Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

liothyronine 25 mcg Tab [KMC]

Facility

$3.00

Service Code	NDC 60793011601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

liothyronine 5 mcg Tab [KMC]

Facility

$3.00

Service Code	NDC 60793011501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

liothyronine 5 mcg Tab [KMC]

Facility

$3.00

Service Code	NDC 60793011501
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

Lipase DLS

Facility

$69.00

Service Code	HCPCS 83690
Hospital Charge Code	422836905
Hospital Revenue Code	301
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.52
Rate for Payer: Hawaii Medical Service Association Commercial	$8.61
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$6.89
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$17.80

Lipase DLS

Facility

$69.00

Service Code	HCPCS 83690
Hospital Charge Code	422836905
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Lipase Level

Facility

$69.00

Service Code	HCPCS 83690
Hospital Charge Code	422836900
Hospital Revenue Code	301
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.52
Rate for Payer: Hawaii Medical Service Association Commercial	$8.61
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$6.89
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$17.80

Lipase Level

Facility

$69.00

Service Code	HCPCS 83690
Hospital Charge Code	422836900
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

lipid 20% (50 gm / 250 mL) IV emulsion [KMC]

Facility

$0.50

Service Code	NDC 63323082074
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.49
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Management Network Commercial	$0.43
Rate for Payer: Kaiser Permanente Commercial	$0.45
Rate for Payer: MDX Hawaii PPO	$0.49

lipid 20% (50 gm / 250 mL) IV emulsion [KMC]

Facility

$0.50

Service Code	NDC 63323082074
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.49
Rate for Payer: AlohaCare Medicaid	$0.25
Rate for Payer: AlohaCare Medicare	$0.21
Rate for Payer: Cash Price	$0.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.46
Rate for Payer: Devoted Health Medicare	$0.21
Rate for Payer: Hawaii Medical Service Association Medicare	$0.21
Rate for Payer: Hawaii Western Management Group Commercial	$0.48
Rate for Payer: Health Management Network Commercial	$0.43
Rate for Payer: Humana Medicare	$0.21
Rate for Payer: Kaiser Permanente Commercial	$0.45
Rate for Payer: Kaiser Permanente Medicaid	$0.26
Rate for Payer: Kaiser Permanente Medicare	$0.21
Rate for Payer: MDX Hawaii PPO	$0.49
Rate for Payer: Ohana Health Plan Medicaid	$0.21
Rate for Payer: Ohana Health Plan Medicare	$0.21
Rate for Payer: UnitedHealthcare Medicaid	$0.30
Rate for Payer: UnitedHealthcare Medicare	$0.21
Rate for Payer: University Health Alliance Commercial	$0.36

Lipid 20% IV emulsion [KMC]

Facility

$0.18

Service Code	NDC 00264446000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Management Network Commercial	$0.15
Rate for Payer: Kaiser Permanente Commercial	$0.16
Rate for Payer: MDX Hawaii PPO	$0.17

Lipid 20% IV emulsion [KMC]

Facility

$0.18

Service Code	NDC 00264446000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.17
Rate for Payer: AlohaCare Medicaid	$0.09
Rate for Payer: AlohaCare Medicare	$0.08
Rate for Payer: Cash Price	$0.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Hawaii Medical Service Association Medicare	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$0.17
Rate for Payer: Health Management Network Commercial	$0.15
Rate for Payer: Humana Medicare	$0.08
Rate for Payer: Kaiser Permanente Commercial	$0.16
Rate for Payer: Kaiser Permanente Medicaid	$0.09
Rate for Payer: Kaiser Permanente Medicare	$0.08
Rate for Payer: MDX Hawaii PPO	$0.17
Rate for Payer: Ohana Health Plan Medicaid	$0.08
Rate for Payer: Ohana Health Plan Medicare	$0.08
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicare	$0.08
Rate for Payer: University Health Alliance Commercial	$0.13

Lipid Panel

Facility

$301.00

Service Code	HCPCS 80061
Hospital Charge Code	422800610
Hospital Revenue Code	301
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$126.42
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.92
Rate for Payer: Devoted Health Medicare	$126.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.51
Rate for Payer: Hawaii Medical Service Association Commercial	$16.74
Rate for Payer: Hawaii Medical Service Association Medicare	$126.42
Rate for Payer: Hawaii Western Management Group Commercial	$13.39
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$126.42
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$126.42
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$126.42
Rate for Payer: Ohana Health Plan Medicare	$126.42
Rate for Payer: UnitedHealthcare Medicaid	$18.51
Rate for Payer: UnitedHealthcare Medicare	$126.42
Rate for Payer: University Health Alliance Commercial	$34.63

Lipid Panel

Facility

$301.00

Service Code	HCPCS 80061
Hospital Charge Code	422800610
Hospital Revenue Code	301
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

Lipid Panel 3

Facility

$301.00

Service Code	HCPCS 80061
Hospital Charge Code	422800610
Hospital Revenue Code	301
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$126.42
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.92
Rate for Payer: Devoted Health Medicare	$126.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.51
Rate for Payer: Hawaii Medical Service Association Commercial	$16.74
Rate for Payer: Hawaii Medical Service Association Medicare	$126.42
Rate for Payer: Hawaii Western Management Group Commercial	$13.39
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$126.42
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$126.42
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$126.42
Rate for Payer: Ohana Health Plan Medicare	$126.42
Rate for Payer: UnitedHealthcare Medicaid	$18.51
Rate for Payer: UnitedHealthcare Medicare	$126.42
Rate for Payer: University Health Alliance Commercial	$34.63

Lipid Panel 3

Facility

$301.00

Service Code	HCPCS 80061
Hospital Charge Code	422800610
Hospital Revenue Code	301
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

Lipid Profile DLS

Facility

$301.00

Service Code	HCPCS 80061
Hospital Charge Code	422800615
Hospital Revenue Code	301
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$126.42
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.92
Rate for Payer: Devoted Health Medicare	$126.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.51
Rate for Payer: Hawaii Medical Service Association Commercial	$16.74
Rate for Payer: Hawaii Medical Service Association Medicare	$126.42
Rate for Payer: Hawaii Western Management Group Commercial	$13.39
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$126.42
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$126.42
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$126.42
Rate for Payer: Ohana Health Plan Medicare	$126.42
Rate for Payer: UnitedHealthcare Medicaid	$18.51
Rate for Payer: UnitedHealthcare Medicare	$126.42
Rate for Payer: University Health Alliance Commercial	$34.63

Lipid Profile DLS

Facility

$301.00

Service Code	HCPCS 80061
Hospital Charge Code	422800615
Hospital Revenue Code	301
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

Lipids 20% IV emulsion 500 mL [KMC]

Facility

$0.16

Service Code	NDC 00409979103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Kaiser Permanente Commercial	$0.14
Rate for Payer: MDX Hawaii PPO	$0.16

Lipids 20% IV emulsion 500 mL [KMC]

Facility

$0.16

Service Code	NDC 00409979103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: AlohaCare Medicaid	$0.08
Rate for Payer: AlohaCare Medicare	$0.07
Rate for Payer: Cash Price	$0.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.15
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Hawaii Medical Service Association Medicare	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$0.15
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Humana Medicare	$0.07
Rate for Payer: Kaiser Permanente Commercial	$0.14
Rate for Payer: Kaiser Permanente Medicaid	$0.08
Rate for Payer: Kaiser Permanente Medicare	$0.07
Rate for Payer: MDX Hawaii PPO	$0.16
Rate for Payer: Ohana Health Plan Medicaid	$0.07
Rate for Payer: Ohana Health Plan Medicare	$0.07
Rate for Payer: UnitedHealthcare Medicaid	$0.10
Rate for Payer: UnitedHealthcare Medicare	$0.07
Rate for Payer: University Health Alliance Commercial	$0.12

LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL

Professional

Both

$34.00

Service Code	HCPCS 83718
Hospital Revenue Code	300
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$28.90
Rate for Payer: AlohaCare Medicaid	$11.31
Rate for Payer: AlohaCare Medicare	$8.19
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$8.19
Rate for Payer: Hawaii Medical Service Association Medicare	$8.19
Rate for Payer: Hawaii Western Management Group Commercial	$11.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$9.83
Rate for Payer: Kaiser Permanente Medicaid	$9.83
Rate for Payer: Kaiser Permanente Medicare	$9.83
Rate for Payer: Ohana Health Plan Medicaid	$11.31
Rate for Payer: Ohana Health Plan Medicare	$8.19
Rate for Payer: UnitedHealthcare Medicaid	$11.31
Rate for Payer: UnitedHealthcare Medicare	$8.19

liraglutide 18 mg/3 mL Soln [KMC]

Facility

$422.01

Service Code	NDC 00169406012
Hospital Revenue Code	250
Min. Negotiated Rate	$358.71
Max. Negotiated Rate	$409.35
Rate for Payer: Cash Price	$274.31
Rate for Payer: Health Management Network Commercial	$358.71
Rate for Payer: Kaiser Permanente Commercial	$379.81
Rate for Payer: MDX Hawaii PPO	$409.35

liraglutide 18 mg/3 mL Soln [KMC]

Facility

$422.01

Service Code	NDC 00169406012
Hospital Revenue Code	250
Min. Negotiated Rate	$177.24
Max. Negotiated Rate	$409.35
Rate for Payer: AlohaCare Medicaid	$211.00
Rate for Payer: AlohaCare Medicare	$177.24
Rate for Payer: Cash Price	$274.31
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$388.25
Rate for Payer: Devoted Health Medicare	$177.24
Rate for Payer: Hawaii Medical Service Association Medicare	$177.24
Rate for Payer: Hawaii Western Management Group Commercial	$400.91
Rate for Payer: Health Management Network Commercial	$358.71
Rate for Payer: Humana Medicare	$177.24
Rate for Payer: Kaiser Permanente Commercial	$379.81
Rate for Payer: Kaiser Permanente Medicaid	$215.23
Rate for Payer: Kaiser Permanente Medicare	$177.24
Rate for Payer: MDX Hawaii PPO	$409.35
Rate for Payer: Ohana Health Plan Medicaid	$177.24
Rate for Payer: Ohana Health Plan Medicare	$177.24
Rate for Payer: UnitedHealthcare Medicaid	$253.21
Rate for Payer: UnitedHealthcare Medicare	$177.24
Rate for Payer: University Health Alliance Commercial	$307.60

lisinopril 10 mg Tab [KMC]

Facility

$3.97

Service Code	NDC 68180098001
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.85
Rate for Payer: Cash Price	$2.58
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: MDX Hawaii PPO	$3.85

lisinopril 10 mg Tab [KMC]

Facility

$3.97

Service Code	NDC 68180098001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$3.85
Rate for Payer: AlohaCare Medicaid	$1.99
Rate for Payer: AlohaCare Medicare	$1.67
Rate for Payer: Cash Price	$2.58
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.65
Rate for Payer: Devoted Health Medicare	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$1.67
Rate for Payer: Hawaii Western Management Group Commercial	$3.77
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Humana Medicare	$1.67
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: Kaiser Permanente Medicaid	$2.02
Rate for Payer: Kaiser Permanente Medicare	$1.67
Rate for Payer: MDX Hawaii PPO	$3.85
Rate for Payer: Ohana Health Plan Medicaid	$1.67
Rate for Payer: Ohana Health Plan Medicare	$1.67
Rate for Payer: UnitedHealthcare Medicaid	$2.38
Rate for Payer: UnitedHealthcare Medicare	$1.67
Rate for Payer: University Health Alliance Commercial	$2.89

lisinopril 20 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904679961
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

Know your out-of-pocket cost for care.

All Charges