Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]

Facility

$124.00

Service Code	NDC 65862059602
Hospital Revenue Code	637
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$94.24
Rate for Payer: Cash Price	$74.40
Rate for Payer: Devoted Health Medicare	$104.16
Rate for Payer: Hawaii Medical Service Association Medicare	$94.24
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$94.24
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$94.24
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$94.24
Rate for Payer: Ohana Health Plan Medicare	$94.24
Rate for Payer: UnitedHealthcare Medicare	$94.24
Rate for Payer: University Health Alliance Commercial	$90.38

CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]

Facility

$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: Kaiser Permanente Commercial	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35

CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9627]

Facility

$55.00

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$27.50
Rate for Payer: AlohaCare Medicare	$41.80
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association ABD	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$41.80
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: Humana Medicare	$41.80
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$41.80
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$41.80
Rate for Payer: Ohana Health Plan Medicare	$41.80
Rate for Payer: UnitedHealthcare Medicaid	$33.00
Rate for Payer: UnitedHealthcare Medicare	$41.80
Rate for Payer: University Health Alliance Commercial	$40.09

CLINDAMYCIN CAPSULES (CLEOCIN) 150 MG (TAKE HOME) [4080348]

Facility

$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: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CLINDAMYCIN CAPSULES (CLEOCIN) 150 MG (TAKE HOME) [4080348]

Facility

$15.00

Service Code	NDC 00004080136
Hospital Revenue Code	253
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

CLINDAMYCIN CAPSULES (CLEOCIN) 300 MG (TAKE HOME) [4080349]

Facility

$15.00

Service Code	NDC 00004080137
Hospital Revenue Code	253
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

CLINDAMYCIN CAPSULES (CLEOCIN) 300 MG (TAKE HOME) [4080349]

Facility

$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: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CLINDAMYCIN HCL 150 MG CAPSULE [1740]

Facility

$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: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

CLINDAMYCIN HCL 150 MG CAPSULE [1740]

Facility

$3.00

Service Code	NDC 68084024301
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLINDAMYCIN HCL 150 MG CAPSULE [1740]

Facility

$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: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CLINDAMYCIN HCL 150 MG CAPSULE [1740]

Facility

$5.00

Service Code	NDC 42571025101
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

CLINDAMYCIN HCL 150 MG CAPSULE [1740]

Facility

$3.00

Service Code	NDC 68084024311
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

CLINDAMYCIN HCL 150 MG CAPSULE [1740]

Facility

$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: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CLINDAMYCIN HCL 300 MG CAPSULE [9621]

Facility

$5.00

Service Code	NDC 68084024401
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

CLINDAMYCIN HCL 300 MG CAPSULE [9621]

Facility

$5.00

Service Code	NDC 68084024411
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

CLINDAMYCIN HCL 300 MG CAPSULE [9621]

Facility

$14.00

Service Code	NDC 42571025201
Hospital Revenue Code	637
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$10.64
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$11.76
Rate for Payer: Hawaii Medical Service Association Medicare	$10.64
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$10.64
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$10.64
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$10.64
Rate for Payer: Ohana Health Plan Medicare	$10.64
Rate for Payer: UnitedHealthcare Medicare	$10.64
Rate for Payer: University Health Alliance Commercial	$10.20

CLINDAMYCIN HCL 300 MG CAPSULE [9621]

Facility

$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: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

CLINDAMYCIN HCL 300 MG CAPSULE [9621]

Facility

$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: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

CLINDAMYCIN HCL 300 MG CAPSULE [9621]

Facility

$5.00

Service Code	NDC 68084024411
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: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

CLIP 5MM ENDO

Facility

$462.00

Hospital Revenue Code	272
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$448.14
Rate for Payer: AlohaCare Medicaid	$231.00
Rate for Payer: AlohaCare Medicare	$351.12
Rate for Payer: Cash Price	$277.20
Rate for Payer: Devoted Health Medicare	$388.08
Rate for Payer: Hawaii Medical Service Association Medicare	$351.12
Rate for Payer: Hawaii Western Management Group Commercial	$438.90
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Humana Medicare	$351.12
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: Kaiser Permanente Medicaid	$235.62
Rate for Payer: Kaiser Permanente Medicare	$351.12
Rate for Payer: MDX Hawaii PPO	$448.14
Rate for Payer: Ohana Health Plan Medicaid	$351.12
Rate for Payer: Ohana Health Plan Medicare	$351.12
Rate for Payer: UnitedHealthcare Medicare	$351.12
Rate for Payer: University Health Alliance Commercial	$336.75

CLIP 5MM ENDO

Facility

$462.00

Hospital Revenue Code	272
Min. Negotiated Rate	$392.70
Max. Negotiated Rate	$448.14
Rate for Payer: Cash Price	$277.20
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: MDX Hawaii PPO	$448.14

CLIP CLOSED GAMMA 1320-0125S

Facility

$871.00

Hospital Revenue Code	272
Min. Negotiated Rate	$740.35
Max. Negotiated Rate	$844.87
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$740.35
Rate for Payer: Kaiser Permanente Commercial	$783.90
Rate for Payer: MDX Hawaii PPO	$844.87

CLIP CLOSED GAMMA 1320-0125S

Facility

$871.00

Hospital Revenue Code	272
Min. Negotiated Rate	$435.50
Max. Negotiated Rate	$844.87
Rate for Payer: AlohaCare Medicaid	$435.50
Rate for Payer: AlohaCare Medicare	$661.96
Rate for Payer: Cash Price	$522.60
Rate for Payer: Devoted Health Medicare	$731.64
Rate for Payer: Hawaii Medical Service Association Medicare	$661.96
Rate for Payer: Hawaii Western Management Group Commercial	$827.45
Rate for Payer: Health Management Network Commercial	$740.35
Rate for Payer: Humana Medicare	$661.96
Rate for Payer: Kaiser Permanente Commercial	$783.90
Rate for Payer: Kaiser Permanente Medicaid	$444.21
Rate for Payer: Kaiser Permanente Medicare	$661.96
Rate for Payer: MDX Hawaii PPO	$844.87
Rate for Payer: Ohana Health Plan Medicaid	$661.96
Rate for Payer: Ohana Health Plan Medicare	$661.96
Rate for Payer: UnitedHealthcare Medicare	$661.96
Rate for Payer: University Health Alliance Commercial	$634.87

CLIP DYNAMIZATION 390.032

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$727.50
Rate for Payer: AlohaCare Medicaid	$375.00
Rate for Payer: AlohaCare Medicare	$570.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Devoted Health Medicare	$630.00
Rate for Payer: Hawaii Medical Service Association Medicare	$570.00
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Humana Medicare	$570.00
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: Kaiser Permanente Medicare	$570.00
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: Ohana Health Plan Medicaid	$570.00
Rate for Payer: Ohana Health Plan Medicare	$570.00
Rate for Payer: UnitedHealthcare Medicare	$570.00
Rate for Payer: University Health Alliance Commercial	$546.67

CLIP DYNAMIZATION 390.032

Facility

$750.00

Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: MDX Hawaii PPO	$727.50

Know your out-of-pocket cost for care.

All Charges