Kohala Hospital

All Charges

Charge

Type

Setting

Price

CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV IVPB

Facility

$72.03

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$71.31
Rate for Payer: AlohaCare Medicaid	$36.02
Rate for Payer: AlohaCare Medicare	$64.83
Rate for Payer: Cash Price	$46.82
Rate for Payer: Cash Price	$46.82
Rate for Payer: Devoted Health Medicare	$71.31
Rate for Payer: Hawaii Medical Service Association ABD	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$64.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.67
Rate for Payer: Hawaii Western Management Group Commercial	$68.43
Rate for Payer: Health Management Network Commercial	$61.23
Rate for Payer: Humana Medicare	$64.83
Rate for Payer: Kaiser Permanente Commercial	$64.83
Rate for Payer: Kaiser Permanente Medicaid	$36.74
Rate for Payer: Kaiser Permanente Medicare	$64.83
Rate for Payer: MDX Hawaii PPO	$69.87
Rate for Payer: Ohana Health Plan Medicaid	$64.83
Rate for Payer: Ohana Health Plan Medicare	$64.83
Rate for Payer: UnitedHealthcare Medicaid	$43.22
Rate for Payer: UnitedHealthcare Medicare	$64.83
Rate for Payer: University Health Alliance Commercial	$52.50

CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV IVPB

Facility

$72.03

Service Code	HCPCS J0736
Hospital Revenue Code	250
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$69.87
Rate for Payer: Cash Price	$46.82
Rate for Payer: Health Management Network Commercial	$61.23
Rate for Payer: Kaiser Permanente Commercial	$64.83
Rate for Payer: MDX Hawaii PPO	$69.87

CLINDAMYCIN PALMITATE HCL 75 MG/5 ML PO RECON.SOLN. (PER BOTTLE)

Facility

$313.88

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$266.80
Max. Negotiated Rate	$304.46
Rate for Payer: Cash Price	$204.02
Rate for Payer: Health Management Network Commercial	$266.80
Rate for Payer: Kaiser Permanente Commercial	$282.49
Rate for Payer: MDX Hawaii PPO	$304.46

CLINDAMYCIN PALMITATE HCL 75 MG/5 ML PO RECON.SOLN. (PER BOTTLE)

Facility

$313.88

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$156.94
Max. Negotiated Rate	$310.74
Rate for Payer: AlohaCare Medicaid	$156.94
Rate for Payer: AlohaCare Medicare	$282.49
Rate for Payer: Cash Price	$204.02
Rate for Payer: Devoted Health Medicare	$310.74
Rate for Payer: Hawaii Medical Service Association Medicare	$282.49
Rate for Payer: Hawaii Western Management Group Commercial	$298.19
Rate for Payer: Health Management Network Commercial	$266.80
Rate for Payer: Humana Medicare	$282.49
Rate for Payer: Kaiser Permanente Commercial	$282.49
Rate for Payer: Kaiser Permanente Medicaid	$160.08
Rate for Payer: Kaiser Permanente Medicare	$282.49
Rate for Payer: MDX Hawaii PPO	$304.46
Rate for Payer: Ohana Health Plan Medicaid	$282.49
Rate for Payer: Ohana Health Plan Medicare	$282.49
Rate for Payer: UnitedHealthcare Medicare	$282.49
Rate for Payer: University Health Alliance Commercial	$228.79

CLOBETASOL 0.05 % TOP CR

Facility

$57.92

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$57.34
Rate for Payer: AlohaCare Medicaid	$28.96
Rate for Payer: AlohaCare Medicaid	$386.22
Rate for Payer: AlohaCare Medicare	$52.13
Rate for Payer: AlohaCare Medicare	$695.20
Rate for Payer: Cash Price	$502.09
Rate for Payer: Cash Price	$37.65
Rate for Payer: Devoted Health Medicare	$57.34
Rate for Payer: Devoted Health Medicare	$764.72
Rate for Payer: Hawaii Medical Service Association Medicare	$695.20
Rate for Payer: Hawaii Medical Service Association Medicare	$52.13
Rate for Payer: Hawaii Western Management Group Commercial	$733.82
Rate for Payer: Hawaii Western Management Group Commercial	$55.02
Rate for Payer: Health Management Network Commercial	$49.23
Rate for Payer: Health Management Network Commercial	$656.57
Rate for Payer: Humana Medicare	$695.20
Rate for Payer: Humana Medicare	$52.13
Rate for Payer: Kaiser Permanente Commercial	$52.13
Rate for Payer: Kaiser Permanente Commercial	$695.20
Rate for Payer: Kaiser Permanente Medicaid	$393.94
Rate for Payer: Kaiser Permanente Medicaid	$29.54
Rate for Payer: Kaiser Permanente Medicare	$695.20
Rate for Payer: Kaiser Permanente Medicare	$52.13
Rate for Payer: MDX Hawaii PPO	$749.27
Rate for Payer: MDX Hawaii PPO	$56.18
Rate for Payer: Ohana Health Plan Medicaid	$52.13
Rate for Payer: Ohana Health Plan Medicaid	$695.20
Rate for Payer: Ohana Health Plan Medicare	$52.13
Rate for Payer: Ohana Health Plan Medicare	$695.20
Rate for Payer: UnitedHealthcare Medicare	$52.13
Rate for Payer: UnitedHealthcare Medicare	$695.20
Rate for Payer: University Health Alliance Commercial	$563.03
Rate for Payer: University Health Alliance Commercial	$42.22

CLOBETASOL 0.05 % TOP CR

Facility

$772.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$656.57
Max. Negotiated Rate	$749.27
Rate for Payer: Cash Price	$502.09
Rate for Payer: Cash Price	$37.65
Rate for Payer: Health Management Network Commercial	$656.57
Rate for Payer: Health Management Network Commercial	$49.23
Rate for Payer: Kaiser Permanente Commercial	$695.20
Rate for Payer: Kaiser Permanente Commercial	$52.13
Rate for Payer: MDX Hawaii PPO	$56.18
Rate for Payer: MDX Hawaii PPO	$749.27

CLONAZEPAM 0.5 MG PO TABLET

Facility

$2.89

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.86
Rate for Payer: AlohaCare Medicaid	$1.45
Rate for Payer: AlohaCare Medicare	$2.60
Rate for Payer: Cash Price	$1.88
Rate for Payer: Devoted Health Medicare	$2.86
Rate for Payer: Hawaii Medical Service Association Medicare	$2.60
Rate for Payer: Hawaii Western Management Group Commercial	$2.75
Rate for Payer: Health Management Network Commercial	$2.46
Rate for Payer: Humana Medicare	$2.60
Rate for Payer: Kaiser Permanente Commercial	$2.60
Rate for Payer: Kaiser Permanente Medicaid	$1.47
Rate for Payer: Kaiser Permanente Medicare	$2.60
Rate for Payer: MDX Hawaii PPO	$2.80
Rate for Payer: Ohana Health Plan Medicaid	$2.60
Rate for Payer: Ohana Health Plan Medicare	$2.60
Rate for Payer: UnitedHealthcare Medicare	$2.60
Rate for Payer: University Health Alliance Commercial	$2.11

CLONAZEPAM 0.5 MG PO TABLET

Facility

$2.89

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.80
Rate for Payer: Cash Price	$1.88
Rate for Payer: Health Management Network Commercial	$2.46
Rate for Payer: Kaiser Permanente Commercial	$2.60
Rate for Payer: MDX Hawaii PPO	$2.80

CLONAZEPAM 0.5 MG PO TABLET (0.5 TAB) = 0.25 MG

Facility

$3.26

Service Code	NDC RPKWH000704
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$3.16
Rate for Payer: Cash Price	$2.12
Rate for Payer: Health Management Network Commercial	$2.77
Rate for Payer: Kaiser Permanente Commercial	$2.93
Rate for Payer: MDX Hawaii PPO	$3.16

CLONAZEPAM 0.5 MG PO TABLET (0.5 TAB) = 0.25 MG

Facility

$3.26

Service Code	NDC RPKWH000704
Hospital Revenue Code	637
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.23
Rate for Payer: AlohaCare Medicaid	$1.63
Rate for Payer: AlohaCare Medicare	$2.93
Rate for Payer: Cash Price	$2.12
Rate for Payer: Devoted Health Medicare	$3.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.93
Rate for Payer: Hawaii Western Management Group Commercial	$3.10
Rate for Payer: Health Management Network Commercial	$2.77
Rate for Payer: Humana Medicare	$2.93
Rate for Payer: Kaiser Permanente Commercial	$2.93
Rate for Payer: Kaiser Permanente Medicaid	$1.66
Rate for Payer: Kaiser Permanente Medicare	$2.93
Rate for Payer: MDX Hawaii PPO	$3.16
Rate for Payer: Ohana Health Plan Medicaid	$2.93
Rate for Payer: Ohana Health Plan Medicare	$2.93
Rate for Payer: UnitedHealthcare Medicare	$2.93
Rate for Payer: University Health Alliance Commercial	$2.38

CLONAZEPAM 1 MG PO TABLET

Facility

$3.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.79
Rate for Payer: Cash Price	$2.54
Rate for Payer: Health Management Network Commercial	$3.32
Rate for Payer: Kaiser Permanente Commercial	$3.52
Rate for Payer: MDX Hawaii PPO	$3.79

CLONAZEPAM 1 MG PO TABLET

Facility

$3.91

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$3.87
Rate for Payer: AlohaCare Medicaid	$1.96
Rate for Payer: AlohaCare Medicare	$3.52
Rate for Payer: Cash Price	$2.54
Rate for Payer: Devoted Health Medicare	$3.87
Rate for Payer: Hawaii Medical Service Association Medicare	$3.52
Rate for Payer: Hawaii Western Management Group Commercial	$3.71
Rate for Payer: Health Management Network Commercial	$3.32
Rate for Payer: Humana Medicare	$3.52
Rate for Payer: Kaiser Permanente Commercial	$3.52
Rate for Payer: Kaiser Permanente Medicaid	$1.99
Rate for Payer: Kaiser Permanente Medicare	$3.52
Rate for Payer: MDX Hawaii PPO	$3.79
Rate for Payer: Ohana Health Plan Medicaid	$3.52
Rate for Payer: Ohana Health Plan Medicare	$3.52
Rate for Payer: UnitedHealthcare Medicare	$3.52
Rate for Payer: University Health Alliance Commercial	$2.85

CLONAZEPAM 2 MG PO TABLET

Facility

$6.54

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$6.47
Rate for Payer: AlohaCare Medicaid	$3.27
Rate for Payer: AlohaCare Medicare	$5.89
Rate for Payer: Cash Price	$4.25
Rate for Payer: Devoted Health Medicare	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.89
Rate for Payer: Hawaii Western Management Group Commercial	$6.21
Rate for Payer: Health Management Network Commercial	$5.56
Rate for Payer: Humana Medicare	$5.89
Rate for Payer: Kaiser Permanente Commercial	$5.89
Rate for Payer: Kaiser Permanente Medicaid	$3.34
Rate for Payer: Kaiser Permanente Medicare	$5.89
Rate for Payer: MDX Hawaii PPO	$6.34
Rate for Payer: Ohana Health Plan Medicaid	$5.89
Rate for Payer: Ohana Health Plan Medicare	$5.89
Rate for Payer: UnitedHealthcare Medicare	$5.89
Rate for Payer: University Health Alliance Commercial	$4.77

CLONAZEPAM 2 MG PO TABLET

Facility

$6.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$6.34
Rate for Payer: Cash Price	$4.25
Rate for Payer: Health Management Network Commercial	$5.56
Rate for Payer: Kaiser Permanente Commercial	$5.89
Rate for Payer: MDX Hawaii PPO	$6.34

CLONIDINE 0.1 MG TRANSDERM PTWK

Facility

$155.13

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$77.56
Max. Negotiated Rate	$153.58
Rate for Payer: AlohaCare Medicaid	$77.56
Rate for Payer: AlohaCare Medicare	$139.62
Rate for Payer: Cash Price	$100.83
Rate for Payer: Devoted Health Medicare	$153.58
Rate for Payer: Hawaii Medical Service Association Medicare	$139.62
Rate for Payer: Hawaii Western Management Group Commercial	$147.37
Rate for Payer: Health Management Network Commercial	$131.86
Rate for Payer: Humana Medicare	$139.62
Rate for Payer: Kaiser Permanente Commercial	$139.62
Rate for Payer: Kaiser Permanente Medicaid	$79.12
Rate for Payer: Kaiser Permanente Medicare	$139.62
Rate for Payer: MDX Hawaii PPO	$150.48
Rate for Payer: Ohana Health Plan Medicaid	$139.62
Rate for Payer: Ohana Health Plan Medicare	$139.62
Rate for Payer: UnitedHealthcare Medicare	$139.62
Rate for Payer: University Health Alliance Commercial	$113.07

CLONIDINE 0.1 MG TRANSDERM PTWK

Facility

$155.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$131.86
Max. Negotiated Rate	$150.48
Rate for Payer: Cash Price	$100.83
Rate for Payer: Health Management Network Commercial	$131.86
Rate for Payer: Kaiser Permanente Commercial	$139.62
Rate for Payer: MDX Hawaii PPO	$150.48

CLONIDINE 0.3 MG/24 HR TRANSDERM PTWK

Facility

$367.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$183.63
Max. Negotiated Rate	$363.60
Rate for Payer: AlohaCare Medicaid	$183.63
Rate for Payer: AlohaCare Medicare	$330.54
Rate for Payer: Cash Price	$238.73
Rate for Payer: Devoted Health Medicare	$363.60
Rate for Payer: Hawaii Medical Service Association Medicare	$330.54
Rate for Payer: Hawaii Western Management Group Commercial	$348.91
Rate for Payer: Health Management Network Commercial	$312.18
Rate for Payer: Humana Medicare	$330.54
Rate for Payer: Kaiser Permanente Commercial	$330.54
Rate for Payer: Kaiser Permanente Medicaid	$187.31
Rate for Payer: Kaiser Permanente Medicare	$330.54
Rate for Payer: MDX Hawaii PPO	$356.25
Rate for Payer: Ohana Health Plan Medicaid	$330.54
Rate for Payer: Ohana Health Plan Medicare	$330.54
Rate for Payer: UnitedHealthcare Medicare	$330.54
Rate for Payer: University Health Alliance Commercial	$267.70

CLONIDINE 0.3 MG/24 HR TRANSDERM PTWK

Facility

$367.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$312.18
Max. Negotiated Rate	$356.25
Rate for Payer: Cash Price	$238.73
Rate for Payer: Health Management Network Commercial	$312.18
Rate for Payer: Kaiser Permanente Commercial	$330.54
Rate for Payer: MDX Hawaii PPO	$356.25

CLONIDINE HCL 0.1 MG PO TABLET

Facility

$2.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.96
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Management Network Commercial	$1.72
Rate for Payer: Kaiser Permanente Commercial	$1.82
Rate for Payer: MDX Hawaii PPO	$1.96

CLONIDINE HCL 0.1 MG PO TABLET

Facility

$2.02

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.00
Rate for Payer: AlohaCare Medicaid	$1.01
Rate for Payer: AlohaCare Medicare	$1.82
Rate for Payer: Cash Price	$1.31
Rate for Payer: Devoted Health Medicare	$2.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1.82
Rate for Payer: Hawaii Western Management Group Commercial	$1.92
Rate for Payer: Health Management Network Commercial	$1.72
Rate for Payer: Humana Medicare	$1.82
Rate for Payer: Kaiser Permanente Commercial	$1.82
Rate for Payer: Kaiser Permanente Medicaid	$1.03
Rate for Payer: Kaiser Permanente Medicare	$1.82
Rate for Payer: MDX Hawaii PPO	$1.96
Rate for Payer: Ohana Health Plan Medicaid	$1.82
Rate for Payer: Ohana Health Plan Medicare	$1.82
Rate for Payer: UnitedHealthcare Medicare	$1.82
Rate for Payer: University Health Alliance Commercial	$1.47

CLOPIDOGREL 300 MG PO TABLET

Facility

$133.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$113.29
Max. Negotiated Rate	$129.28
Rate for Payer: Cash Price	$86.63
Rate for Payer: Health Management Network Commercial	$113.29
Rate for Payer: Kaiser Permanente Commercial	$119.95
Rate for Payer: MDX Hawaii PPO	$129.28

CLOPIDOGREL 300 MG PO TABLET

Facility

$133.28

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$66.64
Max. Negotiated Rate	$131.95
Rate for Payer: AlohaCare Medicaid	$66.64
Rate for Payer: AlohaCare Medicare	$119.95
Rate for Payer: Cash Price	$86.63
Rate for Payer: Devoted Health Medicare	$131.95
Rate for Payer: Hawaii Medical Service Association Medicare	$119.95
Rate for Payer: Hawaii Western Management Group Commercial	$126.62
Rate for Payer: Health Management Network Commercial	$113.29
Rate for Payer: Humana Medicare	$119.95
Rate for Payer: Kaiser Permanente Commercial	$119.95
Rate for Payer: Kaiser Permanente Medicaid	$67.97
Rate for Payer: Kaiser Permanente Medicare	$119.95
Rate for Payer: MDX Hawaii PPO	$129.28
Rate for Payer: Ohana Health Plan Medicaid	$119.95
Rate for Payer: Ohana Health Plan Medicare	$119.95
Rate for Payer: UnitedHealthcare Medicare	$119.95
Rate for Payer: University Health Alliance Commercial	$97.15

CLOPIDOGREL 75 MG PO TABLET

Facility

$42.55

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$21.27
Max. Negotiated Rate	$42.12
Rate for Payer: AlohaCare Medicaid	$21.27
Rate for Payer: AlohaCare Medicaid	$21.61
Rate for Payer: AlohaCare Medicare	$38.30
Rate for Payer: AlohaCare Medicare	$38.90
Rate for Payer: Cash Price	$28.09
Rate for Payer: Cash Price	$27.66
Rate for Payer: Devoted Health Medicare	$42.12
Rate for Payer: Devoted Health Medicare	$42.79
Rate for Payer: Hawaii Medical Service Association Medicare	$38.90
Rate for Payer: Hawaii Medical Service Association Medicare	$38.30
Rate for Payer: Hawaii Western Management Group Commercial	$41.06
Rate for Payer: Hawaii Western Management Group Commercial	$40.42
Rate for Payer: Health Management Network Commercial	$36.17
Rate for Payer: Health Management Network Commercial	$36.74
Rate for Payer: Humana Medicare	$38.90
Rate for Payer: Humana Medicare	$38.30
Rate for Payer: Kaiser Permanente Commercial	$38.30
Rate for Payer: Kaiser Permanente Commercial	$38.90
Rate for Payer: Kaiser Permanente Medicaid	$22.04
Rate for Payer: Kaiser Permanente Medicaid	$21.70
Rate for Payer: Kaiser Permanente Medicare	$38.90
Rate for Payer: Kaiser Permanente Medicare	$38.30
Rate for Payer: MDX Hawaii PPO	$41.92
Rate for Payer: MDX Hawaii PPO	$41.27
Rate for Payer: Ohana Health Plan Medicaid	$38.30
Rate for Payer: Ohana Health Plan Medicaid	$38.90
Rate for Payer: Ohana Health Plan Medicare	$38.30
Rate for Payer: Ohana Health Plan Medicare	$38.90
Rate for Payer: UnitedHealthcare Medicare	$38.30
Rate for Payer: UnitedHealthcare Medicare	$38.90
Rate for Payer: University Health Alliance Commercial	$31.50
Rate for Payer: University Health Alliance Commercial	$31.01

CLOPIDOGREL 75 MG PO TABLET

Facility

$43.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$36.74
Max. Negotiated Rate	$41.92
Rate for Payer: Cash Price	$28.09
Rate for Payer: Cash Price	$27.66
Rate for Payer: Health Management Network Commercial	$36.74
Rate for Payer: Health Management Network Commercial	$36.17
Rate for Payer: Kaiser Permanente Commercial	$38.90
Rate for Payer: Kaiser Permanente Commercial	$38.30
Rate for Payer: MDX Hawaii PPO	$41.27
Rate for Payer: MDX Hawaii PPO	$41.92

CLOTRIMAZOLE 10 MG MM TROCHE

Facility

$8.88

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$8.61
Rate for Payer: Cash Price	$5.77
Rate for Payer: Health Management Network Commercial	$7.55
Rate for Payer: Kaiser Permanente Commercial	$7.99
Rate for Payer: MDX Hawaii PPO	$8.61

Know your out-of-pocket cost for care.

All Charges