Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION [43717]

Facility

IP

$109.00

Service Code	NDC 76329630005
Hospital Revenue Code	250
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$65.40
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: MDX Hawaii PPO	$105.73

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE [166252]

Facility

IP

$31.00

Service Code	NDC 00409132305
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE [166252]

Facility

IP

$38.00

Service Code	NDC 76329339001
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE [166252]

Facility

IP

$32.00

Service Code	NDC 00409490334
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE [166252]

Facility

IP

$31.00

Service Code	NDC 00409132315
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]

Facility

IP

$11.00

Service Code	NDC 55150016102
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]

Facility

IP

$10.00

Service Code	NDC 55150015974
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]

Facility

IP

$15.00

Service Code	NDC 55150016205
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]

Facility

IP

$10.00

Service Code	NDC 63323049227
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]

Facility

IP

$11.00

Service Code	NDC 73293000101
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: MDX Hawaii PPO	$2.91

LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION [104207]

Facility

IP

$11.00

Service Code	NDC 73293000102
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]

Facility

IP

$31.00

Service Code	NDC 00409428202
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]

Facility

IP

$13.00

Service Code	NDC 63323049527
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]

Facility

IP

$13.00

Service Code	NDC 63323049509
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]

Facility

IP

$31.00

Service Code	NDC 00409428212
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]

Facility

IP

$13.00

Service Code	NDC 55150016505
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [104208]

Facility

IP

$12.00

Service Code	NDC 00409206605
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

LIDOCAINE (PF) 3.5 % EYE GEL [94220]

Facility

IP

$71.00

Service Code	NDC 82584079201
Hospital Revenue Code	250
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14868]

Facility

IP

$28.00

Service Code	HCPCS J2002
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14868]

Facility

OP

$28.00

Service Code	HCPCS J2002
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicaid	$16.80
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: University Health Alliance Commercial	$20.41

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]

Facility

OP

$38.00

Service Code	HCPCS J2001
Hospital Revenue Code	636
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$19.00
Rate for Payer: AlohaCare Medicare	$11.78
Rate for Payer: Cash Price	$22.80
Rate for Payer: Devoted Health Medicare	$12.92
Rate for Payer: Hawaii Medical Service Association Medicare	$11.78
Rate for Payer: Hawaii Western Management Group Commercial	$36.10
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$11.78
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$11.78
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$11.78
Rate for Payer: Ohana Health Plan Medicare	$11.78
Rate for Payer: UnitedHealthcare Medicaid	$22.80
Rate for Payer: UnitedHealthcare Medicare	$11.78
Rate for Payer: University Health Alliance Commercial	$27.70

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]

Facility

IP

$38.00

Service Code	HCPCS J2001
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

OP

$35.00

Service Code	NDC 00168035705
Hospital Revenue Code	637
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$33.95
Rate for Payer: AlohaCare Medicaid	$17.50
Rate for Payer: AlohaCare Medicare	$10.85
Rate for Payer: Cash Price	$21.00
Rate for Payer: Devoted Health Medicare	$11.90
Rate for Payer: Hawaii Medical Service Association Medicare	$10.85
Rate for Payer: Hawaii Western Management Group Commercial	$33.25
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Humana Medicare	$10.85
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$17.85
Rate for Payer: Kaiser Permanente Medicare	$10.85
Rate for Payer: MDX Hawaii PPO	$33.95
Rate for Payer: Ohana Health Plan Medicaid	$10.85
Rate for Payer: Ohana Health Plan Medicare	$10.85
Rate for Payer: UnitedHealthcare Medicare	$10.85
Rate for Payer: University Health Alliance Commercial	$25.51

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

IP

$35.00

Service Code	NDC 00168035755
Hospital Revenue Code	250
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]

Facility

IP

$35.00

Service Code	NDC 00168035705
Hospital Revenue Code	250
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95

<<
<
386
387
388
389
390
391
392
393
394
395
>
>>