Kohala Hospital

All Charges

Charge

Type

Setting

Price

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$28,513.51

Service Code	MSDRG 293
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$270,036.89

Service Code	MSDRG 001
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$270,036.89

Service Code	MSDRG 002
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN

Facility

$21.37

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Kaiser Permanente Commercial	$19.23
Rate for Payer: MDX Hawaii PPO	$20.73

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN

Facility

$21.37

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$21.16
Rate for Payer: AlohaCare Medicaid	$10.69
Rate for Payer: AlohaCare Medicare	$19.23
Rate for Payer: Cash Price	$13.89
Rate for Payer: Cash Price	$13.89
Rate for Payer: Devoted Health Medicare	$21.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$19.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$20.30
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Humana Medicare	$19.23
Rate for Payer: Kaiser Permanente Commercial	$19.23
Rate for Payer: Kaiser Permanente Medicaid	$10.90
Rate for Payer: Kaiser Permanente Medicare	$19.23
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: Ohana Health Plan Medicaid	$19.23
Rate for Payer: Ohana Health Plan Medicare	$19.23
Rate for Payer: UnitedHealthcare Medicaid	$12.82
Rate for Payer: UnitedHealthcare Medicare	$19.23
Rate for Payer: University Health Alliance Commercial	$15.58

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$21.37

Service Code	NDC 63323054013
Hospital Revenue Code	250
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Kaiser Permanente Commercial	$19.23
Rate for Payer: MDX Hawaii PPO	$20.73

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$21.37

Service Code	NDC 63323054013
Hospital Revenue Code	250
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$21.16
Rate for Payer: AlohaCare Medicaid	$10.69
Rate for Payer: AlohaCare Medicare	$19.23
Rate for Payer: Cash Price	$13.89
Rate for Payer: Devoted Health Medicare	$21.16
Rate for Payer: Hawaii Medical Service Association Medicare	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$20.30
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Humana Medicare	$19.23
Rate for Payer: Kaiser Permanente Commercial	$19.23
Rate for Payer: Kaiser Permanente Medicaid	$10.90
Rate for Payer: Kaiser Permanente Medicare	$19.23
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: Ohana Health Plan Medicaid	$19.23
Rate for Payer: Ohana Health Plan Medicare	$19.23
Rate for Payer: UnitedHealthcare Medicaid	$12.82
Rate for Payer: UnitedHealthcare Medicare	$19.23
Rate for Payer: University Health Alliance Commercial	$15.58

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$21.37

Service Code	NDC 63323054003
Hospital Revenue Code	250
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$21.16
Rate for Payer: AlohaCare Medicaid	$10.69
Rate for Payer: AlohaCare Medicare	$19.23
Rate for Payer: Cash Price	$13.89
Rate for Payer: Devoted Health Medicare	$21.16
Rate for Payer: Hawaii Medical Service Association Medicare	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$20.30
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Humana Medicare	$19.23
Rate for Payer: Kaiser Permanente Commercial	$19.23
Rate for Payer: Kaiser Permanente Medicaid	$10.90
Rate for Payer: Kaiser Permanente Medicare	$19.23
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: Ohana Health Plan Medicaid	$19.23
Rate for Payer: Ohana Health Plan Medicare	$19.23
Rate for Payer: UnitedHealthcare Medicaid	$12.82
Rate for Payer: UnitedHealthcare Medicare	$19.23
Rate for Payer: University Health Alliance Commercial	$15.58

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$9.94

Service Code	NDC 71288040201
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$6.46
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Kaiser Permanente Commercial	$8.95
Rate for Payer: MDX Hawaii PPO	$9.64

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$9.94

Service Code	NDC 71288040201
Hospital Revenue Code	250
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$9.84
Rate for Payer: AlohaCare Medicaid	$4.97
Rate for Payer: AlohaCare Medicare	$8.95
Rate for Payer: Cash Price	$6.46
Rate for Payer: Devoted Health Medicare	$9.84
Rate for Payer: Hawaii Medical Service Association Medicare	$8.95
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Humana Medicare	$8.95
Rate for Payer: Kaiser Permanente Commercial	$8.95
Rate for Payer: Kaiser Permanente Medicaid	$5.07
Rate for Payer: Kaiser Permanente Medicare	$8.95
Rate for Payer: MDX Hawaii PPO	$9.64
Rate for Payer: Ohana Health Plan Medicaid	$8.95
Rate for Payer: Ohana Health Plan Medicare	$8.95
Rate for Payer: UnitedHealthcare Medicaid	$5.96
Rate for Payer: UnitedHealthcare Medicare	$8.95
Rate for Payer: University Health Alliance Commercial	$7.25

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$9.94

Service Code	NDC 71288040202
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$6.46
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Kaiser Permanente Commercial	$8.95
Rate for Payer: MDX Hawaii PPO	$9.64

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$9.94

Service Code	NDC 71288040202
Hospital Revenue Code	250
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$9.84
Rate for Payer: AlohaCare Medicaid	$4.97
Rate for Payer: AlohaCare Medicare	$8.95
Rate for Payer: Cash Price	$6.46
Rate for Payer: Devoted Health Medicare	$9.84
Rate for Payer: Hawaii Medical Service Association Medicare	$8.95
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Humana Medicare	$8.95
Rate for Payer: Kaiser Permanente Commercial	$8.95
Rate for Payer: Kaiser Permanente Medicaid	$5.07
Rate for Payer: Kaiser Permanente Medicare	$8.95
Rate for Payer: MDX Hawaii PPO	$9.64
Rate for Payer: Ohana Health Plan Medicaid	$8.95
Rate for Payer: Ohana Health Plan Medicare	$8.95
Rate for Payer: UnitedHealthcare Medicaid	$5.96
Rate for Payer: UnitedHealthcare Medicare	$8.95
Rate for Payer: University Health Alliance Commercial	$7.25

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

$21.37

Service Code	NDC 63323054003
Hospital Revenue Code	250
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Kaiser Permanente Commercial	$19.23
Rate for Payer: MDX Hawaii PPO	$20.73

HEPARIN (PORCINE) 5000 UNIT/ML INJ SOLN

Facility

$8.28

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$8.20
Rate for Payer: AlohaCare Medicaid	$4.14
Rate for Payer: AlohaCare Medicaid	$4.42
Rate for Payer: AlohaCare Medicare	$7.96
Rate for Payer: AlohaCare Medicare	$7.45
Rate for Payer: Cash Price	$5.75
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$5.75
Rate for Payer: Devoted Health Medicare	$8.20
Rate for Payer: Devoted Health Medicare	$8.75
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$7.96
Rate for Payer: Hawaii Medical Service Association Medicare	$7.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$7.87
Rate for Payer: Hawaii Western Management Group Commercial	$8.40
Rate for Payer: Health Management Network Commercial	$7.51
Rate for Payer: Health Management Network Commercial	$7.04
Rate for Payer: Humana Medicare	$7.45
Rate for Payer: Humana Medicare	$7.96
Rate for Payer: Kaiser Permanente Commercial	$7.45
Rate for Payer: Kaiser Permanente Commercial	$7.96
Rate for Payer: Kaiser Permanente Medicaid	$4.51
Rate for Payer: Kaiser Permanente Medicaid	$4.22
Rate for Payer: Kaiser Permanente Medicare	$7.45
Rate for Payer: Kaiser Permanente Medicare	$7.96
Rate for Payer: MDX Hawaii PPO	$8.03
Rate for Payer: MDX Hawaii PPO	$8.57
Rate for Payer: Ohana Health Plan Medicaid	$7.96
Rate for Payer: Ohana Health Plan Medicaid	$7.45
Rate for Payer: Ohana Health Plan Medicare	$7.45
Rate for Payer: Ohana Health Plan Medicare	$7.96
Rate for Payer: UnitedHealthcare Medicaid	$5.30
Rate for Payer: UnitedHealthcare Medicaid	$4.97
Rate for Payer: UnitedHealthcare Medicare	$7.45
Rate for Payer: UnitedHealthcare Medicare	$7.96
Rate for Payer: University Health Alliance Commercial	$6.04
Rate for Payer: University Health Alliance Commercial	$6.44

HEPARIN (PORCINE) 5000 UNIT/ML INJ SOLN

Facility

$8.28

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$8.03
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$5.75
Rate for Payer: Health Management Network Commercial	$7.04
Rate for Payer: Health Management Network Commercial	$7.51
Rate for Payer: Kaiser Permanente Commercial	$7.45
Rate for Payer: Kaiser Permanente Commercial	$7.96
Rate for Payer: MDX Hawaii PPO	$8.57
Rate for Payer: MDX Hawaii PPO	$8.03

HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/500 ML (50 UNIT/ML) IV SOLP

Facility

$86.31

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$83.72
Rate for Payer: Cash Price	$56.10
Rate for Payer: Health Management Network Commercial	$73.36
Rate for Payer: Kaiser Permanente Commercial	$77.68
Rate for Payer: MDX Hawaii PPO	$83.72

HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/500 ML (50 UNIT/ML) IV SOLP

Facility

$86.31

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$85.45
Rate for Payer: AlohaCare Medicaid	$43.16
Rate for Payer: AlohaCare Medicare	$77.68
Rate for Payer: Cash Price	$56.10
Rate for Payer: Cash Price	$56.10
Rate for Payer: Devoted Health Medicare	$85.45
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$77.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$81.99
Rate for Payer: Health Management Network Commercial	$73.36
Rate for Payer: Humana Medicare	$77.68
Rate for Payer: Kaiser Permanente Commercial	$77.68
Rate for Payer: Kaiser Permanente Medicaid	$44.02
Rate for Payer: Kaiser Permanente Medicare	$77.68
Rate for Payer: MDX Hawaii PPO	$83.72
Rate for Payer: Ohana Health Plan Medicaid	$77.68
Rate for Payer: Ohana Health Plan Medicare	$77.68
Rate for Payer: UnitedHealthcare Medicaid	$51.79
Rate for Payer: UnitedHealthcare Medicare	$77.68
Rate for Payer: University Health Alliance Commercial	$62.91

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$65,464.92

Service Code	MSDRG 421
Min. Negotiated Rate	$65,464.92
Max. Negotiated Rate	$65,464.92
Rate for Payer: Hawaii Medical Service Association Commercial	$65,464.92

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$65,464.92

Service Code	MSDRG 420
Min. Negotiated Rate	$65,464.92
Max. Negotiated Rate	$65,464.92
Rate for Payer: Hawaii Medical Service Association Commercial	$65,464.92

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$58,093.60

Service Code	MSDRG 422
Min. Negotiated Rate	$58,093.60
Max. Negotiated Rate	$58,093.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,093.60

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$31,950.30

Service Code	MSDRG 354
Min. Negotiated Rate	$31,950.30
Max. Negotiated Rate	$31,950.30
Rate for Payer: Hawaii Medical Service Association Commercial	$31,950.30

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$41,407.39

Service Code	MSDRG 353
Min. Negotiated Rate	$41,407.39
Max. Negotiated Rate	$41,407.39
Rate for Payer: Hawaii Medical Service Association Commercial	$41,407.39

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$23,607.19

Service Code	MSDRG 355
Min. Negotiated Rate	$23,607.19
Max. Negotiated Rate	$23,607.19
Rate for Payer: Hawaii Medical Service Association Commercial	$23,607.19

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$48,517.99

Service Code	MSDRG 481
Min. Negotiated Rate	$48,517.99
Max. Negotiated Rate	$48,517.99
Rate for Payer: Hawaii Medical Service Association Commercial	$48,517.99

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$49,750.50

Service Code	MSDRG 480
Min. Negotiated Rate	$49,750.50
Max. Negotiated Rate	$49,750.50
Rate for Payer: Hawaii Medical Service Association Commercial	$49,750.50

Know your out-of-pocket cost for care.

All Charges