Kohala Hospital

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN HCL 250 MG PO TABLET

Facility

$24.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.82
Max. Negotiated Rate	$23.76
Rate for Payer: Cash Price	$15.92
Rate for Payer: Health Management Network Commercial	$20.82
Rate for Payer: Kaiser Permanente Commercial	$22.04
Rate for Payer: MDX Hawaii PPO	$23.76

CIPROFLOXACIN HCL 250 MG PO TABLET

Facility

$24.49

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.24
Rate for Payer: AlohaCare Medicare	$22.04
Rate for Payer: Cash Price	$15.92
Rate for Payer: Devoted Health Medicare	$24.25
Rate for Payer: Hawaii Medical Service Association Medicare	$22.04
Rate for Payer: Hawaii Western Management Group Commercial	$23.27
Rate for Payer: Health Management Network Commercial	$20.82
Rate for Payer: Humana Medicare	$22.04
Rate for Payer: Kaiser Permanente Commercial	$22.04
Rate for Payer: Kaiser Permanente Medicaid	$12.49
Rate for Payer: Kaiser Permanente Medicare	$22.04
Rate for Payer: MDX Hawaii PPO	$23.76
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	$17.85

CIPROFLOXACIN HCL 500 MG PO TABLET

Facility

$1.71

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.69
Rate for Payer: AlohaCare Medicaid	$0.86
Rate for Payer: AlohaCare Medicare	$1.54
Rate for Payer: Cash Price	$1.11
Rate for Payer: Devoted Health Medicare	$1.69
Rate for Payer: Hawaii Medical Service Association Medicare	$1.54
Rate for Payer: Hawaii Western Management Group Commercial	$1.62
Rate for Payer: Health Management Network Commercial	$1.45
Rate for Payer: Humana Medicare	$1.54
Rate for Payer: Kaiser Permanente Commercial	$1.54
Rate for Payer: Kaiser Permanente Medicaid	$0.87
Rate for Payer: Kaiser Permanente Medicare	$1.54
Rate for Payer: MDX Hawaii PPO	$1.66
Rate for Payer: Ohana Health Plan Medicaid	$1.54
Rate for Payer: Ohana Health Plan Medicare	$1.54
Rate for Payer: UnitedHealthcare Medicare	$1.54
Rate for Payer: University Health Alliance Commercial	$1.25

CIPROFLOXACIN HCL 500 MG PO TABLET

Facility

$1.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.66
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Management Network Commercial	$1.45
Rate for Payer: Kaiser Permanente Commercial	$1.54
Rate for Payer: MDX Hawaii PPO	$1.66

CIPROFLOXACIN HCL 750 MG PO TABLET

Facility

$30.07

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$29.77
Rate for Payer: AlohaCare Medicaid	$15.04
Rate for Payer: AlohaCare Medicare	$27.06
Rate for Payer: Cash Price	$19.55
Rate for Payer: Devoted Health Medicare	$29.77
Rate for Payer: Hawaii Medical Service Association Medicare	$27.06
Rate for Payer: Hawaii Western Management Group Commercial	$28.57
Rate for Payer: Health Management Network Commercial	$25.56
Rate for Payer: Humana Medicare	$27.06
Rate for Payer: Kaiser Permanente Commercial	$27.06
Rate for Payer: Kaiser Permanente Medicaid	$15.34
Rate for Payer: Kaiser Permanente Medicare	$27.06
Rate for Payer: MDX Hawaii PPO	$29.17
Rate for Payer: Ohana Health Plan Medicaid	$27.06
Rate for Payer: Ohana Health Plan Medicare	$27.06
Rate for Payer: UnitedHealthcare Medicare	$27.06
Rate for Payer: University Health Alliance Commercial	$21.92

CIPROFLOXACIN HCL 750 MG PO TABLET

Facility

$30.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$29.17
Rate for Payer: Cash Price	$19.55
Rate for Payer: Health Management Network Commercial	$25.56
Rate for Payer: Kaiser Permanente Commercial	$27.06
Rate for Payer: MDX Hawaii PPO	$29.17

CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV IVPB

Facility

$43.46

Service Code	HCPCS J0744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$43.03
Rate for Payer: AlohaCare Medicaid	$21.73
Rate for Payer: AlohaCare Medicare	$39.11
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$28.25
Rate for Payer: Devoted Health Medicare	$43.03
Rate for Payer: Hawaii Medical Service Association ABD	$2.32
Rate for Payer: Hawaii Medical Service Association Medicare	$39.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.32
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Humana Medicare	$39.11
Rate for Payer: Kaiser Permanente Commercial	$39.11
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: Kaiser Permanente Medicare	$39.11
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: Ohana Health Plan Medicaid	$39.11
Rate for Payer: Ohana Health Plan Medicare	$39.11
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: UnitedHealthcare Medicare	$39.11
Rate for Payer: University Health Alliance Commercial	$31.68

CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV IVPB

Facility

$43.46

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Kaiser Permanente Commercial	$39.11
Rate for Payer: MDX Hawaii PPO	$42.16

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$34,130.88

Service Code	MSDRG 286
Min. Negotiated Rate	$34,130.88
Max. Negotiated Rate	$34,130.88
Rate for Payer: Hawaii Medical Service Association Commercial	$34,130.88

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$30,054.14

Service Code	MSDRG 287
Min. Negotiated Rate	$30,054.14
Max. Negotiated Rate	$30,054.14
Rate for Payer: Hawaii Medical Service Association Commercial	$30,054.14

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$41,336.29

Service Code	MSDRG 433
Min. Negotiated Rate	$41,336.29
Max. Negotiated Rate	$41,336.29
Rate for Payer: Hawaii Medical Service Association Commercial	$41,336.29

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$41,336.29

Service Code	MSDRG 432
Min. Negotiated Rate	$41,336.29
Max. Negotiated Rate	$41,336.29
Rate for Payer: Hawaii Medical Service Association Commercial	$41,336.29

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$41,336.29

Service Code	MSDRG 434
Min. Negotiated Rate	$41,336.29
Max. Negotiated Rate	$41,336.29
Rate for Payer: Hawaii Medical Service Association Commercial	$41,336.29

CITALOPRAM 10 MG PO TABLET

Facility

$14.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$13.82
Rate for Payer: Cash Price	$9.26
Rate for Payer: Health Management Network Commercial	$12.11
Rate for Payer: Kaiser Permanente Commercial	$12.82
Rate for Payer: MDX Hawaii PPO	$13.82

CITALOPRAM 10 MG PO TABLET

Facility

$14.25

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$14.11
Rate for Payer: AlohaCare Medicaid	$7.12
Rate for Payer: AlohaCare Medicare	$12.82
Rate for Payer: Cash Price	$9.26
Rate for Payer: Devoted Health Medicare	$14.11
Rate for Payer: Hawaii Medical Service Association Medicare	$12.82
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$12.11
Rate for Payer: Humana Medicare	$12.82
Rate for Payer: Kaiser Permanente Commercial	$12.82
Rate for Payer: Kaiser Permanente Medicaid	$7.27
Rate for Payer: Kaiser Permanente Medicare	$12.82
Rate for Payer: MDX Hawaii PPO	$13.82
Rate for Payer: Ohana Health Plan Medicaid	$12.82
Rate for Payer: Ohana Health Plan Medicare	$12.82
Rate for Payer: UnitedHealthcare Medicare	$12.82
Rate for Payer: University Health Alliance Commercial	$10.39

CITALOPRAM 20 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87

CITALOPRAM 20 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

CLARITHROMYCIN 500 MG PO TABLET

Facility

$38.69

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$38.30
Rate for Payer: AlohaCare Medicaid	$19.34
Rate for Payer: AlohaCare Medicare	$34.82
Rate for Payer: Cash Price	$25.15
Rate for Payer: Devoted Health Medicare	$38.30
Rate for Payer: Hawaii Medical Service Association Medicare	$34.82
Rate for Payer: Hawaii Western Management Group Commercial	$36.76
Rate for Payer: Health Management Network Commercial	$32.89
Rate for Payer: Humana Medicare	$34.82
Rate for Payer: Kaiser Permanente Commercial	$34.82
Rate for Payer: Kaiser Permanente Medicaid	$19.73
Rate for Payer: Kaiser Permanente Medicare	$34.82
Rate for Payer: MDX Hawaii PPO	$37.53
Rate for Payer: Ohana Health Plan Medicaid	$34.82
Rate for Payer: Ohana Health Plan Medicare	$34.82
Rate for Payer: UnitedHealthcare Medicare	$34.82
Rate for Payer: University Health Alliance Commercial	$28.20

CLARITHROMYCIN 500 MG PO TABLET

Facility

$38.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$32.89
Max. Negotiated Rate	$37.53
Rate for Payer: Cash Price	$25.15
Rate for Payer: Health Management Network Commercial	$32.89
Rate for Payer: Kaiser Permanente Commercial	$34.82
Rate for Payer: MDX Hawaii PPO	$37.53

CLINDAMYCIN HCL 150 MG PO CAP

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: MDX Hawaii PPO	$1.78

CLINDAMYCIN HCL 150 MG PO CAP

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.81
Rate for Payer: AlohaCare Medicaid	$0.92
Rate for Payer: AlohaCare Medicare	$1.65
Rate for Payer: Cash Price	$1.19
Rate for Payer: Devoted Health Medicare	$1.81
Rate for Payer: Hawaii Medical Service Association Medicare	$1.65
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Humana Medicare	$1.65
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: Kaiser Permanente Medicare	$1.65
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: Ohana Health Plan Medicaid	$1.65
Rate for Payer: Ohana Health Plan Medicare	$1.65
Rate for Payer: UnitedHealthcare Medicare	$1.65
Rate for Payer: University Health Alliance Commercial	$1.33

CLINDAMYCIN HCL 300 MG PO CAP

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$7.10
Rate for Payer: AlohaCare Medicaid	$3.58
Rate for Payer: AlohaCare Medicare	$6.45
Rate for Payer: Cash Price	$4.66
Rate for Payer: Devoted Health Medicare	$7.10
Rate for Payer: Hawaii Medical Service Association Medicare	$6.45
Rate for Payer: Hawaii Western Management Group Commercial	$6.81
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: Humana Medicare	$6.45
Rate for Payer: Kaiser Permanente Commercial	$6.45
Rate for Payer: Kaiser Permanente Medicaid	$3.66
Rate for Payer: Kaiser Permanente Medicare	$6.45
Rate for Payer: MDX Hawaii PPO	$6.95
Rate for Payer: Ohana Health Plan Medicaid	$6.45
Rate for Payer: Ohana Health Plan Medicare	$6.45
Rate for Payer: UnitedHealthcare Medicare	$6.45
Rate for Payer: University Health Alliance Commercial	$5.23

CLINDAMYCIN HCL 300 MG PO CAP

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$6.95
Rate for Payer: Cash Price	$4.66
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: Kaiser Permanente Commercial	$6.45
Rate for Payer: MDX Hawaii PPO	$6.95

CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV IVPB

Facility

$79.48

Service Code	HCPCS J0736
Hospital Revenue Code	250
Min. Negotiated Rate	$67.56
Max. Negotiated Rate	$77.10
Rate for Payer: Cash Price	$51.66
Rate for Payer: Cash Price	$39.88
Rate for Payer: Health Management Network Commercial	$67.56
Rate for Payer: Health Management Network Commercial	$52.15
Rate for Payer: Kaiser Permanente Commercial	$55.22
Rate for Payer: Kaiser Permanente Commercial	$71.53
Rate for Payer: MDX Hawaii PPO	$59.51
Rate for Payer: MDX Hawaii PPO	$77.10

CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV IVPB

Facility

$79.48

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$78.69
Rate for Payer: AlohaCare Medicaid	$39.74
Rate for Payer: AlohaCare Medicaid	$30.68
Rate for Payer: AlohaCare Medicare	$55.22
Rate for Payer: AlohaCare Medicare	$71.53
Rate for Payer: Cash Price	$51.66
Rate for Payer: Cash Price	$39.88
Rate for Payer: Cash Price	$51.66
Rate for Payer: Cash Price	$39.88
Rate for Payer: Devoted Health Medicare	$60.74
Rate for Payer: Devoted Health Medicare	$78.69
Rate for Payer: Hawaii Medical Service Association ABD	$1.67
Rate for Payer: Hawaii Medical Service Association ABD	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$71.53
Rate for Payer: Hawaii Medical Service Association Medicare	$55.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.67
Rate for Payer: Hawaii Western Management Group Commercial	$58.28
Rate for Payer: Hawaii Western Management Group Commercial	$75.51
Rate for Payer: Health Management Network Commercial	$67.56
Rate for Payer: Health Management Network Commercial	$52.15
Rate for Payer: Humana Medicare	$71.53
Rate for Payer: Humana Medicare	$55.22
Rate for Payer: Kaiser Permanente Commercial	$55.22
Rate for Payer: Kaiser Permanente Commercial	$71.53
Rate for Payer: Kaiser Permanente Medicaid	$31.29
Rate for Payer: Kaiser Permanente Medicaid	$40.53
Rate for Payer: Kaiser Permanente Medicare	$55.22
Rate for Payer: Kaiser Permanente Medicare	$71.53
Rate for Payer: MDX Hawaii PPO	$77.10
Rate for Payer: MDX Hawaii PPO	$59.51
Rate for Payer: Ohana Health Plan Medicaid	$55.22
Rate for Payer: Ohana Health Plan Medicaid	$71.53
Rate for Payer: Ohana Health Plan Medicare	$71.53
Rate for Payer: Ohana Health Plan Medicare	$55.22
Rate for Payer: UnitedHealthcare Medicaid	$36.81
Rate for Payer: UnitedHealthcare Medicaid	$47.69
Rate for Payer: UnitedHealthcare Medicare	$71.53
Rate for Payer: UnitedHealthcare Medicare	$55.22
Rate for Payer: University Health Alliance Commercial	$57.93
Rate for Payer: University Health Alliance Commercial	$44.72

Know your out-of-pocket cost for care.

All Charges