Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

LVP Dextrose 5% in Water 100 mL IV Solution [KMC]

Facility

$0.10

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Management Network Commercial	$0.09
Rate for Payer: Kaiser Permanente Commercial	$0.09
Rate for Payer: MDX Hawaii PPO	$0.10

LVP Dextrose 5% in Water 100 mL IV Solution [KMC]

Facility

$0.10

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$2.03
Rate for Payer: AlohaCare Medicaid	$0.05
Rate for Payer: AlohaCare Medicare	$0.04
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cash Price	$0.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.09
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.04
Rate for Payer: Hawaii Western Management Group Commercial	$0.10
Rate for Payer: Health Management Network Commercial	$0.09
Rate for Payer: Humana Medicare	$0.04
Rate for Payer: Kaiser Permanente Commercial	$0.09
Rate for Payer: Kaiser Permanente Medicaid	$0.05
Rate for Payer: Kaiser Permanente Medicare	$0.04
Rate for Payer: MDX Hawaii PPO	$0.10
Rate for Payer: Ohana Health Plan Medicaid	$0.04
Rate for Payer: Ohana Health Plan Medicare	$0.04
Rate for Payer: UnitedHealthcare Medicaid	$0.06
Rate for Payer: UnitedHealthcare Medicare	$0.04
Rate for Payer: University Health Alliance Commercial	$0.07

LVP Dextrose 5% in Water Soln 1000mL [KMC]

Facility

$0.02

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.03
Rate for Payer: AlohaCare Medicaid	$0.01
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.02
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.02
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.01
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

LVP Dextrose 5% in Water Soln 1000mL [KMC]

Facility

$0.02

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: MDX Hawaii PPO	$0.02

LVP Dextrose 5% in Water Soln 250mL [KMC]

Facility

$0.08

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Management Network Commercial	$0.07
Rate for Payer: Kaiser Permanente Commercial	$0.07
Rate for Payer: MDX Hawaii PPO	$0.08

LVP Dextrose 5% in Water Soln 250mL [KMC]

Facility

$0.08

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$2.03
Rate for Payer: AlohaCare Medicaid	$0.04
Rate for Payer: AlohaCare Medicare	$0.03
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cash Price	$0.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.07
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$0.08
Rate for Payer: Health Management Network Commercial	$0.07
Rate for Payer: Humana Medicare	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.07
Rate for Payer: Kaiser Permanente Medicaid	$0.04
Rate for Payer: Kaiser Permanente Medicare	$0.03
Rate for Payer: MDX Hawaii PPO	$0.08
Rate for Payer: Ohana Health Plan Medicaid	$0.03
Rate for Payer: Ohana Health Plan Medicare	$0.03
Rate for Payer: UnitedHealthcare Medicaid	$0.05
Rate for Payer: UnitedHealthcare Medicare	$0.03
Rate for Payer: University Health Alliance Commercial	$0.06

LVP Dextrose 5% in Water Soln 500mL [KMC]

Facility

$0.03

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.03
Rate for Payer: AlohaCare Medicaid	$0.02
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.03
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.03
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.02

LVP Dextrose 5% in Water Soln 500mL [KMC]

Facility

$0.03

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: MDX Hawaii PPO	$0.03

LVP solution Lactated Ringers 1000mL bag [KMC]

Facility

$0.01

Service Code	HCPCS J7120
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.01
Rate for Payer: MDX Hawaii PPO	$0.01

LVP solution Lactated Ringers 1000mL bag [KMC]

Facility

$0.01

Service Code	HCPCS J7120
Hospital Revenue Code	636
Max. Negotiated Rate	$2.46
Rate for Payer: AlohaCare Medicaid	$0.01
Rate for Payer: AlohaCare Medicare	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Medicare	$0.00
Rate for Payer: Hawaii Western Management Group Commercial	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Humana Medicare	$0.00
Rate for Payer: Kaiser Permanente Commercial	$0.01
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: Kaiser Permanente Medicare	$0.00
Rate for Payer: MDX Hawaii PPO	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$0.00
Rate for Payer: Ohana Health Plan Medicare	$0.00
Rate for Payer: UnitedHealthcare Medicaid	$0.01
Rate for Payer: UnitedHealthcare Medicare	$0.00
Rate for Payer: University Health Alliance Commercial	$0.01

LVP solution Sodium Chloride 0.9% Sol 1000mL [KMC]

Facility

$0.02

Service Code	HCPCS J7030
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.28
Rate for Payer: AlohaCare Medicaid	$0.01
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.02
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.02
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.01
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

LVP solution Sodium Chloride 0.9% Sol 1000mL [KMC]

Facility

$0.02

Service Code	HCPCS J7030
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: MDX Hawaii PPO	$0.02

LVP solution Sodium Chloride 0.9% Sol 100mL [KMC]

Facility

$0.12

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Management Network Commercial	$0.10
Rate for Payer: Kaiser Permanente Commercial	$0.11
Rate for Payer: MDX Hawaii PPO	$0.12

LVP solution Sodium Chloride 0.9% Sol 100mL [KMC]

Facility

$0.12

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.38
Rate for Payer: AlohaCare Medicaid	$0.06
Rate for Payer: AlohaCare Medicare	$0.05
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cash Price	$0.08
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.11
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.38
Rate for Payer: Hawaii Medical Service Association Medicare	$0.05
Rate for Payer: Hawaii Western Management Group Commercial	$0.11
Rate for Payer: Health Management Network Commercial	$0.10
Rate for Payer: Humana Medicare	$0.05
Rate for Payer: Kaiser Permanente Commercial	$0.11
Rate for Payer: Kaiser Permanente Medicaid	$0.06
Rate for Payer: Kaiser Permanente Medicare	$0.05
Rate for Payer: MDX Hawaii PPO	$0.12
Rate for Payer: Ohana Health Plan Medicaid	$0.05
Rate for Payer: Ohana Health Plan Medicare	$0.05
Rate for Payer: UnitedHealthcare Medicaid	$0.07
Rate for Payer: UnitedHealthcare Medicare	$0.05
Rate for Payer: University Health Alliance Commercial	$0.09

LVP solution Sodium Chloride 0.9% Sol 250mL [KMC]

Facility

$0.05

Service Code	HCPCS J7050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.71
Rate for Payer: AlohaCare Medicaid	$0.03
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Medicare	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$0.05
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Humana Medicare	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: Kaiser Permanente Medicaid	$0.03
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: MDX Hawaii PPO	$0.05
Rate for Payer: Ohana Health Plan Medicaid	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.03
Rate for Payer: UnitedHealthcare Medicare	$0.02
Rate for Payer: University Health Alliance Commercial	$0.04

LVP solution Sodium Chloride 0.9% Sol 250mL [KMC]

Facility

$0.05

Service Code	HCPCS J7050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: MDX Hawaii PPO	$0.05

LVP solution Sodium Chloride 0.9% Sol 500mL [KMC]

Facility

$0.03

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: MDX Hawaii PPO	$0.03

LVP solution Sodium Chloride 0.9% Sol 500mL [KMC]

Facility

$0.03

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.38
Rate for Payer: AlohaCare Medicaid	$0.02
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.38
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.03
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.03
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.02

LVP solution Sodium Chloride 0.9% Sol 50mL[KMC]

Facility

$0.23

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Management Network Commercial	$0.20
Rate for Payer: Kaiser Permanente Commercial	$0.21
Rate for Payer: MDX Hawaii PPO	$0.22

LVP solution Sodium Chloride 0.9% Sol 50mL[KMC]

Facility

$0.23

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$1.38
Rate for Payer: AlohaCare Medicaid	$0.12
Rate for Payer: AlohaCare Medicare	$0.10
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cash Price	$0.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.21
Rate for Payer: Devoted Health Medicare	$0.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.38
Rate for Payer: Hawaii Medical Service Association Medicare	$0.10
Rate for Payer: Hawaii Western Management Group Commercial	$0.22
Rate for Payer: Health Management Network Commercial	$0.20
Rate for Payer: Humana Medicare	$0.10
Rate for Payer: Kaiser Permanente Commercial	$0.21
Rate for Payer: Kaiser Permanente Medicaid	$0.12
Rate for Payer: Kaiser Permanente Medicare	$0.10
Rate for Payer: MDX Hawaii PPO	$0.22
Rate for Payer: Ohana Health Plan Medicaid	$0.10
Rate for Payer: Ohana Health Plan Medicare	$0.10
Rate for Payer: UnitedHealthcare Medicaid	$0.14
Rate for Payer: UnitedHealthcare Medicare	$0.10
Rate for Payer: University Health Alliance Commercial	$0.17

Lyme Disease Abs, Rflx to Blot DLS

Facility

$305.00

Service Code	HCPCS 86618
Hospital Charge Code	422866185
Hospital Revenue Code	302
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$295.85
Rate for Payer: AlohaCare Medicaid	$152.50
Rate for Payer: AlohaCare Medicare	$128.10
Rate for Payer: Cash Price	$198.25
Rate for Payer: Cash Price	$198.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$280.60
Rate for Payer: Devoted Health Medicare	$128.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.54
Rate for Payer: Hawaii Medical Service Association Commercial	$21.29
Rate for Payer: Hawaii Medical Service Association Medicare	$128.10
Rate for Payer: Hawaii Western Management Group Commercial	$17.03
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: Humana Medicare	$128.10
Rate for Payer: Kaiser Permanente Commercial	$274.50
Rate for Payer: Kaiser Permanente Medicaid	$155.55
Rate for Payer: Kaiser Permanente Medicare	$128.10
Rate for Payer: MDX Hawaii PPO	$295.85
Rate for Payer: Ohana Health Plan Medicaid	$128.10
Rate for Payer: Ohana Health Plan Medicare	$128.10
Rate for Payer: UnitedHealthcare Medicaid	$23.54
Rate for Payer: UnitedHealthcare Medicare	$128.10
Rate for Payer: University Health Alliance Commercial	$44.03

Lyme Disease Abs, Rflx to Blot DLS

Facility

$305.00

Service Code	HCPCS 86618
Hospital Charge Code	422866185
Hospital Revenue Code	302
Min. Negotiated Rate	$259.25
Max. Negotiated Rate	$295.85
Rate for Payer: Cash Price	$198.25
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: Kaiser Permanente Commercial	$274.50
Rate for Payer: MDX Hawaii PPO	$295.85

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$76,510.06

Service Code	MSDRG 821
Min. Negotiated Rate	$76,510.06
Max. Negotiated Rate	$76,510.06
Rate for Payer: Hawaii Medical Service Association Commercial	$76,510.06

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$76,510.06

Service Code	MSDRG 820
Min. Negotiated Rate	$76,510.06
Max. Negotiated Rate	$76,510.06
Rate for Payer: Hawaii Medical Service Association Commercial	$76,510.06

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$30,646.69

Service Code	MSDRG 822
Min. Negotiated Rate	$30,646.69
Max. Negotiated Rate	$30,646.69
Rate for Payer: Hawaii Medical Service Association Commercial	$30,646.69

Know your out-of-pocket cost for care.

All Charges