Kona Community Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE (PF) 3.5 % OPHT GEL

Facility

$114.72

Service Code	NDC 82584079201
Hospital Revenue Code	250
Min. Negotiated Rate	$97.51
Max. Negotiated Rate	$111.28
Rate for Payer: Cash Price	$74.57
Rate for Payer: Health Management Network Commercial	$97.51
Rate for Payer: MDX Hawaii PPO	$111.28

LIDOCAINE (PF) 3.5 % OPHT GEL

Facility

$114.72

Service Code	NDC 82584079201
Hospital Revenue Code	250
Min. Negotiated Rate	$58.51
Max. Negotiated Rate	$111.28
Rate for Payer: Cash Price	$74.57
Rate for Payer: Hawaii Western Management Group Commercial	$108.98
Rate for Payer: Health Management Network Commercial	$97.51
Rate for Payer: Kaiser Permanente Commercial	$72.27
Rate for Payer: Kaiser Permanente Medicaid	$58.51
Rate for Payer: MDX Hawaii PPO	$111.28
Rate for Payer: UnitedHealthcare Medicaid	$68.83
Rate for Payer: University Health Alliance Commercial	$83.62

LIDOCAINE-RACEPINEP-TETRACAINE 4-0.05-0.5 % TOP SOLN

Facility

$86.19

Service Code	NDC 70092165844
Hospital Revenue Code	250
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$83.60
Rate for Payer: Cash Price	$56.02
Rate for Payer: Hawaii Western Management Group Commercial	$81.88
Rate for Payer: Health Management Network Commercial	$73.26
Rate for Payer: Kaiser Permanente Commercial	$54.30
Rate for Payer: Kaiser Permanente Medicaid	$43.96
Rate for Payer: MDX Hawaii PPO	$83.60
Rate for Payer: UnitedHealthcare Medicaid	$51.71
Rate for Payer: University Health Alliance Commercial	$62.82

LIDOCAINE-RACEPINEP-TETRACAINE 4-0.05-0.5 % TOP SOLN

Facility

$86.19

Service Code	NDC 70092165844
Hospital Revenue Code	250
Min. Negotiated Rate	$73.26
Max. Negotiated Rate	$83.60
Rate for Payer: Cash Price	$56.02
Rate for Payer: Health Management Network Commercial	$73.26
Rate for Payer: MDX Hawaii PPO	$83.60

LIDOCAINE-TRANSPARENT DRESSING 4 % TOP KIT

Facility

$100.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$97.78
Rate for Payer: Cash Price	$65.52
Rate for Payer: Health Management Network Commercial	$85.68
Rate for Payer: MDX Hawaii PPO	$97.78

LIDOCAINE-TRANSPARENT DRESSING 4 % TOP KIT

Facility

$100.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$51.41
Max. Negotiated Rate	$97.78
Rate for Payer: Cash Price	$65.52
Rate for Payer: Hawaii Western Management Group Commercial	$95.76
Rate for Payer: Health Management Network Commercial	$85.68
Rate for Payer: Kaiser Permanente Commercial	$63.50
Rate for Payer: Kaiser Permanente Medicaid	$51.41
Rate for Payer: MDX Hawaii PPO	$97.78
Rate for Payer: UnitedHealthcare Medicaid	$60.48
Rate for Payer: University Health Alliance Commercial	$73.47

Ligasure Exact Dissector Lf2019 [3643882]

Facility

$2,772.53

Hospital Charge Code	3643882
Hospital Revenue Code	272
Min. Negotiated Rate	$1,413.99
Max. Negotiated Rate	$2,689.35
Rate for Payer: Cash Price	$1,802.14
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.90
Rate for Payer: Health Management Network Commercial	$2,356.65
Rate for Payer: Kaiser Permanente Commercial	$1,746.69
Rate for Payer: Kaiser Permanente Medicaid	$1,413.99
Rate for Payer: MDX Hawaii PPO	$2,689.35
Rate for Payer: University Health Alliance Commercial	$2,020.90

Ligasure Exact Dissector Lf2019 [3643882]

Facility

$2,772.53

Hospital Charge Code	3643882
Hospital Revenue Code	272
Min. Negotiated Rate	$2,356.65
Max. Negotiated Rate	$2,689.35
Rate for Payer: Cash Price	$1,802.14
Rate for Payer: Health Management Network Commercial	$2,356.65
Rate for Payer: MDX Hawaii PPO	$2,689.35

LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA

Facility

$6,743.44

Service Code	CPT 37607
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

LIGATION OR BIOPSY, TEMPORAL ARTERY

Facility

$6,183.00

Service Code	CPT 37609
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$217,903.17

Service Code	MSDRG 956
Min. Negotiated Rate	$49,493.86
Max. Negotiated Rate	$217,903.17
Rate for Payer: AlohaCare Medicare	$49,493.86
Rate for Payer: Devoted Health Medicare	$54,443.25
Rate for Payer: Hawaii Medical Service Association Commercial	$217,903.17
Rate for Payer: Hawaii Medical Service Association Medicare	$49,493.86
Rate for Payer: Humana Medicare	$49,493.86
Rate for Payer: Kaiser Permanente Commercial	$64,911.75
Rate for Payer: Kaiser Permanente Medicare	$49,493.86
Rate for Payer: Ohana Health Plan Medicare	$49,493.86
Rate for Payer: UnitedHealthcare Medicare	$49,493.86

LINEZOLID 600 MG PO TABLET

Facility

$502.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$426.93
Max. Negotiated Rate	$487.20
Rate for Payer: Cash Price	$326.48
Rate for Payer: Cash Price	$403.84
Rate for Payer: Health Management Network Commercial	$528.10
Rate for Payer: Health Management Network Commercial	$426.93
Rate for Payer: MDX Hawaii PPO	$487.20
Rate for Payer: MDX Hawaii PPO	$602.65

LINEZOLID 600 MG PO TABLET

Facility

$502.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$487.20
Rate for Payer: Cash Price	$326.48
Rate for Payer: Cash Price	$403.84
Rate for Payer: Hawaii Western Management Group Commercial	$590.23
Rate for Payer: Hawaii Western Management Group Commercial	$477.16
Rate for Payer: Health Management Network Commercial	$426.93
Rate for Payer: Health Management Network Commercial	$528.10
Rate for Payer: Kaiser Permanente Commercial	$316.43
Rate for Payer: Kaiser Permanente Commercial	$391.41
Rate for Payer: Kaiser Permanente Medicaid	$256.16
Rate for Payer: Kaiser Permanente Medicaid	$316.86
Rate for Payer: MDX Hawaii PPO	$487.20
Rate for Payer: MDX Hawaii PPO	$602.65
Rate for Payer: UnitedHealthcare Medicaid	$372.77
Rate for Payer: UnitedHealthcare Medicaid	$301.36
Rate for Payer: University Health Alliance Commercial	$366.10
Rate for Payer: University Health Alliance Commercial	$452.86

LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV IVPB

Facility

$87.56

Service Code	HCPCS J2020
Hospital Revenue Code	636
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$84.93
Rate for Payer: Cash Price	$56.91
Rate for Payer: Cash Price	$134.41
Rate for Payer: Cash Price	$134.41
Rate for Payer: Cash Price	$62.56
Rate for Payer: Cash Price	$62.56
Rate for Payer: Cash Price	$56.91
Rate for Payer: Hawaii Medical Service Association ABD	$3.47
Rate for Payer: Hawaii Medical Service Association ABD	$3.47
Rate for Payer: Hawaii Medical Service Association ABD	$3.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.47
Rate for Payer: Hawaii Western Management Group Commercial	$83.18
Rate for Payer: Hawaii Western Management Group Commercial	$196.45
Rate for Payer: Hawaii Western Management Group Commercial	$91.44
Rate for Payer: Health Management Network Commercial	$74.43
Rate for Payer: Health Management Network Commercial	$175.77
Rate for Payer: Health Management Network Commercial	$81.81
Rate for Payer: Kaiser Permanente Commercial	$130.28
Rate for Payer: Kaiser Permanente Commercial	$55.16
Rate for Payer: Kaiser Permanente Commercial	$60.64
Rate for Payer: Kaiser Permanente Medicaid	$105.46
Rate for Payer: Kaiser Permanente Medicaid	$44.66
Rate for Payer: Kaiser Permanente Medicaid	$49.09
Rate for Payer: MDX Hawaii PPO	$93.36
Rate for Payer: MDX Hawaii PPO	$200.59
Rate for Payer: MDX Hawaii PPO	$84.93
Rate for Payer: UnitedHealthcare Medicaid	$124.07
Rate for Payer: UnitedHealthcare Medicaid	$57.75
Rate for Payer: UnitedHealthcare Medicaid	$52.54
Rate for Payer: University Health Alliance Commercial	$70.16
Rate for Payer: University Health Alliance Commercial	$150.73
Rate for Payer: University Health Alliance Commercial	$63.82

LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV IVPB

Facility

$87.56

Service Code	HCPCS J2020
Hospital Revenue Code	250
Min. Negotiated Rate	$74.43
Max. Negotiated Rate	$84.93
Rate for Payer: Cash Price	$56.91
Rate for Payer: Cash Price	$134.41
Rate for Payer: Cash Price	$62.56
Rate for Payer: Health Management Network Commercial	$74.43
Rate for Payer: Health Management Network Commercial	$175.77
Rate for Payer: Health Management Network Commercial	$81.81
Rate for Payer: MDX Hawaii PPO	$200.59
Rate for Payer: MDX Hawaii PPO	$93.36
Rate for Payer: MDX Hawaii PPO	$84.93

LIPASE-PROTEASE-AMYLASE (PORK) 24,000-76,000 -120,000 UNIT PO CAP DR EC

Facility

$50.73

Service Code	NDC 00032263601
Hospital Revenue Code	250
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$49.21
Rate for Payer: Cash Price	$32.97
Rate for Payer: Hawaii Western Management Group Commercial	$48.19
Rate for Payer: Health Management Network Commercial	$43.12
Rate for Payer: Kaiser Permanente Commercial	$31.96
Rate for Payer: Kaiser Permanente Medicaid	$25.87
Rate for Payer: MDX Hawaii PPO	$49.21
Rate for Payer: UnitedHealthcare Medicaid	$30.44
Rate for Payer: University Health Alliance Commercial	$36.98

LIPASE-PROTEASE-AMYLASE (PORK) 24,000-76,000 -120,000 UNIT PO CAP DR EC

Facility

$50.73

Service Code	NDC 00032263601
Hospital Revenue Code	250
Min. Negotiated Rate	$43.12
Max. Negotiated Rate	$49.21
Rate for Payer: Cash Price	$32.97
Rate for Payer: Health Management Network Commercial	$43.12
Rate for Payer: MDX Hawaii PPO	$49.21

Lisfranc Dual Ray 2nd & 3rd TMT Plate Left Small P53-110-L211 [3644336]

Facility

$10,015.00

Service Code	HCPCS C1713
Hospital Charge Code	3644336
Hospital Revenue Code	278
Min. Negotiated Rate	$5,608.40
Max. Negotiated Rate	$9,714.55
Rate for Payer: Cash Price	$6,509.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,010.50
Rate for Payer: Health Management Network Commercial	$8,512.75
Rate for Payer: MDX Hawaii PPO	$9,714.55
Rate for Payer: University Health Alliance Commercial	$5,608.40

Lisfranc Dual Ray 2nd & 3rd TMT Plate Left Small P53-110-L211 [3644336]

Facility

$10,015.00

Service Code	HCPCS C1713
Hospital Charge Code	3644336
Hospital Revenue Code	278
Min. Negotiated Rate	$5,107.65
Max. Negotiated Rate	$9,714.55
Rate for Payer: Cash Price	$6,509.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,010.50
Rate for Payer: Health Management Network Commercial	$8,512.75
Rate for Payer: Kaiser Permanente Commercial	$6,309.45
Rate for Payer: Kaiser Permanente Medicaid	$5,107.65
Rate for Payer: MDX Hawaii PPO	$9,714.55
Rate for Payer: University Health Alliance Commercial	$5,608.40

LISINOPRIL 10 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

LISINOPRIL 10 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

LISINOPRIL 20 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$3.86
Rate for Payer: Health Management Network Commercial	$5.05
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$5.76

LISINOPRIL 20 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$3.86
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$5.64
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$5.05
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$3.74
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$3.03
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$5.76
Rate for Payer: UnitedHealthcare Medicaid	$3.56
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$4.33

LISINOPRIL 5 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

LISINOPRIL 5 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

Know your out-of-pocket cost for care.

All Charges