Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

linezolid 600 mg tablet [HHSC]

Facility

$625.85

Service Code	NDC 67877041984
Hospital Charge Code	2500489
Hospital Revenue Code	250
Min. Negotiated Rate	$531.97
Max. Negotiated Rate	$607.07
Rate for Payer: Cash Price	$406.80
Rate for Payer: Health Management Network Commercial	$531.97
Rate for Payer: Kaiser Permanente Commercial	$563.26
Rate for Payer: MDX Hawaii PPO	$607.07

linezolid 600 mg tablet [HHSC]

Facility

$506.04

Service Code	NDC 60687030921
Hospital Charge Code	2500489
Hospital Revenue Code	250
Min. Negotiated Rate	$253.02
Max. Negotiated Rate	$490.86
Rate for Payer: AlohaCare Medicaid	$253.02
Rate for Payer: AlohaCare Medicare	$253.02
Rate for Payer: Cash Price	$328.93
Rate for Payer: Devoted Health Medicare	$278.32
Rate for Payer: Hawaii Medical Service Association Medicare	$253.02
Rate for Payer: Hawaii Western Management Group Commercial	$480.74
Rate for Payer: Health Management Network Commercial	$430.13
Rate for Payer: Humana Medicare	$253.02
Rate for Payer: Kaiser Permanente Commercial	$455.44
Rate for Payer: Kaiser Permanente Medicaid	$258.08
Rate for Payer: Kaiser Permanente Medicare	$253.02
Rate for Payer: MDX Hawaii PPO	$490.86
Rate for Payer: Ohana Health Plan Medicaid	$253.02
Rate for Payer: Ohana Health Plan Medicare	$253.02
Rate for Payer: UnitedHealthcare Medicaid	$303.62
Rate for Payer: UnitedHealthcare Medicare	$253.02
Rate for Payer: University Health Alliance Commercial	$368.85

Lipase FSI

Facility

$94.00

Service Code	HCPCS 83690
Hospital Charge Code	8117982
Hospital Revenue Code	301
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$61.10
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

Lipase FSI

Facility

$94.00

Service Code	HCPCS 83690
Hospital Charge Code	8117982
Hospital Revenue Code	301
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$47.00
Rate for Payer: Cash Price	$61.10
Rate for Payer: Cash Price	$61.10
Rate for Payer: Devoted Health Medicare	$51.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.52
Rate for Payer: Hawaii Medical Service Association Commercial	$8.61
Rate for Payer: Hawaii Medical Service Association Medicare	$47.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.00
Rate for Payer: Hawaii Western Management Group Commercial	$6.89
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$47.00
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$47.00
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$47.00
Rate for Payer: Ohana Health Plan Medicare	$47.00
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: UnitedHealthcare Medicare	$47.00
Rate for Payer: University Health Alliance Commercial	$17.80

Lipid Profile FSI

Facility

$154.00

Service Code	HCPCS 80061
Hospital Charge Code	8117983
Hospital Revenue Code	301
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

Lipid Profile FSI

Facility

$154.00

Service Code	HCPCS 80061
Hospital Charge Code	8117983
Hospital Revenue Code	301
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$77.00
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Devoted Health Medicare	$84.70
Rate for Payer: Hawaii Medical Service Association ABD	$18.51
Rate for Payer: Hawaii Medical Service Association Commercial	$16.74
Rate for Payer: Hawaii Medical Service Association Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.44
Rate for Payer: Hawaii Western Management Group Commercial	$13.39
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$77.00
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$77.00
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$77.00
Rate for Payer: Ohana Health Plan Medicare	$77.00
Rate for Payer: UnitedHealthcare Medicaid	$18.51
Rate for Payer: UnitedHealthcare Medicare	$77.00
Rate for Payer: University Health Alliance Commercial	$34.63

Lipoprotein (a) FSI

Facility

$177.00

Service Code	HCPCS 83695
Hospital Charge Code	8117984
Hospital Revenue Code	301
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$88.50
Rate for Payer: Cash Price	$115.05
Rate for Payer: Cash Price	$115.05
Rate for Payer: Devoted Health Medicare	$97.35
Rate for Payer: Hawaii Medical Service Association ABD	$12.66
Rate for Payer: Hawaii Medical Service Association Commercial	$17.90
Rate for Payer: Hawaii Medical Service Association Medicare	$88.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.32
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$88.50
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$88.50
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$88.50
Rate for Payer: Ohana Health Plan Medicare	$88.50
Rate for Payer: UnitedHealthcare Medicaid	$12.66
Rate for Payer: UnitedHealthcare Medicare	$88.50
Rate for Payer: University Health Alliance Commercial	$33.47

Lipoprotein (a) FSI

Facility

$177.00

Service Code	HCPCS 83695
Hospital Charge Code	8117984
Hospital Revenue Code	301
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

lisinopril 20 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 60687033301
Hospital Charge Code	2500491
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

lisinopril 20 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904679961
Hospital Charge Code	2500491
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

lisinopril 20 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 60687033301
Hospital Charge Code	2500491
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

lisinopril 20 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904679961
Hospital Charge Code	2500491
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

lisinopril 5 mg tablet [HHSC]

Facility

$5.08

Service Code	NDC 51079098120
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.93
Rate for Payer: Cash Price	$3.30
Rate for Payer: Health Management Network Commercial	$4.32
Rate for Payer: Kaiser Permanente Commercial	$4.57
Rate for Payer: MDX Hawaii PPO	$4.93

lisinopril 5 mg tablet [HHSC]

Facility

$5.08

Service Code	NDC 51079098120
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$4.93
Rate for Payer: AlohaCare Medicaid	$2.54
Rate for Payer: AlohaCare Medicare	$2.54
Rate for Payer: Cash Price	$3.30
Rate for Payer: Devoted Health Medicare	$2.79
Rate for Payer: Hawaii Medical Service Association Medicare	$2.54
Rate for Payer: Hawaii Western Management Group Commercial	$4.83
Rate for Payer: Health Management Network Commercial	$4.32
Rate for Payer: Humana Medicare	$2.54
Rate for Payer: Kaiser Permanente Commercial	$4.57
Rate for Payer: Kaiser Permanente Medicaid	$2.59
Rate for Payer: Kaiser Permanente Medicare	$2.54
Rate for Payer: MDX Hawaii PPO	$4.93
Rate for Payer: Ohana Health Plan Medicaid	$2.54
Rate for Payer: Ohana Health Plan Medicare	$2.54
Rate for Payer: UnitedHealthcare Medicaid	$3.05
Rate for Payer: UnitedHealthcare Medicare	$2.54
Rate for Payer: University Health Alliance Commercial	$3.70

lisinopril 5 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904679761
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

lisinopril 5 mg tablet [HHSC]

Facility

$4.85

Service Code	NDC 68084019601
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$4.70
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Management Network Commercial	$4.12
Rate for Payer: Kaiser Permanente Commercial	$4.37
Rate for Payer: MDX Hawaii PPO	$4.70

lisinopril 5 mg tablet [HHSC]

Facility

$4.85

Service Code	NDC 60687066701
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$4.70
Rate for Payer: AlohaCare Medicaid	$2.42
Rate for Payer: AlohaCare Medicare	$2.42
Rate for Payer: Cash Price	$3.15
Rate for Payer: Devoted Health Medicare	$2.67
Rate for Payer: Hawaii Medical Service Association Medicare	$2.42
Rate for Payer: Hawaii Western Management Group Commercial	$4.61
Rate for Payer: Health Management Network Commercial	$4.12
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Kaiser Permanente Commercial	$4.37
Rate for Payer: Kaiser Permanente Medicaid	$2.47
Rate for Payer: Kaiser Permanente Medicare	$2.42
Rate for Payer: MDX Hawaii PPO	$4.70
Rate for Payer: Ohana Health Plan Medicaid	$2.42
Rate for Payer: Ohana Health Plan Medicare	$2.42
Rate for Payer: UnitedHealthcare Medicaid	$2.91
Rate for Payer: UnitedHealthcare Medicare	$2.42
Rate for Payer: University Health Alliance Commercial	$3.54

lisinopril 5 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904679761
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

lisinopril 5 mg tablet [HHSC]

Facility

$4.85

Service Code	NDC 60687066701
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$4.70
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Management Network Commercial	$4.12
Rate for Payer: Kaiser Permanente Commercial	$4.37
Rate for Payer: MDX Hawaii PPO	$4.70

lisinopril 5 mg tablet [HHSC]

Facility

$4.85

Service Code	NDC 68084019601
Hospital Charge Code	2500492
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$4.70
Rate for Payer: AlohaCare Medicaid	$2.42
Rate for Payer: AlohaCare Medicare	$2.42
Rate for Payer: Cash Price	$3.15
Rate for Payer: Devoted Health Medicare	$2.67
Rate for Payer: Hawaii Medical Service Association Medicare	$2.42
Rate for Payer: Hawaii Western Management Group Commercial	$4.61
Rate for Payer: Health Management Network Commercial	$4.12
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Kaiser Permanente Commercial	$4.37
Rate for Payer: Kaiser Permanente Medicaid	$2.47
Rate for Payer: Kaiser Permanente Medicare	$2.42
Rate for Payer: MDX Hawaii PPO	$4.70
Rate for Payer: Ohana Health Plan Medicaid	$2.42
Rate for Payer: Ohana Health Plan Medicare	$2.42
Rate for Payer: UnitedHealthcare Medicaid	$2.91
Rate for Payer: UnitedHealthcare Medicare	$2.42
Rate for Payer: University Health Alliance Commercial	$3.54

Lithium FSI

Facility

$90.00

Service Code	HCPCS 80178
Hospital Charge Code	8117985
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association ABD	$9.13
Rate for Payer: Hawaii Medical Service Association Commercial	$8.26
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.59
Rate for Payer: Hawaii Western Management Group Commercial	$6.61
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicaid	$9.13
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$17.09

Lithium FSI

Facility

$90.00

Service Code	HCPCS 80178
Hospital Charge Code	8117985
Hospital Revenue Code	301
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM)

Facility

$5,655.00

Service Code	CPT 52317
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$385,754.48

Service Code	MSDRG 005
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$385,754.48
Rate for Payer: Hawaii Medical Service Association Commercial	$385,754.48
Rate for Payer: University Health Alliance Commercial	$10,400.00

LIVER TRANSPLANT WITHOUT MCC

Facility

$385,754.48

Service Code	MSDRG 006
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$385,754.48
Rate for Payer: Hawaii Medical Service Association Commercial	$385,754.48
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges