Kona Community Hospital

All Charges

Charge

Type

Setting

Price

LACTOBACILLUS ACIDOPHILUS 20 BILLION CELLS PO CAP

Facility

$2.65

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.57
Rate for Payer: Cash Price	$1.72
Rate for Payer: Health Management Network Commercial	$2.25
Rate for Payer: MDX Hawaii PPO	$2.57

LACTOBACILLUS ACIDOPHILUS 20 BILLION CELLS PO CAP

Facility

$2.65

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.57
Rate for Payer: Cash Price	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$2.52
Rate for Payer: Health Management Network Commercial	$2.25
Rate for Payer: Kaiser Permanente Commercial	$1.67
Rate for Payer: Kaiser Permanente Medicaid	$1.35
Rate for Payer: MDX Hawaii PPO	$2.57
Rate for Payer: UnitedHealthcare Medicaid	$1.59
Rate for Payer: University Health Alliance Commercial	$1.93

LACTULOSE 10 G/15 ML PO SOLN

Facility

$13.58

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$13.17
Rate for Payer: Cash Price	$8.83
Rate for Payer: Cash Price	$188.00
Rate for Payer: Health Management Network Commercial	$245.85
Rate for Payer: Health Management Network Commercial	$11.54
Rate for Payer: MDX Hawaii PPO	$13.17
Rate for Payer: MDX Hawaii PPO	$280.55

LACTULOSE 10 G/15 ML PO SOLN

Facility

$289.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$147.51
Max. Negotiated Rate	$280.55
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$8.83
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Hawaii Western Management Group Commercial	$274.77
Rate for Payer: Health Management Network Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$245.85
Rate for Payer: Kaiser Permanente Commercial	$8.56
Rate for Payer: Kaiser Permanente Commercial	$182.21
Rate for Payer: Kaiser Permanente Medicaid	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$147.51
Rate for Payer: MDX Hawaii PPO	$13.17
Rate for Payer: MDX Hawaii PPO	$280.55
Rate for Payer: UnitedHealthcare Medicaid	$8.15
Rate for Payer: UnitedHealthcare Medicaid	$173.54
Rate for Payer: University Health Alliance Commercial	$210.82
Rate for Payer: University Health Alliance Commercial	$9.90

LACTULOSE ENEMA

Facility

$289.23

Service Code	NDC 00121087332
Hospital Revenue Code	250
Min. Negotiated Rate	$147.51
Max. Negotiated Rate	$280.55
Rate for Payer: Cash Price	$188.00
Rate for Payer: Hawaii Western Management Group Commercial	$274.77
Rate for Payer: Health Management Network Commercial	$245.85
Rate for Payer: Kaiser Permanente Commercial	$182.21
Rate for Payer: Kaiser Permanente Medicaid	$147.51
Rate for Payer: MDX Hawaii PPO	$280.55
Rate for Payer: UnitedHealthcare Medicaid	$173.54
Rate for Payer: University Health Alliance Commercial	$210.82

LACTULOSE ENEMA

Facility

$289.23

Service Code	NDC 00121087332
Hospital Revenue Code	250
Min. Negotiated Rate	$245.85
Max. Negotiated Rate	$280.55
Rate for Payer: Cash Price	$188.00
Rate for Payer: Health Management Network Commercial	$245.85
Rate for Payer: MDX Hawaii PPO	$280.55

LAMOTRIGINE 100 MG PO TABLET

Facility

$1.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.23
Rate for Payer: Cash Price	$0.83
Rate for Payer: Health Management Network Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.23

LAMOTRIGINE 100 MG PO TABLET

Facility

$1.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.23
Rate for Payer: Cash Price	$0.83
Rate for Payer: Hawaii Western Management Group Commercial	$1.21
Rate for Payer: Health Management Network Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$0.80
Rate for Payer: Kaiser Permanente Medicaid	$0.65
Rate for Payer: MDX Hawaii PPO	$1.23
Rate for Payer: UnitedHealthcare Medicaid	$0.76
Rate for Payer: University Health Alliance Commercial	$0.93

LAMOTRIGINE 25 MG PO TABLET

Facility

$1.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.81
Rate for Payer: Hawaii Western Management Group Commercial	$1.18
Rate for Payer: Health Management Network Commercial	$1.05
Rate for Payer: Kaiser Permanente Commercial	$0.78
Rate for Payer: Kaiser Permanente Medicaid	$0.63
Rate for Payer: MDX Hawaii PPO	$1.20
Rate for Payer: UnitedHealthcare Medicaid	$0.74
Rate for Payer: University Health Alliance Commercial	$0.90

LAMOTRIGINE 25 MG PO TABLET

Facility

$1.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Management Network Commercial	$1.05
Rate for Payer: MDX Hawaii PPO	$1.20

LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYR

Facility

$11,789.60

Service Code	HCPCS J1932
Hospital Revenue Code	636
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$11,435.91
Rate for Payer: AlohaCare Medicaid	$32.19
Rate for Payer: AlohaCare Medicare	$32.19
Rate for Payer: Cash Price	$7,663.24
Rate for Payer: Cash Price	$7,663.24
Rate for Payer: Devoted Health Medicare	$35.41
Rate for Payer: Hawaii Medical Service Association ABD	$24.45
Rate for Payer: Hawaii Medical Service Association Commercial	$40.24
Rate for Payer: Hawaii Medical Service Association Medicare	$32.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.45
Rate for Payer: Hawaii Western Management Group Commercial	$11,200.12
Rate for Payer: Health Management Network Commercial	$10,021.16
Rate for Payer: Humana Medicare	$32.19
Rate for Payer: Kaiser Permanente Commercial	$7,427.45
Rate for Payer: Kaiser Permanente Medicaid	$6,012.70
Rate for Payer: Kaiser Permanente Medicare	$32.19
Rate for Payer: MDX Hawaii PPO	$11,435.91
Rate for Payer: Ohana Health Plan Medicaid	$35.41
Rate for Payer: Ohana Health Plan Medicare	$32.19
Rate for Payer: UnitedHealthcare Medicaid	$7,073.76
Rate for Payer: UnitedHealthcare Medicare	$32.19
Rate for Payer: University Health Alliance Commercial	$8,593.44

LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYR

Facility

$11,789.60

Service Code	HCPCS J1932
Hospital Revenue Code	250
Min. Negotiated Rate	$10,021.16
Max. Negotiated Rate	$11,435.91
Rate for Payer: Cash Price	$7,663.24
Rate for Payer: Health Management Network Commercial	$10,021.16
Rate for Payer: MDX Hawaii PPO	$11,435.91

Lantern Surgical Assistant Navigation Unit 406000 [3644321]

Facility

$7,628.00

Hospital Charge Code	3644321
Hospital Revenue Code	272
Min. Negotiated Rate	$6,483.80
Max. Negotiated Rate	$7,399.16
Rate for Payer: Cash Price	$4,958.20
Rate for Payer: Health Management Network Commercial	$6,483.80
Rate for Payer: MDX Hawaii PPO	$7,399.16

Lantern Surgical Assistant Navigation Unit 406000 [3644321]

Facility

$7,628.00

Hospital Charge Code	3644321
Hospital Revenue Code	272
Min. Negotiated Rate	$3,890.28
Max. Negotiated Rate	$7,399.16
Rate for Payer: Cash Price	$4,958.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,246.60
Rate for Payer: Health Management Network Commercial	$6,483.80
Rate for Payer: Kaiser Permanente Commercial	$4,805.64
Rate for Payer: Kaiser Permanente Medicaid	$3,890.28
Rate for Payer: MDX Hawaii PPO	$7,399.16
Rate for Payer: University Health Alliance Commercial	$5,560.05

Lap 5mm ABC Probe w/10' cord 160636 [3641621]

Facility

$501.46

Hospital Charge Code	3641621
Hospital Revenue Code	272
Min. Negotiated Rate	$255.74
Max. Negotiated Rate	$486.42
Rate for Payer: Cash Price	$325.95
Rate for Payer: Hawaii Western Management Group Commercial	$476.39
Rate for Payer: Health Management Network Commercial	$426.24
Rate for Payer: Kaiser Permanente Commercial	$315.92
Rate for Payer: Kaiser Permanente Medicaid	$255.74
Rate for Payer: MDX Hawaii PPO	$486.42
Rate for Payer: University Health Alliance Commercial	$365.51

Lap 5mm ABC Probe w/10' cord 160636 [3641621]

Facility

$501.46

Hospital Charge Code	3641621
Hospital Revenue Code	272
Min. Negotiated Rate	$426.24
Max. Negotiated Rate	$486.42
Rate for Payer: Cash Price	$325.95
Rate for Payer: Health Management Network Commercial	$426.24
Rate for Payer: MDX Hawaii PPO	$486.42

Lap Allis Grasper Tip Disp 3372 [3640967]

Facility

$413.88

Hospital Charge Code	3640967
Hospital Revenue Code	272
Min. Negotiated Rate	$351.80
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: MDX Hawaii PPO	$401.46

Lap Allis Grasper Tip Disp 3372 [3640967]

Facility

$413.88

Hospital Charge Code	3640967
Hospital Revenue Code	272
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$401.46
Rate for Payer: Cash Price	$269.02
Rate for Payer: Hawaii Western Management Group Commercial	$393.19
Rate for Payer: Health Management Network Commercial	$351.80
Rate for Payer: Kaiser Permanente Commercial	$260.74
Rate for Payer: Kaiser Permanente Medicaid	$211.08
Rate for Payer: MDX Hawaii PPO	$401.46
Rate for Payer: University Health Alliance Commercial	$301.68

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

$29,180.10

Service Code	MSDRG 418
Min. Negotiated Rate	$22,249.22
Max. Negotiated Rate	$29,180.10
Rate for Payer: AlohaCare Medicare	$22,249.22
Rate for Payer: Devoted Health Medicare	$24,474.14
Rate for Payer: Hawaii Medical Service Association Commercial	$27,457.87
Rate for Payer: Hawaii Medical Service Association Medicare	$22,249.22
Rate for Payer: Humana Medicare	$22,249.22
Rate for Payer: Kaiser Permanente Commercial	$29,180.10
Rate for Payer: Kaiser Permanente Medicare	$22,249.22
Rate for Payer: Ohana Health Plan Medicare	$22,249.22
Rate for Payer: UnitedHealthcare Medicare	$22,249.22

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

$41,165.40

Service Code	MSDRG 417
Min. Negotiated Rate	$30,109.64
Max. Negotiated Rate	$41,165.40
Rate for Payer: AlohaCare Medicare	$31,387.76
Rate for Payer: Devoted Health Medicare	$34,526.54
Rate for Payer: Hawaii Medical Service Association Commercial	$30,109.64
Rate for Payer: Hawaii Medical Service Association Medicare	$31,387.76
Rate for Payer: Humana Medicare	$31,387.76
Rate for Payer: Kaiser Permanente Commercial	$41,165.40
Rate for Payer: Kaiser Permanente Medicare	$31,387.76
Rate for Payer: Ohana Health Plan Medicare	$31,387.76
Rate for Payer: UnitedHealthcare Medicare	$31,387.76

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$23,560.05

Service Code	MSDRG 419
Min. Negotiated Rate	$17,766.86
Max. Negotiated Rate	$23,560.05
Rate for Payer: AlohaCare Medicare	$17,964.05
Rate for Payer: Devoted Health Medicare	$19,760.46
Rate for Payer: Hawaii Medical Service Association Commercial	$17,766.86
Rate for Payer: Hawaii Medical Service Association Medicare	$17,964.05
Rate for Payer: Humana Medicare	$17,964.05
Rate for Payer: Kaiser Permanente Commercial	$23,560.05
Rate for Payer: Kaiser Permanente Medicare	$17,964.05
Rate for Payer: Ohana Health Plan Medicare	$17,964.05
Rate for Payer: UnitedHealthcare Medicare	$17,964.05

LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY

Facility

$17,484.00

Service Code	CPT 59151
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$17,484.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$17,484.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,902.37
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$11,157.19

LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

Facility

$14,715.00

Service Code	CPT 49320
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$6,743.44

LAPAROSCOPY, SURGICAL, APPENDECTOMY

Facility

$24,500.00

Service Code	CPT 44970
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$24,500.00

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY

Facility

$20,300.00

Service Code	CPT 47562
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,300.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$20,300.00

Know your out-of-pocket cost for care.

All Charges