rate for Payer: UnitedHealthcare Medicaid	$24.83
Rate for Payer: University Health Alliance Commercial	$13.17
Rate for Payer: University Health Alliance Commercial	$11.47
Rate for Payer: University Health Alliance Commercial	$30.16

BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN

Facility

$15.74

Service Code	HCPCS J0665
Hospital Revenue Code	250
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$15.27
Rate for Payer: Cash Price	$10.23
Rate for Payer: Cash Price	$11.75
Rate for Payer: Cash Price	$26.90
Rate for Payer: Health Management Network Commercial	$15.36
Rate for Payer: Health Management Network Commercial	$35.17
Rate for Payer: Health Management Network Commercial	$13.38
Rate for Payer: MDX Hawaii PPO	$17.53
Rate for Payer: MDX Hawaii PPO	$40.14
Rate for Payer: MDX Hawaii PPO	$15.27

BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN

Facility

$55.06

Service Code	NDC 00409381201
Hospital Revenue Code	250
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$53.41
Rate for Payer: Cash Price	$35.79
Rate for Payer: Health Management Network Commercial	$46.80
Rate for Payer: MDX Hawaii PPO	$53.41

BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN

Facility

$88.38

Service Code	NDC 00409175250
Hospital Revenue Code	250
Min. Negotiated Rate	$75.12
Max. Negotiated Rate	$85.73
Rate for Payer: Cash Price	$57.45
Rate for Payer: Health Management Network Commercial	$75.12
Rate for Payer: MDX Hawaii PPO	$85.73

BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN

Facility

$55.06

Service Code	NDC 00409381201
Hospital Revenue Code	250
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$53.41
Rate for Payer: Cash Price	$35.79
Rate for Payer: Hawaii Western Management Group Commercial	$52.31
Rate for Payer: Health Management Network Commercial	$46.80
Rate for Payer: Kaiser Permanente Commercial	$34.69
Rate for Payer: Kaiser Permanente Medicaid	$28.08
Rate for Payer: MDX Hawaii PPO	$53.41
Rate for Payer: UnitedHealthcare Medicaid	$33.04
Rate for Payer: University Health Alliance Commercial	$40.13

BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN

Facility

$88.38

Service Code	NDC 00409175250
Hospital Revenue Code	250
Min. Negotiated Rate	$45.07
Max. Negotiated Rate	$85.73
Rate for Payer: Cash Price	$57.45
Rate for Payer: Hawaii Western Management Group Commercial	$83.96
Rate for Payer: Health Management Network Commercial	$75.12
Rate for Payer: Kaiser Permanente Commercial	$55.68
Rate for Payer: Kaiser Permanente Medicaid	$45.07
Rate for Payer: MDX Hawaii PPO	$85.73
Rate for Payer: UnitedHealthcare Medicaid	$53.03
Rate for Payer: University Health Alliance Commercial	$64.42

BUPIVACAINE-EPINEPHRINE BITART 0.5 %-1:200,000 INJ CRTG

Facility

$178.75

Service Code	NDC 00362901150
Hospital Revenue Code	250
Min. Negotiated Rate	$91.16
Max. Negotiated Rate	$173.39
Rate for Payer: Cash Price	$116.19
Rate for Payer: Hawaii Western Management Group Commercial	$169.81
Rate for Payer: Health Management Network Commercial	$151.94
Rate for Payer: Kaiser Permanente Commercial	$112.61
Rate for Payer: Kaiser Permanente Medicaid	$91.16
Rate for Payer: MDX Hawaii PPO	$173.39
Rate for Payer: UnitedHealthcare Medicaid	$107.25
Rate for Payer: University Health Alliance Commercial	$130.29

BUPIVACAINE-EPINEPHRINE BITART 0.5 %-1:200,000 INJ CRTG

Facility

$3.85

Service Code	NDC 00362055705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$3.73
Rate for Payer: Cash Price	$2.50
Rate for Payer: Hawaii Western Management Group Commercial	$3.66
Rate for Payer: Health Management Network Commercial	$3.27
Rate for Payer: Kaiser Permanente Commercial	$2.43
Rate for Payer: Kaiser Permanente Medicaid	$1.96
Rate for Payer: MDX Hawaii PPO	$3.73
Rate for Payer: UnitedHealthcare Medicaid	$2.31
Rate for Payer: University Health Alliance Commercial	$2.81

BUPIVACAINE-EPINEPHRINE BITART 0.5 %-1:200,000 INJ CRTG

Facility

$3.85

Service Code	NDC 00362055705
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.73
Rate for Payer: Cash Price	$2.50
Rate for Payer: Health Management Network Commercial	$3.27
Rate for Payer: MDX Hawaii PPO	$3.73

BUPIVACAINE-EPINEPHRINE BITART 0.5 %-1:200,000 INJ CRTG

Facility

$178.75

Service Code	NDC 00362901150
Hospital Revenue Code	250
Min. Negotiated Rate	$151.94
Max. Negotiated Rate	$173.39
Rate for Payer: Cash Price	$116.19
Rate for Payer: Health Management Network Commercial	$151.94
Rate for Payer: MDX Hawaii PPO	$173.39

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN 30 ML

Facility

$57.05

Service Code	NDC 00409174929
Hospital Revenue Code	250
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$55.34
Rate for Payer: Cash Price	$37.08
Rate for Payer: Health Management Network Commercial	$48.49
Rate for Payer: MDX Hawaii PPO	$55.34

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN 30 ML

Facility

$71.91

Service Code	NDC 63323046201
Hospital Revenue Code	250
Min. Negotiated Rate	$61.12
Max. Negotiated Rate	$69.75
Rate for Payer: Cash Price	$46.74
Rate for Payer: Health Management Network Commercial	$61.12
Rate for Payer: MDX Hawaii PPO	$69.75

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN 30 ML

Facility

$57.05

Service Code	NDC 00409174929
Hospital Revenue Code	250
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$55.34
Rate for Payer: Cash Price	$37.08
Rate for Payer: Hawaii Western Management Group Commercial	$54.20
Rate for Payer: Health Management Network Commercial	$48.49
Rate for Payer: Kaiser Permanente Commercial	$35.94
Rate for Payer: Kaiser Permanente Medicaid	$29.10
Rate for Payer: MDX Hawaii PPO	$55.34
Rate for Payer: UnitedHealthcare Medicaid	$34.23
Rate for Payer: University Health Alliance Commercial	$41.58

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN 30 ML

Facility

$57.05

Service Code	NDC 00409174971
Hospital Revenue Code	250
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$55.34
Rate for Payer: Cash Price	$37.08
Rate for Payer: Hawaii Western Management Group Commercial	$54.20
Rate for Payer: Health Management Network Commercial	$48.49
Rate for Payer: Kaiser Permanente Commercial	$35.94
Rate for Payer: Kaiser Permanente Medicaid	$29.10
Rate for Payer: MDX Hawaii PPO	$55.34
Rate for Payer: UnitedHealthcare Medicaid	$34.23
Rate for Payer: University Health Alliance Commercial	$41.58

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN 30 ML

Facility

$71.91

Service Code	NDC 63323046201
Hospital Revenue Code	250
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$69.75
Rate for Payer: Cash Price	$46.74
Rate for Payer: Hawaii Western Management Group Commercial	$68.31
Rate for Payer: Health Management Network Commercial	$61.12
Rate for Payer: Kaiser Permanente Commercial	$45.30
Rate for Payer: Kaiser Permanente Medicaid	$36.67
Rate for Payer: MDX Hawaii PPO	$69.75
Rate for Payer: UnitedHealthcare Medicaid	$43.15
Rate for Payer: University Health Alliance Commercial	$52.42

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN 30 ML

Facility

$57.05

Service Code	NDC 00409174971
Hospital Revenue Code	250
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$55.34
Rate for Payer: Cash Price	$37.08
Rate for Payer: Health Management Network Commercial	$48.49
Rate for Payer: MDX Hawaii PPO	$55.34

BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN

Facility

$57.96

Service Code	HCPCS J0665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$56.22
Rate for Payer: Cash Price	$37.67
Rate for Payer: Cash Price	$12.74
Rate for Payer: Cash Price	$12.74
Rate for Payer: Cash Price	$37.67
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$18.62
Rate for Payer: Hawaii Western Management Group Commercial	$55.06
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Health Management Network Commercial	$16.66
Rate for Payer: Kaiser Permanente Commercial	$36.51
Rate for Payer: Kaiser Permanente Commercial	$12.35
Rate for Payer: Kaiser Permanente Medicaid	$10.00
Rate for Payer: Kaiser Permanente Medicaid	$29.56
Rate for Payer: MDX Hawaii PPO	$19.01
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: UnitedHealthcare Medicaid	$11.76
Rate for Payer: UnitedHealthcare Medicaid	$34.78
Rate for Payer: University Health Alliance Commercial	$14.29
Rate for Payer: University Health Alliance Commercial	$42.25

BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN

Facility

$19.60

Service Code	HCPCS J0665
Hospital Revenue Code	250
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$19.01
Rate for Payer: Cash Price	$12.74
Rate for Payer: Cash Price	$37.67
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Health Management Network Commercial	$16.66
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: MDX Hawaii PPO	$19.01

BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN

Facility

$22.91

Service Code	HCPCS J0665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$22.22
Rate for Payer: Cash Price	$14.89
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$14.89
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$15.48
Rate for Payer: Hawaii Western Management Group Commercial	$21.76
Rate for Payer: Health Management Network Commercial	$19.47
Rate for Payer: Health Management Network Commercial	$13.85
Rate for Payer: Kaiser Permanente Commercial	$14.43
Rate for Payer: Kaiser Permanente Commercial	$10.26
Rate for Payer: Kaiser Permanente Medicaid	$8.31
Rate for Payer: Kaiser Permanente Medicaid	$11.68
Rate for Payer: MDX Hawaii PPO	$15.80
Rate for Payer: MDX Hawaii PPO	$22.22
Rate for Payer: UnitedHealthcare Medicaid	$13.75
Rate for Payer: UnitedHealthcare Medicaid	$9.77
Rate for Payer: University Health Alliance Commercial	$11.87
Rate for Payer: University Health Alliance Commercial	$16.70

BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN

Facility

$16.29

Service Code	HCPCS J0665
Hospital Revenue Code	250
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$15.80
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$14.89
Rate for Payer: Health Management Network Commercial	$13.85
Rate for Payer: Health Management Network Commercial	$19.47
Rate for Payer: MDX Hawaii PPO	$15.80
Rate for Payer: MDX Hawaii PPO	$22.22

BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP

Facility

$1,067.66

Service Code	HCPCS J0666
Hospital Revenue Code	250
Min. Negotiated Rate	$907.51
Max. Negotiated Rate	$1,035.63
Rate for Payer: Cash Price	$693.98
Rate for Payer: Health Management Network Commercial	$907.51
Rate for Payer: MDX Hawaii PPO	$1,035.63

BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP

Facility

$1,067.66

Service Code	HCPCS J0666
Hospital Revenue Code	636
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1,035.63
Rate for Payer: AlohaCare Medicaid	$1.63
Rate for Payer: AlohaCare Medicare	$1.63
Rate for Payer: Cash Price	$693.98
Rate for Payer: Cash Price	$693.98
Rate for Payer: Devoted Health Medicare	$1.79
Rate for Payer: Hawaii Medical Service Association ABD	$1.49
Rate for Payer: Hawaii Medical Service Association Commercial	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.28
Rate for Payer: Health Management Network Commercial	$907.51
Rate for Payer: Humana Medicare	$1.63
Rate for Payer: Kaiser Permanente Commercial	$672.63
Rate for Payer: Kaiser Permanente Medicaid	$544.51
Rate for Payer: Kaiser Permanente Medicare	$1.63
Rate for Payer: MDX Hawaii PPO	$1,035.63
Rate for Payer: Ohana Health Plan Medicaid	$1.79
Rate for Payer: Ohana Health Plan Medicare	$1.63
Rate for Payer: UnitedHealthcare Medicaid	$640.60
Rate for Payer: UnitedHealthcare Medicare	$1.63
Rate for Payer: University Health Alliance Commercial	$778.22

Know your out-of-pocket cost for care.

All Charges