Kau Hospital

All Charges

Charge

Type

Setting

Price

CLONAZEPAM 1 MG TABLET [9638]

Facility

$3.00

Service Code	NDC 60687055501
Hospital Revenue Code	637
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$0.93
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$1.02
Rate for Payer: Hawaii Medical Service Association Medicare	$0.93
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$0.93
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$0.93
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$0.93
Rate for Payer: Ohana Health Plan Medicare	$0.93
Rate for Payer: UnitedHealthcare Medicare	$0.93
Rate for Payer: University Health Alliance Commercial	$2.19

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [162634]

Facility

$83.00

Service Code	NDC 75907002348
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: MDX Hawaii PPO	$80.51

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [162634]

Facility

$83.00

Service Code	NDC 75907002311
Hospital Revenue Code	637
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$80.51
Rate for Payer: AlohaCare Medicaid	$41.50
Rate for Payer: AlohaCare Medicare	$25.73
Rate for Payer: Cash Price	$49.80
Rate for Payer: Devoted Health Medicare	$28.22
Rate for Payer: Hawaii Medical Service Association Medicare	$25.73
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Humana Medicare	$25.73
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: Kaiser Permanente Medicare	$25.73
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: Ohana Health Plan Medicaid	$25.73
Rate for Payer: Ohana Health Plan Medicare	$25.73
Rate for Payer: UnitedHealthcare Medicare	$25.73
Rate for Payer: University Health Alliance Commercial	$60.50

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [162634]

Facility

$83.00

Service Code	NDC 75907002311
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: MDX Hawaii PPO	$80.51

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [162634]

Facility

$83.00

Service Code	NDC 00591350804
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: MDX Hawaii PPO	$80.51

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [162634]

Facility

$83.00

Service Code	NDC 00591350804
Hospital Revenue Code	637
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$80.51
Rate for Payer: AlohaCare Medicaid	$41.50
Rate for Payer: AlohaCare Medicare	$25.73
Rate for Payer: Cash Price	$49.80
Rate for Payer: Devoted Health Medicare	$28.22
Rate for Payer: Hawaii Medical Service Association Medicare	$25.73
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Humana Medicare	$25.73
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: Kaiser Permanente Medicare	$25.73
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: Ohana Health Plan Medicaid	$25.73
Rate for Payer: Ohana Health Plan Medicare	$25.73
Rate for Payer: UnitedHealthcare Medicare	$25.73
Rate for Payer: University Health Alliance Commercial	$60.50

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [162634]

Facility

$83.00

Service Code	NDC 75907002348
Hospital Revenue Code	637
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$80.51
Rate for Payer: AlohaCare Medicaid	$41.50
Rate for Payer: AlohaCare Medicare	$25.73
Rate for Payer: Cash Price	$49.80
Rate for Payer: Devoted Health Medicare	$28.22
Rate for Payer: Hawaii Medical Service Association Medicare	$25.73
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Humana Medicare	$25.73
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: Kaiser Permanente Medicare	$25.73
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: Ohana Health Plan Medicaid	$25.73
Rate for Payer: Ohana Health Plan Medicare	$25.73
Rate for Payer: UnitedHealthcare Medicare	$25.73
Rate for Payer: University Health Alliance Commercial	$60.50

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [162635]

Facility

$112.00

Service Code	NDC 75907002411
Hospital Revenue Code	637
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$56.00
Rate for Payer: AlohaCare Medicare	$34.72
Rate for Payer: Cash Price	$67.20
Rate for Payer: Devoted Health Medicare	$38.08
Rate for Payer: Hawaii Medical Service Association Medicare	$34.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.40
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$34.72
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$34.72
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$34.72
Rate for Payer: Ohana Health Plan Medicare	$34.72
Rate for Payer: UnitedHealthcare Medicare	$34.72
Rate for Payer: University Health Alliance Commercial	$81.64

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [162635]

Facility

$112.00

Service Code	NDC 75907002448
Hospital Revenue Code	250
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [162635]

Facility

$112.00

Service Code	NDC 75907002411
Hospital Revenue Code	250
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [162635]

Facility

$112.00

Service Code	NDC 75907002448
Hospital Revenue Code	637
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$56.00
Rate for Payer: AlohaCare Medicare	$34.72
Rate for Payer: Cash Price	$67.20
Rate for Payer: Devoted Health Medicare	$38.08
Rate for Payer: Hawaii Medical Service Association Medicare	$34.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.40
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$34.72
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$34.72
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$34.72
Rate for Payer: Ohana Health Plan Medicare	$34.72
Rate for Payer: UnitedHealthcare Medicare	$34.72
Rate for Payer: University Health Alliance Commercial	$81.64

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [162635]

Facility

$112.00

Service Code	NDC 00591350904
Hospital Revenue Code	637
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$56.00
Rate for Payer: AlohaCare Medicare	$34.72
Rate for Payer: Cash Price	$67.20
Rate for Payer: Devoted Health Medicare	$38.08
Rate for Payer: Hawaii Medical Service Association Medicare	$34.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.40
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$34.72
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$34.72
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$34.72
Rate for Payer: Ohana Health Plan Medicare	$34.72
Rate for Payer: UnitedHealthcare Medicare	$34.72
Rate for Payer: University Health Alliance Commercial	$81.64

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH [162635]

Facility

$112.00

Service Code	NDC 00591350904
Hospital Revenue Code	250
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 75907002548
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 00591351004
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 51862045504
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 51862045504
Hospital Revenue Code	637
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 00591351004
Hospital Revenue Code	637
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 75907002548
Hospital Revenue Code	637
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 75907002511
Hospital Revenue Code	637
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH [162636]

Facility

$155.00

Service Code	NDC 75907002511
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$1.00

Service Code	NDC 68001023700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

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

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$1.00

Service Code	NDC 68001023700
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$2.00

Service Code	NDC 60687011301
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

Know your out-of-pocket cost for care.

All Charges