Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

clindamycin 150 mg capsule [HHSC]

Facility

$4.06

Service Code	NDC 00904595961
Hospital Charge Code	2500184
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$3.94
Rate for Payer: AlohaCare Medicaid	$2.03
Rate for Payer: AlohaCare Medicare	$2.03
Rate for Payer: Cash Price	$2.64
Rate for Payer: Devoted Health Medicare	$2.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.03
Rate for Payer: Hawaii Western Management Group Commercial	$3.86
Rate for Payer: Health Management Network Commercial	$3.45
Rate for Payer: Humana Medicare	$2.03
Rate for Payer: Kaiser Permanente Commercial	$3.65
Rate for Payer: Kaiser Permanente Medicaid	$2.07
Rate for Payer: Kaiser Permanente Medicare	$2.03
Rate for Payer: MDX Hawaii PPO	$3.94
Rate for Payer: Ohana Health Plan Medicaid	$2.03
Rate for Payer: Ohana Health Plan Medicare	$2.03
Rate for Payer: UnitedHealthcare Medicaid	$2.44
Rate for Payer: UnitedHealthcare Medicare	$2.03
Rate for Payer: University Health Alliance Commercial	$2.96

clindamycin 150 mg capsule [HHSC]

Facility

$3.49

Service Code	NDC 68084024301
Hospital Charge Code	2500184
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.39
Rate for Payer: AlohaCare Medicaid	$1.75
Rate for Payer: AlohaCare Medicare	$1.75
Rate for Payer: Cash Price	$2.27
Rate for Payer: Devoted Health Medicare	$1.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1.75
Rate for Payer: Hawaii Western Management Group Commercial	$3.32
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: Humana Medicare	$1.75
Rate for Payer: Kaiser Permanente Commercial	$3.14
Rate for Payer: Kaiser Permanente Medicaid	$1.78
Rate for Payer: Kaiser Permanente Medicare	$1.75
Rate for Payer: MDX Hawaii PPO	$3.39
Rate for Payer: Ohana Health Plan Medicaid	$1.75
Rate for Payer: Ohana Health Plan Medicare	$1.75
Rate for Payer: UnitedHealthcare Medicaid	$2.09
Rate for Payer: UnitedHealthcare Medicare	$1.75
Rate for Payer: University Health Alliance Commercial	$2.54

clindamycin 300 mg capsule [HHSC]

Facility

$3.06

Service Code	NDC 59762501002
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.97
Rate for Payer: AlohaCare Medicaid	$1.53
Rate for Payer: AlohaCare Medicare	$1.53
Rate for Payer: Cash Price	$1.99
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.53
Rate for Payer: Hawaii Western Management Group Commercial	$2.91
Rate for Payer: Health Management Network Commercial	$2.60
Rate for Payer: Humana Medicare	$1.53
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: Kaiser Permanente Medicare	$1.53
Rate for Payer: MDX Hawaii PPO	$2.97
Rate for Payer: Ohana Health Plan Medicaid	$1.53
Rate for Payer: Ohana Health Plan Medicare	$1.53
Rate for Payer: UnitedHealthcare Medicaid	$1.84
Rate for Payer: UnitedHealthcare Medicare	$1.53
Rate for Payer: University Health Alliance Commercial	$2.23

clindamycin 300 mg capsule [HHSC]

Facility

$3.06

Service Code	NDC 59762501002
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.97
Rate for Payer: Cash Price	$1.99
Rate for Payer: Health Management Network Commercial	$2.60
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: MDX Hawaii PPO	$2.97

clindamycin 300 mg capsule [HHSC]

Facility

$7.22

Service Code	NDC 68084024401
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$7.00
Rate for Payer: Cash Price	$4.69
Rate for Payer: Health Management Network Commercial	$6.14
Rate for Payer: Kaiser Permanente Commercial	$6.50
Rate for Payer: MDX Hawaii PPO	$7.00

clindamycin 300 mg capsule [HHSC]

Facility

$20.67

Service Code	NDC 65862018601
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$20.05
Rate for Payer: AlohaCare Medicaid	$10.34
Rate for Payer: AlohaCare Medicare	$10.34
Rate for Payer: Cash Price	$13.44
Rate for Payer: Devoted Health Medicare	$11.37
Rate for Payer: Hawaii Medical Service Association Medicare	$10.34
Rate for Payer: Hawaii Western Management Group Commercial	$19.64
Rate for Payer: Health Management Network Commercial	$17.57
Rate for Payer: Humana Medicare	$10.34
Rate for Payer: Kaiser Permanente Commercial	$18.60
Rate for Payer: Kaiser Permanente Medicaid	$10.54
Rate for Payer: Kaiser Permanente Medicare	$10.34
Rate for Payer: MDX Hawaii PPO	$20.05
Rate for Payer: Ohana Health Plan Medicaid	$10.34
Rate for Payer: Ohana Health Plan Medicare	$10.34
Rate for Payer: UnitedHealthcare Medicaid	$12.40
Rate for Payer: UnitedHealthcare Medicare	$10.34
Rate for Payer: University Health Alliance Commercial	$15.07

clindamycin 300 mg capsule [HHSC]

Facility

$20.67

Service Code	NDC 65862018601
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$20.05
Rate for Payer: Cash Price	$13.44
Rate for Payer: Health Management Network Commercial	$17.57
Rate for Payer: Kaiser Permanente Commercial	$18.60
Rate for Payer: MDX Hawaii PPO	$20.05

clindamycin 300 mg capsule [HHSC]

Facility

$20.67

Service Code	NDC 42571025201
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$20.05
Rate for Payer: AlohaCare Medicaid	$10.34
Rate for Payer: AlohaCare Medicare	$10.34
Rate for Payer: Cash Price	$13.44
Rate for Payer: Devoted Health Medicare	$11.37
Rate for Payer: Hawaii Medical Service Association Medicare	$10.34
Rate for Payer: Hawaii Western Management Group Commercial	$19.64
Rate for Payer: Health Management Network Commercial	$17.57
Rate for Payer: Humana Medicare	$10.34
Rate for Payer: Kaiser Permanente Commercial	$18.60
Rate for Payer: Kaiser Permanente Medicaid	$10.54
Rate for Payer: Kaiser Permanente Medicare	$10.34
Rate for Payer: MDX Hawaii PPO	$20.05
Rate for Payer: Ohana Health Plan Medicaid	$10.34
Rate for Payer: Ohana Health Plan Medicare	$10.34
Rate for Payer: UnitedHealthcare Medicaid	$12.40
Rate for Payer: UnitedHealthcare Medicare	$10.34
Rate for Payer: University Health Alliance Commercial	$15.07

clindamycin 300 mg capsule [HHSC]

Facility

$20.67

Service Code	NDC 63304069301
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$20.05
Rate for Payer: AlohaCare Medicaid	$10.34
Rate for Payer: AlohaCare Medicare	$10.34
Rate for Payer: Cash Price	$13.44
Rate for Payer: Devoted Health Medicare	$11.37
Rate for Payer: Hawaii Medical Service Association Medicare	$10.34
Rate for Payer: Hawaii Western Management Group Commercial	$19.64
Rate for Payer: Health Management Network Commercial	$17.57
Rate for Payer: Humana Medicare	$10.34
Rate for Payer: Kaiser Permanente Commercial	$18.60
Rate for Payer: Kaiser Permanente Medicaid	$10.54
Rate for Payer: Kaiser Permanente Medicare	$10.34
Rate for Payer: MDX Hawaii PPO	$20.05
Rate for Payer: Ohana Health Plan Medicaid	$10.34
Rate for Payer: Ohana Health Plan Medicare	$10.34
Rate for Payer: UnitedHealthcare Medicaid	$12.40
Rate for Payer: UnitedHealthcare Medicare	$10.34
Rate for Payer: University Health Alliance Commercial	$15.07

clindamycin 300 mg capsule [HHSC]

Facility

$7.22

Service Code	NDC 68084024401
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$7.00
Rate for Payer: AlohaCare Medicaid	$3.61
Rate for Payer: AlohaCare Medicare	$3.61
Rate for Payer: Cash Price	$4.69
Rate for Payer: Devoted Health Medicare	$3.97
Rate for Payer: Hawaii Medical Service Association Medicare	$3.61
Rate for Payer: Hawaii Western Management Group Commercial	$6.86
Rate for Payer: Health Management Network Commercial	$6.14
Rate for Payer: Humana Medicare	$3.61
Rate for Payer: Kaiser Permanente Commercial	$6.50
Rate for Payer: Kaiser Permanente Medicaid	$3.68
Rate for Payer: Kaiser Permanente Medicare	$3.61
Rate for Payer: MDX Hawaii PPO	$7.00
Rate for Payer: Ohana Health Plan Medicaid	$3.61
Rate for Payer: Ohana Health Plan Medicare	$3.61
Rate for Payer: UnitedHealthcare Medicaid	$4.33
Rate for Payer: UnitedHealthcare Medicare	$3.61
Rate for Payer: University Health Alliance Commercial	$5.26

clindamycin 300 mg capsule [HHSC]

Facility

$7.91

Service Code	NDC 50268018515
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$7.67
Rate for Payer: Cash Price	$5.14
Rate for Payer: Health Management Network Commercial	$6.72
Rate for Payer: Kaiser Permanente Commercial	$7.12
Rate for Payer: MDX Hawaii PPO	$7.67

clindamycin 300 mg capsule [HHSC]

Facility

$7.91

Service Code	NDC 50268018515
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.67
Rate for Payer: AlohaCare Medicaid	$3.96
Rate for Payer: AlohaCare Medicare	$3.96
Rate for Payer: Cash Price	$5.14
Rate for Payer: Devoted Health Medicare	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.96
Rate for Payer: Hawaii Western Management Group Commercial	$7.51
Rate for Payer: Health Management Network Commercial	$6.72
Rate for Payer: Humana Medicare	$3.96
Rate for Payer: Kaiser Permanente Commercial	$7.12
Rate for Payer: Kaiser Permanente Medicaid	$4.03
Rate for Payer: Kaiser Permanente Medicare	$3.96
Rate for Payer: MDX Hawaii PPO	$7.67
Rate for Payer: Ohana Health Plan Medicaid	$3.96
Rate for Payer: Ohana Health Plan Medicare	$3.96
Rate for Payer: UnitedHealthcare Medicaid	$4.75
Rate for Payer: UnitedHealthcare Medicare	$3.96
Rate for Payer: University Health Alliance Commercial	$5.77

clindamycin 300 mg capsule [HHSC]

Facility

$20.67

Service Code	NDC 63304069301
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$20.05
Rate for Payer: Cash Price	$13.44
Rate for Payer: Health Management Network Commercial	$17.57
Rate for Payer: Kaiser Permanente Commercial	$18.60
Rate for Payer: MDX Hawaii PPO	$20.05

clindamycin 300 mg capsule [HHSC]

Facility

$20.67

Service Code	NDC 42571025201
Hospital Charge Code	2500186
Hospital Revenue Code	250
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$20.05
Rate for Payer: Cash Price	$13.44
Rate for Payer: Health Management Network Commercial	$17.57
Rate for Payer: Kaiser Permanente Commercial	$18.60
Rate for Payer: MDX Hawaii PPO	$20.05

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$57.59

Service Code	NDC 00781922109
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$55.86
Rate for Payer: AlohaCare Medicaid	$28.80
Rate for Payer: AlohaCare Medicare	$28.80
Rate for Payer: Cash Price	$37.43
Rate for Payer: Devoted Health Medicare	$31.67
Rate for Payer: Hawaii Medical Service Association Medicare	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$54.71
Rate for Payer: Health Management Network Commercial	$48.95
Rate for Payer: Humana Medicare	$28.80
Rate for Payer: Kaiser Permanente Commercial	$51.83
Rate for Payer: Kaiser Permanente Medicaid	$29.37
Rate for Payer: Kaiser Permanente Medicare	$28.80
Rate for Payer: MDX Hawaii PPO	$55.86
Rate for Payer: Ohana Health Plan Medicaid	$28.80
Rate for Payer: Ohana Health Plan Medicare	$28.80
Rate for Payer: UnitedHealthcare Medicaid	$34.55
Rate for Payer: UnitedHealthcare Medicare	$28.80
Rate for Payer: University Health Alliance Commercial	$41.98

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$57.59

Service Code	NDC 00781922109
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$55.86
Rate for Payer: Cash Price	$37.43
Rate for Payer: Health Management Network Commercial	$48.95
Rate for Payer: Kaiser Permanente Commercial	$51.83
Rate for Payer: MDX Hawaii PPO	$55.86

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$80.18

Service Code	NDC 00781328909
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$77.77
Rate for Payer: AlohaCare Medicaid	$40.09
Rate for Payer: AlohaCare Medicare	$40.09
Rate for Payer: Cash Price	$52.12
Rate for Payer: Devoted Health Medicare	$44.10
Rate for Payer: Hawaii Medical Service Association Medicare	$40.09
Rate for Payer: Hawaii Western Management Group Commercial	$76.17
Rate for Payer: Health Management Network Commercial	$68.15
Rate for Payer: Humana Medicare	$40.09
Rate for Payer: Kaiser Permanente Commercial	$72.16
Rate for Payer: Kaiser Permanente Medicaid	$40.89
Rate for Payer: Kaiser Permanente Medicare	$40.09
Rate for Payer: MDX Hawaii PPO	$77.77
Rate for Payer: Ohana Health Plan Medicaid	$40.09
Rate for Payer: Ohana Health Plan Medicare	$40.09
Rate for Payer: UnitedHealthcare Medicaid	$48.11
Rate for Payer: UnitedHealthcare Medicare	$40.09
Rate for Payer: University Health Alliance Commercial	$58.44

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$80.18

Service Code	NDC 00781328909
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$68.15
Max. Negotiated Rate	$77.77
Rate for Payer: Cash Price	$52.12
Rate for Payer: Health Management Network Commercial	$68.15
Rate for Payer: Kaiser Permanente Commercial	$72.16
Rate for Payer: MDX Hawaii PPO	$77.77

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$71.72

Service Code	NDC 00338361224
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$69.57
Rate for Payer: AlohaCare Medicaid	$35.86
Rate for Payer: AlohaCare Medicare	$35.86
Rate for Payer: Cash Price	$46.62
Rate for Payer: Devoted Health Medicare	$39.45
Rate for Payer: Hawaii Medical Service Association Medicare	$35.86
Rate for Payer: Hawaii Western Management Group Commercial	$68.13
Rate for Payer: Health Management Network Commercial	$60.96
Rate for Payer: Humana Medicare	$35.86
Rate for Payer: Kaiser Permanente Commercial	$64.55
Rate for Payer: Kaiser Permanente Medicaid	$36.58
Rate for Payer: Kaiser Permanente Medicare	$35.86
Rate for Payer: MDX Hawaii PPO	$69.57
Rate for Payer: Ohana Health Plan Medicaid	$35.86
Rate for Payer: Ohana Health Plan Medicare	$35.86
Rate for Payer: UnitedHealthcare Medicaid	$43.03
Rate for Payer: UnitedHealthcare Medicare	$35.86
Rate for Payer: University Health Alliance Commercial	$52.28

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$105.62

Service Code	NDC 00009337502
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$102.45
Rate for Payer: AlohaCare Medicaid	$52.81
Rate for Payer: AlohaCare Medicare	$52.81
Rate for Payer: Cash Price	$68.65
Rate for Payer: Devoted Health Medicare	$58.09
Rate for Payer: Hawaii Medical Service Association Medicare	$52.81
Rate for Payer: Hawaii Western Management Group Commercial	$100.34
Rate for Payer: Health Management Network Commercial	$89.78
Rate for Payer: Humana Medicare	$52.81
Rate for Payer: Kaiser Permanente Commercial	$95.06
Rate for Payer: Kaiser Permanente Medicaid	$53.87
Rate for Payer: Kaiser Permanente Medicare	$52.81
Rate for Payer: MDX Hawaii PPO	$102.45
Rate for Payer: Ohana Health Plan Medicaid	$52.81
Rate for Payer: Ohana Health Plan Medicare	$52.81
Rate for Payer: UnitedHealthcare Medicaid	$63.37
Rate for Payer: UnitedHealthcare Medicare	$52.81
Rate for Payer: University Health Alliance Commercial	$76.99

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$105.62

Service Code	NDC 00009337502
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$89.78
Max. Negotiated Rate	$102.45
Rate for Payer: Cash Price	$68.65
Rate for Payer: Health Management Network Commercial	$89.78
Rate for Payer: Kaiser Permanente Commercial	$95.06
Rate for Payer: MDX Hawaii PPO	$102.45

clindamycin 600 mg/50 mL-d5w premix [HHSC]

Facility

$71.72

Service Code	NDC 00338361224
Hospital Charge Code	2500187
Hospital Revenue Code	250
Min. Negotiated Rate	$60.96
Max. Negotiated Rate	$69.57
Rate for Payer: Cash Price	$46.62
Rate for Payer: Health Management Network Commercial	$60.96
Rate for Payer: Kaiser Permanente Commercial	$64.55
Rate for Payer: MDX Hawaii PPO	$69.57

clindamycin 75 mg/5 mL 100ml [HHSC]

Facility

$316.29

Service Code	NDC 65862059601
Hospital Charge Code	2500188
Hospital Revenue Code	250
Min. Negotiated Rate	$158.15
Max. Negotiated Rate	$306.80
Rate for Payer: AlohaCare Medicaid	$158.15
Rate for Payer: AlohaCare Medicare	$158.15
Rate for Payer: Cash Price	$205.59
Rate for Payer: Devoted Health Medicare	$173.96
Rate for Payer: Hawaii Medical Service Association Medicare	$158.15
Rate for Payer: Hawaii Western Management Group Commercial	$300.48
Rate for Payer: Health Management Network Commercial	$268.85
Rate for Payer: Humana Medicare	$158.15
Rate for Payer: Kaiser Permanente Commercial	$284.66
Rate for Payer: Kaiser Permanente Medicaid	$161.31
Rate for Payer: Kaiser Permanente Medicare	$158.15
Rate for Payer: MDX Hawaii PPO	$306.80
Rate for Payer: Ohana Health Plan Medicaid	$158.15
Rate for Payer: Ohana Health Plan Medicare	$158.15
Rate for Payer: UnitedHealthcare Medicaid	$189.77
Rate for Payer: UnitedHealthcare Medicare	$158.15
Rate for Payer: University Health Alliance Commercial	$230.54

clindamycin 75 mg/5 mL 100ml [HHSC]

Facility

$316.29

Service Code	NDC 65862059601
Hospital Charge Code	2500188
Hospital Revenue Code	250
Min. Negotiated Rate	$268.85
Max. Negotiated Rate	$306.80
Rate for Payer: Cash Price	$205.59
Rate for Payer: Health Management Network Commercial	$268.85
Rate for Payer: Kaiser Permanente Commercial	$284.66
Rate for Payer: MDX Hawaii PPO	$306.80

clindamycin 75 mg/5 mL 100ml [HHSC]

Facility

$316.29

Service Code	NDC 65862059602
Hospital Charge Code	2500188
Hospital Revenue Code	250
Min. Negotiated Rate	$268.85
Max. Negotiated Rate	$306.80
Rate for Payer: Cash Price	$205.59
Rate for Payer: Health Management Network Commercial	$268.85
Rate for Payer: Kaiser Permanente Commercial	$284.66
Rate for Payer: MDX Hawaii PPO	$306.80

Know your out-of-pocket cost for care.

All Charges