Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$2.00

Service Code	NDC 60687011311
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$2.00

Service Code	NDC 60687011311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

CLOPIDOGREL 300 MG TABLET [89346]

Facility

$67.00

Service Code	NDC 68084075225
Hospital Revenue Code	637
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$50.92
Rate for Payer: Cash Price	$40.20
Rate for Payer: Devoted Health Medicare	$56.28
Rate for Payer: Hawaii Medical Service Association Medicare	$50.92
Rate for Payer: Hawaii Western Management Group Commercial	$63.65
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$50.92
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$50.92
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$50.92
Rate for Payer: Ohana Health Plan Medicare	$50.92
Rate for Payer: UnitedHealthcare Medicare	$50.92
Rate for Payer: University Health Alliance Commercial	$48.84

CLOPIDOGREL 300 MG TABLET [89346]

Facility

$29.00

Service Code	NDC 68084075219
Hospital Revenue Code	637
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$22.04
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$24.36
Rate for Payer: Hawaii Medical Service Association Medicare	$22.04
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$22.04
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$22.04
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$22.04
Rate for Payer: Ohana Health Plan Medicare	$22.04
Rate for Payer: UnitedHealthcare Medicare	$22.04
Rate for Payer: University Health Alliance Commercial	$21.14

CLOPIDOGREL 300 MG TABLET [89346]

Facility

$29.00

Service Code	NDC 68084075218
Hospital Revenue Code	637
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$22.04
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$24.36
Rate for Payer: Hawaii Medical Service Association Medicare	$22.04
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$22.04
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$22.04
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$22.04
Rate for Payer: Ohana Health Plan Medicare	$22.04
Rate for Payer: UnitedHealthcare Medicare	$22.04
Rate for Payer: University Health Alliance Commercial	$21.14

CLOPIDOGREL 300 MG TABLET [89346]

Facility

$67.00

Service Code	NDC 68084075225
Hospital Revenue Code	250
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$40.20
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99

CLOPIDOGREL 300 MG TABLET [89346]

Facility

$29.00

Service Code	NDC 68084075218
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

CLOPIDOGREL 300 MG TABLET [89346]

Facility

$29.00

Service Code	NDC 68084075219
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

CLOPIDOGREL 75 MG TABLET [22142]

Facility

$21.00

Service Code	NDC 68084053611
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

CLOPIDOGREL 75 MG TABLET [22142]

Facility

$21.00

Service Code	NDC 68084053601
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

CLOPIDOGREL 75 MG TABLET [22142]

Facility

$21.00

Service Code	NDC 68084053611
Hospital Revenue Code	637
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$15.31

CLOPIDOGREL 75 MG TABLET [22142]

Facility

$21.00

Service Code	NDC 68084053601
Hospital Revenue Code	637
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$17.64
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$15.31

CLOTRIMAZOLE 10 MG TROCHE [9644]

Facility

$12.00

Service Code	NDC 00054414622
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

CLOTRIMAZOLE 10 MG TROCHE [9644]

Facility

$12.00

Service Code	NDC 00054414622
Hospital Revenue Code	637
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: University Health Alliance Commercial	$8.75

CLOTRIMAZOLE 1 % VAGINAL CREAM [1769]

Facility

$17.00

Service Code	NDC 61269022063
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CLOTRIMAZOLE 1 % VAGINAL CREAM [1769]

Facility

$17.00

Service Code	NDC 61269022063
Hospital Revenue Code	637
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$12.92
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$12.39

CLOTRIMAZOLE 1 % VAGINAL CREAM [1769]

Facility

$17.00

Service Code	NDC 61269022041
Hospital Revenue Code	637
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$14.28
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$12.92
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$12.39

CLOTRIMAZOLE 1 % VAGINAL CREAM [1769]

Facility

$17.00

Service Code	NDC 61269022041
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CLOTRIMAZOLE/BETAMETHASONE 1-0.05% CREAM (LOTRISONE) (15 GRAM) (TAKE HOME) [4080372]

Facility

$15.00

Service Code	NDC 00004080160
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

CLOTRIMAZOLE/BETAMETHASONE 1-0.05% CREAM (LOTRISONE) (15 GRAM) (TAKE HOME) [4080372]

Facility

$15.00

Service Code	NDC 00004080160
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

CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]

Facility

$136.00

Service Code	NDC 00472037915
Hospital Revenue Code	637
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$103.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$103.36
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$103.36
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$103.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$103.36
Rate for Payer: Ohana Health Plan Medicare	$103.36
Rate for Payer: UnitedHealthcare Medicare	$103.36
Rate for Payer: University Health Alliance Commercial	$99.13

CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]

Facility

$153.00

Service Code	NDC 00168025846
Hospital Revenue Code	637
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$116.28
Rate for Payer: Cash Price	$91.80
Rate for Payer: Devoted Health Medicare	$128.52
Rate for Payer: Hawaii Medical Service Association Medicare	$116.28
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$116.28
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$116.28
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$116.28
Rate for Payer: Ohana Health Plan Medicare	$116.28
Rate for Payer: UnitedHealthcare Medicare	$116.28
Rate for Payer: University Health Alliance Commercial	$111.52

CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]

Facility

$197.00

Service Code	NDC 68462029817
Hospital Revenue Code	637
Min. Negotiated Rate	$98.50
Max. Negotiated Rate	$191.09
Rate for Payer: AlohaCare Medicaid	$98.50
Rate for Payer: AlohaCare Medicare	$149.72
Rate for Payer: Cash Price	$118.20
Rate for Payer: Devoted Health Medicare	$165.48
Rate for Payer: Hawaii Medical Service Association Medicare	$149.72
Rate for Payer: Hawaii Western Management Group Commercial	$187.15
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Humana Medicare	$149.72
Rate for Payer: Kaiser Permanente Commercial	$177.30
Rate for Payer: Kaiser Permanente Medicaid	$100.47
Rate for Payer: Kaiser Permanente Medicare	$149.72
Rate for Payer: MDX Hawaii PPO	$191.09
Rate for Payer: Ohana Health Plan Medicaid	$149.72
Rate for Payer: Ohana Health Plan Medicare	$149.72
Rate for Payer: UnitedHealthcare Medicare	$149.72
Rate for Payer: University Health Alliance Commercial	$143.59

CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]

Facility

$293.00

Service Code	NDC 00472037945
Hospital Revenue Code	637
Min. Negotiated Rate	$146.50
Max. Negotiated Rate	$284.21
Rate for Payer: AlohaCare Medicaid	$146.50
Rate for Payer: AlohaCare Medicare	$222.68
Rate for Payer: Cash Price	$175.80
Rate for Payer: Devoted Health Medicare	$246.12
Rate for Payer: Hawaii Medical Service Association Medicare	$222.68
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Humana Medicare	$222.68
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: Kaiser Permanente Medicare	$222.68
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: Ohana Health Plan Medicaid	$222.68
Rate for Payer: Ohana Health Plan Medicare	$222.68
Rate for Payer: UnitedHealthcare Medicare	$222.68
Rate for Payer: University Health Alliance Commercial	$213.57

CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM [29424]

Facility

$197.00

Service Code	NDC 68462029817
Hospital Revenue Code	250
Min. Negotiated Rate	$167.45
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$118.20
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$177.30
Rate for Payer: MDX Hawaii PPO	$191.09

Know your out-of-pocket cost for care.

All Charges