Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

labetalol 100 mg/20ml vial [HHSC]

Facility

$148.78

Service Code	NDC 17478042020
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$126.46
Max. Negotiated Rate	$144.32
Rate for Payer: Cash Price	$96.71
Rate for Payer: Health Management Network Commercial	$126.46
Rate for Payer: Kaiser Permanente Commercial	$133.90
Rate for Payer: MDX Hawaii PPO	$144.32

labetalol 100 mg/20ml vial [HHSC]

Facility

$46.20

Service Code	NDC 00143962201
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$44.81
Rate for Payer: Cash Price	$30.03
Rate for Payer: Health Management Network Commercial	$39.27
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: MDX Hawaii PPO	$44.81

labetalol 100 mg/20ml vial [HHSC]

Facility

$24.02

Service Code	NDC 25021031720
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$23.30
Rate for Payer: AlohaCare Medicaid	$12.01
Rate for Payer: AlohaCare Medicare	$12.01
Rate for Payer: Cash Price	$15.61
Rate for Payer: Devoted Health Medicare	$13.21
Rate for Payer: Hawaii Medical Service Association Medicare	$12.01
Rate for Payer: Hawaii Western Management Group Commercial	$22.82
Rate for Payer: Health Management Network Commercial	$20.42
Rate for Payer: Humana Medicare	$12.01
Rate for Payer: Kaiser Permanente Commercial	$21.62
Rate for Payer: Kaiser Permanente Medicaid	$12.25
Rate for Payer: Kaiser Permanente Medicare	$12.01
Rate for Payer: MDX Hawaii PPO	$23.30
Rate for Payer: Ohana Health Plan Medicaid	$12.01
Rate for Payer: Ohana Health Plan Medicare	$12.01
Rate for Payer: UnitedHealthcare Medicaid	$14.41
Rate for Payer: UnitedHealthcare Medicare	$12.01
Rate for Payer: University Health Alliance Commercial	$17.51

labetalol 100 mg/20ml vial [HHSC]

Facility

$14.12

Service Code	NDC 36000032202
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$13.70
Rate for Payer: AlohaCare Medicaid	$7.06
Rate for Payer: AlohaCare Medicare	$7.06
Rate for Payer: Cash Price	$9.18
Rate for Payer: Devoted Health Medicare	$7.77
Rate for Payer: Hawaii Medical Service Association Medicare	$7.06
Rate for Payer: Hawaii Western Management Group Commercial	$13.41
Rate for Payer: Health Management Network Commercial	$12.00
Rate for Payer: Humana Medicare	$7.06
Rate for Payer: Kaiser Permanente Commercial	$12.71
Rate for Payer: Kaiser Permanente Medicaid	$7.20
Rate for Payer: Kaiser Permanente Medicare	$7.06
Rate for Payer: MDX Hawaii PPO	$13.70
Rate for Payer: Ohana Health Plan Medicaid	$7.06
Rate for Payer: Ohana Health Plan Medicare	$7.06
Rate for Payer: UnitedHealthcare Medicaid	$8.47
Rate for Payer: UnitedHealthcare Medicare	$7.06
Rate for Payer: University Health Alliance Commercial	$10.29

labetalol 100 mg/20ml vial [HHSC]

Facility

$20.68

Service Code	NDC 00409226720
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$20.06
Rate for Payer: AlohaCare Medicaid	$10.34
Rate for Payer: AlohaCare Medicare	$10.34
Rate for Payer: Cash Price	$13.44
Rate for Payer: Devoted Health Medicare	$11.37
Rate for Payer: Hawaii Medical Service Association Medicare	$10.34
Rate for Payer: Hawaii Western Management Group Commercial	$19.65
Rate for Payer: Health Management Network Commercial	$17.58
Rate for Payer: Humana Medicare	$10.34
Rate for Payer: Kaiser Permanente Commercial	$18.61
Rate for Payer: Kaiser Permanente Medicaid	$10.55
Rate for Payer: Kaiser Permanente Medicare	$10.34
Rate for Payer: MDX Hawaii PPO	$20.06
Rate for Payer: Ohana Health Plan Medicaid	$10.34
Rate for Payer: Ohana Health Plan Medicare	$10.34
Rate for Payer: UnitedHealthcare Medicaid	$12.41
Rate for Payer: UnitedHealthcare Medicare	$10.34
Rate for Payer: University Health Alliance Commercial	$15.07

labetalol 100 mg/20ml vial [HHSC]

Facility

$56.43

Service Code	NDC 72266010201
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$47.97
Max. Negotiated Rate	$54.74
Rate for Payer: Cash Price	$36.68
Rate for Payer: Health Management Network Commercial	$47.97
Rate for Payer: Kaiser Permanente Commercial	$50.79
Rate for Payer: MDX Hawaii PPO	$54.74

labetalol 100 mg/20ml vial [HHSC]

Facility

$56.43

Service Code	NDC 72266010201
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$28.21
Max. Negotiated Rate	$54.74
Rate for Payer: AlohaCare Medicaid	$28.21
Rate for Payer: AlohaCare Medicare	$28.21
Rate for Payer: Cash Price	$36.68
Rate for Payer: Devoted Health Medicare	$31.04
Rate for Payer: Hawaii Medical Service Association Medicare	$28.21
Rate for Payer: Hawaii Western Management Group Commercial	$53.61
Rate for Payer: Health Management Network Commercial	$47.97
Rate for Payer: Humana Medicare	$28.21
Rate for Payer: Kaiser Permanente Commercial	$50.79
Rate for Payer: Kaiser Permanente Medicaid	$28.78
Rate for Payer: Kaiser Permanente Medicare	$28.21
Rate for Payer: MDX Hawaii PPO	$54.74
Rate for Payer: Ohana Health Plan Medicaid	$28.21
Rate for Payer: Ohana Health Plan Medicare	$28.21
Rate for Payer: UnitedHealthcare Medicaid	$33.86
Rate for Payer: UnitedHealthcare Medicare	$28.21
Rate for Payer: University Health Alliance Commercial	$41.13

labetalol 100 mg/20ml vial [HHSC]

Facility

$46.20

Service Code	NDC 00143962201
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$44.81
Rate for Payer: AlohaCare Medicaid	$23.10
Rate for Payer: AlohaCare Medicare	$23.10
Rate for Payer: Cash Price	$30.03
Rate for Payer: Devoted Health Medicare	$25.41
Rate for Payer: Hawaii Medical Service Association Medicare	$23.10
Rate for Payer: Hawaii Western Management Group Commercial	$43.89
Rate for Payer: Health Management Network Commercial	$39.27
Rate for Payer: Humana Medicare	$23.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$23.56
Rate for Payer: Kaiser Permanente Medicare	$23.10
Rate for Payer: MDX Hawaii PPO	$44.81
Rate for Payer: Ohana Health Plan Medicaid	$23.10
Rate for Payer: Ohana Health Plan Medicare	$23.10
Rate for Payer: UnitedHealthcare Medicaid	$27.72
Rate for Payer: UnitedHealthcare Medicare	$23.10
Rate for Payer: University Health Alliance Commercial	$33.68

labetalol 100 mg/20ml vial [HHSC]

Facility

$20.68

Service Code	NDC 00409226720
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$20.06
Rate for Payer: Cash Price	$13.44
Rate for Payer: Health Management Network Commercial	$17.58
Rate for Payer: Kaiser Permanente Commercial	$18.61
Rate for Payer: MDX Hawaii PPO	$20.06

labetalol 100 mg/20ml vial [HHSC]

Facility

$26.42

Service Code	NDC 00409012525
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$25.63
Rate for Payer: Cash Price	$17.17
Rate for Payer: Health Management Network Commercial	$22.46
Rate for Payer: Kaiser Permanente Commercial	$23.78
Rate for Payer: MDX Hawaii PPO	$25.63

labetalol 100 mg/20ml vial [HHSC]

Facility

$22.35

Service Code	NDC 00409226725
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$21.68
Rate for Payer: Cash Price	$14.53
Rate for Payer: Health Management Network Commercial	$19.00
Rate for Payer: Kaiser Permanente Commercial	$20.11
Rate for Payer: MDX Hawaii PPO	$21.68

labetalol 100 mg/20ml vial [HHSC]

Facility

$24.02

Service Code	NDC 25021031720
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$20.42
Max. Negotiated Rate	$23.30
Rate for Payer: Cash Price	$15.61
Rate for Payer: Health Management Network Commercial	$20.42
Rate for Payer: Kaiser Permanente Commercial	$21.62
Rate for Payer: MDX Hawaii PPO	$23.30

labetalol 100 mg/20ml vial [HHSC]

Facility

$148.78

Service Code	NDC 17478042020
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$74.39
Max. Negotiated Rate	$144.32
Rate for Payer: AlohaCare Medicaid	$74.39
Rate for Payer: AlohaCare Medicare	$74.39
Rate for Payer: Cash Price	$96.71
Rate for Payer: Devoted Health Medicare	$81.83
Rate for Payer: Hawaii Medical Service Association Medicare	$74.39
Rate for Payer: Hawaii Western Management Group Commercial	$141.34
Rate for Payer: Health Management Network Commercial	$126.46
Rate for Payer: Humana Medicare	$74.39
Rate for Payer: Kaiser Permanente Commercial	$133.90
Rate for Payer: Kaiser Permanente Medicaid	$75.88
Rate for Payer: Kaiser Permanente Medicare	$74.39
Rate for Payer: MDX Hawaii PPO	$144.32
Rate for Payer: Ohana Health Plan Medicaid	$74.39
Rate for Payer: Ohana Health Plan Medicare	$74.39
Rate for Payer: UnitedHealthcare Medicaid	$89.27
Rate for Payer: UnitedHealthcare Medicare	$74.39
Rate for Payer: University Health Alliance Commercial	$108.45

labetalol 100 mg/20ml vial [HHSC]

Facility

$75.62

Service Code	NDC 47781058629
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$37.81
Max. Negotiated Rate	$73.35
Rate for Payer: AlohaCare Medicaid	$37.81
Rate for Payer: AlohaCare Medicare	$37.81
Rate for Payer: Cash Price	$49.15
Rate for Payer: Devoted Health Medicare	$41.59
Rate for Payer: Hawaii Medical Service Association Medicare	$37.81
Rate for Payer: Hawaii Western Management Group Commercial	$71.84
Rate for Payer: Health Management Network Commercial	$64.28
Rate for Payer: Humana Medicare	$37.81
Rate for Payer: Kaiser Permanente Commercial	$68.06
Rate for Payer: Kaiser Permanente Medicaid	$38.57
Rate for Payer: Kaiser Permanente Medicare	$37.81
Rate for Payer: MDX Hawaii PPO	$73.35
Rate for Payer: Ohana Health Plan Medicaid	$37.81
Rate for Payer: Ohana Health Plan Medicare	$37.81
Rate for Payer: UnitedHealthcare Medicaid	$45.37
Rate for Payer: UnitedHealthcare Medicare	$37.81
Rate for Payer: University Health Alliance Commercial	$55.12

labetalol 100 mg/20ml vial [HHSC]

Facility

$75.62

Service Code	NDC 47781058629
Hospital Charge Code	2500444
Hospital Revenue Code	250
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$73.35
Rate for Payer: Cash Price	$49.15
Rate for Payer: Health Management Network Commercial	$64.28
Rate for Payer: Kaiser Permanente Commercial	$68.06
Rate for Payer: MDX Hawaii PPO	$73.35

labetalol 100 mg tablet [HHSC]

Facility

$3.03

Service Code	NDC 60687043901
Hospital Charge Code	2500442
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.94
Rate for Payer: Cash Price	$1.97
Rate for Payer: Health Management Network Commercial	$2.58
Rate for Payer: Kaiser Permanente Commercial	$2.73
Rate for Payer: MDX Hawaii PPO	$2.94

labetalol 100 mg tablet [HHSC]

Facility

$12.68

Service Code	NDC 00904592861
Hospital Charge Code	2500442
Hospital Revenue Code	250
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$12.30
Rate for Payer: Cash Price	$8.24
Rate for Payer: Health Management Network Commercial	$10.78
Rate for Payer: Kaiser Permanente Commercial	$11.41
Rate for Payer: MDX Hawaii PPO	$12.30

labetalol 100 mg tablet [HHSC]

Facility

$3.06

Service Code	NDC 60687011401
Hospital Charge Code	2500442
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.97
Rate for Payer: AlohaCare Medicaid	$1.53
Rate for Payer: AlohaCare Medicare	$1.53
Rate for Payer: Cash Price	$1.99
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.53
Rate for Payer: Hawaii Western Management Group Commercial	$2.91
Rate for Payer: Health Management Network Commercial	$2.60
Rate for Payer: Humana Medicare	$1.53
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: Kaiser Permanente Medicare	$1.53
Rate for Payer: MDX Hawaii PPO	$2.97
Rate for Payer: Ohana Health Plan Medicaid	$1.53
Rate for Payer: Ohana Health Plan Medicare	$1.53
Rate for Payer: UnitedHealthcare Medicaid	$1.84
Rate for Payer: UnitedHealthcare Medicare	$1.53
Rate for Payer: University Health Alliance Commercial	$2.23

labetalol 100 mg tablet [HHSC]

Facility

$3.03

Service Code	NDC 60687043901
Hospital Charge Code	2500442
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$2.94
Rate for Payer: AlohaCare Medicaid	$1.51
Rate for Payer: AlohaCare Medicare	$1.51
Rate for Payer: Cash Price	$1.97
Rate for Payer: Devoted Health Medicare	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$1.51
Rate for Payer: Hawaii Western Management Group Commercial	$2.88
Rate for Payer: Health Management Network Commercial	$2.58
Rate for Payer: Humana Medicare	$1.51
Rate for Payer: Kaiser Permanente Commercial	$2.73
Rate for Payer: Kaiser Permanente Medicaid	$1.55
Rate for Payer: Kaiser Permanente Medicare	$1.51
Rate for Payer: MDX Hawaii PPO	$2.94
Rate for Payer: Ohana Health Plan Medicaid	$1.51
Rate for Payer: Ohana Health Plan Medicare	$1.51
Rate for Payer: UnitedHealthcare Medicaid	$1.82
Rate for Payer: UnitedHealthcare Medicare	$1.51
Rate for Payer: University Health Alliance Commercial	$2.21

labetalol 100 mg tablet [HHSC]

Facility

$3.06

Service Code	NDC 60687011401
Hospital Charge Code	2500442
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.97
Rate for Payer: Cash Price	$1.99
Rate for Payer: Health Management Network Commercial	$2.60
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: MDX Hawaii PPO	$2.97

labetalol 100 mg tablet [HHSC]

Facility

$12.68

Service Code	NDC 00904592861
Hospital Charge Code	2500442
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$12.30
Rate for Payer: AlohaCare Medicaid	$6.34
Rate for Payer: AlohaCare Medicare	$6.34
Rate for Payer: Cash Price	$8.24
Rate for Payer: Devoted Health Medicare	$6.97
Rate for Payer: Hawaii Medical Service Association Medicare	$6.34
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$10.78
Rate for Payer: Humana Medicare	$6.34
Rate for Payer: Kaiser Permanente Commercial	$11.41
Rate for Payer: Kaiser Permanente Medicaid	$6.47
Rate for Payer: Kaiser Permanente Medicare	$6.34
Rate for Payer: MDX Hawaii PPO	$12.30
Rate for Payer: Ohana Health Plan Medicaid	$6.34
Rate for Payer: Ohana Health Plan Medicare	$6.34
Rate for Payer: UnitedHealthcare Medicaid	$7.61
Rate for Payer: UnitedHealthcare Medicare	$6.34
Rate for Payer: University Health Alliance Commercial	$9.24

labetalol 300 mg tablet [HHSC]

Facility

$6.61

Service Code	NDC 60687046101
Hospital Charge Code	2500443
Hospital Revenue Code	250
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$6.41
Rate for Payer: AlohaCare Medicaid	$3.31
Rate for Payer: AlohaCare Medicare	$3.31
Rate for Payer: Cash Price	$4.30
Rate for Payer: Devoted Health Medicare	$3.64
Rate for Payer: Hawaii Medical Service Association Medicare	$3.31
Rate for Payer: Hawaii Western Management Group Commercial	$6.28
Rate for Payer: Health Management Network Commercial	$5.62
Rate for Payer: Humana Medicare	$3.31
Rate for Payer: Kaiser Permanente Commercial	$5.95
Rate for Payer: Kaiser Permanente Medicaid	$3.37
Rate for Payer: Kaiser Permanente Medicare	$3.31
Rate for Payer: MDX Hawaii PPO	$6.41
Rate for Payer: Ohana Health Plan Medicaid	$3.31
Rate for Payer: Ohana Health Plan Medicare	$3.31
Rate for Payer: UnitedHealthcare Medicaid	$3.97
Rate for Payer: UnitedHealthcare Medicare	$3.31
Rate for Payer: University Health Alliance Commercial	$4.82

labetalol 300 mg tablet [HHSC]

Facility

$5.38

Service Code	NDC 68001038300
Hospital Charge Code	2500443
Hospital Revenue Code	250
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$5.22
Rate for Payer: Cash Price	$3.50
Rate for Payer: Health Management Network Commercial	$4.57
Rate for Payer: Kaiser Permanente Commercial	$4.84
Rate for Payer: MDX Hawaii PPO	$5.22

labetalol 300 mg tablet [HHSC]

Facility

$5.38

Service Code	NDC 68001020600
Hospital Charge Code	2500443
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$5.22
Rate for Payer: AlohaCare Medicaid	$2.69
Rate for Payer: AlohaCare Medicare	$2.69
Rate for Payer: Cash Price	$3.50
Rate for Payer: Devoted Health Medicare	$2.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2.69
Rate for Payer: Hawaii Western Management Group Commercial	$5.11
Rate for Payer: Health Management Network Commercial	$4.57
Rate for Payer: Humana Medicare	$2.69
Rate for Payer: Kaiser Permanente Commercial	$4.84
Rate for Payer: Kaiser Permanente Medicaid	$2.74
Rate for Payer: Kaiser Permanente Medicare	$2.69
Rate for Payer: MDX Hawaii PPO	$5.22
Rate for Payer: Ohana Health Plan Medicaid	$2.69
Rate for Payer: Ohana Health Plan Medicare	$2.69
Rate for Payer: UnitedHealthcare Medicaid	$3.23
Rate for Payer: UnitedHealthcare Medicare	$2.69
Rate for Payer: University Health Alliance Commercial	$3.92

labetalol 300 mg tablet [HHSC]

Facility

$6.39

Service Code	NDC 68382080001
Hospital Charge Code	2500443
Hospital Revenue Code	250
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$6.20
Rate for Payer: AlohaCare Medicaid	$3.19
Rate for Payer: AlohaCare Medicare	$3.19
Rate for Payer: Cash Price	$4.15
Rate for Payer: Devoted Health Medicare	$3.51
Rate for Payer: Hawaii Medical Service Association Medicare	$3.19
Rate for Payer: Hawaii Western Management Group Commercial	$6.07
Rate for Payer: Health Management Network Commercial	$5.43
Rate for Payer: Humana Medicare	$3.19
Rate for Payer: Kaiser Permanente Commercial	$5.75
Rate for Payer: Kaiser Permanente Medicaid	$3.26
Rate for Payer: Kaiser Permanente Medicare	$3.19
Rate for Payer: MDX Hawaii PPO	$6.20
Rate for Payer: Ohana Health Plan Medicaid	$3.19
Rate for Payer: Ohana Health Plan Medicare	$3.19
Rate for Payer: UnitedHealthcare Medicaid	$3.83
Rate for Payer: UnitedHealthcare Medicare	$3.19
Rate for Payer: University Health Alliance Commercial	$4.66

Know your out-of-pocket cost for care.

All Charges