Kau Hospital

All Charges

Charge

Type

Setting

Price

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

$237.00

Service Code	NDC 65862021901
Hospital Revenue Code	250
Min. Negotiated Rate	$201.45
Max. Negotiated Rate	$229.89
Rate for Payer: Cash Price	$142.20
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

$237.00

Service Code	NDC 68180072305
Hospital Revenue Code	637
Min. Negotiated Rate	$73.47
Max. Negotiated Rate	$229.89
Rate for Payer: AlohaCare Medicaid	$118.50
Rate for Payer: AlohaCare Medicare	$73.47
Rate for Payer: Cash Price	$142.20
Rate for Payer: Devoted Health Medicare	$80.58
Rate for Payer: Hawaii Medical Service Association Medicare	$73.47
Rate for Payer: Hawaii Western Management Group Commercial	$225.15
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Humana Medicare	$73.47
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: Kaiser Permanente Medicaid	$120.87
Rate for Payer: Kaiser Permanente Medicare	$73.47
Rate for Payer: MDX Hawaii PPO	$229.89
Rate for Payer: Ohana Health Plan Medicaid	$73.47
Rate for Payer: Ohana Health Plan Medicare	$73.47
Rate for Payer: UnitedHealthcare Medicare	$73.47
Rate for Payer: University Health Alliance Commercial	$172.75

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

$237.00

Service Code	NDC 68180072305
Hospital Revenue Code	250
Min. Negotiated Rate	$201.45
Max. Negotiated Rate	$229.89
Rate for Payer: Cash Price	$142.20
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89

CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]

Facility

$237.00

Service Code	NDC 65862021901
Hospital Revenue Code	637
Min. Negotiated Rate	$73.47
Max. Negotiated Rate	$229.89
Rate for Payer: AlohaCare Medicaid	$118.50
Rate for Payer: AlohaCare Medicare	$73.47
Rate for Payer: Cash Price	$142.20
Rate for Payer: Devoted Health Medicare	$80.58
Rate for Payer: Hawaii Medical Service Association Medicare	$73.47
Rate for Payer: Hawaii Western Management Group Commercial	$225.15
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Humana Medicare	$73.47
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: Kaiser Permanente Medicaid	$120.87
Rate for Payer: Kaiser Permanente Medicare	$73.47
Rate for Payer: MDX Hawaii PPO	$229.89
Rate for Payer: Ohana Health Plan Medicaid	$73.47
Rate for Payer: Ohana Health Plan Medicare	$73.47
Rate for Payer: UnitedHealthcare Medicare	$73.47
Rate for Payer: University Health Alliance Commercial	$172.75

CEFDINIR 300 MG CAPSULE [22289]

Facility

$15.00

Service Code	NDC 60687069911
Hospital Revenue Code	637
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

CEFDINIR 300 MG CAPSULE [22289]

Facility

$15.00

Service Code	NDC 60687069921
Hospital Revenue Code	637
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

CEFDINIR 300 MG CAPSULE [22289]

Facility

$18.00

Service Code	NDC 68001036206
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

CEFDINIR 300 MG CAPSULE [22289]

Facility

$18.00

Service Code	NDC 68001036206
Hospital Revenue Code	637
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$5.58
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association Medicare	$5.58
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$5.58
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$5.58
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$5.58
Rate for Payer: Ohana Health Plan Medicare	$5.58
Rate for Payer: UnitedHealthcare Medicare	$5.58
Rate for Payer: University Health Alliance Commercial	$13.12

CEFDINIR 300 MG CAPSULE [22289]

Facility

$15.00

Service Code	NDC 60687069921
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CEFDINIR 300 MG CAPSULE [22289]

Facility

$15.00

Service Code	NDC 60687069911
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CEFDINIR CAPSULES (OMNICEF) 300 MG (TAKE HOME) [4080342]

Facility

$15.00

Service Code	NDC 00004080130
Hospital Revenue Code	253
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

CEFDINIR CAPSULES (OMNICEF) 300 MG (TAKE HOME) [4080342]

Facility

$15.00

Service Code	NDC 00004080130
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CEFDINIR SUSPENSION (OMNICEF) 250 MG/5 ML (100 ML) (TAKE HOME) [4080341]

Facility

$15.00

Service Code	NDC 00004080129
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CEFDINIR SUSPENSION (OMNICEF) 250 MG/5 ML (100 ML) (TAKE HOME) [4080341]

Facility

$15.00

Service Code	NDC 00004080129
Hospital Revenue Code	253
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

CEFEPIME 1 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [163109]

Facility

$60.00

Service Code	HCPCS J0703
Hospital Revenue Code	636
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$18.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$20.40
Rate for Payer: Hawaii Medical Service Association ABD	$5.07
Rate for Payer: Hawaii Medical Service Association Medicare	$18.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.07
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$18.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$18.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$18.60
Rate for Payer: Ohana Health Plan Medicare	$18.60
Rate for Payer: UnitedHealthcare Medicaid	$36.00
Rate for Payer: UnitedHealthcare Medicare	$18.60
Rate for Payer: University Health Alliance Commercial	$43.73

CEFEPIME 1 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [163109]

Facility

$60.00

Service Code	HCPCS J0703
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]

Facility

$51.00

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$15.81
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$17.34
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$15.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$15.81
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$15.81
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$15.81
Rate for Payer: Ohana Health Plan Medicare	$15.81
Rate for Payer: UnitedHealthcare Medicaid	$30.60
Rate for Payer: UnitedHealthcare Medicare	$15.81
Rate for Payer: University Health Alliance Commercial	$37.17

CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]

Facility

$51.00

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

CEFEPIME 2 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [163115]

Facility

$90.00

Service Code	HCPCS J0703
Hospital Revenue Code	250
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

CEFEPIME 2 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [163115]

Facility

$90.00

Service Code	HCPCS J0703
Hospital Revenue Code	636
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$27.90
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$30.60
Rate for Payer: Hawaii Medical Service Association ABD	$5.07
Rate for Payer: Hawaii Medical Service Association Medicare	$27.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.07
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$27.90
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$27.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$27.90
Rate for Payer: Ohana Health Plan Medicare	$27.90
Rate for Payer: UnitedHealthcare Medicaid	$54.00
Rate for Payer: UnitedHealthcare Medicare	$27.90
Rate for Payer: University Health Alliance Commercial	$65.60

CEFEPIME 2 GRAM SOLUTION FOR INJECTION [27311]

Facility

$101.00

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: MDX Hawaii PPO	$97.97

CEFEPIME 2 GRAM SOLUTION FOR INJECTION [27311]

Facility

$101.00

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$50.50
Rate for Payer: AlohaCare Medicare	$31.31
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$34.34
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$31.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$31.31
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$31.31
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$31.31
Rate for Payer: Ohana Health Plan Medicare	$31.31
Rate for Payer: UnitedHealthcare Medicaid	$60.60
Rate for Payer: UnitedHealthcare Medicare	$31.31
Rate for Payer: University Health Alliance Commercial	$73.62

CEFEPIME HCL 1 G/10ML IJ (WET SOLR VIAL) [43016369]

Facility

$110.00

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: MDX Hawaii PPO	$106.70

CEFEPIME HCL 1 G/10ML IJ (WET SOLR VIAL) [43016369]

Facility

$110.00

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$15.81
Rate for Payer: AlohaCare Medicare	$34.10
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$37.40
Rate for Payer: Devoted Health Medicare	$17.34
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$15.81
Rate for Payer: Hawaii Medical Service Association Medicare	$34.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$34.10
Rate for Payer: Humana Medicare	$15.81
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$34.10
Rate for Payer: Kaiser Permanente Medicare	$15.81
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$15.81
Rate for Payer: Ohana Health Plan Medicaid	$34.10
Rate for Payer: Ohana Health Plan Medicare	$34.10
Rate for Payer: Ohana Health Plan Medicare	$15.81
Rate for Payer: UnitedHealthcare Medicaid	$30.60
Rate for Payer: UnitedHealthcare Medicaid	$66.00
Rate for Payer: UnitedHealthcare Medicare	$34.10
Rate for Payer: UnitedHealthcare Medicare	$15.81
Rate for Payer: University Health Alliance Commercial	$80.18
Rate for Payer: University Health Alliance Commercial	$37.17

CEFEPIME HCL 2 G/20ML IV (WET SOLR VIAL) [43027311]

Facility

$101.00

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: MDX Hawaii PPO	$97.97

Know your out-of-pocket cost for care.

All Charges