Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

IP

$1,436.00

Service Code	NDC 00054031950
Hospital Revenue Code	250
Min. Negotiated Rate	$1,220.60
Max. Negotiated Rate	$1,392.92
Rate for Payer: Cash Price	$861.60
Rate for Payer: Health Management Network Commercial	$1,220.60
Rate for Payer: Kaiser Permanente Commercial	$1,292.40
Rate for Payer: MDX Hawaii PPO	$1,392.92

LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]

Facility

IP

$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

LINEZOLID 600 MG TABLET [28224]

Facility

OP

$276.00

Service Code	NDC 67877041933
Hospital Revenue Code	637
Min. Negotiated Rate	$85.56
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$85.56
Rate for Payer: Cash Price	$165.60
Rate for Payer: Devoted Health Medicare	$93.84
Rate for Payer: Hawaii Medical Service Association Medicare	$85.56
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$85.56
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$85.56
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$85.56
Rate for Payer: Ohana Health Plan Medicare	$85.56
Rate for Payer: UnitedHealthcare Medicare	$85.56
Rate for Payer: University Health Alliance Commercial	$201.18

LINEZOLID 600 MG TABLET [28224]

Facility

OP

$190.00

Service Code	NDC 60687030921
Hospital Revenue Code	637
Min. Negotiated Rate	$58.90
Max. Negotiated Rate	$184.30
Rate for Payer: AlohaCare Medicaid	$95.00
Rate for Payer: AlohaCare Medicare	$58.90
Rate for Payer: Cash Price	$114.00
Rate for Payer: Devoted Health Medicare	$64.60
Rate for Payer: Hawaii Medical Service Association Medicare	$58.90
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Humana Medicare	$58.90
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: Kaiser Permanente Medicare	$58.90
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: Ohana Health Plan Medicaid	$58.90
Rate for Payer: Ohana Health Plan Medicare	$58.90
Rate for Payer: UnitedHealthcare Medicare	$58.90
Rate for Payer: University Health Alliance Commercial	$138.49

LINEZOLID 600 MG TABLET [28224]

Facility

IP

$190.00

Service Code	NDC 60687030921
Hospital Revenue Code	250
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: MDX Hawaii PPO	$184.30

LINEZOLID 600 MG TABLET [28224]

Facility

IP

$276.00

Service Code	NDC 67877041984
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

LINEZOLID 600 MG TABLET [28224]

Facility

IP

$276.00

Service Code	NDC 67877041933
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

LINEZOLID 600 MG TABLET [28224]

Facility

OP

$276.00

Service Code	NDC 67877041984
Hospital Revenue Code	637
Min. Negotiated Rate	$85.56
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$85.56
Rate for Payer: Cash Price	$165.60
Rate for Payer: Devoted Health Medicare	$93.84
Rate for Payer: Hawaii Medical Service Association Medicare	$85.56
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$85.56
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$85.56
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$85.56
Rate for Payer: Ohana Health Plan Medicare	$85.56
Rate for Payer: UnitedHealthcare Medicare	$85.56
Rate for Payer: University Health Alliance Commercial	$201.18

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [131499]

Facility

OP

$80.00

Service Code	HCPCS J2020
Hospital Revenue Code	636
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$24.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Devoted Health Medicare	$27.20
Rate for Payer: Hawaii Medical Service Association ABD	$3.47
Rate for Payer: Hawaii Medical Service Association Medicare	$24.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.47
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$24.80
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$24.80
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$24.80
Rate for Payer: Ohana Health Plan Medicare	$24.80
Rate for Payer: UnitedHealthcare Medicaid	$48.00
Rate for Payer: UnitedHealthcare Medicare	$24.80
Rate for Payer: University Health Alliance Commercial	$58.31

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [131499]

Facility

IP

$80.00

Service Code	HCPCS J2020
Hospital Revenue Code	250
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

LIPASE-PROTEASE-AMYLASE (PORK) 15,000-47,000-63K UNIT CAPSULE,DEL REL [208816]

Facility

OP

$22.00

Service Code	NDC 73562011101
Hospital Revenue Code	637
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$6.82
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: University Health Alliance Commercial	$16.04

LIPASE-PROTEASE-AMYLASE (PORK) 15,000-47,000-63K UNIT CAPSULE,DEL REL [208816]

Facility

IP

$22.00

Service Code	NDC 73562011101
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

LIPASE-PROTEASE-AMYLASE(PORK)5,000-17,000-24,000 UNIT CAPSULE, DEL REL [151365]

Facility

OP

$9.00

Service Code	NDC 73562011501
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

LIPASE-PROTEASE-AMYLASE(PORK)5,000-17,000-24,000 UNIT CAPSULE, DEL REL [151365]

Facility

IP

$9.00

Service Code	NDC 73562011501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

LIPOASPIRATE WASH VIALITY-1400

Facility

OP

$2,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$646.35
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$646.35
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Devoted Health Medicare	$708.90
Rate for Payer: Hawaii Medical Service Association Medicare	$646.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,980.75
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$646.35
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$646.35
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$646.35
Rate for Payer: Ohana Health Plan Medicare	$646.35
Rate for Payer: UnitedHealthcare Medicare	$646.35
Rate for Payer: University Health Alliance Commercial	$1,519.76

LIPOASPIRATE WASH VIALITY-1400

Facility

IP

$2,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,772.25
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45

LIPOFILTER CANISTER ASP-CAN-2S

Facility

OP

$863.00

Hospital Revenue Code	272
Min. Negotiated Rate	$267.53
Max. Negotiated Rate	$837.11
Rate for Payer: AlohaCare Medicaid	$431.50
Rate for Payer: AlohaCare Medicare	$267.53
Rate for Payer: Cash Price	$517.80
Rate for Payer: Devoted Health Medicare	$293.42
Rate for Payer: Hawaii Medical Service Association Medicare	$267.53
Rate for Payer: Hawaii Western Management Group Commercial	$819.85
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: Humana Medicare	$267.53
Rate for Payer: Kaiser Permanente Commercial	$776.70
Rate for Payer: Kaiser Permanente Medicaid	$440.13
Rate for Payer: Kaiser Permanente Medicare	$267.53
Rate for Payer: MDX Hawaii PPO	$837.11
Rate for Payer: Ohana Health Plan Medicaid	$267.53
Rate for Payer: Ohana Health Plan Medicare	$267.53
Rate for Payer: UnitedHealthcare Medicare	$267.53
Rate for Payer: University Health Alliance Commercial	$629.04

LIPOFILTER CANISTER ASP-CAN-2S

Facility

IP

$863.00

Hospital Revenue Code	272
Min. Negotiated Rate	$733.55
Max. Negotiated Rate	$837.11
Rate for Payer: Cash Price	$517.80
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: Kaiser Permanente Commercial	$776.70
Rate for Payer: MDX Hawaii PPO	$837.11

LIPOTOWER BIOFILTER ASP-FLTR

Facility

OP

$213.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.03
Max. Negotiated Rate	$206.61
Rate for Payer: AlohaCare Medicaid	$106.50
Rate for Payer: AlohaCare Medicare	$66.03
Rate for Payer: Cash Price	$127.80
Rate for Payer: Devoted Health Medicare	$72.42
Rate for Payer: Hawaii Medical Service Association Medicare	$66.03
Rate for Payer: Hawaii Western Management Group Commercial	$202.35
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Humana Medicare	$66.03
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: Kaiser Permanente Medicare	$66.03
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: Ohana Health Plan Medicaid	$66.03
Rate for Payer: Ohana Health Plan Medicare	$66.03
Rate for Payer: UnitedHealthcare Medicare	$66.03
Rate for Payer: University Health Alliance Commercial	$155.26

LIPOTOWER BIOFILTER ASP-FLTR

Facility

IP

$213.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$127.80
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: MDX Hawaii PPO	$206.61

LISINOPRIL 10 MG TABLET [10449]

Facility

OP

$1.00

Service Code	NDC 00904679861
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

LISINOPRIL 10 MG TABLET [10449]

Facility

IP

$1.00

Service Code	NDC 00904679861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LISINOPRIL 10 MG TABLET [10449]

Facility

OP

$1.00

Service Code	NDC 60687032501
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

LISINOPRIL 10 MG TABLET [10449]

Facility

IP

$1.00

Service Code	NDC 60687032501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LISINOPRIL 20 MG TABLET [4526]

Facility

OP

$1.00

Service Code	NDC 60687033301
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

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