Kohala Hospital

All Charges

Charge

Type

Setting

Price

LISINOPRIL 10 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

LISINOPRIL 10 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

LISINOPRIL 20 MG PO TABLET

Facility

$5.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.76
Rate for Payer: Cash Price	$3.86
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$5.05
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$5.35
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$5.76

LISINOPRIL 20 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 Medicaid	$2.97
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: AlohaCare Medicare	$5.35
Rate for Payer: Cash Price	$3.86
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.35
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$5.64
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$5.05
Rate for Payer: Humana Medicare	$5.35
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$5.35
Rate for Payer: Kaiser Permanente Medicaid	$3.03
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$5.35
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$5.76
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicaid	$5.35
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$5.35
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$5.35
Rate for Payer: University Health Alliance Commercial	$4.33
Rate for Payer: University Health Alliance Commercial	$0.87

LISINOPRIL 5 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

LISINOPRIL 5 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

LITHIUM CARBONATE 300 MG PO CAP

Facility

$2.03

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.01
Rate for Payer: AlohaCare Medicaid	$1.01
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: AlohaCare Medicare	$1.83
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$1.32
Rate for Payer: Devoted Health Medicare	$2.01
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1.83
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$1.93
Rate for Payer: Health Management Network Commercial	$1.73
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.83
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.83
Rate for Payer: Kaiser Permanente Medicaid	$1.04
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: Kaiser Permanente Medicare	$1.83
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$1.97
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicaid	$1.83
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.83
Rate for Payer: UnitedHealthcare Medicare	$1.83
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$1.48
Rate for Payer: University Health Alliance Commercial	$0.87

LITHIUM CARBONATE 300 MG PO CAP

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: Cash Price	$1.32
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.73
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.83
Rate for Payer: MDX Hawaii PPO	$1.97
Rate for Payer: MDX Hawaii PPO	$1.16

LITHIUM CARBONATE 300 MG PO TAB SR

Facility

$2.57

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$2.54
Rate for Payer: AlohaCare Medicaid	$1.28
Rate for Payer: AlohaCare Medicare	$2.31
Rate for Payer: Cash Price	$1.67
Rate for Payer: Devoted Health Medicare	$2.54
Rate for Payer: Hawaii Medical Service Association Medicare	$2.31
Rate for Payer: Hawaii Western Management Group Commercial	$2.44
Rate for Payer: Health Management Network Commercial	$2.18
Rate for Payer: Humana Medicare	$2.31
Rate for Payer: Kaiser Permanente Commercial	$2.31
Rate for Payer: Kaiser Permanente Medicaid	$1.31
Rate for Payer: Kaiser Permanente Medicare	$2.31
Rate for Payer: MDX Hawaii PPO	$2.49
Rate for Payer: Ohana Health Plan Medicaid	$2.31
Rate for Payer: Ohana Health Plan Medicare	$2.31
Rate for Payer: UnitedHealthcare Medicare	$2.31
Rate for Payer: University Health Alliance Commercial	$1.87

LITHIUM CARBONATE 300 MG PO TAB SR

Facility

$2.57

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.49
Rate for Payer: Cash Price	$1.67
Rate for Payer: Health Management Network Commercial	$2.18
Rate for Payer: Kaiser Permanente Commercial	$2.31
Rate for Payer: MDX Hawaii PPO	$2.49

LITHIUM CARBONATE 450 MG PO TAB SR

Facility

$4.18

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$4.14
Rate for Payer: AlohaCare Medicaid	$2.09
Rate for Payer: AlohaCare Medicare	$3.76
Rate for Payer: Cash Price	$2.72
Rate for Payer: Devoted Health Medicare	$4.14
Rate for Payer: Hawaii Medical Service Association Medicare	$3.76
Rate for Payer: Hawaii Western Management Group Commercial	$3.97
Rate for Payer: Health Management Network Commercial	$3.55
Rate for Payer: Humana Medicare	$3.76
Rate for Payer: Kaiser Permanente Commercial	$3.76
Rate for Payer: Kaiser Permanente Medicaid	$2.13
Rate for Payer: Kaiser Permanente Medicare	$3.76
Rate for Payer: MDX Hawaii PPO	$4.05
Rate for Payer: Ohana Health Plan Medicaid	$3.76
Rate for Payer: Ohana Health Plan Medicare	$3.76
Rate for Payer: UnitedHealthcare Medicare	$3.76
Rate for Payer: University Health Alliance Commercial	$3.05

LITHIUM CARBONATE 450 MG PO TAB SR

Facility

$4.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$4.05
Rate for Payer: Cash Price	$2.72
Rate for Payer: Health Management Network Commercial	$3.55
Rate for Payer: Kaiser Permanente Commercial	$3.76
Rate for Payer: MDX Hawaii PPO	$4.05

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$358,611.26

Service Code	MSDRG 005
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$358,611.26
Rate for Payer: Hawaii Medical Service Association Commercial	$358,611.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

LIVER TRANSPLANT WITHOUT MCC

Facility

$358,611.26

Service Code	MSDRG 006
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$358,611.26
Rate for Payer: Hawaii Medical Service Association Commercial	$358,611.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$35,553.00

Service Code	MSDRG 496
Min. Negotiated Rate	$35,553.00
Max. Negotiated Rate	$35,553.00
Rate for Payer: Hawaii Medical Service Association Commercial	$35,553.00

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$38,278.73

Service Code	MSDRG 495
Min. Negotiated Rate	$38,278.73
Max. Negotiated Rate	$38,278.73
Rate for Payer: Hawaii Medical Service Association Commercial	$38,278.73

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$24,673.78

Service Code	MSDRG 497
Min. Negotiated Rate	$24,673.78
Max. Negotiated Rate	$24,673.78
Rate for Payer: Hawaii Medical Service Association Commercial	$24,673.78

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$42,971.73

Service Code	MSDRG 498
Min. Negotiated Rate	$42,971.73
Max. Negotiated Rate	$42,971.73
Rate for Payer: Hawaii Medical Service Association Commercial	$42,971.73

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$42,971.73

Service Code	MSDRG 499
Min. Negotiated Rate	$42,971.73
Max. Negotiated Rate	$42,971.73
Rate for Payer: Hawaii Medical Service Association Commercial	$42,971.73

LOPERAMIDE 1 MG/7.5 ML PO LIQ

Facility

$2.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cash Price	$11.36
Rate for Payer: Cash Price	$13.57
Rate for Payer: Health Management Network Commercial	$14.86
Rate for Payer: Health Management Network Commercial	$17.74
Rate for Payer: Health Management Network Commercial	$2.12
Rate for Payer: Kaiser Permanente Commercial	$18.78
Rate for Payer: Kaiser Permanente Commercial	$15.73
Rate for Payer: Kaiser Permanente Commercial	$2.24
Rate for Payer: MDX Hawaii PPO	$20.24
Rate for Payer: MDX Hawaii PPO	$2.42
Rate for Payer: MDX Hawaii PPO	$16.96

LOPERAMIDE 1 MG/7.5 ML PO LIQ

Facility

$20.87

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$20.66
Rate for Payer: AlohaCare Medicaid	$10.44
Rate for Payer: AlohaCare Medicaid	$8.74
Rate for Payer: AlohaCare Medicaid	$1.25
Rate for Payer: AlohaCare Medicare	$15.73
Rate for Payer: AlohaCare Medicare	$2.24
Rate for Payer: AlohaCare Medicare	$18.78
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cash Price	$13.57
Rate for Payer: Cash Price	$11.36
Rate for Payer: Devoted Health Medicare	$17.31
Rate for Payer: Devoted Health Medicare	$20.66
Rate for Payer: Devoted Health Medicare	$2.47
Rate for Payer: Hawaii Medical Service Association Medicare	$18.78
Rate for Payer: Hawaii Medical Service Association Medicare	$15.73
Rate for Payer: Hawaii Medical Service Association Medicare	$2.24
Rate for Payer: Hawaii Western Management Group Commercial	$19.83
Rate for Payer: Hawaii Western Management Group Commercial	$16.61
Rate for Payer: Hawaii Western Management Group Commercial	$2.37
Rate for Payer: Health Management Network Commercial	$14.86
Rate for Payer: Health Management Network Commercial	$2.12
Rate for Payer: Health Management Network Commercial	$17.74
Rate for Payer: Humana Medicare	$18.78
Rate for Payer: Humana Medicare	$2.24
Rate for Payer: Humana Medicare	$15.73
Rate for Payer: Kaiser Permanente Commercial	$18.78
Rate for Payer: Kaiser Permanente Commercial	$15.73
Rate for Payer: Kaiser Permanente Commercial	$2.24
Rate for Payer: Kaiser Permanente Medicaid	$1.27
Rate for Payer: Kaiser Permanente Medicaid	$10.64
Rate for Payer: Kaiser Permanente Medicaid	$8.91
Rate for Payer: Kaiser Permanente Medicare	$18.78
Rate for Payer: Kaiser Permanente Medicare	$2.24
Rate for Payer: Kaiser Permanente Medicare	$15.73
Rate for Payer: MDX Hawaii PPO	$16.96
Rate for Payer: MDX Hawaii PPO	$20.24
Rate for Payer: MDX Hawaii PPO	$2.42
Rate for Payer: Ohana Health Plan Medicaid	$15.73
Rate for Payer: Ohana Health Plan Medicaid	$18.78
Rate for Payer: Ohana Health Plan Medicaid	$2.24
Rate for Payer: Ohana Health Plan Medicare	$15.73
Rate for Payer: Ohana Health Plan Medicare	$2.24
Rate for Payer: Ohana Health Plan Medicare	$18.78
Rate for Payer: UnitedHealthcare Medicare	$2.24
Rate for Payer: UnitedHealthcare Medicare	$18.78
Rate for Payer: UnitedHealthcare Medicare	$15.73
Rate for Payer: University Health Alliance Commercial	$15.21
Rate for Payer: University Health Alliance Commercial	$12.74
Rate for Payer: University Health Alliance Commercial	$1.81

LOPERAMIDE 2 MG PO CAP

Facility

$5.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$5.47
Rate for Payer: Cash Price	$3.67
Rate for Payer: Health Management Network Commercial	$4.79
Rate for Payer: Kaiser Permanente Commercial	$5.08
Rate for Payer: MDX Hawaii PPO	$5.47

LOPERAMIDE 2 MG PO CAP

Facility

$5.64

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$5.58
Rate for Payer: AlohaCare Medicaid	$2.82
Rate for Payer: AlohaCare Medicare	$5.08
Rate for Payer: Cash Price	$3.67
Rate for Payer: Devoted Health Medicare	$5.58
Rate for Payer: Hawaii Medical Service Association Medicare	$5.08
Rate for Payer: Hawaii Western Management Group Commercial	$5.36
Rate for Payer: Health Management Network Commercial	$4.79
Rate for Payer: Humana Medicare	$5.08
Rate for Payer: Kaiser Permanente Commercial	$5.08
Rate for Payer: Kaiser Permanente Medicaid	$2.88
Rate for Payer: Kaiser Permanente Medicare	$5.08
Rate for Payer: MDX Hawaii PPO	$5.47
Rate for Payer: Ohana Health Plan Medicaid	$5.08
Rate for Payer: Ohana Health Plan Medicare	$5.08
Rate for Payer: UnitedHealthcare Medicare	$5.08
Rate for Payer: University Health Alliance Commercial	$4.11

LORATADINE 10 MG PO TABLET

Facility

$3.88

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.76
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cash Price	$3.07
Rate for Payer: Health Management Network Commercial	$3.30
Rate for Payer: Health Management Network Commercial	$4.01
Rate for Payer: Kaiser Permanente Commercial	$3.49
Rate for Payer: Kaiser Permanente Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$4.58
Rate for Payer: MDX Hawaii PPO	$3.76

LORATADINE 10 MG PO TABLET

Facility

$4.72

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$4.67
Rate for Payer: AlohaCare Medicaid	$2.36
Rate for Payer: AlohaCare Medicaid	$1.94
Rate for Payer: AlohaCare Medicare	$3.49
Rate for Payer: AlohaCare Medicare	$4.25
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cash Price	$3.07
Rate for Payer: Devoted Health Medicare	$4.67
Rate for Payer: Devoted Health Medicare	$3.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3.49
Rate for Payer: Hawaii Medical Service Association Medicare	$4.25
Rate for Payer: Hawaii Western Management Group Commercial	$3.69
Rate for Payer: Hawaii Western Management Group Commercial	$4.48
Rate for Payer: Health Management Network Commercial	$4.01
Rate for Payer: Health Management Network Commercial	$3.30
Rate for Payer: Humana Medicare	$4.25
Rate for Payer: Humana Medicare	$3.49
Rate for Payer: Kaiser Permanente Commercial	$3.49
Rate for Payer: Kaiser Permanente Commercial	$4.25
Rate for Payer: Kaiser Permanente Medicaid	$2.41
Rate for Payer: Kaiser Permanente Medicaid	$1.98
Rate for Payer: Kaiser Permanente Medicare	$3.49
Rate for Payer: Kaiser Permanente Medicare	$4.25
Rate for Payer: MDX Hawaii PPO	$3.76
Rate for Payer: MDX Hawaii PPO	$4.58
Rate for Payer: Ohana Health Plan Medicaid	$3.49
Rate for Payer: Ohana Health Plan Medicaid	$4.25
Rate for Payer: Ohana Health Plan Medicare	$3.49
Rate for Payer: Ohana Health Plan Medicare	$4.25
Rate for Payer: UnitedHealthcare Medicare	$4.25
Rate for Payer: UnitedHealthcare Medicare	$3.49
Rate for Payer: University Health Alliance Commercial	$3.44
Rate for Payer: University Health Alliance Commercial	$2.83

Know your out-of-pocket cost for care.

All Charges