Kohala Hospital

All Charges

Charge

Type

Setting

Price

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$34,960.45

Service Code	MSDRG 482
Min. Negotiated Rate	$34,960.45
Max. Negotiated Rate	$34,960.45
Rate for Payer: Hawaii Medical Service Association Commercial	$34,960.45

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$50,580.07

Service Code	MSDRG 521
Min. Negotiated Rate	$50,580.07
Max. Negotiated Rate	$50,580.07
Rate for Payer: Hawaii Medical Service Association Commercial	$50,580.07

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$36,880.31

Service Code	MSDRG 522
Min. Negotiated Rate	$36,880.31
Max. Negotiated Rate	$36,880.31
Rate for Payer: Hawaii Medical Service Association Commercial	$36,880.31

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$99,074.36

Service Code	MSDRG 969
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$99,074.36

Service Code	MSDRG 970
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$57,643.26

Service Code	MSDRG 975
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$57,643.26

Service Code	MSDRG 974
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$57,643.26

Service Code	MSDRG 976
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$41,431.10

Service Code	MSDRG 977
Min. Negotiated Rate	$41,431.10
Max. Negotiated Rate	$41,431.10
Rate for Payer: Hawaii Medical Service Association Commercial	$41,431.10

HYDRALAZINE 10 MG PO TABLET

Facility

$2.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.20
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Management Network Commercial	$1.93
Rate for Payer: Kaiser Permanente Commercial	$2.04
Rate for Payer: MDX Hawaii PPO	$2.20

HYDRALAZINE 10 MG PO TABLET

Facility

$2.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.25
Rate for Payer: AlohaCare Medicaid	$1.14
Rate for Payer: AlohaCare Medicare	$2.04
Rate for Payer: Cash Price	$1.48
Rate for Payer: Devoted Health Medicare	$2.25
Rate for Payer: Hawaii Medical Service Association Medicare	$2.04
Rate for Payer: Hawaii Western Management Group Commercial	$2.16
Rate for Payer: Health Management Network Commercial	$1.93
Rate for Payer: Humana Medicare	$2.04
Rate for Payer: Kaiser Permanente Commercial	$2.04
Rate for Payer: Kaiser Permanente Medicaid	$1.16
Rate for Payer: Kaiser Permanente Medicare	$2.04
Rate for Payer: MDX Hawaii PPO	$2.20
Rate for Payer: Ohana Health Plan Medicaid	$2.04
Rate for Payer: Ohana Health Plan Medicare	$2.04
Rate for Payer: UnitedHealthcare Medicare	$2.04
Rate for Payer: University Health Alliance Commercial	$1.65

HYDRALAZINE 20 MG/ML INJ SOLN

Facility

$88.55

Service Code	HCPCS J0360
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$87.66
Rate for Payer: AlohaCare Medicaid	$44.27
Rate for Payer: AlohaCare Medicare	$79.69
Rate for Payer: Cash Price	$57.56
Rate for Payer: Cash Price	$57.56
Rate for Payer: Devoted Health Medicare	$87.66
Rate for Payer: Hawaii Medical Service Association ABD	$5.19
Rate for Payer: Hawaii Medical Service Association Medicare	$79.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.19
Rate for Payer: Hawaii Western Management Group Commercial	$84.12
Rate for Payer: Health Management Network Commercial	$75.27
Rate for Payer: Humana Medicare	$79.69
Rate for Payer: Kaiser Permanente Commercial	$79.69
Rate for Payer: Kaiser Permanente Medicaid	$45.16
Rate for Payer: Kaiser Permanente Medicare	$79.69
Rate for Payer: MDX Hawaii PPO	$85.89
Rate for Payer: Ohana Health Plan Medicaid	$79.69
Rate for Payer: Ohana Health Plan Medicare	$79.69
Rate for Payer: UnitedHealthcare Medicaid	$53.13
Rate for Payer: UnitedHealthcare Medicare	$79.69
Rate for Payer: University Health Alliance Commercial	$64.54

HYDRALAZINE 20 MG/ML INJ SOLN

Facility

$88.55

Service Code	HCPCS J0360
Hospital Revenue Code	250
Min. Negotiated Rate	$75.27
Max. Negotiated Rate	$85.89
Rate for Payer: Cash Price	$57.56
Rate for Payer: Health Management Network Commercial	$75.27
Rate for Payer: Kaiser Permanente Commercial	$79.69
Rate for Payer: MDX Hawaii PPO	$85.89

HYDRALAZINE 25 MG PO TABLET

Facility

$1.41

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.40
Rate for Payer: AlohaCare Medicaid	$0.71
Rate for Payer: AlohaCare Medicare	$1.27
Rate for Payer: Cash Price	$0.92
Rate for Payer: Devoted Health Medicare	$1.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1.27
Rate for Payer: Hawaii Western Management Group Commercial	$1.34
Rate for Payer: Health Management Network Commercial	$1.20
Rate for Payer: Humana Medicare	$1.27
Rate for Payer: Kaiser Permanente Commercial	$1.27
Rate for Payer: Kaiser Permanente Medicaid	$0.72
Rate for Payer: Kaiser Permanente Medicare	$1.27
Rate for Payer: MDX Hawaii PPO	$1.37
Rate for Payer: Ohana Health Plan Medicaid	$1.27
Rate for Payer: Ohana Health Plan Medicare	$1.27
Rate for Payer: UnitedHealthcare Medicare	$1.27
Rate for Payer: University Health Alliance Commercial	$1.03

HYDRALAZINE 25 MG PO TABLET

Facility

$1.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.37
Rate for Payer: Cash Price	$0.92
Rate for Payer: Health Management Network Commercial	$1.20
Rate for Payer: Kaiser Permanente Commercial	$1.27
Rate for Payer: MDX Hawaii PPO	$1.37

HYDROCHLOROTHIAZIDE 12.5 MG PO CAP

Facility

$1.56

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.54
Rate for Payer: AlohaCare Medicaid	$0.78
Rate for Payer: AlohaCare Medicaid	$1.18
Rate for Payer: AlohaCare Medicare	$1.40
Rate for Payer: AlohaCare Medicare	$2.12
Rate for Payer: Cash Price	$1.53
Rate for Payer: Cash Price	$1.01
Rate for Payer: Devoted Health Medicare	$1.54
Rate for Payer: Devoted Health Medicare	$2.33
Rate for Payer: Hawaii Medical Service Association Medicare	$2.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$2.23
Rate for Payer: Hawaii Western Management Group Commercial	$1.48
Rate for Payer: Health Management Network Commercial	$1.33
Rate for Payer: Health Management Network Commercial	$2.00
Rate for Payer: Humana Medicare	$2.12
Rate for Payer: Humana Medicare	$1.40
Rate for Payer: Kaiser Permanente Commercial	$1.40
Rate for Payer: Kaiser Permanente Commercial	$2.12
Rate for Payer: Kaiser Permanente Medicaid	$1.20
Rate for Payer: Kaiser Permanente Medicaid	$0.80
Rate for Payer: Kaiser Permanente Medicare	$2.12
Rate for Payer: Kaiser Permanente Medicare	$1.40
Rate for Payer: MDX Hawaii PPO	$2.28
Rate for Payer: MDX Hawaii PPO	$1.51
Rate for Payer: Ohana Health Plan Medicaid	$1.40
Rate for Payer: Ohana Health Plan Medicaid	$2.12
Rate for Payer: Ohana Health Plan Medicare	$1.40
Rate for Payer: Ohana Health Plan Medicare	$2.12
Rate for Payer: UnitedHealthcare Medicare	$1.40
Rate for Payer: UnitedHealthcare Medicare	$2.12
Rate for Payer: University Health Alliance Commercial	$1.71
Rate for Payer: University Health Alliance Commercial	$1.14

HYDROCHLOROTHIAZIDE 12.5 MG PO CAP

Facility

$2.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.28
Rate for Payer: Cash Price	$1.53
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Management Network Commercial	$2.00
Rate for Payer: Health Management Network Commercial	$1.33
Rate for Payer: Kaiser Permanente Commercial	$2.12
Rate for Payer: Kaiser Permanente Commercial	$1.40
Rate for Payer: MDX Hawaii PPO	$1.51
Rate for Payer: MDX Hawaii PPO	$2.28

HYDROCHLOROTHIAZIDE 25 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

HYDROCHLOROTHIAZIDE 25 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

HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABLET

Facility

$6.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$5.90
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$3.51
Rate for Payer: Cash Price	$6.04
Rate for Payer: Health Management Network Commercial	$7.90
Rate for Payer: Health Management Network Commercial	$4.59
Rate for Payer: Health Management Network Commercial	$5.17
Rate for Payer: Kaiser Permanente Commercial	$8.36
Rate for Payer: Kaiser Permanente Commercial	$4.86
Rate for Payer: Kaiser Permanente Commercial	$5.47
Rate for Payer: MDX Hawaii PPO	$5.90
Rate for Payer: MDX Hawaii PPO	$5.24
Rate for Payer: MDX Hawaii PPO	$9.01

HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABLET

Facility

$5.40

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$5.35
Rate for Payer: AlohaCare Medicaid	$2.70
Rate for Payer: AlohaCare Medicaid	$4.64
Rate for Payer: AlohaCare Medicaid	$3.04
Rate for Payer: AlohaCare Medicare	$5.47
Rate for Payer: AlohaCare Medicare	$4.86
Rate for Payer: AlohaCare Medicare	$8.36
Rate for Payer: Cash Price	$6.04
Rate for Payer: Cash Price	$3.51
Rate for Payer: Cash Price	$3.95
Rate for Payer: Devoted Health Medicare	$6.02
Rate for Payer: Devoted Health Medicare	$5.35
Rate for Payer: Devoted Health Medicare	$9.20
Rate for Payer: Hawaii Medical Service Association Medicare	$8.36
Rate for Payer: Hawaii Medical Service Association Medicare	$4.86
Rate for Payer: Hawaii Medical Service Association Medicare	$5.47
Rate for Payer: Hawaii Western Management Group Commercial	$8.83
Rate for Payer: Hawaii Western Management Group Commercial	$5.13
Rate for Payer: Hawaii Western Management Group Commercial	$5.78
Rate for Payer: Health Management Network Commercial	$4.59
Rate for Payer: Health Management Network Commercial	$5.17
Rate for Payer: Health Management Network Commercial	$7.90
Rate for Payer: Humana Medicare	$5.47
Rate for Payer: Humana Medicare	$8.36
Rate for Payer: Humana Medicare	$4.86
Rate for Payer: Kaiser Permanente Commercial	$5.47
Rate for Payer: Kaiser Permanente Commercial	$4.86
Rate for Payer: Kaiser Permanente Commercial	$8.36
Rate for Payer: Kaiser Permanente Medicaid	$4.74
Rate for Payer: Kaiser Permanente Medicaid	$2.75
Rate for Payer: Kaiser Permanente Medicaid	$3.10
Rate for Payer: Kaiser Permanente Medicare	$4.86
Rate for Payer: Kaiser Permanente Medicare	$5.47
Rate for Payer: Kaiser Permanente Medicare	$8.36
Rate for Payer: MDX Hawaii PPO	$5.24
Rate for Payer: MDX Hawaii PPO	$5.90
Rate for Payer: MDX Hawaii PPO	$9.01
Rate for Payer: Ohana Health Plan Medicaid	$5.47
Rate for Payer: Ohana Health Plan Medicaid	$4.86
Rate for Payer: Ohana Health Plan Medicaid	$8.36
Rate for Payer: Ohana Health Plan Medicare	$4.86
Rate for Payer: Ohana Health Plan Medicare	$5.47
Rate for Payer: Ohana Health Plan Medicare	$8.36
Rate for Payer: UnitedHealthcare Medicare	$4.86
Rate for Payer: UnitedHealthcare Medicare	$8.36
Rate for Payer: UnitedHealthcare Medicare	$5.47
Rate for Payer: University Health Alliance Commercial	$4.43
Rate for Payer: University Health Alliance Commercial	$3.94
Rate for Payer: University Health Alliance Commercial	$6.77

HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABLET

Facility

$6.11

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.93
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cash Price	$2.24
Rate for Payer: Health Management Network Commercial	$5.19
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$3.25
Rate for Payer: Kaiser Permanente Commercial	$3.44
Rate for Payer: Kaiser Permanente Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$5.50
Rate for Payer: MDX Hawaii PPO	$3.71
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: MDX Hawaii PPO	$5.93

HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABLET

Facility

$6.11

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.05
Rate for Payer: AlohaCare Medicaid	$3.06
Rate for Payer: AlohaCare Medicaid	$1.73
Rate for Payer: AlohaCare Medicaid	$1.91
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: AlohaCare Medicare	$5.50
Rate for Payer: AlohaCare Medicare	$3.44
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cash Price	$3.97
Rate for Payer: Devoted Health Medicare	$3.78
Rate for Payer: Devoted Health Medicare	$3.42
Rate for Payer: Devoted Health Medicare	$6.05
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Medical Service Association Medicare	$3.44
Rate for Payer: Hawaii Medical Service Association Medicare	$5.50
Rate for Payer: Hawaii Western Management Group Commercial	$3.63
Rate for Payer: Hawaii Western Management Group Commercial	$5.80
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$5.19
Rate for Payer: Health Management Network Commercial	$3.25
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Humana Medicare	$3.44
Rate for Payer: Humana Medicare	$5.50
Rate for Payer: Kaiser Permanente Commercial	$5.50
Rate for Payer: Kaiser Permanente Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$3.44
Rate for Payer: Kaiser Permanente Medicaid	$1.76
Rate for Payer: Kaiser Permanente Medicaid	$3.12
Rate for Payer: Kaiser Permanente Medicaid	$1.95
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: Kaiser Permanente Medicare	$5.50
Rate for Payer: Kaiser Permanente Medicare	$3.44
Rate for Payer: MDX Hawaii PPO	$5.93
Rate for Payer: MDX Hawaii PPO	$3.71
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicaid	$3.44
Rate for Payer: Ohana Health Plan Medicaid	$5.50
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.44
Rate for Payer: Ohana Health Plan Medicare	$5.50
Rate for Payer: UnitedHealthcare Medicare	$3.44
Rate for Payer: UnitedHealthcare Medicare	$5.50
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$4.45
Rate for Payer: University Health Alliance Commercial	$2.51
Rate for Payer: University Health Alliance Commercial	$2.78

HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML PO SOLN

Facility

$27.16

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$26.89
Rate for Payer: AlohaCare Medicaid	$13.58
Rate for Payer: AlohaCare Medicaid	$15.45
Rate for Payer: AlohaCare Medicare	$24.44
Rate for Payer: AlohaCare Medicare	$27.80
Rate for Payer: Cash Price	$20.08
Rate for Payer: Cash Price	$17.65
Rate for Payer: Devoted Health Medicare	$26.89
Rate for Payer: Devoted Health Medicare	$30.58
Rate for Payer: Hawaii Medical Service Association Medicare	$27.80
Rate for Payer: Hawaii Medical Service Association Medicare	$24.44
Rate for Payer: Hawaii Western Management Group Commercial	$29.35
Rate for Payer: Hawaii Western Management Group Commercial	$25.80
Rate for Payer: Health Management Network Commercial	$23.09
Rate for Payer: Health Management Network Commercial	$26.26
Rate for Payer: Humana Medicare	$27.80
Rate for Payer: Humana Medicare	$24.44
Rate for Payer: Kaiser Permanente Commercial	$24.44
Rate for Payer: Kaiser Permanente Commercial	$27.80
Rate for Payer: Kaiser Permanente Medicaid	$15.75
Rate for Payer: Kaiser Permanente Medicaid	$13.85
Rate for Payer: Kaiser Permanente Medicare	$27.80
Rate for Payer: Kaiser Permanente Medicare	$24.44
Rate for Payer: MDX Hawaii PPO	$29.96
Rate for Payer: MDX Hawaii PPO	$26.35
Rate for Payer: Ohana Health Plan Medicaid	$24.44
Rate for Payer: Ohana Health Plan Medicaid	$27.80
Rate for Payer: Ohana Health Plan Medicare	$24.44
Rate for Payer: Ohana Health Plan Medicare	$27.80
Rate for Payer: UnitedHealthcare Medicare	$24.44
Rate for Payer: UnitedHealthcare Medicare	$27.80
Rate for Payer: University Health Alliance Commercial	$22.52
Rate for Payer: University Health Alliance Commercial	$19.80

HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML PO SOLN

Facility

$30.89

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$29.96
Rate for Payer: Cash Price	$20.08
Rate for Payer: Cash Price	$17.65
Rate for Payer: Health Management Network Commercial	$26.26
Rate for Payer: Health Management Network Commercial	$23.09
Rate for Payer: Kaiser Permanente Commercial	$27.80
Rate for Payer: Kaiser Permanente Commercial	$24.44
Rate for Payer: MDX Hawaii PPO	$26.35
Rate for Payer: MDX Hawaii PPO	$29.96

Know your out-of-pocket cost for care.

All Charges