Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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: 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	250
Min. Negotiated Rate	$160.08
Max. Negotiated Rate	$304.46
Rate for Payer: Cash Price	$204.02
Rate for Payer: Hawaii Western Management Group Commercial	$298.19
Rate for Payer: Health Management Network Commercial	$266.80
Rate for Payer: Kaiser Permanente Commercial	$197.74
Rate for Payer: Kaiser Permanente Medicaid	$160.08
Rate for Payer: MDX Hawaii PPO	$304.46
Rate for Payer: UnitedHealthcare Medicaid	$188.33
Rate for Payer: University Health Alliance Commercial	$228.79

CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN

Facility

$22.28

Service Code	HCPCS J0736
Hospital Revenue Code	250
Min. Negotiated Rate	$18.94
Max. Negotiated Rate	$21.61
Rate for Payer: Cash Price	$14.48
Rate for Payer: Health Management Network Commercial	$18.94
Rate for Payer: MDX Hawaii PPO	$21.61

CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN

Facility

$22.28

Service Code	HCPCS J0736
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$21.61
Rate for Payer: Cash Price	$14.48
Rate for Payer: Cash Price	$14.48
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	$21.17
Rate for Payer: Health Management Network Commercial	$18.94
Rate for Payer: Kaiser Permanente Commercial	$14.04
Rate for Payer: Kaiser Permanente Medicaid	$11.36
Rate for Payer: MDX Hawaii PPO	$21.61
Rate for Payer: UnitedHealthcare Medicaid	$13.37
Rate for Payer: University Health Alliance Commercial	$16.24

Clip Applier Ligaclip Large 33.7cm Mcl20 [3642495]

Facility

$1,237.73

Hospital Charge Code	3642495
Hospital Revenue Code	272
Min. Negotiated Rate	$1,052.07
Max. Negotiated Rate	$1,200.60
Rate for Payer: Cash Price	$804.52
Rate for Payer: Health Management Network Commercial	$1,052.07
Rate for Payer: MDX Hawaii PPO	$1,200.60

Clip Applier Ligaclip Large 33.7cm Mcl20 [3642495]

Facility

$1,237.73

Hospital Charge Code	3642495
Hospital Revenue Code	272
Min. Negotiated Rate	$631.24
Max. Negotiated Rate	$1,200.60
Rate for Payer: Cash Price	$804.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,175.84
Rate for Payer: Health Management Network Commercial	$1,052.07
Rate for Payer: Kaiser Permanente Commercial	$779.77
Rate for Payer: Kaiser Permanente Medicaid	$631.24
Rate for Payer: MDX Hawaii PPO	$1,200.60
Rate for Payer: University Health Alliance Commercial	$902.18

Clip Applier Ligaclip Titan LARGE 33.7cm MCL20 [3642494A]

Facility

$1,237.73

Hospital Charge Code	3642494A
Hospital Revenue Code	272
Min. Negotiated Rate	$631.24
Max. Negotiated Rate	$1,200.60
Rate for Payer: Cash Price	$804.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,175.84
Rate for Payer: Health Management Network Commercial	$1,052.07
Rate for Payer: Kaiser Permanente Commercial	$779.77
Rate for Payer: Kaiser Permanente Medicaid	$631.24
Rate for Payer: MDX Hawaii PPO	$1,200.60
Rate for Payer: University Health Alliance Commercial	$902.18

Clip Applier Ligaclip Titan LARGE 33.7cm MCL20 [3642494A]

Facility

$1,237.73

Hospital Charge Code	3642494A
Hospital Revenue Code	272
Min. Negotiated Rate	$1,052.07
Max. Negotiated Rate	$1,200.60
Rate for Payer: Cash Price	$804.52
Rate for Payer: Health Management Network Commercial	$1,052.07
Rate for Payer: MDX Hawaii PPO	$1,200.60

Clip Applier Ligaclip Titan MED 29.2cm MCM20 [3642494]

Facility

$1,337.71

Hospital Charge Code	3642494
Hospital Revenue Code	272
Min. Negotiated Rate	$1,137.05
Max. Negotiated Rate	$1,297.58
Rate for Payer: Cash Price	$869.51
Rate for Payer: Health Management Network Commercial	$1,137.05
Rate for Payer: MDX Hawaii PPO	$1,297.58

Clip Applier Ligaclip Titan MED 29.2cm MCM20 [3642494]

Facility

$1,337.71

Hospital Charge Code	3642494
Hospital Revenue Code	272
Min. Negotiated Rate	$682.23
Max. Negotiated Rate	$1,297.58
Rate for Payer: Cash Price	$869.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.82
Rate for Payer: Health Management Network Commercial	$1,137.05
Rate for Payer: Kaiser Permanente Commercial	$842.76
Rate for Payer: Kaiser Permanente Medicaid	$682.23
Rate for Payer: MDX Hawaii PPO	$1,297.58
Rate for Payer: University Health Alliance Commercial	$975.06

Clip Applier Ligaclip Titan SMALL 23.8cm MCS20 [3642493]

Facility

$1,337.71

Hospital Charge Code	3642493
Hospital Revenue Code	272
Min. Negotiated Rate	$682.23
Max. Negotiated Rate	$1,297.58
Rate for Payer: Cash Price	$869.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.82
Rate for Payer: Health Management Network Commercial	$1,137.05
Rate for Payer: Kaiser Permanente Commercial	$842.76
Rate for Payer: Kaiser Permanente Medicaid	$682.23
Rate for Payer: MDX Hawaii PPO	$1,297.58
Rate for Payer: University Health Alliance Commercial	$975.06

Clip Applier Ligaclip Titan SMALL 23.8cm MCS20 [3642493]

Facility

$1,337.71

Hospital Charge Code	3642493
Hospital Revenue Code	272
Min. Negotiated Rate	$1,137.05
Max. Negotiated Rate	$1,297.58
Rate for Payer: Cash Price	$869.51
Rate for Payer: Health Management Network Commercial	$1,137.05
Rate for Payer: MDX Hawaii PPO	$1,297.58

Clip Applier Surgiclip Titan Prem LG 13.0 134048 [3641082]

Facility

$239.40

Hospital Charge Code	3641082
Hospital Revenue Code	272
Min. Negotiated Rate	$122.09
Max. Negotiated Rate	$232.22
Rate for Payer: Cash Price	$155.61
Rate for Payer: Hawaii Western Management Group Commercial	$227.43
Rate for Payer: Health Management Network Commercial	$203.49
Rate for Payer: Kaiser Permanente Commercial	$150.82
Rate for Payer: Kaiser Permanente Medicaid	$122.09
Rate for Payer: MDX Hawaii PPO	$232.22
Rate for Payer: University Health Alliance Commercial	$174.50

Clip Applier Surgiclip Titan Prem LG 13.0 134048 [3641082]

Facility

$239.40

Hospital Charge Code	3641082
Hospital Revenue Code	272
Min. Negotiated Rate	$203.49
Max. Negotiated Rate	$232.22
Rate for Payer: Cash Price	$155.61
Rate for Payer: Health Management Network Commercial	$203.49
Rate for Payer: MDX Hawaii PPO	$232.22

Clip Applier Surgiclip Titan Prem MED 11.5 134053 [3641080]

Facility

$421.35

Hospital Charge Code	3641080
Hospital Revenue Code	272
Min. Negotiated Rate	$214.89
Max. Negotiated Rate	$408.71
Rate for Payer: Cash Price	$273.88
Rate for Payer: Hawaii Western Management Group Commercial	$400.28
Rate for Payer: Health Management Network Commercial	$358.15
Rate for Payer: Kaiser Permanente Commercial	$265.45
Rate for Payer: Kaiser Permanente Medicaid	$214.89
Rate for Payer: MDX Hawaii PPO	$408.71
Rate for Payer: University Health Alliance Commercial	$307.12

Clip Applier Surgiclip Titan Prem MED 11.5 134053 [3641080]

Facility

$421.35

Hospital Charge Code	3641080
Hospital Revenue Code	272
Min. Negotiated Rate	$358.15
Max. Negotiated Rate	$408.71
Rate for Payer: Cash Price	$273.88
Rate for Payer: Health Management Network Commercial	$358.15
Rate for Payer: MDX Hawaii PPO	$408.71

Clip Applier Surgiclip Titan Prem Small 9 133650 [3641664]

Facility

$378.80

Hospital Charge Code	3641664
Hospital Revenue Code	272
Min. Negotiated Rate	$321.98
Max. Negotiated Rate	$367.44
Rate for Payer: Cash Price	$246.22
Rate for Payer: Health Management Network Commercial	$321.98
Rate for Payer: MDX Hawaii PPO	$367.44

Clip Applier Surgiclip Titan Prem Small 9 133650 [3641664]

Facility

$378.80

Hospital Charge Code	3641664
Hospital Revenue Code	272
Min. Negotiated Rate	$193.19
Max. Negotiated Rate	$367.44
Rate for Payer: Cash Price	$246.22
Rate for Payer: Hawaii Western Management Group Commercial	$359.86
Rate for Payer: Health Management Network Commercial	$321.98
Rate for Payer: Kaiser Permanente Commercial	$238.64
Rate for Payer: Kaiser Permanente Medicaid	$193.19
Rate for Payer: MDX Hawaii PPO	$367.44
Rate for Payer: University Health Alliance Commercial	$276.11

CLOBETASOL 0.05 % TOP CR

Facility

$57.92

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$56.18
Rate for Payer: Cash Price	$37.65
Rate for Payer: Cash Price	$502.09
Rate for Payer: Hawaii Western Management Group Commercial	$55.02
Rate for Payer: Hawaii Western Management Group Commercial	$733.82
Rate for Payer: Health Management Network Commercial	$656.57
Rate for Payer: Health Management Network Commercial	$49.23
Rate for Payer: Kaiser Permanente Commercial	$36.49
Rate for Payer: Kaiser Permanente Commercial	$486.64
Rate for Payer: Kaiser Permanente Medicaid	$393.94
Rate for Payer: Kaiser Permanente Medicaid	$29.54
Rate for Payer: MDX Hawaii PPO	$749.27
Rate for Payer: MDX Hawaii PPO	$56.18
Rate for Payer: UnitedHealthcare Medicaid	$34.75
Rate for Payer: UnitedHealthcare Medicaid	$463.46
Rate for Payer: University Health Alliance Commercial	$563.03
Rate for Payer: University Health Alliance Commercial	$42.22

CLOBETASOL 0.05 % TOP CR

Facility

$57.92

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

CLONAZEPAM 0.5 MG PO TABLET

Facility

$2.89

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.80
Rate for Payer: Cash Price	$1.88
Rate for Payer: Hawaii Western Management Group Commercial	$2.75
Rate for Payer: Health Management Network Commercial	$2.46
Rate for Payer: Kaiser Permanente Commercial	$1.82
Rate for Payer: Kaiser Permanente Medicaid	$1.47
Rate for Payer: MDX Hawaii PPO	$2.80
Rate for Payer: UnitedHealthcare Medicaid	$1.73
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: 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	$1.66
Max. Negotiated Rate	$3.16
Rate for Payer: Cash Price	$2.12
Rate for Payer: Hawaii Western Management Group Commercial	$3.10
Rate for Payer: Health Management Network Commercial	$2.77
Rate for Payer: Kaiser Permanente Commercial	$2.05
Rate for Payer: Kaiser Permanente Medicaid	$1.66
Rate for Payer: MDX Hawaii PPO	$3.16
Rate for Payer: UnitedHealthcare Medicaid	$1.96
Rate for Payer: University Health Alliance Commercial	$2.38

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: MDX Hawaii PPO	$3.16

CLONAZEPAM 1 MG PO TABLET

Facility

$3.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.79
Rate for Payer: Cash Price	$2.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.71
Rate for Payer: Health Management Network Commercial	$3.32
Rate for Payer: Kaiser Permanente Commercial	$2.46
Rate for Payer: Kaiser Permanente Medicaid	$1.99
Rate for Payer: MDX Hawaii PPO	$3.79
Rate for Payer: UnitedHealthcare Medicaid	$2.35
Rate for Payer: University Health Alliance Commercial	$2.85

Know your out-of-pocket cost for care.

All Charges