Kau Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$35.00

Service Code	NDC 00168035755
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

$96.00

Service Code	NDC 62332058231
Hospital Revenue Code	637
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$32.64
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$29.76
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$69.97

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

Facility

$96.00

Service Code	NDC 62332058231
Hospital Revenue Code	250
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT [30183]

Facility

$60.00

Service Code	NDC 24357070107
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

LIGASURE ADVANCE SPD#LF5544

Facility

$2,200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$682.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: AlohaCare Medicaid	$1,100.00
Rate for Payer: AlohaCare Medicare	$682.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Devoted Health Medicare	$748.00
Rate for Payer: Hawaii Medical Service Association Medicare	$682.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,090.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Humana Medicare	$682.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: Kaiser Permanente Medicaid	$1,122.00
Rate for Payer: Kaiser Permanente Medicare	$682.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: Ohana Health Plan Medicaid	$682.00
Rate for Payer: Ohana Health Plan Medicare	$682.00
Rate for Payer: UnitedHealthcare Medicare	$682.00
Rate for Payer: University Health Alliance Commercial	$1,603.58

LIGASURE ADVANCE SPD#LF5544

Facility

$2,200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,870.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00

LIGASURE EXACT DISSECT LF2019

Facility

$1,521.00

Hospital Revenue Code	272
Min. Negotiated Rate	$471.51
Max. Negotiated Rate	$1,475.37
Rate for Payer: AlohaCare Medicaid	$760.50
Rate for Payer: AlohaCare Medicare	$471.51
Rate for Payer: Cash Price	$912.60
Rate for Payer: Devoted Health Medicare	$517.14
Rate for Payer: Hawaii Medical Service Association Medicare	$471.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.95
Rate for Payer: Health Management Network Commercial	$1,292.85
Rate for Payer: Humana Medicare	$471.51
Rate for Payer: Kaiser Permanente Commercial	$1,368.90
Rate for Payer: Kaiser Permanente Medicaid	$775.71
Rate for Payer: Kaiser Permanente Medicare	$471.51
Rate for Payer: MDX Hawaii PPO	$1,475.37
Rate for Payer: Ohana Health Plan Medicaid	$471.51
Rate for Payer: Ohana Health Plan Medicare	$471.51
Rate for Payer: UnitedHealthcare Medicare	$471.51
Rate for Payer: University Health Alliance Commercial	$1,108.66

LIGASURE EXACT DISSECT LF2019

Facility

$1,521.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,292.85
Max. Negotiated Rate	$1,475.37
Rate for Payer: Cash Price	$912.60
Rate for Payer: Health Management Network Commercial	$1,292.85
Rate for Payer: Kaiser Permanente Commercial	$1,368.90
Rate for Payer: MDX Hawaii PPO	$1,475.37

LIGASURE L-HOOK 5X44 LF5644

Facility

$1,814.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,541.90
Max. Negotiated Rate	$1,759.58
Rate for Payer: Cash Price	$1,088.40
Rate for Payer: Health Management Network Commercial	$1,541.90
Rate for Payer: Kaiser Permanente Commercial	$1,632.60
Rate for Payer: MDX Hawaii PPO	$1,759.58

LIGASURE L-HOOK 5X44 LF5644

Facility

$1,814.00

Hospital Revenue Code	272
Min. Negotiated Rate	$562.34
Max. Negotiated Rate	$1,759.58
Rate for Payer: AlohaCare Medicaid	$907.00
Rate for Payer: AlohaCare Medicare	$562.34
Rate for Payer: Cash Price	$1,088.40
Rate for Payer: Devoted Health Medicare	$616.76
Rate for Payer: Hawaii Medical Service Association Medicare	$562.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,723.30
Rate for Payer: Health Management Network Commercial	$1,541.90
Rate for Payer: Humana Medicare	$562.34
Rate for Payer: Kaiser Permanente Commercial	$1,632.60
Rate for Payer: Kaiser Permanente Medicaid	$925.14
Rate for Payer: Kaiser Permanente Medicare	$562.34
Rate for Payer: MDX Hawaii PPO	$1,759.58
Rate for Payer: Ohana Health Plan Medicaid	$562.34
Rate for Payer: Ohana Health Plan Medicare	$562.34
Rate for Payer: UnitedHealthcare Medicare	$562.34
Rate for Payer: University Health Alliance Commercial	$1,322.22

LIGASURE MARYLA LF1937/ LF1737

Facility

$1,650.00

Hospital Revenue Code	272
Min. Negotiated Rate	$511.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$511.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$561.00
Rate for Payer: Hawaii Medical Service Association Medicare	$511.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.50
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$511.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$511.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$511.50
Rate for Payer: Ohana Health Plan Medicare	$511.50
Rate for Payer: UnitedHealthcare Medicare	$511.50
Rate for Payer: University Health Alliance Commercial	$1,202.68

LIGASURE MARYLA LF1937/ LF1737

Facility

$1,650.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,402.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50

LIGASURE MARYLAND XP LXMJ37L

Facility

$1,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$504.06
Max. Negotiated Rate	$1,577.22
Rate for Payer: AlohaCare Medicaid	$813.00
Rate for Payer: AlohaCare Medicare	$504.06
Rate for Payer: Cash Price	$975.60
Rate for Payer: Devoted Health Medicare	$552.84
Rate for Payer: Hawaii Medical Service Association Medicare	$504.06
Rate for Payer: Hawaii Western Management Group Commercial	$1,544.70
Rate for Payer: Health Management Network Commercial	$1,382.10
Rate for Payer: Humana Medicare	$504.06
Rate for Payer: Kaiser Permanente Commercial	$1,463.40
Rate for Payer: Kaiser Permanente Medicaid	$829.26
Rate for Payer: Kaiser Permanente Medicare	$504.06
Rate for Payer: MDX Hawaii PPO	$1,577.22
Rate for Payer: Ohana Health Plan Medicaid	$504.06
Rate for Payer: Ohana Health Plan Medicare	$504.06
Rate for Payer: UnitedHealthcare Medicare	$504.06
Rate for Payer: University Health Alliance Commercial	$1,185.19

LIGASURE MARYLAND XP LXMJ37L

Facility

$1,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,382.10
Max. Negotiated Rate	$1,577.22
Rate for Payer: Cash Price	$975.60
Rate for Payer: Health Management Network Commercial	$1,382.10
Rate for Payer: Kaiser Permanente Commercial	$1,463.40
Rate for Payer: MDX Hawaii PPO	$1,577.22

LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$214,242.38

Service Code	MSDRG 956
Min. Negotiated Rate	$214,242.38
Max. Negotiated Rate	$214,242.38
Rate for Payer: Hawaii Medical Service Association Commercial	$214,242.38

LINER 42MM CMNTLESS 626-00-42E

Facility

$3,331.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.61
Max. Negotiated Rate	$3,231.07
Rate for Payer: AlohaCare Medicaid	$1,665.50
Rate for Payer: AlohaCare Medicare	$1,032.61
Rate for Payer: Cash Price	$1,998.60
Rate for Payer: Devoted Health Medicare	$1,132.54
Rate for Payer: Hawaii Medical Service Association Medicare	$1,032.61
Rate for Payer: Hawaii Western Management Group Commercial	$2,331.70
Rate for Payer: Health Management Network Commercial	$2,831.35
Rate for Payer: Humana Medicare	$1,032.61
Rate for Payer: Kaiser Permanente Commercial	$2,997.90
Rate for Payer: Kaiser Permanente Medicaid	$1,698.81
Rate for Payer: Kaiser Permanente Medicare	$1,032.61
Rate for Payer: MDX Hawaii PPO	$3,231.07
Rate for Payer: Ohana Health Plan Medicaid	$1,032.61
Rate for Payer: Ohana Health Plan Medicare	$1,032.61
Rate for Payer: UnitedHealthcare Medicare	$1,032.61
Rate for Payer: University Health Alliance Commercial	$1,865.36

LINER 42MM CMNTLESS 626-00-42E

Facility

$3,331.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,865.36
Max. Negotiated Rate	$3,231.07
Rate for Payer: Cash Price	$1,998.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,331.70
Rate for Payer: Health Management Network Commercial	$2,831.35
Rate for Payer: Kaiser Permanente Commercial	$2,997.90
Rate for Payer: MDX Hawaii PPO	$3,231.07
Rate for Payer: University Health Alliance Commercial	$1,865.36

LINER MDM 38MM 626-00-38D

Facility

$3,344.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.64
Max. Negotiated Rate	$3,243.68
Rate for Payer: Cash Price	$2,006.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,340.80
Rate for Payer: Health Management Network Commercial	$2,842.40
Rate for Payer: Kaiser Permanente Commercial	$3,009.60
Rate for Payer: MDX Hawaii PPO	$3,243.68
Rate for Payer: University Health Alliance Commercial	$1,872.64

LINER MDM 38MM 626-00-38D

Facility

$3,344.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,036.64
Max. Negotiated Rate	$3,243.68
Rate for Payer: AlohaCare Medicaid	$1,672.00
Rate for Payer: AlohaCare Medicare	$1,036.64
Rate for Payer: Cash Price	$2,006.40
Rate for Payer: Devoted Health Medicare	$1,136.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,036.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,340.80
Rate for Payer: Health Management Network Commercial	$2,842.40
Rate for Payer: Humana Medicare	$1,036.64
Rate for Payer: Kaiser Permanente Commercial	$3,009.60
Rate for Payer: Kaiser Permanente Medicaid	$1,705.44
Rate for Payer: Kaiser Permanente Medicare	$1,036.64
Rate for Payer: MDX Hawaii PPO	$3,243.68
Rate for Payer: Ohana Health Plan Medicaid	$1,036.64
Rate for Payer: Ohana Health Plan Medicare	$1,036.64
Rate for Payer: UnitedHealthcare Medicare	$1,036.64
Rate for Payer: University Health Alliance Commercial	$1,872.64

LINER NEUTRAL #00-8751-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$868.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$868.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$952.00
Rate for Payer: Hawaii Medical Service Association Medicare	$868.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$868.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$868.00
Rate for Payer: Ohana Health Plan Medicare	$868.00
Rate for Payer: UnitedHealthcare Medicare	$868.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINER NEUTRAL #00-8751-013-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINER RIM JJ/36 00-8752-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$868.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$868.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$952.00
Rate for Payer: Hawaii Medical Service Association Medicare	$868.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$868.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$868.00
Rate for Payer: Ohana Health Plan Medicare	$868.00
Rate for Payer: UnitedHealthcare Medicare	$868.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINER RIM JJ/36 00-8752-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$1,436.00

Service Code	NDC 00054031950
Hospital Revenue Code	637
Min. Negotiated Rate	$445.16
Max. Negotiated Rate	$1,392.92
Rate for Payer: AlohaCare Medicaid	$718.00
Rate for Payer: AlohaCare Medicare	$445.16
Rate for Payer: Cash Price	$861.60
Rate for Payer: Devoted Health Medicare	$488.24
Rate for Payer: Hawaii Medical Service Association Medicare	$445.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,364.20
Rate for Payer: Health Management Network Commercial	$1,220.60
Rate for Payer: Humana Medicare	$445.16
Rate for Payer: Kaiser Permanente Commercial	$1,292.40
Rate for Payer: Kaiser Permanente Medicaid	$732.36
Rate for Payer: Kaiser Permanente Medicare	$445.16
Rate for Payer: MDX Hawaii PPO	$1,392.92
Rate for Payer: Ohana Health Plan Medicaid	$445.16
Rate for Payer: Ohana Health Plan Medicare	$445.16
Rate for Payer: UnitedHealthcare Medicare	$445.16
Rate for Payer: University Health Alliance Commercial	$1,046.70

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

$607.00

Service Code	NDC 60687075405
Hospital Revenue Code	250
Min. Negotiated Rate	$515.95
Max. Negotiated Rate	$588.79
Rate for Payer: Cash Price	$364.20
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Kaiser Permanente Commercial	$546.30
Rate for Payer: MDX Hawaii PPO	$588.79

Know your out-of-pocket cost for care.

All Charges