Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

ziprasidone 60 mg Cap [KMC]

Facility

$43.05

Service Code	NDC 16714083701
Hospital Revenue Code	250
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$41.76
Rate for Payer: AlohaCare Medicaid	$21.52
Rate for Payer: AlohaCare Medicare	$18.08
Rate for Payer: Cash Price	$27.98
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$39.61
Rate for Payer: Devoted Health Medicare	$18.08
Rate for Payer: Hawaii Medical Service Association Medicare	$18.08
Rate for Payer: Hawaii Western Management Group Commercial	$40.90
Rate for Payer: Health Management Network Commercial	$36.59
Rate for Payer: Humana Medicare	$18.08
Rate for Payer: Kaiser Permanente Commercial	$38.74
Rate for Payer: Kaiser Permanente Medicaid	$21.96
Rate for Payer: Kaiser Permanente Medicare	$18.08
Rate for Payer: MDX Hawaii PPO	$41.76
Rate for Payer: Ohana Health Plan Medicaid	$18.08
Rate for Payer: Ohana Health Plan Medicare	$18.08
Rate for Payer: UnitedHealthcare Medicaid	$25.83
Rate for Payer: UnitedHealthcare Medicare	$18.08
Rate for Payer: University Health Alliance Commercial	$31.38

ziprasidone 80 mg Cap [KMC]

Facility

$43.11

Service Code	NDC 16714083801
Hospital Revenue Code	250
Min. Negotiated Rate	$18.11
Max. Negotiated Rate	$41.82
Rate for Payer: AlohaCare Medicaid	$21.55
Rate for Payer: AlohaCare Medicare	$18.11
Rate for Payer: Cash Price	$28.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$39.66
Rate for Payer: Devoted Health Medicare	$18.11
Rate for Payer: Hawaii Medical Service Association Medicare	$18.11
Rate for Payer: Hawaii Western Management Group Commercial	$40.95
Rate for Payer: Health Management Network Commercial	$36.64
Rate for Payer: Humana Medicare	$18.11
Rate for Payer: Kaiser Permanente Commercial	$38.80
Rate for Payer: Kaiser Permanente Medicaid	$21.99
Rate for Payer: Kaiser Permanente Medicare	$18.11
Rate for Payer: MDX Hawaii PPO	$41.82
Rate for Payer: Ohana Health Plan Medicaid	$18.11
Rate for Payer: Ohana Health Plan Medicare	$18.11
Rate for Payer: UnitedHealthcare Medicaid	$25.87
Rate for Payer: UnitedHealthcare Medicare	$18.11
Rate for Payer: University Health Alliance Commercial	$31.42

ziprasidone 80 mg Cap [KMC]

Facility

$43.11

Service Code	NDC 16714083801
Hospital Revenue Code	250
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$41.82
Rate for Payer: Cash Price	$28.02
Rate for Payer: Health Management Network Commercial	$36.64
Rate for Payer: Kaiser Permanente Commercial	$38.80
Rate for Payer: MDX Hawaii PPO	$41.82

zoledronic acid 5 mg/100 mL IV bottle [KMC]

Facility

$14.40

Service Code	HCPCS J3489
Hospital Revenue Code	636
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$13.97
Rate for Payer: Cash Price	$9.36
Rate for Payer: Health Management Network Commercial	$12.24
Rate for Payer: Kaiser Permanente Commercial	$12.96
Rate for Payer: MDX Hawaii PPO	$13.97

zoledronic acid 5 mg/100 mL IV bottle [KMC]

Facility

$14.40

Service Code	HCPCS J3489
Hospital Revenue Code	636
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$13.97
Rate for Payer: AlohaCare Medicaid	$7.20
Rate for Payer: AlohaCare Medicare	$6.05
Rate for Payer: Cash Price	$9.36
Rate for Payer: Cash Price	$9.36
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.25
Rate for Payer: Devoted Health Medicare	$6.05
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$5.20
Rate for Payer: Hawaii Medical Service Association Medicare	$6.05
Rate for Payer: Hawaii Western Management Group Commercial	$13.68
Rate for Payer: Health Management Network Commercial	$12.24
Rate for Payer: Humana Medicare	$6.05
Rate for Payer: Kaiser Permanente Commercial	$12.96
Rate for Payer: Kaiser Permanente Medicaid	$7.34
Rate for Payer: Kaiser Permanente Medicare	$6.05
Rate for Payer: MDX Hawaii PPO	$13.97
Rate for Payer: Ohana Health Plan Medicaid	$6.05
Rate for Payer: Ohana Health Plan Medicare	$6.05
Rate for Payer: UnitedHealthcare Medicaid	$8.64
Rate for Payer: UnitedHealthcare Medicare	$6.05
Rate for Payer: University Health Alliance Commercial	$10.50

ZOLL STAT PADS ADULT ELECTRODES

Facility

$76.00

Hospital Charge Code	8396
Hospital Revenue Code	270
Min. Negotiated Rate	$31.92
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$31.92
Rate for Payer: Cash Price	$49.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$69.92
Rate for Payer: Devoted Health Medicare	$31.92
Rate for Payer: Hawaii Medical Service Association Medicare	$31.92
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$31.92
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$31.92
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$31.92
Rate for Payer: Ohana Health Plan Medicare	$31.92
Rate for Payer: UnitedHealthcare Medicare	$31.92
Rate for Payer: University Health Alliance Commercial	$55.40

ZOLL STAT PADS ADULT ELECTRODES

Facility

$76.00

Hospital Charge Code	8396
Hospital Revenue Code	270
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

ZOLL STAT PADS PEDS ELECTRODES

Facility

$76.00

Hospital Charge Code	8397
Hospital Revenue Code	270
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

ZOLL STAT PADS PEDS ELECTRODES

Facility

$76.00

Hospital Charge Code	8397
Hospital Revenue Code	270
Min. Negotiated Rate	$31.92
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$31.92
Rate for Payer: Cash Price	$49.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$69.92
Rate for Payer: Devoted Health Medicare	$31.92
Rate for Payer: Hawaii Medical Service Association Medicare	$31.92
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$31.92
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$31.92
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$31.92
Rate for Payer: Ohana Health Plan Medicare	$31.92
Rate for Payer: UnitedHealthcare Medicare	$31.92
Rate for Payer: University Health Alliance Commercial	$55.40

zolpidem 12.5 mg ER Tab [KMC]

Facility

$24.47

Service Code	NDC 68180078001
Hospital Revenue Code	250
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$23.74
Rate for Payer: Cash Price	$15.91
Rate for Payer: Health Management Network Commercial	$20.80
Rate for Payer: Kaiser Permanente Commercial	$22.02
Rate for Payer: MDX Hawaii PPO	$23.74

zolpidem 12.5 mg ER Tab [KMC]

Facility

$24.47

Service Code	NDC 68180078001
Hospital Revenue Code	250
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$23.74
Rate for Payer: AlohaCare Medicaid	$12.23
Rate for Payer: AlohaCare Medicare	$10.28
Rate for Payer: Cash Price	$15.91
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.51
Rate for Payer: Devoted Health Medicare	$10.28
Rate for Payer: Hawaii Medical Service Association Medicare	$10.28
Rate for Payer: Hawaii Western Management Group Commercial	$23.25
Rate for Payer: Health Management Network Commercial	$20.80
Rate for Payer: Humana Medicare	$10.28
Rate for Payer: Kaiser Permanente Commercial	$22.02
Rate for Payer: Kaiser Permanente Medicaid	$12.48
Rate for Payer: Kaiser Permanente Medicare	$10.28
Rate for Payer: MDX Hawaii PPO	$23.74
Rate for Payer: Ohana Health Plan Medicaid	$10.28
Rate for Payer: Ohana Health Plan Medicare	$10.28
Rate for Payer: UnitedHealthcare Medicaid	$14.68
Rate for Payer: UnitedHealthcare Medicare	$10.28
Rate for Payer: University Health Alliance Commercial	$17.84

zolpidem 5 mg Tab [KMC]

Facility

$18.48

Service Code	NDC 16714062101
Hospital Revenue Code	250
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$17.93
Rate for Payer: AlohaCare Medicaid	$9.24
Rate for Payer: AlohaCare Medicare	$7.76
Rate for Payer: Cash Price	$12.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$17.00
Rate for Payer: Devoted Health Medicare	$7.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7.76
Rate for Payer: Hawaii Western Management Group Commercial	$17.56
Rate for Payer: Health Management Network Commercial	$15.71
Rate for Payer: Humana Medicare	$7.76
Rate for Payer: Kaiser Permanente Commercial	$16.63
Rate for Payer: Kaiser Permanente Medicaid	$9.42
Rate for Payer: Kaiser Permanente Medicare	$7.76
Rate for Payer: MDX Hawaii PPO	$17.93
Rate for Payer: Ohana Health Plan Medicaid	$7.76
Rate for Payer: Ohana Health Plan Medicare	$7.76
Rate for Payer: UnitedHealthcare Medicaid	$11.09
Rate for Payer: UnitedHealthcare Medicare	$7.76
Rate for Payer: University Health Alliance Commercial	$13.47

zolpidem 5 mg Tab [KMC]

Facility

$18.48

Service Code	NDC 16714062101
Hospital Revenue Code	250
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$17.93
Rate for Payer: Cash Price	$12.01
Rate for Payer: Health Management Network Commercial	$15.71
Rate for Payer: Kaiser Permanente Commercial	$16.63
Rate for Payer: MDX Hawaii PPO	$17.93

Zostavax (zoster vaccine, LIVE) 0.65 mL SQ Inj [KMC]

Facility

$1,070.98

Service Code	NDC 00006496300
Hospital Revenue Code	250
Min. Negotiated Rate	$910.33
Max. Negotiated Rate	$1,038.85
Rate for Payer: Cash Price	$696.14
Rate for Payer: Health Management Network Commercial	$910.33
Rate for Payer: Kaiser Permanente Commercial	$963.88
Rate for Payer: MDX Hawaii PPO	$1,038.85

Zostavax (zoster vaccine, LIVE) 0.65 mL SQ Inj [KMC]

Facility

$1,070.98

Service Code	NDC 00006496300
Hospital Revenue Code	250
Min. Negotiated Rate	$449.81
Max. Negotiated Rate	$1,038.85
Rate for Payer: AlohaCare Medicaid	$535.49
Rate for Payer: AlohaCare Medicare	$449.81
Rate for Payer: Cash Price	$696.14
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$985.30
Rate for Payer: Devoted Health Medicare	$449.81
Rate for Payer: Hawaii Medical Service Association Medicare	$449.81
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.43
Rate for Payer: Health Management Network Commercial	$910.33
Rate for Payer: Humana Medicare	$449.81
Rate for Payer: Kaiser Permanente Commercial	$963.88
Rate for Payer: Kaiser Permanente Medicaid	$546.20
Rate for Payer: Kaiser Permanente Medicare	$449.81
Rate for Payer: MDX Hawaii PPO	$1,038.85
Rate for Payer: Ohana Health Plan Medicaid	$449.81
Rate for Payer: Ohana Health Plan Medicare	$449.81
Rate for Payer: UnitedHealthcare Medicaid	$642.59
Rate for Payer: UnitedHealthcare Medicare	$449.81
Rate for Payer: University Health Alliance Commercial	$780.64

Know your out-of-pocket cost for care.

All Charges