Kona Community Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJ SOLN

Facility

$115.29

Service Code	NDC 63323048927
Hospital Revenue Code	250
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$111.83
Rate for Payer: Cash Price	$74.94
Rate for Payer: Health Management Network Commercial	$98.00
Rate for Payer: MDX Hawaii PPO	$111.83

LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJ SOLN

Facility

$115.29

Service Code	NDC 63323048902
Hospital Revenue Code	250
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$111.83
Rate for Payer: Cash Price	$74.94
Rate for Payer: Health Management Network Commercial	$98.00
Rate for Payer: MDX Hawaii PPO	$111.83

LIDOCAINE HCL 10 MG/ML (1 %) 20 ML MDV (OR USE ONLY)

Facility

$18.77

Service Code	NDC 63323048527
Hospital Revenue Code	250
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$18.21
Rate for Payer: Cash Price	$12.20
Rate for Payer: Hawaii Western Management Group Commercial	$17.83
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Kaiser Permanente Commercial	$11.83
Rate for Payer: Kaiser Permanente Medicaid	$9.57
Rate for Payer: MDX Hawaii PPO	$18.21
Rate for Payer: UnitedHealthcare Medicaid	$11.26
Rate for Payer: University Health Alliance Commercial	$13.68

LIDOCAINE HCL 10 MG/ML (1 %) 20 ML MDV (OR USE ONLY)

Facility

$18.77

Service Code	NDC 63323048501
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$18.21
Rate for Payer: Cash Price	$12.20
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: MDX Hawaii PPO	$18.21

LIDOCAINE HCL 10 MG/ML (1 %) 20 ML MDV (OR USE ONLY)

Facility

$18.77

Service Code	NDC 63323048501
Hospital Revenue Code	250
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$18.21
Rate for Payer: Cash Price	$12.20
Rate for Payer: Hawaii Western Management Group Commercial	$17.83
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Kaiser Permanente Commercial	$11.83
Rate for Payer: Kaiser Permanente Medicaid	$9.57
Rate for Payer: MDX Hawaii PPO	$18.21
Rate for Payer: UnitedHealthcare Medicaid	$11.26
Rate for Payer: University Health Alliance Commercial	$13.68

LIDOCAINE HCL 10 MG/ML (1 %) 20 ML MDV (OR USE ONLY)

Facility

$18.77

Service Code	NDC 63323048527
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$18.21
Rate for Payer: Cash Price	$12.20
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: MDX Hawaii PPO	$18.21

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$17.56

Service Code	NDC 00409427616
Hospital Revenue Code	250
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$17.03
Rate for Payer: Cash Price	$11.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.68
Rate for Payer: Health Management Network Commercial	$14.93
Rate for Payer: Kaiser Permanente Commercial	$11.06
Rate for Payer: Kaiser Permanente Medicaid	$8.96
Rate for Payer: MDX Hawaii PPO	$17.03
Rate for Payer: UnitedHealthcare Medicaid	$10.54
Rate for Payer: University Health Alliance Commercial	$12.80

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$14.69

Service Code	NDC 63323020110
Hospital Revenue Code	250
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$9.55
Rate for Payer: Health Management Network Commercial	$12.49
Rate for Payer: MDX Hawaii PPO	$14.25

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$14.69

Service Code	NDC 63323020110
Hospital Revenue Code	250
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$9.55
Rate for Payer: Hawaii Western Management Group Commercial	$13.96
Rate for Payer: Health Management Network Commercial	$12.49
Rate for Payer: Kaiser Permanente Commercial	$9.25
Rate for Payer: Kaiser Permanente Medicaid	$7.49
Rate for Payer: MDX Hawaii PPO	$14.25
Rate for Payer: UnitedHealthcare Medicaid	$8.81
Rate for Payer: University Health Alliance Commercial	$10.71

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$14.69

Service Code	NDC 63323020103
Hospital Revenue Code	250
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$9.55
Rate for Payer: Hawaii Western Management Group Commercial	$13.96
Rate for Payer: Health Management Network Commercial	$12.49
Rate for Payer: Kaiser Permanente Commercial	$9.25
Rate for Payer: Kaiser Permanente Medicaid	$7.49
Rate for Payer: MDX Hawaii PPO	$14.25
Rate for Payer: UnitedHealthcare Medicaid	$8.81
Rate for Payer: University Health Alliance Commercial	$10.71

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$17.56

Service Code	NDC 00409427616
Hospital Revenue Code	250
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$17.03
Rate for Payer: Cash Price	$11.41
Rate for Payer: Health Management Network Commercial	$14.93
Rate for Payer: MDX Hawaii PPO	$17.03

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$14.69

Service Code	NDC 63323020103
Hospital Revenue Code	250
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$9.55
Rate for Payer: Health Management Network Commercial	$12.49
Rate for Payer: MDX Hawaii PPO	$14.25

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$17.56

Service Code	NDC 00409427601
Hospital Revenue Code	250
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$17.03
Rate for Payer: Cash Price	$11.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.68
Rate for Payer: Health Management Network Commercial	$14.93
Rate for Payer: Kaiser Permanente Commercial	$11.06
Rate for Payer: Kaiser Permanente Medicaid	$8.96
Rate for Payer: MDX Hawaii PPO	$17.03
Rate for Payer: UnitedHealthcare Medicaid	$10.54
Rate for Payer: University Health Alliance Commercial	$12.80

LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN

Facility

$17.56

Service Code	NDC 00409427601
Hospital Revenue Code	250
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$17.03
Rate for Payer: Cash Price	$11.41
Rate for Payer: Health Management Network Commercial	$14.93
Rate for Payer: MDX Hawaii PPO	$17.03

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$21.20

Service Code	NDC 63323048602
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$20.56
Rate for Payer: Cash Price	$13.78
Rate for Payer: Health Management Network Commercial	$18.02
Rate for Payer: MDX Hawaii PPO	$20.56

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$19.05

Service Code	NDC 63323048617
Hospital Revenue Code	250
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$18.48
Rate for Payer: Cash Price	$12.38
Rate for Payer: Hawaii Western Management Group Commercial	$18.10
Rate for Payer: Health Management Network Commercial	$16.19
Rate for Payer: Kaiser Permanente Commercial	$12.00
Rate for Payer: Kaiser Permanente Medicaid	$9.72
Rate for Payer: MDX Hawaii PPO	$18.48
Rate for Payer: UnitedHealthcare Medicaid	$11.43
Rate for Payer: University Health Alliance Commercial	$13.89

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$19.05

Service Code	NDC 63323048617
Hospital Revenue Code	250
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$18.48
Rate for Payer: Cash Price	$12.38
Rate for Payer: Health Management Network Commercial	$16.19
Rate for Payer: MDX Hawaii PPO	$18.48

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$19.05

Service Code	NDC 63323048601
Hospital Revenue Code	250
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$18.48
Rate for Payer: Cash Price	$12.38
Rate for Payer: Hawaii Western Management Group Commercial	$18.10
Rate for Payer: Health Management Network Commercial	$16.19
Rate for Payer: Kaiser Permanente Commercial	$12.00
Rate for Payer: Kaiser Permanente Medicaid	$9.72
Rate for Payer: MDX Hawaii PPO	$18.48
Rate for Payer: UnitedHealthcare Medicaid	$11.43
Rate for Payer: University Health Alliance Commercial	$13.89

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$21.20

Service Code	NDC 63323048602
Hospital Revenue Code	250
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$20.56
Rate for Payer: Cash Price	$13.78
Rate for Payer: Hawaii Western Management Group Commercial	$20.14
Rate for Payer: Health Management Network Commercial	$18.02
Rate for Payer: Kaiser Permanente Commercial	$13.36
Rate for Payer: Kaiser Permanente Medicaid	$10.81
Rate for Payer: MDX Hawaii PPO	$20.56
Rate for Payer: UnitedHealthcare Medicaid	$12.72
Rate for Payer: University Health Alliance Commercial	$15.45

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$19.05

Service Code	NDC 63323048601
Hospital Revenue Code	250
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$18.48
Rate for Payer: Cash Price	$12.38
Rate for Payer: Health Management Network Commercial	$16.19
Rate for Payer: MDX Hawaii PPO	$18.48

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$21.20

Service Code	NDC 63323048627
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$20.56
Rate for Payer: Cash Price	$13.78
Rate for Payer: Health Management Network Commercial	$18.02
Rate for Payer: MDX Hawaii PPO	$20.56

LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN

Facility

$21.20

Service Code	NDC 63323048627
Hospital Revenue Code	250
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$20.56
Rate for Payer: Cash Price	$13.78
Rate for Payer: Hawaii Western Management Group Commercial	$20.14
Rate for Payer: Health Management Network Commercial	$18.02
Rate for Payer: Kaiser Permanente Commercial	$13.36
Rate for Payer: Kaiser Permanente Medicaid	$10.81
Rate for Payer: MDX Hawaii PPO	$20.56
Rate for Payer: UnitedHealthcare Medicaid	$12.72
Rate for Payer: University Health Alliance Commercial	$15.45

LIDOCAINE HCL 2 % MM JELP

Facility

$32.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$31.87
Rate for Payer: Cash Price	$21.36
Rate for Payer: Health Management Network Commercial	$27.93
Rate for Payer: MDX Hawaii PPO	$31.87

LIDOCAINE HCL 2 % MM JELP

Facility

$32.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.76
Max. Negotiated Rate	$31.87
Rate for Payer: Cash Price	$21.36
Rate for Payer: Hawaii Western Management Group Commercial	$31.22
Rate for Payer: Health Management Network Commercial	$27.93
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$16.76
Rate for Payer: MDX Hawaii PPO	$31.87
Rate for Payer: UnitedHealthcare Medicaid	$19.72
Rate for Payer: University Health Alliance Commercial	$23.95

LIDOCAINE HCL 2 % MM SOLN

Facility

$91.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$77.38
Max. Negotiated Rate	$88.30
Rate for Payer: Cash Price	$59.17
Rate for Payer: Cash Price	$30.43
Rate for Payer: Health Management Network Commercial	$39.80
Rate for Payer: Health Management Network Commercial	$77.38
Rate for Payer: MDX Hawaii PPO	$88.30
Rate for Payer: MDX Hawaii PPO	$45.42

Know your out-of-pocket cost for care.

All Charges