Kona Community Hospital

All Charges

Charge

Type

Setting

Price

K-Wire Single End Trocar Tip Smooth 1.2 x 100mm P99-192-1210 [3644499]

Facility

$265.80

Hospital Charge Code	3644499
Hospital Revenue Code	272
Min. Negotiated Rate	$225.93
Max. Negotiated Rate	$257.83
Rate for Payer: Cash Price	$172.77
Rate for Payer: Health Management Network Commercial	$225.93
Rate for Payer: MDX Hawaii PPO	$257.83

K-Wire Single End Trocar Tip Smooth 1.2 x 100mm P99-192-1210 [3644499]

Facility

$265.80

Hospital Charge Code	3644499
Hospital Revenue Code	272
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$257.83
Rate for Payer: Cash Price	$172.77
Rate for Payer: Hawaii Western Management Group Commercial	$252.51
Rate for Payer: Health Management Network Commercial	$225.93
Rate for Payer: Kaiser Permanente Commercial	$167.45
Rate for Payer: Kaiser Permanente Medicaid	$135.56
Rate for Payer: MDX Hawaii PPO	$257.83
Rate for Payer: University Health Alliance Commercial	$193.74

K-Wire Single End Trocar Tip Smooth 1.6 x 150mm P99-192-1615 [3644500]

Facility

$265.80

Hospital Charge Code	3644500
Hospital Revenue Code	272
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$257.83
Rate for Payer: Cash Price	$172.77
Rate for Payer: Hawaii Western Management Group Commercial	$252.51
Rate for Payer: Health Management Network Commercial	$225.93
Rate for Payer: Kaiser Permanente Commercial	$167.45
Rate for Payer: Kaiser Permanente Medicaid	$135.56
Rate for Payer: MDX Hawaii PPO	$257.83
Rate for Payer: University Health Alliance Commercial	$193.74

K-Wire Single End Trocar Tip Smooth 1.6 x 150mm P99-192-1615 [3644500]

Facility

$265.80

Hospital Charge Code	3644500
Hospital Revenue Code	272
Min. Negotiated Rate	$225.93
Max. Negotiated Rate	$257.83
Rate for Payer: Cash Price	$172.77
Rate for Payer: Health Management Network Commercial	$225.93
Rate for Payer: MDX Hawaii PPO	$257.83

K Wire Single End Trocar Tip Smooth 2.3 x 150mm P99-192-2315 [3644917]

Facility

$265.80

Hospital Charge Code	3644917
Hospital Revenue Code	272
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$257.83
Rate for Payer: Cash Price	$172.77
Rate for Payer: Hawaii Western Management Group Commercial	$252.51
Rate for Payer: Health Management Network Commercial	$225.93
Rate for Payer: Kaiser Permanente Commercial	$167.45
Rate for Payer: Kaiser Permanente Medicaid	$135.56
Rate for Payer: MDX Hawaii PPO	$257.83
Rate for Payer: University Health Alliance Commercial	$193.74

K Wire Single End Trocar Tip Smooth 2.3 x 150mm P99-192-2315 [3644917]

Facility

$265.80

Hospital Charge Code	3644917
Hospital Revenue Code	272
Min. Negotiated Rate	$225.93
Max. Negotiated Rate	$257.83
Rate for Payer: Cash Price	$172.77
Rate for Payer: Health Management Network Commercial	$225.93
Rate for Payer: MDX Hawaii PPO	$257.83

K Wire Trocar Tip 2.5x250mm 66042 [3643929]

Facility

$1,140.56

Hospital Charge Code	3643929
Hospital Revenue Code	272
Min. Negotiated Rate	$581.69
Max. Negotiated Rate	$1,106.34
Rate for Payer: Cash Price	$741.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.53
Rate for Payer: Health Management Network Commercial	$969.48
Rate for Payer: Kaiser Permanente Commercial	$718.55
Rate for Payer: Kaiser Permanente Medicaid	$581.69
Rate for Payer: MDX Hawaii PPO	$1,106.34
Rate for Payer: University Health Alliance Commercial	$831.35

K Wire Trocar Tip 2.5x250mm 66042 [3643929]

Facility

$1,140.56

Hospital Charge Code	3643929
Hospital Revenue Code	272
Min. Negotiated Rate	$969.48
Max. Negotiated Rate	$1,106.34
Rate for Payer: Cash Price	$741.36
Rate for Payer: Health Management Network Commercial	$969.48
Rate for Payer: MDX Hawaii PPO	$1,106.34

LABETALOL 100 MG PO TABLET

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.96
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: MDX Hawaii PPO	$2.92

LABETALOL 100 MG PO TABLET

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.96
Rate for Payer: Hawaii Western Management Group Commercial	$2.86
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: Kaiser Permanente Commercial	$1.90
Rate for Payer: Kaiser Permanente Medicaid	$1.54
Rate for Payer: MDX Hawaii PPO	$2.92
Rate for Payer: UnitedHealthcare Medicaid	$1.81
Rate for Payer: University Health Alliance Commercial	$2.19

LABETALOL 200 MG PO TABLET

Facility

$3.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.74
Rate for Payer: Cash Price	$2.51
Rate for Payer: Health Management Network Commercial	$3.28
Rate for Payer: MDX Hawaii PPO	$3.74

LABETALOL 200 MG PO TABLET

Facility

$3.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$3.74
Rate for Payer: Cash Price	$2.51
Rate for Payer: Hawaii Western Management Group Commercial	$3.67
Rate for Payer: Health Management Network Commercial	$3.28
Rate for Payer: Kaiser Permanente Commercial	$2.43
Rate for Payer: Kaiser Permanente Medicaid	$1.97
Rate for Payer: MDX Hawaii PPO	$3.74
Rate for Payer: UnitedHealthcare Medicaid	$2.32
Rate for Payer: University Health Alliance Commercial	$2.81

LABETALOL 20 MG/4 ML (5 MG/ML) IV SYR

Facility

$53.54

Service Code	HCPCS J1920
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$51.93
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$34.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$50.86
Rate for Payer: Health Management Network Commercial	$45.51
Rate for Payer: Kaiser Permanente Commercial	$33.73
Rate for Payer: Kaiser Permanente Medicaid	$27.31
Rate for Payer: MDX Hawaii PPO	$51.93
Rate for Payer: UnitedHealthcare Medicaid	$32.12
Rate for Payer: University Health Alliance Commercial	$39.03

LABETALOL 20 MG/4 ML (5 MG/ML) IV SYR

Facility

$53.54

Service Code	HCPCS J1920
Hospital Revenue Code	250
Min. Negotiated Rate	$45.51
Max. Negotiated Rate	$51.93
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$45.51
Rate for Payer: MDX Hawaii PPO	$51.93

LABETALOL 5 MG/ML IV SOLN

Facility

$43.46

Service Code	HCPCS J1921
Hospital Revenue Code	636
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$28.25
Rate for Payer: Hawaii Medical Service Association ABD	$1.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.38
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Kaiser Permanente Commercial	$27.38
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: University Health Alliance Commercial	$31.68

LABETALOL 5 MG/ML IV SOLN

Facility

$11.71

Service Code	HCPCS J1920
Hospital Revenue Code	250
Min. Negotiated Rate	$9.95
Max. Negotiated Rate	$11.36
Rate for Payer: Cash Price	$7.61
Rate for Payer: Cash Price	$31.39
Rate for Payer: Health Management Network Commercial	$9.95
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: MDX Hawaii PPO	$11.36
Rate for Payer: MDX Hawaii PPO	$46.84

LABETALOL 5 MG/ML IV SOLN

Facility

$43.46

Service Code	HCPCS J1921
Hospital Revenue Code	250
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: MDX Hawaii PPO	$42.16

LABETALOL 5 MG/ML IV SOLN

Facility

$11.71

Service Code	HCPCS J1920
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$11.36
Rate for Payer: Cash Price	$7.61
Rate for Payer: Cash Price	$31.39
Rate for Payer: Cash Price	$31.39
Rate for Payer: Cash Price	$7.61
Rate for Payer: Hawaii Medical Service Association ABD	$0.39
Rate for Payer: Hawaii Medical Service Association ABD	$0.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$11.12
Rate for Payer: Hawaii Western Management Group Commercial	$45.88
Rate for Payer: Health Management Network Commercial	$9.95
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Kaiser Permanente Commercial	$30.42
Rate for Payer: Kaiser Permanente Commercial	$7.38
Rate for Payer: Kaiser Permanente Medicaid	$5.97
Rate for Payer: Kaiser Permanente Medicaid	$24.63
Rate for Payer: MDX Hawaii PPO	$11.36
Rate for Payer: MDX Hawaii PPO	$46.84
Rate for Payer: UnitedHealthcare Medicaid	$28.97
Rate for Payer: UnitedHealthcare Medicaid	$7.03
Rate for Payer: University Health Alliance Commercial	$8.54
Rate for Payer: University Health Alliance Commercial	$35.20

LACOSAMIDE 50 MG PO TABLET

Facility

$13.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$12.63
Rate for Payer: Cash Price	$8.46
Rate for Payer: Hawaii Western Management Group Commercial	$12.37
Rate for Payer: Health Management Network Commercial	$11.07
Rate for Payer: Kaiser Permanente Commercial	$8.20
Rate for Payer: Kaiser Permanente Medicaid	$6.64
Rate for Payer: MDX Hawaii PPO	$12.63
Rate for Payer: UnitedHealthcare Medicaid	$7.81
Rate for Payer: University Health Alliance Commercial	$9.49

LACOSAMIDE 50 MG PO TABLET

Facility

$13.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$12.63
Rate for Payer: Cash Price	$8.46
Rate for Payer: Health Management Network Commercial	$11.07
Rate for Payer: MDX Hawaii PPO	$12.63

LACTATE DEHYDROGENASE LDH

Professional

Both

$12.00

Service Code	HCPCS 83615
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$10.20
Rate for Payer: AlohaCare Medicaid	$8.35
Rate for Payer: AlohaCare Medicare	$6.04
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$6.64
Rate for Payer: Hawaii Medical Service Association Medicare	$6.04
Rate for Payer: Hawaii Western Management Group Commercial	$8.35
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.25
Rate for Payer: Kaiser Permanente Medicaid	$7.25
Rate for Payer: Kaiser Permanente Medicare	$7.25
Rate for Payer: Ohana Health Plan Medicaid	$8.35
Rate for Payer: Ohana Health Plan Medicare	$6.04
Rate for Payer: UnitedHealthcare Medicaid	$8.35
Rate for Payer: UnitedHealthcare Medicare	$6.04

LACTATED RINGERS IRRIG SOLN 3000 ML

Facility

$92.52

Service Code	NDC 00338013727
Hospital Revenue Code	258
Min. Negotiated Rate	$78.64
Max. Negotiated Rate	$89.74
Rate for Payer: Cash Price	$60.14
Rate for Payer: Health Management Network Commercial	$78.64
Rate for Payer: MDX Hawaii PPO	$89.74

LACTATED RINGERS IRRIG SOLN 3000 ML

Facility

$92.52

Service Code	NDC 00338013727
Hospital Revenue Code	258
Min. Negotiated Rate	$47.19
Max. Negotiated Rate	$89.74
Rate for Payer: Cash Price	$60.14
Rate for Payer: Hawaii Western Management Group Commercial	$87.89
Rate for Payer: Health Management Network Commercial	$78.64
Rate for Payer: Kaiser Permanente Commercial	$58.29
Rate for Payer: Kaiser Permanente Medicaid	$47.19
Rate for Payer: MDX Hawaii PPO	$89.74
Rate for Payer: University Health Alliance Commercial	$67.44

LACTATED RINGERS IV SOLP 1000 ML

Facility

$16.56

Service Code	HCPCS J7120
Hospital Revenue Code	258
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$1.85
Rate for Payer: University Health Alliance Commercial	$12.07

LACTATED RINGERS IV SOLP 1000 ML

Facility

$16.56

Service Code	HCPCS J7120
Hospital Revenue Code	258
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

Know your out-of-pocket cost for care.

All Charges