Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CITALOPRAM 10 MG PO TABLET

Facility

$14.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$13.82
Rate for Payer: Cash Price	$9.26
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$12.11
Rate for Payer: Kaiser Permanente Commercial	$8.98
Rate for Payer: Kaiser Permanente Medicaid	$7.27
Rate for Payer: MDX Hawaii PPO	$13.82
Rate for Payer: UnitedHealthcare Medicaid	$8.55
Rate for Payer: University Health Alliance Commercial	$10.39

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: MDX Hawaii PPO	$13.82

CITALOPRAM 20 MG PO TABLET

Facility

$14.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.63
Max. Negotiated Rate	$14.41
Rate for Payer: Cash Price	$9.66
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$12.63
Rate for Payer: MDX Hawaii PPO	$14.41
Rate for Payer: MDX Hawaii PPO	$1.16

CITALOPRAM 20 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$9.66
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$14.12
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$12.63
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$9.36
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$7.58
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$14.41
Rate for Payer: UnitedHealthcare Medicaid	$8.92
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$10.83

CLARITHROMYCIN 250 MG PO TABLET

Facility

$38.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$37.53
Rate for Payer: Cash Price	$25.15
Rate for Payer: Hawaii Western Management Group Commercial	$36.76
Rate for Payer: Health Management Network Commercial	$32.89
Rate for Payer: Kaiser Permanente Commercial	$24.37
Rate for Payer: Kaiser Permanente Medicaid	$19.73
Rate for Payer: MDX Hawaii PPO	$37.53
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: University Health Alliance Commercial	$28.20

CLARITHROMYCIN 250 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: MDX Hawaii PPO	$37.53

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: MDX Hawaii PPO	$37.53

CLARITHROMYCIN 500 MG PO TABLET

Facility

$38.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$37.53
Rate for Payer: Cash Price	$25.15
Rate for Payer: Hawaii Western Management Group Commercial	$36.76
Rate for Payer: Health Management Network Commercial	$32.89
Rate for Payer: Kaiser Permanente Commercial	$24.37
Rate for Payer: Kaiser Permanente Medicaid	$19.73
Rate for Payer: MDX Hawaii PPO	$37.53
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: University Health Alliance Commercial	$28.20

CLAVICULECTOMY; PARTIAL

Facility

$14,715.00

Service Code	CPT 23120
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$11,157.19

Clearify Visualization System 21-345 [3644280]

Facility

$318.52

Hospital Charge Code	3644280
Hospital Revenue Code	272
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$308.96
Rate for Payer: Cash Price	$207.04
Rate for Payer: Health Management Network Commercial	$270.74
Rate for Payer: MDX Hawaii PPO	$308.96

Clearify Visualization System 21-345 [3644280]

Facility

$318.52

Hospital Charge Code	3644280
Hospital Revenue Code	272
Min. Negotiated Rate	$162.45
Max. Negotiated Rate	$308.96
Rate for Payer: Cash Price	$207.04
Rate for Payer: Hawaii Western Management Group Commercial	$302.59
Rate for Payer: Health Management Network Commercial	$270.74
Rate for Payer: Kaiser Permanente Commercial	$200.67
Rate for Payer: Kaiser Permanente Medicaid	$162.45
Rate for Payer: MDX Hawaii PPO	$308.96
Rate for Payer: University Health Alliance Commercial	$232.17

Clear Mix System 414702 [3642437]

Facility

$965.86

Hospital Charge Code	3642437
Hospital Revenue Code	272
Min. Negotiated Rate	$492.59
Max. Negotiated Rate	$936.88
Rate for Payer: Cash Price	$627.81
Rate for Payer: Hawaii Western Management Group Commercial	$917.57
Rate for Payer: Health Management Network Commercial	$820.98
Rate for Payer: Kaiser Permanente Commercial	$608.49
Rate for Payer: Kaiser Permanente Medicaid	$492.59
Rate for Payer: MDX Hawaii PPO	$936.88
Rate for Payer: University Health Alliance Commercial	$704.02

Clear Mix System 414702 [3642437]

Facility

$965.86

Hospital Charge Code	3642437
Hospital Revenue Code	272
Min. Negotiated Rate	$820.98
Max. Negotiated Rate	$936.88
Rate for Payer: Cash Price	$627.81
Rate for Payer: Health Management Network Commercial	$820.98
Rate for Payer: MDX Hawaii PPO	$936.88

CLEFT LIP & PALATE REPAIR

Facility

$4,962.61

Service Code	APR-DRG 0952
Min. Negotiated Rate	$4,962.61
Max. Negotiated Rate	$4,962.61
Rate for Payer: AlohaCare Medicaid	$4,962.61
Rate for Payer: Hawaii Medical Service Association ABD	$4,962.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,962.61
Rate for Payer: Kaiser Permanente Medicaid	$4,962.61
Rate for Payer: Ohana Health Plan Medicaid	$4,962.61
Rate for Payer: UnitedHealthcare Medicaid	$4,962.61

CLEFT LIP & PALATE REPAIR

Facility

$12,936.02

Service Code	APR-DRG 0954
Min. Negotiated Rate	$12,936.02
Max. Negotiated Rate	$12,936.02
Rate for Payer: AlohaCare Medicaid	$12,936.02
Rate for Payer: Hawaii Medical Service Association ABD	$12,936.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,936.02
Rate for Payer: Kaiser Permanente Medicaid	$12,936.02
Rate for Payer: Ohana Health Plan Medicaid	$12,936.02
Rate for Payer: UnitedHealthcare Medicaid	$12,936.02

CLEFT LIP & PALATE REPAIR

Facility

$4,360.19

Service Code	APR-DRG 0951
Min. Negotiated Rate	$4,360.19
Max. Negotiated Rate	$4,360.19
Rate for Payer: AlohaCare Medicaid	$4,360.19
Rate for Payer: Hawaii Medical Service Association ABD	$4,360.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,360.19
Rate for Payer: Kaiser Permanente Medicaid	$4,360.19
Rate for Payer: Ohana Health Plan Medicaid	$4,360.19
Rate for Payer: UnitedHealthcare Medicaid	$4,360.19

CLEFT LIP & PALATE REPAIR

Facility

$7,428.31

Service Code	APR-DRG 0953
Min. Negotiated Rate	$7,428.31
Max. Negotiated Rate	$7,428.31
Rate for Payer: AlohaCare Medicaid	$7,428.31
Rate for Payer: Hawaii Medical Service Association ABD	$7,428.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,428.31
Rate for Payer: Kaiser Permanente Medicaid	$7,428.31
Rate for Payer: Ohana Health Plan Medicaid	$7,428.31
Rate for Payer: UnitedHealthcare Medicaid	$7,428.31

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: Cash Price	$2.26
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: MDX Hawaii PPO	$3.37

CLINDAMYCIN HCL 150 MG PO CAP

Facility

$3.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$3.37
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cash Price	$1.19
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Hawaii Western Management Group Commercial	$3.30
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: Kaiser Permanente Commercial	$2.19
Rate for Payer: Kaiser Permanente Commercial	$1.15
Rate for Payer: Kaiser Permanente Medicaid	$1.77
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: MDX Hawaii PPO	$3.37
Rate for Payer: UnitedHealthcare Medicaid	$1.10
Rate for Payer: UnitedHealthcare Medicaid	$2.08
Rate for Payer: University Health Alliance Commercial	$2.53
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	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: MDX Hawaii PPO	$6.95

CLINDAMYCIN HCL 300 MG PO CAP

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$6.95
Rate for Payer: Cash Price	$4.66
Rate for Payer: Hawaii Western Management Group Commercial	$6.81
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: Kaiser Permanente Commercial	$4.52
Rate for Payer: Kaiser Permanente Medicaid	$3.66
Rate for Payer: MDX Hawaii PPO	$6.95
Rate for Payer: UnitedHealthcare Medicaid	$4.30
Rate for Payer: University Health Alliance Commercial	$5.23

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	$77.10
Rate for Payer: Cash Price	$51.66
Rate for Payer: Cash Price	$39.88
Rate for Payer: Cash Price	$39.88
Rate for Payer: Cash Price	$51.66
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 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: Kaiser Permanente Commercial	$50.07
Rate for Payer: Kaiser Permanente Commercial	$38.65
Rate for Payer: Kaiser Permanente Medicaid	$31.29
Rate for Payer: Kaiser Permanente Medicaid	$40.53
Rate for Payer: MDX Hawaii PPO	$59.51
Rate for Payer: MDX Hawaii PPO	$77.10
Rate for Payer: UnitedHealthcare Medicaid	$36.81
Rate for Payer: UnitedHealthcare Medicaid	$47.69
Rate for Payer: University Health Alliance Commercial	$44.72
Rate for Payer: University Health Alliance Commercial	$57.93

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

Facility

$61.35

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

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

Facility

$92.94

Service Code	HCPCS J0736
Hospital Revenue Code	250
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$90.15
Rate for Payer: Cash Price	$60.41
Rate for Payer: Health Management Network Commercial	$79.00
Rate for Payer: MDX Hawaii PPO	$90.15

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

Facility

$92.94

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$90.15
Rate for Payer: Cash Price	$60.41
Rate for Payer: Cash Price	$60.41
Rate for Payer: Hawaii Medical Service Association ABD	$1.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.67
Rate for Payer: Hawaii Western Management Group Commercial	$88.29
Rate for Payer: Health Management Network Commercial	$79.00
Rate for Payer: Kaiser Permanente Commercial	$58.55
Rate for Payer: Kaiser Permanente Medicaid	$47.40
Rate for Payer: MDX Hawaii PPO	$90.15
Rate for Payer: UnitedHealthcare Medicaid	$55.76
Rate for Payer: University Health Alliance Commercial	$67.74

Know your out-of-pocket cost for care.

All Charges