Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

cephalexin 250 mg/5 mL 100ml [HHSC]

Facility

$138.32

Service Code	NDC 00093417773
Hospital Charge Code	2500167
Hospital Revenue Code	250
Min. Negotiated Rate	$69.16
Max. Negotiated Rate	$134.17
Rate for Payer: AlohaCare Medicaid	$69.16
Rate for Payer: AlohaCare Medicare	$69.16
Rate for Payer: Cash Price	$89.91
Rate for Payer: Devoted Health Medicare	$76.08
Rate for Payer: Hawaii Medical Service Association Medicare	$69.16
Rate for Payer: Hawaii Western Management Group Commercial	$131.40
Rate for Payer: Health Management Network Commercial	$117.57
Rate for Payer: Humana Medicare	$69.16
Rate for Payer: Kaiser Permanente Commercial	$124.49
Rate for Payer: Kaiser Permanente Medicaid	$70.54
Rate for Payer: Kaiser Permanente Medicare	$69.16
Rate for Payer: MDX Hawaii PPO	$134.17
Rate for Payer: Ohana Health Plan Medicaid	$69.16
Rate for Payer: Ohana Health Plan Medicare	$69.16
Rate for Payer: UnitedHealthcare Medicaid	$82.99
Rate for Payer: UnitedHealthcare Medicare	$69.16
Rate for Payer: University Health Alliance Commercial	$100.82

cephalexin 250 mg/5 mL 100ml [HHSC]

Facility

$138.32

Service Code	NDC 00093417773
Hospital Charge Code	2500167
Hospital Revenue Code	250
Min. Negotiated Rate	$117.57
Max. Negotiated Rate	$134.17
Rate for Payer: Cash Price	$89.91
Rate for Payer: Health Management Network Commercial	$117.57
Rate for Payer: Kaiser Permanente Commercial	$124.49
Rate for Payer: MDX Hawaii PPO	$134.17

cephalexin 500 mg capsule [HHSC]

Facility

$7.52

Service Code	NDC 60687016301
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$7.29
Rate for Payer: Cash Price	$4.89
Rate for Payer: Health Management Network Commercial	$6.39
Rate for Payer: Kaiser Permanente Commercial	$6.77
Rate for Payer: MDX Hawaii PPO	$7.29

cephalexin 500 mg capsule [HHSC]

Facility

$7.39

Service Code	NDC 65862001901
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$7.17
Rate for Payer: AlohaCare Medicaid	$3.69
Rate for Payer: AlohaCare Medicare	$3.69
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$4.06
Rate for Payer: Hawaii Medical Service Association Medicare	$3.69
Rate for Payer: Hawaii Western Management Group Commercial	$7.02
Rate for Payer: Health Management Network Commercial	$6.28
Rate for Payer: Humana Medicare	$3.69
Rate for Payer: Kaiser Permanente Commercial	$6.65
Rate for Payer: Kaiser Permanente Medicaid	$3.77
Rate for Payer: Kaiser Permanente Medicare	$3.69
Rate for Payer: MDX Hawaii PPO	$7.17
Rate for Payer: Ohana Health Plan Medicaid	$3.69
Rate for Payer: Ohana Health Plan Medicare	$3.69
Rate for Payer: UnitedHealthcare Medicaid	$4.43
Rate for Payer: UnitedHealthcare Medicare	$3.69
Rate for Payer: University Health Alliance Commercial	$5.39

cephalexin 500 mg capsule [HHSC]

Facility

$7.65

Service Code	NDC 00093314701
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$7.42
Rate for Payer: AlohaCare Medicaid	$3.83
Rate for Payer: AlohaCare Medicare	$3.83
Rate for Payer: Cash Price	$4.97
Rate for Payer: Devoted Health Medicare	$4.21
Rate for Payer: Hawaii Medical Service Association Medicare	$3.83
Rate for Payer: Hawaii Western Management Group Commercial	$7.27
Rate for Payer: Health Management Network Commercial	$6.50
Rate for Payer: Humana Medicare	$3.83
Rate for Payer: Kaiser Permanente Commercial	$6.88
Rate for Payer: Kaiser Permanente Medicaid	$3.90
Rate for Payer: Kaiser Permanente Medicare	$3.83
Rate for Payer: MDX Hawaii PPO	$7.42
Rate for Payer: Ohana Health Plan Medicaid	$3.83
Rate for Payer: Ohana Health Plan Medicare	$3.83
Rate for Payer: UnitedHealthcare Medicaid	$4.59
Rate for Payer: UnitedHealthcare Medicare	$3.83
Rate for Payer: University Health Alliance Commercial	$5.58

cephalexin 500 mg capsule [HHSC]

Facility

$7.65

Service Code	NDC 00093314701
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$7.42
Rate for Payer: Cash Price	$4.97
Rate for Payer: Health Management Network Commercial	$6.50
Rate for Payer: Kaiser Permanente Commercial	$6.88
Rate for Payer: MDX Hawaii PPO	$7.42

cephalexin 500 mg capsule [HHSC]

Facility

$7.65

Service Code	NDC 68180012201
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$7.42
Rate for Payer: AlohaCare Medicaid	$3.83
Rate for Payer: AlohaCare Medicare	$3.83
Rate for Payer: Cash Price	$4.97
Rate for Payer: Devoted Health Medicare	$4.21
Rate for Payer: Hawaii Medical Service Association Medicare	$3.83
Rate for Payer: Hawaii Western Management Group Commercial	$7.27
Rate for Payer: Health Management Network Commercial	$6.50
Rate for Payer: Humana Medicare	$3.83
Rate for Payer: Kaiser Permanente Commercial	$6.88
Rate for Payer: Kaiser Permanente Medicaid	$3.90
Rate for Payer: Kaiser Permanente Medicare	$3.83
Rate for Payer: MDX Hawaii PPO	$7.42
Rate for Payer: Ohana Health Plan Medicaid	$3.83
Rate for Payer: Ohana Health Plan Medicare	$3.83
Rate for Payer: UnitedHealthcare Medicaid	$4.59
Rate for Payer: UnitedHealthcare Medicare	$3.83
Rate for Payer: University Health Alliance Commercial	$5.58

cephalexin 500 mg capsule [HHSC]

Facility

$7.65

Service Code	NDC 68180012201
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$7.42
Rate for Payer: Cash Price	$4.97
Rate for Payer: Health Management Network Commercial	$6.50
Rate for Payer: Kaiser Permanente Commercial	$6.88
Rate for Payer: MDX Hawaii PPO	$7.42

cephalexin 500 mg capsule [HHSC]

Facility

$7.52

Service Code	NDC 60687016301
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$7.29
Rate for Payer: AlohaCare Medicaid	$3.76
Rate for Payer: AlohaCare Medicare	$3.76
Rate for Payer: Cash Price	$4.89
Rate for Payer: Devoted Health Medicare	$4.14
Rate for Payer: Hawaii Medical Service Association Medicare	$3.76
Rate for Payer: Hawaii Western Management Group Commercial	$7.14
Rate for Payer: Health Management Network Commercial	$6.39
Rate for Payer: Humana Medicare	$3.76
Rate for Payer: Kaiser Permanente Commercial	$6.77
Rate for Payer: Kaiser Permanente Medicaid	$3.84
Rate for Payer: Kaiser Permanente Medicare	$3.76
Rate for Payer: MDX Hawaii PPO	$7.29
Rate for Payer: Ohana Health Plan Medicaid	$3.76
Rate for Payer: Ohana Health Plan Medicare	$3.76
Rate for Payer: UnitedHealthcare Medicaid	$4.51
Rate for Payer: UnitedHealthcare Medicare	$3.76
Rate for Payer: University Health Alliance Commercial	$5.48

cephalexin 500 mg capsule [HHSC]

Facility

$7.39

Service Code	NDC 65862001901
Hospital Charge Code	2500168
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$7.17
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.28
Rate for Payer: Kaiser Permanente Commercial	$6.65
Rate for Payer: MDX Hawaii PPO	$7.17

CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL

Facility

$5,655.00

Service Code	CPT 59320
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$4,035.20

CERIBELL EEG HEADBAND MEDIUM/LARGE

Facility

$1,875.00

Hospital Charge Code	11756904
Hospital Revenue Code	272
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,818.75
Rate for Payer: AlohaCare Medicaid	$937.50
Rate for Payer: AlohaCare Medicare	$937.50
Rate for Payer: Cash Price	$1,218.75
Rate for Payer: Devoted Health Medicare	$1,031.25
Rate for Payer: Hawaii Medical Service Association Medicare	$937.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,781.25
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Humana Medicare	$937.50
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: Kaiser Permanente Medicaid	$956.25
Rate for Payer: Kaiser Permanente Medicare	$937.50
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: Ohana Health Plan Medicaid	$937.50
Rate for Payer: Ohana Health Plan Medicare	$937.50
Rate for Payer: UnitedHealthcare Medicare	$937.50
Rate for Payer: University Health Alliance Commercial	$1,366.69

CERIBELL EEG HEADBAND MEDIUM/LARGE

Facility

$1,875.00

Hospital Charge Code	11756904
Hospital Revenue Code	272
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$1,818.75
Rate for Payer: Cash Price	$1,218.75
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: MDX Hawaii PPO	$1,818.75

CERIBELL EEG HEADBAND SMALL

Facility

$1,875.00

Hospital Charge Code	11756903
Hospital Revenue Code	271
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$1,818.75
Rate for Payer: Cash Price	$1,218.75
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: MDX Hawaii PPO	$1,818.75

CERIBELL EEG HEADBAND SMALL

Facility

$1,875.00

Hospital Charge Code	11756903
Hospital Revenue Code	271
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,818.75
Rate for Payer: AlohaCare Medicaid	$937.50
Rate for Payer: AlohaCare Medicare	$937.50
Rate for Payer: Cash Price	$1,218.75
Rate for Payer: Devoted Health Medicare	$1,031.25
Rate for Payer: Hawaii Medical Service Association Medicare	$937.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,781.25
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Humana Medicare	$937.50
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: Kaiser Permanente Medicaid	$956.25
Rate for Payer: Kaiser Permanente Medicare	$937.50
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: Ohana Health Plan Medicaid	$937.50
Rate for Payer: Ohana Health Plan Medicare	$937.50
Rate for Payer: UnitedHealthcare Medicare	$937.50
Rate for Payer: University Health Alliance Commercial	$1,366.69

Ceruloplasmin FSI

Facility

$127.00

Service Code	HCPCS 82390
Hospital Charge Code	9266143
Hospital Revenue Code	300
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association ABD	$14.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13.43
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.58
Rate for Payer: Hawaii Western Management Group Commercial	$10.74
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicaid	$14.84
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$27.77

Ceruloplasmin FSI

Facility

$127.00

Service Code	HCPCS 82390
Hospital Charge Code	9266143
Hospital Revenue Code	300
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

CERVICAL RIPENING BALLOON WITH STYLET

Facility

$234.00

Hospital Charge Code	9271648
Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: AlohaCare Medicare	$117.00
Rate for Payer: Cash Price	$152.10
Rate for Payer: Devoted Health Medicare	$128.70
Rate for Payer: Hawaii Medical Service Association Medicare	$117.00
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Humana Medicare	$117.00
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: Kaiser Permanente Medicare	$117.00
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: Ohana Health Plan Medicaid	$117.00
Rate for Payer: Ohana Health Plan Medicare	$117.00
Rate for Payer: UnitedHealthcare Medicare	$117.00
Rate for Payer: University Health Alliance Commercial	$170.56

CERVICAL RIPENING BALLOON WITH STYLET

Facility

$234.00

Hospital Charge Code	9271648
Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$152.10
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

CERVICAL SPINAL FUSION WITH CC

Facility

$53,924.04

Service Code	MSDRG 472
Min. Negotiated Rate	$53,924.04
Max. Negotiated Rate	$53,924.04
Rate for Payer: Hawaii Medical Service Association Commercial	$53,924.04

CERVICAL SPINAL FUSION WITH MCC

Facility

$66,595.55

Service Code	MSDRG 471
Min. Negotiated Rate	$66,595.55
Max. Negotiated Rate	$66,595.55
Rate for Payer: Hawaii Medical Service Association Commercial	$66,595.55

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$49,487.74

Service Code	MSDRG 473
Min. Negotiated Rate	$49,487.74
Max. Negotiated Rate	$49,487.74
Rate for Payer: Hawaii Medical Service Association Commercial	$49,487.74

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$20,549.78

Service Code	MSDRG 787
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$20,549.78
Rate for Payer: Hawaii Medical Service Association Commercial	$20,549.78
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$20,549.78

Service Code	MSDRG 786
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$20,549.78
Rate for Payer: Hawaii Medical Service Association Commercial	$20,549.78
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$18,204.14

Service Code	MSDRG 788
Min. Negotiated Rate	$18,204.14
Max. Negotiated Rate	$18,204.14
Rate for Payer: Hawaii Medical Service Association Commercial	$18,204.14

Know your out-of-pocket cost for care.

All Charges