Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

C Diff Toxin 1

Facility

$202.00

Service Code	HCPCS 87324
Hospital Charge Code	422873240
Hospital Revenue Code	306
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$131.30
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: MDX Hawaii PPO	$195.94

C Diff Toxin 1

Facility

$202.00

Service Code	HCPCS 87324
Hospital Charge Code	422873240
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$101.00
Rate for Payer: AlohaCare Medicare	$84.84
Rate for Payer: Cash Price	$131.30
Rate for Payer: Cash Price	$131.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$185.84
Rate for Payer: Devoted Health Medicare	$84.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$84.84
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$84.84
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$84.84
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$84.84
Rate for Payer: Ohana Health Plan Medicare	$84.84
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$84.84
Rate for Payer: University Health Alliance Commercial	$31.01

CEA DLS

Facility

$176.00

Service Code	HCPCS 82378
Hospital Charge Code	422823785
Hospital Revenue Code	301
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: MDX Hawaii PPO	$170.72

CEA DLS

Facility

$176.00

Service Code	HCPCS 82378
Hospital Charge Code	422823785
Hospital Revenue Code	301
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$170.72
Rate for Payer: AlohaCare Medicaid	$88.00
Rate for Payer: AlohaCare Medicare	$73.92
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$161.92
Rate for Payer: Devoted Health Medicare	$73.92
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$26.22
Rate for Payer: Hawaii Medical Service Association Commercial	$23.70
Rate for Payer: Hawaii Medical Service Association Medicare	$73.92
Rate for Payer: Hawaii Western Management Group Commercial	$18.96
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Humana Medicare	$73.92
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: Kaiser Permanente Medicaid	$89.76
Rate for Payer: Kaiser Permanente Medicare	$73.92
Rate for Payer: MDX Hawaii PPO	$170.72
Rate for Payer: Ohana Health Plan Medicaid	$73.92
Rate for Payer: Ohana Health Plan Medicare	$73.92
Rate for Payer: UnitedHealthcare Medicaid	$26.22
Rate for Payer: UnitedHealthcare Medicare	$73.92
Rate for Payer: University Health Alliance Commercial	$49.04

ceFAZolin 1 gm vial [KMC]

Facility

$5.05

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$4.90
Rate for Payer: Cash Price	$3.28
Rate for Payer: Health Management Network Commercial	$4.29
Rate for Payer: Kaiser Permanente Commercial	$4.54
Rate for Payer: MDX Hawaii PPO	$4.90

ceFAZolin 1 gm vial [KMC]

Facility

$5.05

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$4.90
Rate for Payer: AlohaCare Medicaid	$2.52
Rate for Payer: AlohaCare Medicare	$2.12
Rate for Payer: Cash Price	$3.28
Rate for Payer: Cash Price	$3.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.65
Rate for Payer: Devoted Health Medicare	$2.12
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Medicare	$2.12
Rate for Payer: Hawaii Western Management Group Commercial	$4.80
Rate for Payer: Health Management Network Commercial	$4.29
Rate for Payer: Humana Medicare	$2.12
Rate for Payer: Kaiser Permanente Commercial	$4.54
Rate for Payer: Kaiser Permanente Medicaid	$2.58
Rate for Payer: Kaiser Permanente Medicare	$2.12
Rate for Payer: MDX Hawaii PPO	$4.90
Rate for Payer: Ohana Health Plan Medicaid	$2.12
Rate for Payer: Ohana Health Plan Medicare	$2.12
Rate for Payer: UnitedHealthcare Medicaid	$3.03
Rate for Payer: UnitedHealthcare Medicare	$2.12
Rate for Payer: University Health Alliance Commercial	$3.68

ceFAZolin 2 gm REC vial [KMC]

Facility

$28.08

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$27.24
Rate for Payer: AlohaCare Medicaid	$14.04
Rate for Payer: AlohaCare Medicare	$11.79
Rate for Payer: Cash Price	$18.25
Rate for Payer: Cash Price	$18.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$25.83
Rate for Payer: Devoted Health Medicare	$11.79
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Medicare	$11.79
Rate for Payer: Hawaii Western Management Group Commercial	$26.68
Rate for Payer: Health Management Network Commercial	$23.87
Rate for Payer: Humana Medicare	$11.79
Rate for Payer: Kaiser Permanente Commercial	$25.27
Rate for Payer: Kaiser Permanente Medicaid	$14.32
Rate for Payer: Kaiser Permanente Medicare	$11.79
Rate for Payer: MDX Hawaii PPO	$27.24
Rate for Payer: Ohana Health Plan Medicaid	$11.79
Rate for Payer: Ohana Health Plan Medicare	$11.79
Rate for Payer: UnitedHealthcare Medicaid	$16.85
Rate for Payer: UnitedHealthcare Medicare	$11.79
Rate for Payer: University Health Alliance Commercial	$20.47

ceFAZolin 2 gm REC vial [KMC]

Facility

$28.08

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$27.24
Rate for Payer: Cash Price	$18.25
Rate for Payer: Health Management Network Commercial	$23.87
Rate for Payer: Kaiser Permanente Commercial	$25.27
Rate for Payer: MDX Hawaii PPO	$27.24

CEFAZOLIN SODIUM INJECTION

Professional

Both

$25.00

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$21.25
Rate for Payer: AlohaCare Medicare	$0.85
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$0.85
Rate for Payer: Hawaii Medical Service Association Medicare	$0.85
Rate for Payer: Hawaii Western Management Group Commercial	$4.46
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$1.02
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.02
Rate for Payer: Ohana Health Plan Medicare	$0.85
Rate for Payer: UnitedHealthcare Medicare	$0.85

cefdinir 300 mg Cap [KMC]

Facility

$20.46

Service Code	NDC 68180071160
Hospital Revenue Code	250
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$19.85
Rate for Payer: AlohaCare Medicaid	$10.23
Rate for Payer: AlohaCare Medicare	$8.59
Rate for Payer: Cash Price	$13.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.82
Rate for Payer: Devoted Health Medicare	$8.59
Rate for Payer: Hawaii Medical Service Association Medicare	$8.59
Rate for Payer: Hawaii Western Management Group Commercial	$19.44
Rate for Payer: Health Management Network Commercial	$17.39
Rate for Payer: Humana Medicare	$8.59
Rate for Payer: Kaiser Permanente Commercial	$18.41
Rate for Payer: Kaiser Permanente Medicaid	$10.43
Rate for Payer: Kaiser Permanente Medicare	$8.59
Rate for Payer: MDX Hawaii PPO	$19.85
Rate for Payer: Ohana Health Plan Medicaid	$8.59
Rate for Payer: Ohana Health Plan Medicare	$8.59
Rate for Payer: UnitedHealthcare Medicaid	$12.28
Rate for Payer: UnitedHealthcare Medicare	$8.59
Rate for Payer: University Health Alliance Commercial	$14.91

cefdinir 300 mg Cap [KMC]

Facility

$20.46

Service Code	NDC 68180071160
Hospital Revenue Code	250
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$19.85
Rate for Payer: Cash Price	$13.30
Rate for Payer: Health Management Network Commercial	$17.39
Rate for Payer: Kaiser Permanente Commercial	$18.41
Rate for Payer: MDX Hawaii PPO	$19.85

cefepime 1 gm Inj [KMC]

Facility

$81.34

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$69.14
Max. Negotiated Rate	$78.90
Rate for Payer: Cash Price	$52.87
Rate for Payer: Health Management Network Commercial	$69.14
Rate for Payer: Kaiser Permanente Commercial	$73.21
Rate for Payer: MDX Hawaii PPO	$78.90

cefepime 1 gm Inj [KMC]

Facility

$81.34

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$78.90
Rate for Payer: AlohaCare Medicaid	$40.67
Rate for Payer: AlohaCare Medicare	$34.16
Rate for Payer: Cash Price	$52.87
Rate for Payer: Cash Price	$52.87
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$74.83
Rate for Payer: Devoted Health Medicare	$34.16
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$34.16
Rate for Payer: Hawaii Western Management Group Commercial	$77.27
Rate for Payer: Health Management Network Commercial	$69.14
Rate for Payer: Humana Medicare	$34.16
Rate for Payer: Kaiser Permanente Commercial	$73.21
Rate for Payer: Kaiser Permanente Medicaid	$41.48
Rate for Payer: Kaiser Permanente Medicare	$34.16
Rate for Payer: MDX Hawaii PPO	$78.90
Rate for Payer: Ohana Health Plan Medicaid	$34.16
Rate for Payer: Ohana Health Plan Medicare	$34.16
Rate for Payer: UnitedHealthcare Medicaid	$48.80
Rate for Payer: UnitedHealthcare Medicare	$34.16
Rate for Payer: University Health Alliance Commercial	$59.29

cefepime 2 g Inj [KMC]

Facility

$161.42

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$156.58
Rate for Payer: AlohaCare Medicaid	$80.71
Rate for Payer: AlohaCare Medicare	$67.80
Rate for Payer: Cash Price	$104.92
Rate for Payer: Cash Price	$104.92
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$148.51
Rate for Payer: Devoted Health Medicare	$67.80
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$67.80
Rate for Payer: Hawaii Western Management Group Commercial	$153.35
Rate for Payer: Health Management Network Commercial	$137.21
Rate for Payer: Humana Medicare	$67.80
Rate for Payer: Kaiser Permanente Commercial	$145.28
Rate for Payer: Kaiser Permanente Medicaid	$82.32
Rate for Payer: Kaiser Permanente Medicare	$67.80
Rate for Payer: MDX Hawaii PPO	$156.58
Rate for Payer: Ohana Health Plan Medicaid	$67.80
Rate for Payer: Ohana Health Plan Medicare	$67.80
Rate for Payer: UnitedHealthcare Medicaid	$96.85
Rate for Payer: UnitedHealthcare Medicare	$67.80
Rate for Payer: University Health Alliance Commercial	$117.66

cefepime 2 g Inj [KMC]

Facility

$161.42

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$137.21
Max. Negotiated Rate	$156.58
Rate for Payer: Cash Price	$104.92
Rate for Payer: Health Management Network Commercial	$137.21
Rate for Payer: Kaiser Permanente Commercial	$145.28
Rate for Payer: MDX Hawaii PPO	$156.58

cefoTEtan 2 gm / 50 mL D5% REC bag [KMC]

Facility

$124.51

Service Code	NDC 00264317511
Hospital Revenue Code	250
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$120.77
Rate for Payer: AlohaCare Medicaid	$62.26
Rate for Payer: AlohaCare Medicare	$52.29
Rate for Payer: Cash Price	$80.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$114.55
Rate for Payer: Devoted Health Medicare	$52.29
Rate for Payer: Hawaii Medical Service Association Medicare	$52.29
Rate for Payer: Hawaii Western Management Group Commercial	$118.28
Rate for Payer: Health Management Network Commercial	$105.83
Rate for Payer: Humana Medicare	$52.29
Rate for Payer: Kaiser Permanente Commercial	$112.06
Rate for Payer: Kaiser Permanente Medicaid	$63.50
Rate for Payer: Kaiser Permanente Medicare	$52.29
Rate for Payer: MDX Hawaii PPO	$120.77
Rate for Payer: Ohana Health Plan Medicaid	$52.29
Rate for Payer: Ohana Health Plan Medicare	$52.29
Rate for Payer: UnitedHealthcare Medicaid	$74.71
Rate for Payer: UnitedHealthcare Medicare	$52.29
Rate for Payer: University Health Alliance Commercial	$90.76

cefoTEtan 2 gm / 50 mL D5% REC bag [KMC]

Facility

$124.51

Service Code	NDC 00264317511
Hospital Revenue Code	250
Min. Negotiated Rate	$105.83
Max. Negotiated Rate	$120.77
Rate for Payer: Cash Price	$80.93
Rate for Payer: Health Management Network Commercial	$105.83
Rate for Payer: Kaiser Permanente Commercial	$112.06
Rate for Payer: MDX Hawaii PPO	$120.77

cefOXitin 2 g Inj [KMC]

Facility

$48.00

Service Code	HCPCS J0694
Hospital Revenue Code	636
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

cefOXitin 2 g Inj [KMC]

Facility

$48.00

Service Code	HCPCS J0694
Hospital Revenue Code	636
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$20.16
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$44.16
Rate for Payer: Devoted Health Medicare	$20.16
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$5.13
Rate for Payer: Hawaii Medical Service Association Medicare	$20.16
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$20.16
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$20.16
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$20.16
Rate for Payer: Ohana Health Plan Medicare	$20.16
Rate for Payer: UnitedHealthcare Medicaid	$28.80
Rate for Payer: UnitedHealthcare Medicare	$20.16
Rate for Payer: University Health Alliance Commercial	$34.99

cefpodoxime 100 mg Tab [KMC]

Facility

$26.95

Service Code	NDC 65862009520
Hospital Revenue Code	250
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$26.14
Rate for Payer: AlohaCare Medicaid	$13.47
Rate for Payer: AlohaCare Medicare	$11.32
Rate for Payer: Cash Price	$17.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$24.79
Rate for Payer: Devoted Health Medicare	$11.32
Rate for Payer: Hawaii Medical Service Association Medicare	$11.32
Rate for Payer: Hawaii Western Management Group Commercial	$25.60
Rate for Payer: Health Management Network Commercial	$22.91
Rate for Payer: Humana Medicare	$11.32
Rate for Payer: Kaiser Permanente Commercial	$24.25
Rate for Payer: Kaiser Permanente Medicaid	$13.74
Rate for Payer: Kaiser Permanente Medicare	$11.32
Rate for Payer: MDX Hawaii PPO	$26.14
Rate for Payer: Ohana Health Plan Medicaid	$11.32
Rate for Payer: Ohana Health Plan Medicare	$11.32
Rate for Payer: UnitedHealthcare Medicaid	$16.17
Rate for Payer: UnitedHealthcare Medicare	$11.32
Rate for Payer: University Health Alliance Commercial	$19.64

cefpodoxime 100 mg Tab [KMC]

Facility

$26.95

Service Code	NDC 65862009520
Hospital Revenue Code	250
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$26.14
Rate for Payer: Cash Price	$17.52
Rate for Payer: Health Management Network Commercial	$22.91
Rate for Payer: Kaiser Permanente Commercial	$24.25
Rate for Payer: MDX Hawaii PPO	$26.14

cefpodoxime 200 mg Tab KMC]

Facility

$33.83

Service Code	NDC 65862009620
Hospital Revenue Code	250
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$32.82
Rate for Payer: AlohaCare Medicaid	$16.91
Rate for Payer: AlohaCare Medicare	$14.21
Rate for Payer: Cash Price	$21.99
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$31.12
Rate for Payer: Devoted Health Medicare	$14.21
Rate for Payer: Hawaii Medical Service Association Medicare	$14.21
Rate for Payer: Hawaii Western Management Group Commercial	$32.14
Rate for Payer: Health Management Network Commercial	$28.76
Rate for Payer: Humana Medicare	$14.21
Rate for Payer: Kaiser Permanente Commercial	$30.45
Rate for Payer: Kaiser Permanente Medicaid	$17.25
Rate for Payer: Kaiser Permanente Medicare	$14.21
Rate for Payer: MDX Hawaii PPO	$32.82
Rate for Payer: Ohana Health Plan Medicaid	$14.21
Rate for Payer: Ohana Health Plan Medicare	$14.21
Rate for Payer: UnitedHealthcare Medicaid	$20.30
Rate for Payer: UnitedHealthcare Medicare	$14.21
Rate for Payer: University Health Alliance Commercial	$24.66

cefpodoxime 200 mg Tab KMC]

Facility

$33.83

Service Code	NDC 65862009620
Hospital Revenue Code	250
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$32.82
Rate for Payer: Cash Price	$21.99
Rate for Payer: Health Management Network Commercial	$28.76
Rate for Payer: Kaiser Permanente Commercial	$30.45
Rate for Payer: MDX Hawaii PPO	$32.82

ceftaroline 600 mg REC [KMC]

Facility

$1,067.54

Service Code	HCPCS J0712
Hospital Revenue Code	636
Min. Negotiated Rate	$907.41
Max. Negotiated Rate	$1,035.51
Rate for Payer: Cash Price	$693.90
Rate for Payer: Health Management Network Commercial	$907.41
Rate for Payer: Kaiser Permanente Commercial	$960.79
Rate for Payer: MDX Hawaii PPO	$1,035.51

ceftaroline 600 mg REC [KMC]

Facility

$1,067.54

Service Code	HCPCS J0712
Hospital Revenue Code	636
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$1,035.51
Rate for Payer: AlohaCare Medicaid	$533.77
Rate for Payer: AlohaCare Medicare	$448.37
Rate for Payer: Cash Price	$693.90
Rate for Payer: Cash Price	$693.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$982.14
Rate for Payer: Devoted Health Medicare	$448.37
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.24
Rate for Payer: Hawaii Medical Service Association Commercial	$5.31
Rate for Payer: Hawaii Medical Service Association Medicare	$448.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.16
Rate for Payer: Health Management Network Commercial	$907.41
Rate for Payer: Humana Medicare	$448.37
Rate for Payer: Kaiser Permanente Commercial	$960.79
Rate for Payer: Kaiser Permanente Medicaid	$544.45
Rate for Payer: Kaiser Permanente Medicare	$448.37
Rate for Payer: MDX Hawaii PPO	$1,035.51
Rate for Payer: Ohana Health Plan Medicaid	$448.37
Rate for Payer: Ohana Health Plan Medicare	$448.37
Rate for Payer: UnitedHealthcare Medicaid	$640.52
Rate for Payer: UnitedHealthcare Medicare	$448.37
Rate for Payer: University Health Alliance Commercial	$778.13

Know your out-of-pocket cost for care.

All Charges