Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

lopinavir-ritonavir 200 mg-50 mg Tab [KMC]

Facility

$28.57

Service Code	NDC 00074679922
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$27.71
Rate for Payer: AlohaCare Medicaid	$14.29
Rate for Payer: AlohaCare Medicare	$12.00
Rate for Payer: Cash Price	$18.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$26.28
Rate for Payer: Devoted Health Medicare	$12.00
Rate for Payer: Hawaii Medical Service Association Medicare	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$27.14
Rate for Payer: Health Management Network Commercial	$24.28
Rate for Payer: Humana Medicare	$12.00
Rate for Payer: Kaiser Permanente Commercial	$25.71
Rate for Payer: Kaiser Permanente Medicaid	$14.57
Rate for Payer: Kaiser Permanente Medicare	$12.00
Rate for Payer: MDX Hawaii PPO	$27.71
Rate for Payer: Ohana Health Plan Medicaid	$12.00
Rate for Payer: Ohana Health Plan Medicare	$12.00
Rate for Payer: UnitedHealthcare Medicaid	$17.14
Rate for Payer: UnitedHealthcare Medicare	$12.00
Rate for Payer: University Health Alliance Commercial	$20.82

loratadine 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 45802065065
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

loratadine 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 45802065065
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

loratadine 5 mg/5 mL Syr [KMC]

Facility

$0.30

Service Code	NDC 49348063634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.29
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Management Network Commercial	$0.26
Rate for Payer: Kaiser Permanente Commercial	$0.27
Rate for Payer: MDX Hawaii PPO	$0.29

loratadine 5 mg/5 mL Syr [KMC]

Facility

$0.30

Service Code	NDC 49348063634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.29
Rate for Payer: AlohaCare Medicaid	$0.15
Rate for Payer: AlohaCare Medicare	$0.13
Rate for Payer: Cash Price	$0.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.28
Rate for Payer: Devoted Health Medicare	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$0.29
Rate for Payer: Health Management Network Commercial	$0.26
Rate for Payer: Humana Medicare	$0.13
Rate for Payer: Kaiser Permanente Commercial	$0.27
Rate for Payer: Kaiser Permanente Medicaid	$0.15
Rate for Payer: Kaiser Permanente Medicare	$0.13
Rate for Payer: MDX Hawaii PPO	$0.29
Rate for Payer: Ohana Health Plan Medicaid	$0.13
Rate for Payer: Ohana Health Plan Medicare	$0.13
Rate for Payer: UnitedHealthcare Medicaid	$0.18
Rate for Payer: UnitedHealthcare Medicare	$0.13
Rate for Payer: University Health Alliance Commercial	$0.22

loratadine-pseudoePHEDrine 10 mg-240 mg ER Tab [KMC]

Facility

$3.00

Service Code	NDC 51660072415
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

loratadine-pseudoePHEDrine 10 mg-240 mg ER Tab [KMC]

Facility

$3.00

Service Code	NDC 51660072415
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

loratadine-pseudoePHEDrine 5 mg-120 mg ER Tab [KMC]

Facility

$3.00

Service Code	NDC 45802010639
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

loratadine-pseudoePHEDrine 5 mg-120 mg ER Tab [KMC]

Facility

$3.00

Service Code	NDC 45802010639
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

LORazepam 0.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 63304077201
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

LORazepam 0.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 63304077201
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

LORazepam 1 mg / 0.5 mL ORAL Conc [KMC]

Facility

$6.40

Service Code	NDC 50383070530
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$6.21
Rate for Payer: Cash Price	$4.16
Rate for Payer: Health Management Network Commercial	$5.44
Rate for Payer: Kaiser Permanente Commercial	$5.76
Rate for Payer: MDX Hawaii PPO	$6.21

LORazepam 1 mg / 0.5 mL ORAL Conc [KMC]

Facility

$6.40

Service Code	NDC 50383070530
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$6.21
Rate for Payer: AlohaCare Medicaid	$3.20
Rate for Payer: AlohaCare Medicare	$2.69
Rate for Payer: Cash Price	$4.16
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.89
Rate for Payer: Devoted Health Medicare	$2.69
Rate for Payer: Hawaii Medical Service Association Medicare	$2.69
Rate for Payer: Hawaii Western Management Group Commercial	$6.08
Rate for Payer: Health Management Network Commercial	$5.44
Rate for Payer: Humana Medicare	$2.69
Rate for Payer: Kaiser Permanente Commercial	$5.76
Rate for Payer: Kaiser Permanente Medicaid	$3.26
Rate for Payer: Kaiser Permanente Medicare	$2.69
Rate for Payer: MDX Hawaii PPO	$6.21
Rate for Payer: Ohana Health Plan Medicaid	$2.69
Rate for Payer: Ohana Health Plan Medicare	$2.69
Rate for Payer: UnitedHealthcare Medicaid	$3.84
Rate for Payer: UnitedHealthcare Medicare	$2.69
Rate for Payer: University Health Alliance Commercial	$4.66

LORazepam 2 mg/mL Inj Sol [KMC]

Facility

$14.23

Service Code	HCPCS J2060
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$13.80
Rate for Payer: AlohaCare Medicaid	$7.12
Rate for Payer: AlohaCare Medicare	$5.98
Rate for Payer: Cash Price	$9.25
Rate for Payer: Cash Price	$9.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.09
Rate for Payer: Devoted Health Medicare	$5.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.32
Rate for Payer: Hawaii Medical Service Association Medicare	$5.98
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$12.10
Rate for Payer: Humana Medicare	$5.98
Rate for Payer: Kaiser Permanente Commercial	$12.81
Rate for Payer: Kaiser Permanente Medicaid	$7.26
Rate for Payer: Kaiser Permanente Medicare	$5.98
Rate for Payer: MDX Hawaii PPO	$13.80
Rate for Payer: Ohana Health Plan Medicaid	$5.98
Rate for Payer: Ohana Health Plan Medicare	$5.98
Rate for Payer: UnitedHealthcare Medicaid	$8.54
Rate for Payer: UnitedHealthcare Medicare	$5.98
Rate for Payer: University Health Alliance Commercial	$10.37

LORazepam 2 mg/mL Inj Sol [KMC]

Facility

$14.23

Service Code	HCPCS J2060
Hospital Revenue Code	636
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$13.80
Rate for Payer: Cash Price	$9.25
Rate for Payer: Health Management Network Commercial	$12.10
Rate for Payer: Kaiser Permanente Commercial	$12.81
Rate for Payer: MDX Hawaii PPO	$13.80

losartan 100 mg Tab [KMC]

Facility

$12.25

Service Code	NDC 31722070290
Hospital Revenue Code	250
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$11.88
Rate for Payer: Cash Price	$7.96
Rate for Payer: Health Management Network Commercial	$10.41
Rate for Payer: Kaiser Permanente Commercial	$11.03
Rate for Payer: MDX Hawaii PPO	$11.88

losartan 100 mg Tab [KMC]

Facility

$12.25

Service Code	NDC 31722070290
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$11.88
Rate for Payer: AlohaCare Medicaid	$6.12
Rate for Payer: AlohaCare Medicare	$5.14
Rate for Payer: Cash Price	$7.96
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.27
Rate for Payer: Devoted Health Medicare	$5.14
Rate for Payer: Hawaii Medical Service Association Medicare	$5.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.64
Rate for Payer: Health Management Network Commercial	$10.41
Rate for Payer: Humana Medicare	$5.14
Rate for Payer: Kaiser Permanente Commercial	$11.03
Rate for Payer: Kaiser Permanente Medicaid	$6.25
Rate for Payer: Kaiser Permanente Medicare	$5.14
Rate for Payer: MDX Hawaii PPO	$11.88
Rate for Payer: Ohana Health Plan Medicaid	$5.14
Rate for Payer: Ohana Health Plan Medicare	$5.14
Rate for Payer: UnitedHealthcare Medicaid	$7.35
Rate for Payer: UnitedHealthcare Medicare	$5.14
Rate for Payer: University Health Alliance Commercial	$8.93

losartan 25 mg Tab [KMC]

Facility

$6.71

Service Code	NDC 72603034001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$6.51
Rate for Payer: AlohaCare Medicaid	$3.35
Rate for Payer: AlohaCare Medicare	$2.82
Rate for Payer: Cash Price	$4.36
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.17
Rate for Payer: Devoted Health Medicare	$2.82
Rate for Payer: Hawaii Medical Service Association Medicare	$2.82
Rate for Payer: Hawaii Western Management Group Commercial	$6.37
Rate for Payer: Health Management Network Commercial	$5.70
Rate for Payer: Humana Medicare	$2.82
Rate for Payer: Kaiser Permanente Commercial	$6.04
Rate for Payer: Kaiser Permanente Medicaid	$3.42
Rate for Payer: Kaiser Permanente Medicare	$2.82
Rate for Payer: MDX Hawaii PPO	$6.51
Rate for Payer: Ohana Health Plan Medicaid	$2.82
Rate for Payer: Ohana Health Plan Medicare	$2.82
Rate for Payer: UnitedHealthcare Medicaid	$4.03
Rate for Payer: UnitedHealthcare Medicare	$2.82
Rate for Payer: University Health Alliance Commercial	$4.89

losartan 25 mg Tab [KMC]

Facility

$6.71

Service Code	NDC 72603034001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$6.51
Rate for Payer: Cash Price	$4.36
Rate for Payer: Health Management Network Commercial	$5.70
Rate for Payer: Kaiser Permanente Commercial	$6.04
Rate for Payer: MDX Hawaii PPO	$6.51

losartan 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 63739068610
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

losartan 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 63739068610
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

loteprednol ophthalmic 0.5% Susp [KMC]

Facility

$241.90

Service Code	NDC 24208029905
Hospital Revenue Code	250
Min. Negotiated Rate	$101.60
Max. Negotiated Rate	$234.64
Rate for Payer: AlohaCare Medicaid	$120.95
Rate for Payer: AlohaCare Medicare	$101.60
Rate for Payer: Cash Price	$157.24
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$222.55
Rate for Payer: Devoted Health Medicare	$101.60
Rate for Payer: Hawaii Medical Service Association Medicare	$101.60
Rate for Payer: Hawaii Western Management Group Commercial	$229.81
Rate for Payer: Health Management Network Commercial	$205.62
Rate for Payer: Humana Medicare	$101.60
Rate for Payer: Kaiser Permanente Commercial	$217.71
Rate for Payer: Kaiser Permanente Medicaid	$123.37
Rate for Payer: Kaiser Permanente Medicare	$101.60
Rate for Payer: MDX Hawaii PPO	$234.64
Rate for Payer: Ohana Health Plan Medicaid	$101.60
Rate for Payer: Ohana Health Plan Medicare	$101.60
Rate for Payer: UnitedHealthcare Medicaid	$145.14
Rate for Payer: UnitedHealthcare Medicare	$101.60
Rate for Payer: University Health Alliance Commercial	$176.32

loteprednol ophthalmic 0.5% Susp [KMC]

Facility

$241.90

Service Code	NDC 24208029905
Hospital Revenue Code	250
Min. Negotiated Rate	$205.62
Max. Negotiated Rate	$234.64
Rate for Payer: Cash Price	$157.24
Rate for Payer: Health Management Network Commercial	$205.62
Rate for Payer: Kaiser Permanente Commercial	$217.71
Rate for Payer: MDX Hawaii PPO	$234.64

lovastatin 20 mg Tab [KMC]

Facility

$9.49

Service Code	NDC 68180046801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$9.21
Rate for Payer: AlohaCare Medicaid	$4.75
Rate for Payer: AlohaCare Medicare	$3.99
Rate for Payer: Cash Price	$6.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.73
Rate for Payer: Devoted Health Medicare	$3.99
Rate for Payer: Hawaii Medical Service Association Medicare	$3.99
Rate for Payer: Hawaii Western Management Group Commercial	$9.02
Rate for Payer: Health Management Network Commercial	$8.07
Rate for Payer: Humana Medicare	$3.99
Rate for Payer: Kaiser Permanente Commercial	$8.54
Rate for Payer: Kaiser Permanente Medicaid	$4.84
Rate for Payer: Kaiser Permanente Medicare	$3.99
Rate for Payer: MDX Hawaii PPO	$9.21
Rate for Payer: Ohana Health Plan Medicaid	$3.99
Rate for Payer: Ohana Health Plan Medicare	$3.99
Rate for Payer: UnitedHealthcare Medicaid	$5.69
Rate for Payer: UnitedHealthcare Medicare	$3.99
Rate for Payer: University Health Alliance Commercial	$6.92

lovastatin 20 mg Tab [KMC]

Facility

$9.49

Service Code	NDC 68180046801
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$9.21
Rate for Payer: Cash Price	$6.17
Rate for Payer: Health Management Network Commercial	$8.07
Rate for Payer: Kaiser Permanente Commercial	$8.54
Rate for Payer: MDX Hawaii PPO	$9.21

Know your out-of-pocket cost for care.

All Charges