Kau Hospital

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	$0.62
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$0.68
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.46

CLONIDINE HCL 0.1 MG TABLET [1755]

Facility

$2.00

Service Code	NDC 60687011301
Hospital Revenue Code	637
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$0.68
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.46

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 300 MG TABLET [89346]

Facility

$67.00

Service Code	NDC 68084075225
Hospital Revenue Code	637
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$20.77
Rate for Payer: Cash Price	$40.20
Rate for Payer: Devoted Health Medicare	$22.78
Rate for Payer: Hawaii Medical Service Association Medicare	$20.77
Rate for Payer: Hawaii Western Management Group Commercial	$63.65
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$20.77
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$20.77
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$20.77
Rate for Payer: Ohana Health Plan Medicare	$20.77
Rate for Payer: UnitedHealthcare Medicare	$20.77
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	$8.99
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$8.99
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$9.86
Rate for Payer: Hawaii Medical Service Association Medicare	$8.99
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$8.99
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$8.99
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$8.99
Rate for Payer: Ohana Health Plan Medicare	$8.99
Rate for Payer: UnitedHealthcare Medicare	$8.99
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	$8.99
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$8.99
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$9.86
Rate for Payer: Hawaii Medical Service Association Medicare	$8.99
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$8.99
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$8.99
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$8.99
Rate for Payer: Ohana Health Plan Medicare	$8.99
Rate for Payer: UnitedHealthcare Medicare	$8.99
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 75 MG TABLET [22142]

Facility

$21.00

Service Code	NDC 68084053611
Hospital Revenue Code	637
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$6.51
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicare	$6.51
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	$6.51
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$6.51
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$15.31

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	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

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	$3.72
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$3.72
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$4.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$3.72
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$3.72
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$3.72
Rate for Payer: Ohana Health Plan Medicare	$3.72
Rate for Payer: UnitedHealthcare Medicare	$3.72
Rate for Payer: University Health Alliance Commercial	$8.75

CLOTRIMAZOLE 1 % VAGINAL CREAM [1769]

Facility

$17.00

Service Code	NDC 61269022041
Hospital Revenue Code	637
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$5.27
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$5.78
Rate for Payer: Hawaii Medical Service Association Medicare	$5.27
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$5.27
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$5.27
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$5.27
Rate for Payer: Ohana Health Plan Medicare	$5.27
Rate for Payer: UnitedHealthcare Medicare	$5.27
Rate for Payer: University Health Alliance Commercial	$12.39

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 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 1 % VAGINAL CREAM [1769]

Facility

$17.00

Service Code	NDC 61269022063
Hospital Revenue Code	637
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$5.27
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$5.78
Rate for Payer: Hawaii Medical Service Association Medicare	$5.27
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$5.27
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$5.27
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$5.27
Rate for Payer: Ohana Health Plan Medicare	$5.27
Rate for Payer: UnitedHealthcare Medicare	$5.27
Rate for Payer: University Health Alliance Commercial	$12.39

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	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
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	250
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92

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

Facility

$71.00

Service Code	NDC 00168025815
Hospital Revenue Code	637
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$22.01
Rate for Payer: Cash Price	$42.60
Rate for Payer: Devoted Health Medicare	$24.14
Rate for Payer: Hawaii Medical Service Association Medicare	$22.01
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$22.01
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$22.01
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$22.01
Rate for Payer: Ohana Health Plan Medicare	$22.01
Rate for Payer: UnitedHealthcare Medicare	$22.01
Rate for Payer: University Health Alliance Commercial	$51.75

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

Facility

$71.00

Service Code	NDC 00168025815
Hospital Revenue Code	250
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

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

Facility

$293.00

Service Code	NDC 00472037945
Hospital Revenue Code	250
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$175.80
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: MDX Hawaii PPO	$284.21

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

Facility

$293.00

Service Code	NDC 00472037945
Hospital Revenue Code	637
Min. Negotiated Rate	$90.83
Max. Negotiated Rate	$284.21
Rate for Payer: AlohaCare Medicaid	$146.50
Rate for Payer: AlohaCare Medicare	$90.83
Rate for Payer: Cash Price	$175.80
Rate for Payer: Devoted Health Medicare	$99.62
Rate for Payer: Hawaii Medical Service Association Medicare	$90.83
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Humana Medicare	$90.83
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: Kaiser Permanente Medicare	$90.83
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: Ohana Health Plan Medicaid	$90.83
Rate for Payer: Ohana Health Plan Medicare	$90.83
Rate for Payer: UnitedHealthcare Medicare	$90.83
Rate for Payer: University Health Alliance Commercial	$213.57

Know your out-of-pocket cost for care.

All Charges