Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

clevidipine 25 mg / 50 mL vial [KMC]

Facility

$7.98

Service Code	HCPCS C9248
Hospital Revenue Code	637
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$7.74
Rate for Payer: Cash Price	$5.19
Rate for Payer: Health Management Network Commercial	$6.78
Rate for Payer: Kaiser Permanente Commercial	$7.18
Rate for Payer: MDX Hawaii PPO	$7.74

clevidipine 25 mg / 50 mL vial [KMC]

Facility

$7.98

Service Code	HCPCS C9248
Hospital Revenue Code	637
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$7.74
Rate for Payer: AlohaCare Medicaid	$3.99
Rate for Payer: AlohaCare Medicare	$3.35
Rate for Payer: Cash Price	$5.19
Rate for Payer: Cash Price	$5.19
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.34
Rate for Payer: Devoted Health Medicare	$3.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.35
Rate for Payer: Hawaii Western Management Group Commercial	$7.58
Rate for Payer: Health Management Network Commercial	$6.78
Rate for Payer: Humana Medicare	$3.35
Rate for Payer: Kaiser Permanente Commercial	$7.18
Rate for Payer: Kaiser Permanente Medicaid	$4.07
Rate for Payer: Kaiser Permanente Medicare	$3.35
Rate for Payer: MDX Hawaii PPO	$7.74
Rate for Payer: Ohana Health Plan Medicaid	$3.35
Rate for Payer: Ohana Health Plan Medicare	$3.35
Rate for Payer: UnitedHealthcare Medicaid	$2.16
Rate for Payer: UnitedHealthcare Medicare	$3.35
Rate for Payer: University Health Alliance Commercial	$5.82

clindamycin 150 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 68462014301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

clindamycin 150 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 68462014301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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 600 mg / 50 mL D5W Soln [KMC]

Facility

$1.03

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.00
Rate for Payer: Cash Price	$0.67
Rate for Payer: Health Management Network Commercial	$0.88
Rate for Payer: Kaiser Permanente Commercial	$0.93
Rate for Payer: MDX Hawaii PPO	$1.00

clindamycin 600 mg / 50 mL D5W Soln [KMC]

Facility

$1.03

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.67
Rate for Payer: AlohaCare Medicaid	$0.52
Rate for Payer: AlohaCare Medicare	$0.43
Rate for Payer: Cash Price	$0.67
Rate for Payer: Cash Price	$0.67
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.95
Rate for Payer: Devoted Health Medicare	$0.43
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$0.43
Rate for Payer: Hawaii Western Management Group Commercial	$0.98
Rate for Payer: Health Management Network Commercial	$0.88
Rate for Payer: Humana Medicare	$0.43
Rate for Payer: Kaiser Permanente Commercial	$0.93
Rate for Payer: Kaiser Permanente Medicaid	$0.53
Rate for Payer: Kaiser Permanente Medicare	$0.43
Rate for Payer: MDX Hawaii PPO	$1.00
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicare	$0.43
Rate for Payer: UnitedHealthcare Medicaid	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.43
Rate for Payer: University Health Alliance Commercial	$0.75

clindamycin 900 mg / 6 mL IV/IM Soln [KMC]

Facility

$10.21

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$9.90
Rate for Payer: AlohaCare Medicaid	$5.11
Rate for Payer: AlohaCare Medicare	$4.29
Rate for Payer: Cash Price	$6.64
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.39
Rate for Payer: Devoted Health Medicare	$4.29
Rate for Payer: Hawaii Medical Service Association Medicare	$4.29
Rate for Payer: Hawaii Western Management Group Commercial	$9.70
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: Humana Medicare	$4.29
Rate for Payer: Kaiser Permanente Commercial	$9.19
Rate for Payer: Kaiser Permanente Medicaid	$5.21
Rate for Payer: Kaiser Permanente Medicare	$4.29
Rate for Payer: MDX Hawaii PPO	$9.90
Rate for Payer: Ohana Health Plan Medicaid	$4.29
Rate for Payer: Ohana Health Plan Medicare	$4.29
Rate for Payer: UnitedHealthcare Medicaid	$6.13
Rate for Payer: UnitedHealthcare Medicare	$4.29
Rate for Payer: University Health Alliance Commercial	$7.44

clindamycin 900 mg / 6 mL IV/IM Soln [KMC]

Facility

$10.21

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$9.90
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: Kaiser Permanente Commercial	$9.19
Rate for Payer: MDX Hawaii PPO	$9.90

Clinimix 5/20 (Amino Acids 5% + 20% Dextrose) 1000 mL soln [KMC]

Facility

$0.19

Service Code	NDC 00338113803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Management Network Commercial	$0.16
Rate for Payer: Kaiser Permanente Commercial	$0.17
Rate for Payer: MDX Hawaii PPO	$0.18

Clinimix 5/20 (Amino Acids 5% + 20% Dextrose) 1000 mL soln [KMC]

Facility

$0.19

Service Code	NDC 00338113803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: AlohaCare Medicaid	$0.10
Rate for Payer: AlohaCare Medicare	$0.08
Rate for Payer: Cash Price	$0.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Hawaii Medical Service Association Medicare	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$0.18
Rate for Payer: Health Management Network Commercial	$0.16
Rate for Payer: Humana Medicare	$0.08
Rate for Payer: Kaiser Permanente Commercial	$0.17
Rate for Payer: Kaiser Permanente Medicaid	$0.10
Rate for Payer: Kaiser Permanente Medicare	$0.08
Rate for Payer: MDX Hawaii PPO	$0.18
Rate for Payer: Ohana Health Plan Medicaid	$0.08
Rate for Payer: Ohana Health Plan Medicare	$0.08
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicare	$0.08
Rate for Payer: University Health Alliance Commercial	$0.14

clobetasol 0.05% cream [KMC]

Facility

$34.19

Service Code	NDC 69238153203
Hospital Revenue Code	250
Min. Negotiated Rate	$29.06
Max. Negotiated Rate	$33.16
Rate for Payer: Cash Price	$22.22
Rate for Payer: Health Management Network Commercial	$29.06
Rate for Payer: Kaiser Permanente Commercial	$30.77
Rate for Payer: MDX Hawaii PPO	$33.16

clobetasol 0.05% cream [KMC]

Facility

$34.19

Service Code	NDC 69238153203
Hospital Revenue Code	250
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$33.16
Rate for Payer: AlohaCare Medicaid	$17.09
Rate for Payer: AlohaCare Medicare	$14.36
Rate for Payer: Cash Price	$22.22
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$31.45
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association Medicare	$14.36
Rate for Payer: Hawaii Western Management Group Commercial	$32.48
Rate for Payer: Health Management Network Commercial	$29.06
Rate for Payer: Humana Medicare	$14.36
Rate for Payer: Kaiser Permanente Commercial	$30.77
Rate for Payer: Kaiser Permanente Medicaid	$17.44
Rate for Payer: Kaiser Permanente Medicare	$14.36
Rate for Payer: MDX Hawaii PPO	$33.16
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$14.36
Rate for Payer: UnitedHealthcare Medicaid	$20.51
Rate for Payer: UnitedHealthcare Medicare	$14.36
Rate for Payer: University Health Alliance Commercial	$24.92

clobetasol 0.05% ointment [KMC]

Facility

$34.63

Service Code	NDC 51672125902
Hospital Revenue Code	250
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$33.59
Rate for Payer: AlohaCare Medicaid	$17.32
Rate for Payer: AlohaCare Medicare	$14.54
Rate for Payer: Cash Price	$22.51
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$31.86
Rate for Payer: Devoted Health Medicare	$14.54
Rate for Payer: Hawaii Medical Service Association Medicare	$14.54
Rate for Payer: Hawaii Western Management Group Commercial	$32.90
Rate for Payer: Health Management Network Commercial	$29.44
Rate for Payer: Humana Medicare	$14.54
Rate for Payer: Kaiser Permanente Commercial	$31.17
Rate for Payer: Kaiser Permanente Medicaid	$17.66
Rate for Payer: Kaiser Permanente Medicare	$14.54
Rate for Payer: MDX Hawaii PPO	$33.59
Rate for Payer: Ohana Health Plan Medicaid	$14.54
Rate for Payer: Ohana Health Plan Medicare	$14.54
Rate for Payer: UnitedHealthcare Medicaid	$20.78
Rate for Payer: UnitedHealthcare Medicare	$14.54
Rate for Payer: University Health Alliance Commercial	$25.24

clobetasol 0.05% ointment [KMC]

Facility

$34.63

Service Code	NDC 51672125902
Hospital Revenue Code	250
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$33.59
Rate for Payer: Cash Price	$22.51
Rate for Payer: Health Management Network Commercial	$29.44
Rate for Payer: Kaiser Permanente Commercial	$31.17
Rate for Payer: MDX Hawaii PPO	$33.59

clonazePAM 0.25 mg DIS tab [KMC]

Facility

$5.20

Service Code	NDC 00555009596
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$5.04
Rate for Payer: Cash Price	$3.38
Rate for Payer: Health Management Network Commercial	$4.42
Rate for Payer: Kaiser Permanente Commercial	$4.68
Rate for Payer: MDX Hawaii PPO	$5.04

clonazePAM 0.25 mg DIS tab [KMC]

Facility

$5.20

Service Code	NDC 00555009596
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$5.04
Rate for Payer: AlohaCare Medicaid	$2.60
Rate for Payer: AlohaCare Medicare	$2.18
Rate for Payer: Cash Price	$3.38
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.78
Rate for Payer: Devoted Health Medicare	$2.18
Rate for Payer: Hawaii Medical Service Association Medicare	$2.18
Rate for Payer: Hawaii Western Management Group Commercial	$4.94
Rate for Payer: Health Management Network Commercial	$4.42
Rate for Payer: Humana Medicare	$2.18
Rate for Payer: Kaiser Permanente Commercial	$4.68
Rate for Payer: Kaiser Permanente Medicaid	$2.65
Rate for Payer: Kaiser Permanente Medicare	$2.18
Rate for Payer: MDX Hawaii PPO	$5.04
Rate for Payer: Ohana Health Plan Medicaid	$2.18
Rate for Payer: Ohana Health Plan Medicare	$2.18
Rate for Payer: UnitedHealthcare Medicaid	$3.12
Rate for Payer: UnitedHealthcare Medicare	$2.18
Rate for Payer: University Health Alliance Commercial	$3.79

clonazePAM 0.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 16729013600
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

clonazePAM 0.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 16729013600
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

cloNIDine 0.1 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

cloNIDine 0.1 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

cloNIDine 0.2 mg patch [KMC]

Facility

$223.31

Service Code	NDC 51862045404
Hospital Revenue Code	250
Min. Negotiated Rate	$93.79
Max. Negotiated Rate	$216.61
Rate for Payer: AlohaCare Medicaid	$111.66
Rate for Payer: AlohaCare Medicare	$93.79
Rate for Payer: Cash Price	$145.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$205.45
Rate for Payer: Devoted Health Medicare	$93.79
Rate for Payer: Hawaii Medical Service Association Medicare	$93.79
Rate for Payer: Hawaii Western Management Group Commercial	$212.14
Rate for Payer: Health Management Network Commercial	$189.81
Rate for Payer: Humana Medicare	$93.79
Rate for Payer: Kaiser Permanente Commercial	$200.98
Rate for Payer: Kaiser Permanente Medicaid	$113.89
Rate for Payer: Kaiser Permanente Medicare	$93.79
Rate for Payer: MDX Hawaii PPO	$216.61
Rate for Payer: Ohana Health Plan Medicaid	$93.79
Rate for Payer: Ohana Health Plan Medicare	$93.79
Rate for Payer: UnitedHealthcare Medicaid	$133.99
Rate for Payer: UnitedHealthcare Medicare	$93.79
Rate for Payer: University Health Alliance Commercial	$162.77

cloNIDine 0.2 mg patch [KMC]

Facility

$223.31

Service Code	NDC 51862045404
Hospital Revenue Code	250
Min. Negotiated Rate	$189.81
Max. Negotiated Rate	$216.61
Rate for Payer: Cash Price	$145.15
Rate for Payer: Health Management Network Commercial	$189.81
Rate for Payer: Kaiser Permanente Commercial	$200.98
Rate for Payer: MDX Hawaii PPO	$216.61

cloNIDine 0.3 mg patch [KMC]

Facility

$309.44

Service Code	NDC 00378087399
Hospital Revenue Code	250
Min. Negotiated Rate	$263.02
Max. Negotiated Rate	$300.16
Rate for Payer: Cash Price	$201.14
Rate for Payer: Health Management Network Commercial	$263.02
Rate for Payer: Kaiser Permanente Commercial	$278.50
Rate for Payer: MDX Hawaii PPO	$300.16

cloNIDine 0.3 mg patch [KMC]

Facility

$309.44

Service Code	NDC 00378087399
Hospital Revenue Code	250
Min. Negotiated Rate	$129.96
Max. Negotiated Rate	$300.16
Rate for Payer: AlohaCare Medicaid	$154.72
Rate for Payer: AlohaCare Medicare	$129.96
Rate for Payer: Cash Price	$201.14
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$284.68
Rate for Payer: Devoted Health Medicare	$129.96
Rate for Payer: Hawaii Medical Service Association Medicare	$129.96
Rate for Payer: Hawaii Western Management Group Commercial	$293.97
Rate for Payer: Health Management Network Commercial	$263.02
Rate for Payer: Humana Medicare	$129.96
Rate for Payer: Kaiser Permanente Commercial	$278.50
Rate for Payer: Kaiser Permanente Medicaid	$157.81
Rate for Payer: Kaiser Permanente Medicare	$129.96
Rate for Payer: MDX Hawaii PPO	$300.16
Rate for Payer: Ohana Health Plan Medicaid	$129.96
Rate for Payer: Ohana Health Plan Medicare	$129.96
Rate for Payer: UnitedHealthcare Medicaid	$185.66
Rate for Payer: UnitedHealthcare Medicare	$129.96
Rate for Payer: University Health Alliance Commercial	$225.55

clopidogrel 300 mg Tab [KMC]

Facility

$63.77

Service Code	NDC 63739017830
Hospital Revenue Code	250
Min. Negotiated Rate	$54.20
Max. Negotiated Rate	$61.86
Rate for Payer: Cash Price	$41.45
Rate for Payer: Health Management Network Commercial	$54.20
Rate for Payer: Kaiser Permanente Commercial	$57.39
Rate for Payer: MDX Hawaii PPO	$61.86

Know your out-of-pocket cost for care.

All Charges