Kohala Hospital

All Charges

Charge

Type

Setting

Price

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$36,524.78

Service Code	MSDRG 331
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$36,524.78
Rate for Payer: Hawaii Medical Service Association Commercial	$36,524.78
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR THUMB OR JOINT PROCEDURES

Facility

$34,865.64

Service Code	MSDRG 506
Min. Negotiated Rate	$34,865.64
Max. Negotiated Rate	$34,865.64
Rate for Payer: Hawaii Medical Service Association Commercial	$34,865.64

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$57,382.54

Service Code	MSDRG 755
Min. Negotiated Rate	$57,382.54
Max. Negotiated Rate	$57,382.54
Rate for Payer: Hawaii Medical Service Association Commercial	$57,382.54

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$57,382.54

Service Code	MSDRG 754
Min. Negotiated Rate	$57,382.54
Max. Negotiated Rate	$57,382.54
Rate for Payer: Hawaii Medical Service Association Commercial	$57,382.54

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$21,545.12

Service Code	MSDRG 756
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$43,350.96

Service Code	MSDRG 723
Min. Negotiated Rate	$43,350.96
Max. Negotiated Rate	$43,350.96
Rate for Payer: Hawaii Medical Service Association Commercial	$43,350.96

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$43,350.96

Service Code	MSDRG 722
Min. Negotiated Rate	$43,350.96
Max. Negotiated Rate	$43,350.96
Rate for Payer: Hawaii Medical Service Association Commercial	$43,350.96

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$30,148.94

Service Code	MSDRG 724
Min. Negotiated Rate	$30,148.94
Max. Negotiated Rate	$30,148.94
Rate for Payer: Hawaii Medical Service Association Commercial	$30,148.94

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$38,634.26

Service Code	MSDRG 436
Min. Negotiated Rate	$38,634.26
Max. Negotiated Rate	$38,634.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,634.26

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC

Facility

$38,634.26

Service Code	MSDRG 435
Min. Negotiated Rate	$38,634.26
Max. Negotiated Rate	$38,634.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,634.26

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$38,634.26

Service Code	MSDRG 437
Min. Negotiated Rate	$38,634.26
Max. Negotiated Rate	$38,634.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,634.26

MALIGNANT BREAST DISORDERS WITH CC

Facility

$51,978.49

Service Code	MSDRG 598
Min. Negotiated Rate	$51,978.49
Max. Negotiated Rate	$51,978.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,978.49

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$51,978.49

Service Code	MSDRG 597
Min. Negotiated Rate	$51,978.49
Max. Negotiated Rate	$51,978.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,978.49

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$1,753.95

Service Code	MSDRG 599
Min. Negotiated Rate	$1,753.95
Max. Negotiated Rate	$1,753.95
Rate for Payer: Hawaii Medical Service Association Commercial	$1,753.95

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$25,029.31

Service Code	MSDRG 582
Min. Negotiated Rate	$25,029.31
Max. Negotiated Rate	$25,029.31
Rate for Payer: Hawaii Medical Service Association Commercial	$25,029.31

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$22,848.73

Service Code	MSDRG 583
Min. Negotiated Rate	$22,848.73
Max. Negotiated Rate	$22,848.73
Rate for Payer: Hawaii Medical Service Association Commercial	$22,848.73

MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBCUTANEOUS RECON.SOLN.

Facility

$430.48

Service Code	HCPCS 90707
Hospital Revenue Code	250
Min. Negotiated Rate	$365.91
Max. Negotiated Rate	$417.57
Rate for Payer: Cash Price	$279.81
Rate for Payer: Health Management Network Commercial	$365.91
Rate for Payer: Kaiser Permanente Commercial	$387.43
Rate for Payer: MDX Hawaii PPO	$417.57

MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBCUTANEOUS RECON.SOLN.

Facility

$430.48

Service Code	HCPCS 90707
Hospital Revenue Code	636
Min. Negotiated Rate	$102.41
Max. Negotiated Rate	$426.18
Rate for Payer: AlohaCare Medicaid	$215.24
Rate for Payer: AlohaCare Medicare	$387.43
Rate for Payer: Cash Price	$279.81
Rate for Payer: Cash Price	$279.81
Rate for Payer: Devoted Health Medicare	$426.18
Rate for Payer: Hawaii Medical Service Association ABD	$102.41
Rate for Payer: Hawaii Medical Service Association Medicare	$387.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$102.41
Rate for Payer: Hawaii Western Management Group Commercial	$408.96
Rate for Payer: Health Management Network Commercial	$365.91
Rate for Payer: Humana Medicare	$387.43
Rate for Payer: Kaiser Permanente Commercial	$387.43
Rate for Payer: Kaiser Permanente Medicaid	$219.54
Rate for Payer: Kaiser Permanente Medicare	$387.43
Rate for Payer: MDX Hawaii PPO	$417.57
Rate for Payer: Ohana Health Plan Medicaid	$387.43
Rate for Payer: Ohana Health Plan Medicare	$387.43
Rate for Payer: UnitedHealthcare Medicaid	$258.29
Rate for Payer: UnitedHealthcare Medicare	$387.43
Rate for Payer: University Health Alliance Commercial	$313.78

MECLIZINE 25 MG PO TABLET

Facility

$4.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$4.50
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$3.07
Rate for Payer: Cash Price	$3.03
Rate for Payer: Health Management Network Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$3.94
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Health Management Network Commercial	$4.02
Rate for Payer: Kaiser Permanente Commercial	$2.00
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: Kaiser Permanente Commercial	$4.18
Rate for Payer: Kaiser Permanente Commercial	$4.26
Rate for Payer: MDX Hawaii PPO	$4.50
Rate for Payer: MDX Hawaii PPO	$4.52
Rate for Payer: MDX Hawaii PPO	$4.59
Rate for Payer: MDX Hawaii PPO	$2.15

MECLIZINE 25 MG PO TABLET

Facility

$4.73

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$4.68
Rate for Payer: AlohaCare Medicaid	$2.37
Rate for Payer: AlohaCare Medicaid	$2.33
Rate for Payer: AlohaCare Medicaid	$1.11
Rate for Payer: AlohaCare Medicaid	$2.32
Rate for Payer: AlohaCare Medicare	$4.18
Rate for Payer: AlohaCare Medicare	$2.00
Rate for Payer: AlohaCare Medicare	$4.26
Rate for Payer: AlohaCare Medicare	$4.19
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cash Price	$3.07
Rate for Payer: Devoted Health Medicare	$4.59
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Devoted Health Medicare	$2.20
Rate for Payer: Devoted Health Medicare	$4.61
Rate for Payer: Hawaii Medical Service Association Medicare	$4.26
Rate for Payer: Hawaii Medical Service Association Medicare	$2.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4.18
Rate for Payer: Hawaii Medical Service Association Medicare	$4.19
Rate for Payer: Hawaii Western Management Group Commercial	$4.43
Rate for Payer: Hawaii Western Management Group Commercial	$2.11
Rate for Payer: Hawaii Western Management Group Commercial	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$4.49
Rate for Payer: Health Management Network Commercial	$3.94
Rate for Payer: Health Management Network Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Health Management Network Commercial	$4.02
Rate for Payer: Humana Medicare	$4.19
Rate for Payer: Humana Medicare	$4.18
Rate for Payer: Humana Medicare	$2.00
Rate for Payer: Humana Medicare	$4.26
Rate for Payer: Kaiser Permanente Commercial	$4.26
Rate for Payer: Kaiser Permanente Commercial	$2.00
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: Kaiser Permanente Commercial	$4.18
Rate for Payer: Kaiser Permanente Medicaid	$2.41
Rate for Payer: Kaiser Permanente Medicaid	$2.37
Rate for Payer: Kaiser Permanente Medicaid	$2.38
Rate for Payer: Kaiser Permanente Medicaid	$1.13
Rate for Payer: Kaiser Permanente Medicare	$4.18
Rate for Payer: Kaiser Permanente Medicare	$4.19
Rate for Payer: Kaiser Permanente Medicare	$2.00
Rate for Payer: Kaiser Permanente Medicare	$4.26
Rate for Payer: MDX Hawaii PPO	$4.50
Rate for Payer: MDX Hawaii PPO	$4.52
Rate for Payer: MDX Hawaii PPO	$4.59
Rate for Payer: MDX Hawaii PPO	$2.15
Rate for Payer: Ohana Health Plan Medicaid	$4.26
Rate for Payer: Ohana Health Plan Medicaid	$4.19
Rate for Payer: Ohana Health Plan Medicaid	$4.18
Rate for Payer: Ohana Health Plan Medicaid	$2.00
Rate for Payer: Ohana Health Plan Medicare	$4.26
Rate for Payer: Ohana Health Plan Medicare	$2.00
Rate for Payer: Ohana Health Plan Medicare	$4.18
Rate for Payer: Ohana Health Plan Medicare	$4.19
Rate for Payer: UnitedHealthcare Medicare	$4.18
Rate for Payer: UnitedHealthcare Medicare	$4.19
Rate for Payer: UnitedHealthcare Medicare	$4.26
Rate for Payer: UnitedHealthcare Medicare	$2.00
Rate for Payer: University Health Alliance Commercial	$3.40
Rate for Payer: University Health Alliance Commercial	$3.38
Rate for Payer: University Health Alliance Commercial	$3.45
Rate for Payer: University Health Alliance Commercial	$1.62

MEDICAL BACK PROBLEMS WITH MCC

Facility

$14,647.84

Service Code	MSDRG 551
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$14,647.84
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$14,647.84

Service Code	MSDRG 552
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$14,647.84
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84

MEDROXYPROGESTERONE 5 MG PO TABLET

Facility

$2.62

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.54
Rate for Payer: Cash Price	$1.70
Rate for Payer: Health Management Network Commercial	$2.23
Rate for Payer: Kaiser Permanente Commercial	$2.36
Rate for Payer: MDX Hawaii PPO	$2.54

MEDROXYPROGESTERONE 5 MG PO TABLET

Facility

$2.62

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.59
Rate for Payer: AlohaCare Medicaid	$1.31
Rate for Payer: AlohaCare Medicare	$2.36
Rate for Payer: Cash Price	$1.70
Rate for Payer: Devoted Health Medicare	$2.59
Rate for Payer: Hawaii Medical Service Association Medicare	$2.36
Rate for Payer: Hawaii Western Management Group Commercial	$2.49
Rate for Payer: Health Management Network Commercial	$2.23
Rate for Payer: Humana Medicare	$2.36
Rate for Payer: Kaiser Permanente Commercial	$2.36
Rate for Payer: Kaiser Permanente Medicaid	$1.34
Rate for Payer: Kaiser Permanente Medicare	$2.36
Rate for Payer: MDX Hawaii PPO	$2.54
Rate for Payer: Ohana Health Plan Medicaid	$2.36
Rate for Payer: Ohana Health Plan Medicare	$2.36
Rate for Payer: UnitedHealthcare Medicare	$2.36
Rate for Payer: University Health Alliance Commercial	$1.91

MEGESTROL 400 MG/10 ML (10 ML) PO SUSP

Facility

$44.38

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$43.94
Rate for Payer: AlohaCare Medicaid	$22.19
Rate for Payer: AlohaCare Medicaid	$13.86
Rate for Payer: AlohaCare Medicare	$24.95
Rate for Payer: AlohaCare Medicare	$39.94
Rate for Payer: Cash Price	$18.02
Rate for Payer: Cash Price	$28.85
Rate for Payer: Devoted Health Medicare	$27.44
Rate for Payer: Devoted Health Medicare	$43.94
Rate for Payer: Hawaii Medical Service Association Medicare	$39.94
Rate for Payer: Hawaii Medical Service Association Medicare	$24.95
Rate for Payer: Hawaii Western Management Group Commercial	$42.16
Rate for Payer: Hawaii Western Management Group Commercial	$26.33
Rate for Payer: Health Management Network Commercial	$23.56
Rate for Payer: Health Management Network Commercial	$37.72
Rate for Payer: Humana Medicare	$24.95
Rate for Payer: Humana Medicare	$39.94
Rate for Payer: Kaiser Permanente Commercial	$24.95
Rate for Payer: Kaiser Permanente Commercial	$39.94
Rate for Payer: Kaiser Permanente Medicaid	$14.14
Rate for Payer: Kaiser Permanente Medicaid	$22.63
Rate for Payer: Kaiser Permanente Medicare	$39.94
Rate for Payer: Kaiser Permanente Medicare	$24.95
Rate for Payer: MDX Hawaii PPO	$43.05
Rate for Payer: MDX Hawaii PPO	$26.89
Rate for Payer: Ohana Health Plan Medicaid	$24.95
Rate for Payer: Ohana Health Plan Medicaid	$39.94
Rate for Payer: Ohana Health Plan Medicare	$24.95
Rate for Payer: Ohana Health Plan Medicare	$39.94
Rate for Payer: UnitedHealthcare Medicare	$24.95
Rate for Payer: UnitedHealthcare Medicare	$39.94
Rate for Payer: University Health Alliance Commercial	$20.21
Rate for Payer: University Health Alliance Commercial	$32.35

Know your out-of-pocket cost for care.

All Charges