Kohala Hospital

All Charges

Charge

Type

Setting

Price

INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$97.80

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$83.13
Max. Negotiated Rate	$94.87
Rate for Payer: Cash Price	$63.57
Rate for Payer: Health Management Network Commercial	$83.13
Rate for Payer: Kaiser Permanente Commercial	$88.02
Rate for Payer: MDX Hawaii PPO	$94.87

INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$97.80

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$96.82
Rate for Payer: AlohaCare Medicaid	$48.90
Rate for Payer: AlohaCare Medicare	$88.02
Rate for Payer: Cash Price	$63.57
Rate for Payer: Cash Price	$63.57
Rate for Payer: Devoted Health Medicare	$96.82
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$88.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$92.91
Rate for Payer: Health Management Network Commercial	$83.13
Rate for Payer: Humana Medicare	$88.02
Rate for Payer: Kaiser Permanente Commercial	$88.02
Rate for Payer: Kaiser Permanente Medicaid	$49.88
Rate for Payer: Kaiser Permanente Medicare	$88.02
Rate for Payer: MDX Hawaii PPO	$94.87
Rate for Payer: Ohana Health Plan Medicaid	$88.02
Rate for Payer: Ohana Health Plan Medicare	$88.02
Rate for Payer: UnitedHealthcare Medicare	$88.02
Rate for Payer: University Health Alliance Commercial	$71.29

INSULIN GLARGINE-YFGN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$378.88

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$322.05
Max. Negotiated Rate	$367.51
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cash Price	$61.22
Rate for Payer: Health Management Network Commercial	$322.05
Rate for Payer: Health Management Network Commercial	$80.05
Rate for Payer: Kaiser Permanente Commercial	$84.76
Rate for Payer: Kaiser Permanente Commercial	$340.99
Rate for Payer: MDX Hawaii PPO	$367.51
Rate for Payer: MDX Hawaii PPO	$91.35

INSULIN GLARGINE-YFGN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$378.88

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$375.09
Rate for Payer: Kaiser Permanente Medicaid	$48.03
Rate for Payer: AlohaCare Medicaid	$189.44
Rate for Payer: AlohaCare Medicaid	$47.09
Rate for Payer: AlohaCare Medicare	$340.99
Rate for Payer: AlohaCare Medicare	$84.76
Rate for Payer: Cash Price	$61.22
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cash Price	$61.22
Rate for Payer: Cash Price	$246.27
Rate for Payer: Devoted Health Medicare	$375.09
Rate for Payer: Devoted Health Medicare	$93.24
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$84.76
Rate for Payer: Hawaii Medical Service Association Medicare	$340.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$359.94
Rate for Payer: Hawaii Western Management Group Commercial	$89.47
Rate for Payer: Health Management Network Commercial	$80.05
Rate for Payer: Health Management Network Commercial	$322.05
Rate for Payer: Humana Medicare	$340.99
Rate for Payer: Humana Medicare	$84.76
Rate for Payer: Kaiser Permanente Commercial	$340.99
Rate for Payer: Kaiser Permanente Commercial	$84.76
Rate for Payer: Kaiser Permanente Medicaid	$193.23
Rate for Payer: Kaiser Permanente Medicare	$84.76
Rate for Payer: Kaiser Permanente Medicare	$340.99
Rate for Payer: MDX Hawaii PPO	$91.35
Rate for Payer: MDX Hawaii PPO	$367.51
Rate for Payer: Ohana Health Plan Medicaid	$340.99
Rate for Payer: Ohana Health Plan Medicaid	$84.76
Rate for Payer: Ohana Health Plan Medicare	$84.76
Rate for Payer: Ohana Health Plan Medicare	$340.99
Rate for Payer: UnitedHealthcare Medicare	$340.99
Rate for Payer: UnitedHealthcare Medicare	$84.76
Rate for Payer: University Health Alliance Commercial	$276.17
Rate for Payer: University Health Alliance Commercial	$68.65

INSULIN LISPRO 100 UNIT/ML 3 ML SQ PEN (ADMELOG)

Facility

$174.78

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$148.56
Max. Negotiated Rate	$169.54
Rate for Payer: Cash Price	$113.61
Rate for Payer: Health Management Network Commercial	$148.56
Rate for Payer: Kaiser Permanente Commercial	$157.30
Rate for Payer: MDX Hawaii PPO	$169.54

INSULIN LISPRO 100 UNIT/ML 3 ML SQ PEN (ADMELOG)

Facility

$174.78

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$173.03
Rate for Payer: AlohaCare Medicaid	$87.39
Rate for Payer: AlohaCare Medicare	$157.30
Rate for Payer: Cash Price	$113.61
Rate for Payer: Cash Price	$113.61
Rate for Payer: Devoted Health Medicare	$173.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$157.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$166.04
Rate for Payer: Health Management Network Commercial	$148.56
Rate for Payer: Humana Medicare	$157.30
Rate for Payer: Kaiser Permanente Commercial	$157.30
Rate for Payer: Kaiser Permanente Medicaid	$89.14
Rate for Payer: Kaiser Permanente Medicare	$157.30
Rate for Payer: MDX Hawaii PPO	$169.54
Rate for Payer: Ohana Health Plan Medicaid	$157.30
Rate for Payer: Ohana Health Plan Medicare	$157.30
Rate for Payer: UnitedHealthcare Medicare	$157.30
Rate for Payer: University Health Alliance Commercial	$127.40

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) 3 ML SQ PEN)

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$133.73
Rate for Payer: AlohaCare Medicaid	$67.54
Rate for Payer: AlohaCare Medicare	$121.57
Rate for Payer: Cash Price	$87.80
Rate for Payer: Cash Price	$87.80
Rate for Payer: Devoted Health Medicare	$133.73
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$121.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$128.33
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: Humana Medicare	$121.57
Rate for Payer: Kaiser Permanente Commercial	$121.57
Rate for Payer: Kaiser Permanente Medicaid	$68.89
Rate for Payer: Kaiser Permanente Medicare	$121.57
Rate for Payer: MDX Hawaii PPO	$131.03
Rate for Payer: Ohana Health Plan Medicaid	$121.57
Rate for Payer: Ohana Health Plan Medicare	$121.57
Rate for Payer: UnitedHealthcare Medicaid	$81.05
Rate for Payer: UnitedHealthcare Medicare	$121.57
Rate for Payer: University Health Alliance Commercial	$98.46

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) 3 ML SQ PEN)

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$131.03
Rate for Payer: Cash Price	$87.80
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: Kaiser Permanente Commercial	$121.57
Rate for Payer: MDX Hawaii PPO	$131.03

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBCUTANEOUS SUSP

Facility

$73.40

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$72.67
Rate for Payer: AlohaCare Medicaid	$36.70
Rate for Payer: AlohaCare Medicare	$66.06
Rate for Payer: Cash Price	$47.71
Rate for Payer: Cash Price	$47.71
Rate for Payer: Devoted Health Medicare	$72.67
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$66.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$69.73
Rate for Payer: Health Management Network Commercial	$62.39
Rate for Payer: Humana Medicare	$66.06
Rate for Payer: Kaiser Permanente Commercial	$66.06
Rate for Payer: Kaiser Permanente Medicaid	$37.43
Rate for Payer: Kaiser Permanente Medicare	$66.06
Rate for Payer: MDX Hawaii PPO	$71.20
Rate for Payer: Ohana Health Plan Medicaid	$66.06
Rate for Payer: Ohana Health Plan Medicare	$66.06
Rate for Payer: UnitedHealthcare Medicare	$66.06
Rate for Payer: University Health Alliance Commercial	$53.50

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBCUTANEOUS SUSP

Facility

$73.40

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$62.39
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$47.71
Rate for Payer: Health Management Network Commercial	$62.39
Rate for Payer: Kaiser Permanente Commercial	$66.06
Rate for Payer: MDX Hawaii PPO	$71.20

INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$131.03
Rate for Payer: Cash Price	$87.80
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: Kaiser Permanente Commercial	$121.57
Rate for Payer: MDX Hawaii PPO	$131.03

INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$133.73
Rate for Payer: AlohaCare Medicaid	$67.54
Rate for Payer: AlohaCare Medicare	$121.57
Rate for Payer: Cash Price	$87.80
Rate for Payer: Cash Price	$87.80
Rate for Payer: Devoted Health Medicare	$133.73
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$121.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$128.33
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: Humana Medicare	$121.57
Rate for Payer: Kaiser Permanente Commercial	$121.57
Rate for Payer: Kaiser Permanente Medicaid	$68.89
Rate for Payer: Kaiser Permanente Medicare	$121.57
Rate for Payer: MDX Hawaii PPO	$131.03
Rate for Payer: Ohana Health Plan Medicaid	$121.57
Rate for Payer: Ohana Health Plan Medicare	$121.57
Rate for Payer: UnitedHealthcare Medicaid	$81.05
Rate for Payer: UnitedHealthcare Medicare	$121.57
Rate for Payer: University Health Alliance Commercial	$98.46

INSULIN REGULAR HUMAN 100 UNIT/ML 3 ML SQ PEN (NOVOLIN R)

Facility

$93.43

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$79.42
Max. Negotiated Rate	$90.63
Rate for Payer: Cash Price	$60.73
Rate for Payer: Health Management Network Commercial	$79.42
Rate for Payer: Kaiser Permanente Commercial	$84.09
Rate for Payer: MDX Hawaii PPO	$90.63

INSULIN REGULAR HUMAN 100 UNIT/ML 3 ML SQ PEN (NOVOLIN R)

Facility

$93.43

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$92.50
Rate for Payer: AlohaCare Medicaid	$46.72
Rate for Payer: AlohaCare Medicare	$84.09
Rate for Payer: Cash Price	$60.73
Rate for Payer: Cash Price	$60.73
Rate for Payer: Devoted Health Medicare	$92.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$84.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$88.76
Rate for Payer: Health Management Network Commercial	$79.42
Rate for Payer: Humana Medicare	$84.09
Rate for Payer: Kaiser Permanente Commercial	$84.09
Rate for Payer: Kaiser Permanente Medicaid	$47.65
Rate for Payer: Kaiser Permanente Medicare	$84.09
Rate for Payer: MDX Hawaii PPO	$90.63
Rate for Payer: Ohana Health Plan Medicaid	$84.09
Rate for Payer: Ohana Health Plan Medicare	$84.09
Rate for Payer: UnitedHealthcare Medicaid	$56.06
Rate for Payer: UnitedHealthcare Medicare	$84.09
Rate for Payer: University Health Alliance Commercial	$68.10

INSULIN REGULAR HUMAN 100 UNIT/ML IV PUSH

Facility

$202.69

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$172.29
Max. Negotiated Rate	$196.61
Rate for Payer: Cash Price	$131.75
Rate for Payer: Health Management Network Commercial	$172.29
Rate for Payer: Kaiser Permanente Commercial	$182.42
Rate for Payer: MDX Hawaii PPO	$196.61

INSULIN REGULAR HUMAN 100 UNIT/ML IV PUSH

Facility

$202.69

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$200.66
Rate for Payer: AlohaCare Medicaid	$101.34
Rate for Payer: AlohaCare Medicare	$182.42
Rate for Payer: Cash Price	$131.75
Rate for Payer: Cash Price	$131.75
Rate for Payer: Devoted Health Medicare	$200.66
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$182.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$192.56
Rate for Payer: Health Management Network Commercial	$172.29
Rate for Payer: Humana Medicare	$182.42
Rate for Payer: Kaiser Permanente Commercial	$182.42
Rate for Payer: Kaiser Permanente Medicaid	$103.37
Rate for Payer: Kaiser Permanente Medicare	$182.42
Rate for Payer: MDX Hawaii PPO	$196.61
Rate for Payer: Ohana Health Plan Medicaid	$182.42
Rate for Payer: Ohana Health Plan Medicare	$182.42
Rate for Payer: UnitedHealthcare Medicare	$182.42
Rate for Payer: University Health Alliance Commercial	$147.74

INSULIN REGULAR HUMAN (1 UNITS/ML NS) (PEDS) (PREMIX) SYR WHR

Facility

$162.90

Service Code	NDC 00338012612
Hospital Revenue Code	636
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$161.27
Rate for Payer: AlohaCare Medicaid	$81.45
Rate for Payer: AlohaCare Medicare	$146.61
Rate for Payer: Cash Price	$105.88
Rate for Payer: Devoted Health Medicare	$161.27
Rate for Payer: Hawaii Medical Service Association Medicare	$146.61
Rate for Payer: Hawaii Western Management Group Commercial	$154.75
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Humana Medicare	$146.61
Rate for Payer: Kaiser Permanente Commercial	$146.61
Rate for Payer: Kaiser Permanente Medicaid	$83.08
Rate for Payer: Kaiser Permanente Medicare	$146.61
Rate for Payer: MDX Hawaii PPO	$158.01
Rate for Payer: Ohana Health Plan Medicaid	$146.61
Rate for Payer: Ohana Health Plan Medicare	$146.61
Rate for Payer: UnitedHealthcare Medicaid	$97.74
Rate for Payer: UnitedHealthcare Medicare	$146.61
Rate for Payer: University Health Alliance Commercial	$118.74

INSULIN REGULAR HUMAN (1 UNITS/ML NS) (PEDS) (PREMIX) SYR WHR

Facility

$162.90

Service Code	NDC 00338012612
Hospital Revenue Code	250
Min. Negotiated Rate	$138.47
Max. Negotiated Rate	$158.01
Rate for Payer: Cash Price	$105.88
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Kaiser Permanente Commercial	$146.61
Rate for Payer: MDX Hawaii PPO	$158.01

INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN

Facility

$162.90

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$161.27
Rate for Payer: AlohaCare Medicaid	$81.45
Rate for Payer: AlohaCare Medicare	$146.61
Rate for Payer: Cash Price	$105.88
Rate for Payer: Devoted Health Medicare	$161.27
Rate for Payer: Hawaii Medical Service Association Medicare	$146.61
Rate for Payer: Hawaii Western Management Group Commercial	$154.75
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Humana Medicare	$146.61
Rate for Payer: Kaiser Permanente Commercial	$146.61
Rate for Payer: Kaiser Permanente Medicaid	$83.08
Rate for Payer: Kaiser Permanente Medicare	$146.61
Rate for Payer: MDX Hawaii PPO	$158.01
Rate for Payer: Ohana Health Plan Medicaid	$146.61
Rate for Payer: Ohana Health Plan Medicare	$146.61
Rate for Payer: UnitedHealthcare Medicaid	$97.74
Rate for Payer: UnitedHealthcare Medicare	$146.61
Rate for Payer: University Health Alliance Commercial	$118.74

INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN

Facility

$162.90

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$138.47
Max. Negotiated Rate	$158.01
Rate for Payer: Cash Price	$105.88
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Kaiser Permanente Commercial	$146.61
Rate for Payer: MDX Hawaii PPO	$158.01

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$34,391.60

Service Code	MSDRG 197
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$34,391.60

Service Code	MSDRG 196
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$34,391.60

Service Code	MSDRG 198
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$34,415.30

Service Code	MSDRG 065
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$34,415.30

Service Code	MSDRG 064
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

Know your out-of-pocket cost for care.

All Charges