Kohala Hospital

All Charges

Charge

Type

Setting

Price

MINERAL OIL, LIGHT STERILE MISC OIL

Facility

$112.31

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$95.46
Max. Negotiated Rate	$108.94
Rate for Payer: Cash Price	$73.00
Rate for Payer: Health Management Network Commercial	$95.46
Rate for Payer: Kaiser Permanente Commercial	$101.08
Rate for Payer: MDX Hawaii PPO	$108.94

MINERAL OIL PO OIL

Facility

$10.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$10.60
Rate for Payer: Cash Price	$7.10
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: Kaiser Permanente Commercial	$9.84
Rate for Payer: MDX Hawaii PPO	$10.60

MINERAL OIL PO OIL

Facility

$10.93

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$10.82
Rate for Payer: AlohaCare Medicaid	$5.46
Rate for Payer: AlohaCare Medicare	$9.84
Rate for Payer: Cash Price	$7.10
Rate for Payer: Devoted Health Medicare	$10.82
Rate for Payer: Hawaii Medical Service Association Medicare	$9.84
Rate for Payer: Hawaii Western Management Group Commercial	$10.38
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: Humana Medicare	$9.84
Rate for Payer: Kaiser Permanente Commercial	$9.84
Rate for Payer: Kaiser Permanente Medicaid	$5.57
Rate for Payer: Kaiser Permanente Medicare	$9.84
Rate for Payer: MDX Hawaii PPO	$10.60
Rate for Payer: Ohana Health Plan Medicaid	$9.84
Rate for Payer: Ohana Health Plan Medicare	$9.84
Rate for Payer: UnitedHealthcare Medicare	$9.84
Rate for Payer: University Health Alliance Commercial	$7.97

MINERAL OIL PR ENEMA

Facility

$19.09

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$18.90
Rate for Payer: AlohaCare Medicaid	$9.54
Rate for Payer: AlohaCare Medicare	$17.18
Rate for Payer: Cash Price	$12.41
Rate for Payer: Devoted Health Medicare	$18.90
Rate for Payer: Hawaii Medical Service Association Medicare	$17.18
Rate for Payer: Hawaii Western Management Group Commercial	$18.14
Rate for Payer: Health Management Network Commercial	$16.23
Rate for Payer: Humana Medicare	$17.18
Rate for Payer: Kaiser Permanente Commercial	$17.18
Rate for Payer: Kaiser Permanente Medicaid	$9.74
Rate for Payer: Kaiser Permanente Medicare	$17.18
Rate for Payer: MDX Hawaii PPO	$18.52
Rate for Payer: Ohana Health Plan Medicaid	$17.18
Rate for Payer: Ohana Health Plan Medicare	$17.18
Rate for Payer: UnitedHealthcare Medicare	$17.18
Rate for Payer: University Health Alliance Commercial	$13.91

MINERAL OIL PR ENEMA

Facility

$19.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$18.52
Rate for Payer: Cash Price	$12.41
Rate for Payer: Health Management Network Commercial	$16.23
Rate for Payer: Kaiser Permanente Commercial	$17.18
Rate for Payer: MDX Hawaii PPO	$18.52

MINOCYCLINE 100 MG PO CAP

Facility

$18.76

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$18.57
Rate for Payer: AlohaCare Medicaid	$9.38
Rate for Payer: AlohaCare Medicare	$16.88
Rate for Payer: Cash Price	$12.19
Rate for Payer: Devoted Health Medicare	$18.57
Rate for Payer: Hawaii Medical Service Association Medicare	$16.88
Rate for Payer: Hawaii Western Management Group Commercial	$17.82
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Humana Medicare	$16.88
Rate for Payer: Kaiser Permanente Commercial	$16.88
Rate for Payer: Kaiser Permanente Medicaid	$9.57
Rate for Payer: Kaiser Permanente Medicare	$16.88
Rate for Payer: MDX Hawaii PPO	$18.20
Rate for Payer: Ohana Health Plan Medicaid	$16.88
Rate for Payer: Ohana Health Plan Medicare	$16.88
Rate for Payer: UnitedHealthcare Medicare	$16.88
Rate for Payer: University Health Alliance Commercial	$13.67

MINOCYCLINE 100 MG PO CAP

Facility

$18.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$12.19
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Kaiser Permanente Commercial	$16.88
Rate for Payer: MDX Hawaii PPO	$18.20

MINOR BLADDER PROCEDURES WITH CC

Facility

$24,365.66

Service Code	MSDRG 663
Min. Negotiated Rate	$24,365.66
Max. Negotiated Rate	$24,365.66
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66

MINOR BLADDER PROCEDURES WITH MCC

Facility

$32,827.27

Service Code	MSDRG 662
Min. Negotiated Rate	$32,827.27
Max. Negotiated Rate	$32,827.27
Rate for Payer: Hawaii Medical Service Association Commercial	$32,827.27

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$19,151.22

Service Code	MSDRG 664
Min. Negotiated Rate	$19,151.22
Max. Negotiated Rate	$19,151.22
Rate for Payer: Hawaii Medical Service Association Commercial	$19,151.22

MINOR SKIN DISORDERS WITH MCC

Facility

$13,913.07

Service Code	MSDRG 606
Min. Negotiated Rate	$13,913.07
Max. Negotiated Rate	$13,913.07
Rate for Payer: Hawaii Medical Service Association Commercial	$13,913.07

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$12,538.36

Service Code	MSDRG 607
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$12,538.36
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$32,448.04

Service Code	MSDRG 345
Min. Negotiated Rate	$32,448.04
Max. Negotiated Rate	$32,448.04
Rate for Payer: Hawaii Medical Service Association Commercial	$32,448.04

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$36,287.76

Service Code	MSDRG 344
Min. Negotiated Rate	$36,287.76
Max. Negotiated Rate	$36,287.76
Rate for Payer: Hawaii Medical Service Association Commercial	$36,287.76

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$26,688.45

Service Code	MSDRG 346
Min. Negotiated Rate	$26,688.45
Max. Negotiated Rate	$26,688.45
Rate for Payer: Hawaii Medical Service Association Commercial	$26,688.45

MINOXIDIL 2.5 MG PO TABLET

Facility

$9.36

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.27
Rate for Payer: AlohaCare Medicaid	$4.68
Rate for Payer: AlohaCare Medicaid	$2.16
Rate for Payer: AlohaCare Medicare	$3.89
Rate for Payer: AlohaCare Medicare	$8.42
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cash Price	$6.08
Rate for Payer: Devoted Health Medicare	$4.28
Rate for Payer: Devoted Health Medicare	$9.27
Rate for Payer: Hawaii Medical Service Association Medicare	$8.42
Rate for Payer: Hawaii Medical Service Association Medicare	$3.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.10
Rate for Payer: Hawaii Western Management Group Commercial	$8.89
Rate for Payer: Health Management Network Commercial	$7.96
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: Humana Medicare	$8.42
Rate for Payer: Humana Medicare	$3.89
Rate for Payer: Kaiser Permanente Commercial	$3.89
Rate for Payer: Kaiser Permanente Commercial	$8.42
Rate for Payer: Kaiser Permanente Medicaid	$2.20
Rate for Payer: Kaiser Permanente Medicaid	$4.77
Rate for Payer: Kaiser Permanente Medicare	$3.89
Rate for Payer: Kaiser Permanente Medicare	$8.42
Rate for Payer: MDX Hawaii PPO	$9.08
Rate for Payer: MDX Hawaii PPO	$4.19
Rate for Payer: Ohana Health Plan Medicaid	$3.89
Rate for Payer: Ohana Health Plan Medicaid	$8.42
Rate for Payer: Ohana Health Plan Medicare	$8.42
Rate for Payer: Ohana Health Plan Medicare	$3.89
Rate for Payer: UnitedHealthcare Medicare	$3.89
Rate for Payer: UnitedHealthcare Medicare	$8.42
Rate for Payer: University Health Alliance Commercial	$3.15
Rate for Payer: University Health Alliance Commercial	$6.82

MINOXIDIL 2.5 MG PO TABLET

Facility

$4.32

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Management Network Commercial	$7.96
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: Kaiser Permanente Commercial	$3.89
Rate for Payer: Kaiser Permanente Commercial	$8.42
Rate for Payer: MDX Hawaii PPO	$4.19
Rate for Payer: MDX Hawaii PPO	$9.08

MIRTAZAPINE 15 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$12.87
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$11.70
Rate for Payer: Cash Price	$8.45
Rate for Payer: Devoted Health Medicare	$12.87
Rate for Payer: Hawaii Medical Service Association Medicare	$11.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$11.70
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$11.70
Rate for Payer: Ohana Health Plan Medicare	$11.70
Rate for Payer: UnitedHealthcare Medicare	$11.70
Rate for Payer: University Health Alliance Commercial	$9.48

MIRTAZAPINE 15 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

MIRTAZAPINE 30 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.40

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$13.27
Rate for Payer: AlohaCare Medicaid	$6.70
Rate for Payer: AlohaCare Medicare	$12.06
Rate for Payer: Cash Price	$8.71
Rate for Payer: Devoted Health Medicare	$13.27
Rate for Payer: Hawaii Medical Service Association Medicare	$12.06
Rate for Payer: Hawaii Western Management Group Commercial	$12.73
Rate for Payer: Health Management Network Commercial	$11.39
Rate for Payer: Humana Medicare	$12.06
Rate for Payer: Kaiser Permanente Commercial	$12.06
Rate for Payer: Kaiser Permanente Medicaid	$6.83
Rate for Payer: Kaiser Permanente Medicare	$12.06
Rate for Payer: MDX Hawaii PPO	$13.00
Rate for Payer: Ohana Health Plan Medicaid	$12.06
Rate for Payer: Ohana Health Plan Medicare	$12.06
Rate for Payer: UnitedHealthcare Medicare	$12.06
Rate for Payer: University Health Alliance Commercial	$9.77

MIRTAZAPINE 30 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$13.00
Rate for Payer: Cash Price	$8.71
Rate for Payer: Health Management Network Commercial	$11.39
Rate for Payer: Kaiser Permanente Commercial	$12.06
Rate for Payer: MDX Hawaii PPO	$13.00

MIRTAZAPINE 7.5 MG PO TABLET

Facility

$14.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$14.10
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Management Network Commercial	$12.36
Rate for Payer: Kaiser Permanente Commercial	$13.09
Rate for Payer: MDX Hawaii PPO	$14.10

MIRTAZAPINE 7.5 MG PO TABLET

Facility

$14.54

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$14.39
Rate for Payer: AlohaCare Medicaid	$7.27
Rate for Payer: AlohaCare Medicare	$13.09
Rate for Payer: Cash Price	$9.45
Rate for Payer: Devoted Health Medicare	$14.39
Rate for Payer: Hawaii Medical Service Association Medicare	$13.09
Rate for Payer: Hawaii Western Management Group Commercial	$13.81
Rate for Payer: Health Management Network Commercial	$12.36
Rate for Payer: Humana Medicare	$13.09
Rate for Payer: Kaiser Permanente Commercial	$13.09
Rate for Payer: Kaiser Permanente Medicaid	$7.42
Rate for Payer: Kaiser Permanente Medicare	$13.09
Rate for Payer: MDX Hawaii PPO	$14.10
Rate for Payer: Ohana Health Plan Medicaid	$13.09
Rate for Payer: Ohana Health Plan Medicare	$13.09
Rate for Payer: UnitedHealthcare Medicare	$13.09
Rate for Payer: University Health Alliance Commercial	$10.60

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$20,217.81

Service Code	MSDRG 640
Min. Negotiated Rate	$20,217.81
Max. Negotiated Rate	$20,217.81
Rate for Payer: Hawaii Medical Service Association Commercial	$20,217.81

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$15,738.13

Service Code	MSDRG 641
Min. Negotiated Rate	$15,738.13
Max. Negotiated Rate	$15,738.13
Rate for Payer: Hawaii Medical Service Association Commercial	$15,738.13

Know your out-of-pocket cost for care.

All Charges