|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.80
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
NDC 45802012801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Health Management Network Commercial |
$343.40
|
| Rate for Payer: MDX Hawaii PPO |
$391.88
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
NDC 45802012801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$383.80
|
| Rate for Payer: Health Management Network Commercial |
$343.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.04
|
| Rate for Payer: MDX Hawaii PPO |
$391.88
|
| Rate for Payer: University Health Alliance Commercial |
$294.48
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM [9624]
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
NDC 00168027740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$388.45 |
| Max. Negotiated Rate |
$443.29 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: MDX Hawaii PPO |
$443.29
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM [9624]
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
NDC 00168027740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.07 |
| Max. Negotiated Rate |
$443.29 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$434.15
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.07
|
| Rate for Payer: MDX Hawaii PPO |
$443.29
|
| Rate for Payer: University Health Alliance Commercial |
$333.11
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.75
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.95
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.00
|
| Rate for Payer: University Health Alliance Commercial |
$32.80
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 65862059602
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.80
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.24
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
| Rate for Payer: University Health Alliance Commercial |
$90.38
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 65862059602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.25
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.00
|
| Rate for Payer: University Health Alliance Commercial |
$40.09
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
|
|
CLINDAMYCIN CAPSULES (CLEOCIN) 150 MG (TAKE HOME) [4080348]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00004080136
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
CLINDAMYCIN CAPSULES (CLEOCIN) 150 MG (TAKE HOME) [4080348]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00004080136
|
|
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: MDX Hawaii PPO |
$14.55
|
|
|
CLINDAMYCIN CAPSULES (CLEOCIN) 300 MG (TAKE HOME) [4080349]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00004080137
|
|
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: MDX Hawaii PPO |
$14.55
|
|
|
CLINDAMYCIN CAPSULES (CLEOCIN) 300 MG (TAKE HOME) [4080349]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00004080137
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [1740]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 42571025101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [1740]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084024301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [1740]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084024311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [1740]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084024311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [1740]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 42571025101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [1740]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084024301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE [9621]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 68084024401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE [9621]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 68084024411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE [9621]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 68084024401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
CLINDAMYCIN HCL 300 MG CAPSULE [9621]
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 42571025201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
|
