Kohala Hospital

All Charges

Charge

Type

Setting

Price

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$43,279.85

Service Code	MSDRG 657
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$43,279.85

Service Code	MSDRG 656
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$43,279.85

Service Code	MSDRG 658
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$46,052.99

Service Code	MSDRG 660
Min. Negotiated Rate	$46,052.99
Max. Negotiated Rate	$46,052.99
Rate for Payer: Hawaii Medical Service Association Commercial	$46,052.99

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$47,759.53

Service Code	MSDRG 659
Min. Negotiated Rate	$47,759.53
Max. Negotiated Rate	$47,759.53
Rate for Payer: Hawaii Medical Service Association Commercial	$47,759.53

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

$31,144.43

Service Code	MSDRG 661
Min. Negotiated Rate	$31,144.43
Max. Negotiated Rate	$31,144.43
Rate for Payer: Hawaii Medical Service Association Commercial	$31,144.43

KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

$17,539.48

Service Code	MSDRG 689
Min. Negotiated Rate	$17,539.48
Max. Negotiated Rate	$17,539.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17,539.48

KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

$14,979.66

Service Code	MSDRG 690
Min. Negotiated Rate	$14,979.66
Max. Negotiated Rate	$14,979.66
Rate for Payer: Hawaii Medical Service Association Commercial	$14,979.66

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$30,931.11

Service Code	MSDRG 687
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

$30,931.11

Service Code	MSDRG 686
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

$30,931.11

Service Code	MSDRG 688
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$20,525.93

Service Code	MSDRG 695
Min. Negotiated Rate	$20,525.93
Max. Negotiated Rate	$20,525.93
Rate for Payer: Hawaii Medical Service Association Commercial	$20,525.93

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$20,525.93

Service Code	MSDRG 696
Min. Negotiated Rate	$20,525.93
Max. Negotiated Rate	$20,525.93
Rate for Payer: Hawaii Medical Service Association Commercial	$20,525.93

KIDNEY TRANSPLANT

Facility

$154,726.66

Service Code	MSDRG 652
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$154,726.66

Service Code	MSDRG 650
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$154,726.66

Service Code	MSDRG 651
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$24,934.50

Service Code	MSDRG 488
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$24,934.50

Service Code	MSDRG 489
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$44,156.83

Service Code	MSDRG 486
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$44,156.83

Service Code	MSDRG 485
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$31,547.36

Service Code	MSDRG 487
Min. Negotiated Rate	$31,547.36
Max. Negotiated Rate	$31,547.36
Rate for Payer: Hawaii Medical Service Association Commercial	$31,547.36

LABETALOL 100 MG PO TABLET

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.96
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: Kaiser Permanente Commercial	$2.71
Rate for Payer: MDX Hawaii PPO	$2.92

LABETALOL 100 MG PO TABLET

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.98
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.71
Rate for Payer: Cash Price	$1.96
Rate for Payer: Devoted Health Medicare	$2.98
Rate for Payer: Hawaii Medical Service Association Medicare	$2.71
Rate for Payer: Hawaii Western Management Group Commercial	$2.86
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: Humana Medicare	$2.71
Rate for Payer: Kaiser Permanente Commercial	$2.71
Rate for Payer: Kaiser Permanente Medicaid	$1.54
Rate for Payer: Kaiser Permanente Medicare	$2.71
Rate for Payer: MDX Hawaii PPO	$2.92
Rate for Payer: Ohana Health Plan Medicaid	$2.71
Rate for Payer: Ohana Health Plan Medicare	$2.71
Rate for Payer: UnitedHealthcare Medicare	$2.71
Rate for Payer: University Health Alliance Commercial	$2.19

LABETALOL 20 MG/4 ML (5 MG/ML) IV SYR

Facility

$53.54

Service Code	HCPCS J1920
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$53.00
Rate for Payer: AlohaCare Medicaid	$26.77
Rate for Payer: AlohaCare Medicare	$48.19
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$53.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$48.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$50.86
Rate for Payer: Health Management Network Commercial	$45.51
Rate for Payer: Humana Medicare	$48.19
Rate for Payer: Kaiser Permanente Commercial	$48.19
Rate for Payer: Kaiser Permanente Medicaid	$27.31
Rate for Payer: Kaiser Permanente Medicare	$48.19
Rate for Payer: MDX Hawaii PPO	$51.93
Rate for Payer: Ohana Health Plan Medicaid	$48.19
Rate for Payer: Ohana Health Plan Medicare	$48.19
Rate for Payer: UnitedHealthcare Medicaid	$32.12
Rate for Payer: UnitedHealthcare Medicare	$48.19
Rate for Payer: University Health Alliance Commercial	$39.03

LABETALOL 20 MG/4 ML (5 MG/ML) IV SYR

Facility

$53.54

Service Code	HCPCS J1920
Hospital Revenue Code	250
Min. Negotiated Rate	$45.51
Max. Negotiated Rate	$51.93
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$45.51
Rate for Payer: Kaiser Permanente Commercial	$48.19
Rate for Payer: MDX Hawaii PPO	$51.93

Know your out-of-pocket cost for care.

All Charges