Kohala Hospital

All Charges

Charge

Type

Setting

Price

CARBIDOPA-LEVODOPA 10-100 MG PO TABLET

Facility

$4.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.23
Rate for Payer: AlohaCare Medicaid	$2.13
Rate for Payer: AlohaCare Medicare	$3.84
Rate for Payer: Cash Price	$2.78
Rate for Payer: Devoted Health Medicare	$4.23
Rate for Payer: Hawaii Medical Service Association Medicare	$3.84
Rate for Payer: Hawaii Western Management Group Commercial	$4.06
Rate for Payer: Health Management Network Commercial	$3.63
Rate for Payer: Humana Medicare	$3.84
Rate for Payer: Kaiser Permanente Commercial	$3.84
Rate for Payer: Kaiser Permanente Medicaid	$2.18
Rate for Payer: Kaiser Permanente Medicare	$3.84
Rate for Payer: MDX Hawaii PPO	$4.14
Rate for Payer: Ohana Health Plan Medicaid	$3.84
Rate for Payer: Ohana Health Plan Medicare	$3.84
Rate for Payer: UnitedHealthcare Medicare	$3.84
Rate for Payer: University Health Alliance Commercial	$3.11

CARBIDOPA-LEVODOPA 10-100 MG PO TABLET

Facility

$4.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$4.14
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Management Network Commercial	$3.63
Rate for Payer: Kaiser Permanente Commercial	$3.84
Rate for Payer: MDX Hawaii PPO	$4.14

CARBIDOPA-LEVODOPA 25-100 MG PO TABLET

Facility

$4.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$4.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Health Management Network Commercial	$3.85
Rate for Payer: Kaiser Permanente Commercial	$4.08
Rate for Payer: MDX Hawaii PPO	$4.39

CARBIDOPA-LEVODOPA 25-100 MG PO TABLET

Facility

$4.53

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$4.48
Rate for Payer: AlohaCare Medicaid	$2.27
Rate for Payer: AlohaCare Medicare	$4.08
Rate for Payer: Cash Price	$2.94
Rate for Payer: Devoted Health Medicare	$4.48
Rate for Payer: Hawaii Medical Service Association Medicare	$4.08
Rate for Payer: Hawaii Western Management Group Commercial	$4.30
Rate for Payer: Health Management Network Commercial	$3.85
Rate for Payer: Humana Medicare	$4.08
Rate for Payer: Kaiser Permanente Commercial	$4.08
Rate for Payer: Kaiser Permanente Medicaid	$2.31
Rate for Payer: Kaiser Permanente Medicare	$4.08
Rate for Payer: MDX Hawaii PPO	$4.39
Rate for Payer: Ohana Health Plan Medicaid	$4.08
Rate for Payer: Ohana Health Plan Medicare	$4.08
Rate for Payer: UnitedHealthcare Medicare	$4.08
Rate for Payer: University Health Alliance Commercial	$3.30

CARBIDOPA-LEVODOPA 25-250 MG PO TABLET

Facility

$6.14

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$5.96
Rate for Payer: Cash Price	$3.99
Rate for Payer: Health Management Network Commercial	$5.22
Rate for Payer: Kaiser Permanente Commercial	$5.53
Rate for Payer: MDX Hawaii PPO	$5.96

CARBIDOPA-LEVODOPA 25-250 MG PO TABLET

Facility

$6.14

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$6.08
Rate for Payer: AlohaCare Medicaid	$3.07
Rate for Payer: AlohaCare Medicare	$5.53
Rate for Payer: Cash Price	$3.99
Rate for Payer: Devoted Health Medicare	$6.08
Rate for Payer: Hawaii Medical Service Association Medicare	$5.53
Rate for Payer: Hawaii Western Management Group Commercial	$5.83
Rate for Payer: Health Management Network Commercial	$5.22
Rate for Payer: Humana Medicare	$5.53
Rate for Payer: Kaiser Permanente Commercial	$5.53
Rate for Payer: Kaiser Permanente Medicaid	$3.13
Rate for Payer: Kaiser Permanente Medicare	$5.53
Rate for Payer: MDX Hawaii PPO	$5.96
Rate for Payer: Ohana Health Plan Medicaid	$5.53
Rate for Payer: Ohana Health Plan Medicare	$5.53
Rate for Payer: UnitedHealthcare Medicare	$5.53
Rate for Payer: University Health Alliance Commercial	$4.48

CARBIDOPA-LEVODOPA 50-200 MG PO TAB SR

Facility

$9.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$9.67
Rate for Payer: Cash Price	$6.48
Rate for Payer: Health Management Network Commercial	$8.47
Rate for Payer: Kaiser Permanente Commercial	$8.97
Rate for Payer: MDX Hawaii PPO	$9.67

CARBIDOPA-LEVODOPA 50-200 MG PO TAB SR

Facility

$9.97

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$9.87
Rate for Payer: AlohaCare Medicaid	$4.99
Rate for Payer: AlohaCare Medicare	$8.97
Rate for Payer: Cash Price	$6.48
Rate for Payer: Devoted Health Medicare	$9.87
Rate for Payer: Hawaii Medical Service Association Medicare	$8.97
Rate for Payer: Hawaii Western Management Group Commercial	$9.47
Rate for Payer: Health Management Network Commercial	$8.47
Rate for Payer: Humana Medicare	$8.97
Rate for Payer: Kaiser Permanente Commercial	$8.97
Rate for Payer: Kaiser Permanente Medicaid	$5.08
Rate for Payer: Kaiser Permanente Medicare	$8.97
Rate for Payer: MDX Hawaii PPO	$9.67
Rate for Payer: Ohana Health Plan Medicaid	$8.97
Rate for Payer: Ohana Health Plan Medicare	$8.97
Rate for Payer: UnitedHealthcare Medicare	$8.97
Rate for Payer: University Health Alliance Commercial	$7.27

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$44,678.27

Service Code	MSDRG 297
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$44,678.27

Service Code	MSDRG 296
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$44,678.27

Service Code	MSDRG 298
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$19,814.87

Service Code	MSDRG 309
Min. Negotiated Rate	$19,814.87
Max. Negotiated Rate	$19,814.87
Rate for Payer: Hawaii Medical Service Association Commercial	$19,814.87

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$21,118.48

Service Code	MSDRG 308
Min. Negotiated Rate	$21,118.48
Max. Negotiated Rate	$21,118.48
Rate for Payer: Hawaii Medical Service Association Commercial	$21,118.48

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$15,192.98

Service Code	MSDRG 310
Min. Negotiated Rate	$15,192.98
Max. Negotiated Rate	$15,192.98
Rate for Payer: Hawaii Medical Service Association Commercial	$15,192.98

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$13,960.48

Service Code	MSDRG 306
Min. Negotiated Rate	$13,960.48
Max. Negotiated Rate	$13,960.48
Rate for Payer: Hawaii Medical Service Association Commercial	$13,960.48

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$12,893.89

Service Code	MSDRG 307
Min. Negotiated Rate	$12,893.89
Max. Negotiated Rate	$12,893.89
Rate for Payer: Hawaii Medical Service Association Commercial	$12,893.89

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$160,035.90

Service Code	MSDRG 275
Min. Negotiated Rate	$160,035.90
Max. Negotiated Rate	$160,035.90
Rate for Payer: Hawaii Medical Service Association Commercial	$160,035.90

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$103,008.89

Service Code	MSDRG 276
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$103,008.89

Service Code	MSDRG 277
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$23,085.75

Service Code	MSDRG 258
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$23,085.75

Service Code	MSDRG 259
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$31,168.13

Service Code	MSDRG 261
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$31,168.13

Service Code	MSDRG 260
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,168.13

Service Code	MSDRG 262
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$193,360.92

Service Code	MSDRG 217
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

Know your out-of-pocket cost for care.

All Charges