Kohala Hospital

All Charges

Charge

Type

Setting

Price

MISOPROSTOL 100 MCG PO TAB (0.25 TAB) = 25 MCG

Facility

$5.41

Service Code	NDC RPKWH000185
Hospital Revenue Code	637
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$5.36
Rate for Payer: AlohaCare Medicaid	$2.71
Rate for Payer: AlohaCare Medicare	$4.87
Rate for Payer: Cash Price	$3.52
Rate for Payer: Devoted Health Medicare	$5.36
Rate for Payer: Hawaii Medical Service Association Medicare	$4.87
Rate for Payer: Hawaii Western Management Group Commercial	$5.14
Rate for Payer: Health Management Network Commercial	$4.60
Rate for Payer: Humana Medicare	$4.87
Rate for Payer: Kaiser Permanente Commercial	$4.87
Rate for Payer: Kaiser Permanente Medicaid	$2.76
Rate for Payer: Kaiser Permanente Medicare	$4.87
Rate for Payer: MDX Hawaii PPO	$5.25
Rate for Payer: Ohana Health Plan Medicaid	$4.87
Rate for Payer: Ohana Health Plan Medicare	$4.87
Rate for Payer: UnitedHealthcare Medicare	$4.87
Rate for Payer: University Health Alliance Commercial	$3.94

MISOPROSTOL 100 MCG PO TAB (0.25 TAB) = 25 MCG

Facility

$5.41

Service Code	NDC RPKWH000185
Hospital Revenue Code	250
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$5.25
Rate for Payer: Cash Price	$3.52
Rate for Payer: Health Management Network Commercial	$4.60
Rate for Payer: Kaiser Permanente Commercial	$4.87
Rate for Payer: MDX Hawaii PPO	$5.25

MISOPROSTOL 100 MCG PO TABLET

Facility

$13.69

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.55
Rate for Payer: AlohaCare Medicaid	$6.84
Rate for Payer: AlohaCare Medicaid	$3.41
Rate for Payer: AlohaCare Medicare	$12.32
Rate for Payer: AlohaCare Medicare	$6.14
Rate for Payer: Cash Price	$4.43
Rate for Payer: Cash Price	$8.90
Rate for Payer: Devoted Health Medicare	$13.55
Rate for Payer: Devoted Health Medicare	$6.75
Rate for Payer: Hawaii Medical Service Association Medicare	$6.14
Rate for Payer: Hawaii Medical Service Association Medicare	$12.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.48
Rate for Payer: Hawaii Western Management Group Commercial	$13.01
Rate for Payer: Health Management Network Commercial	$11.64
Rate for Payer: Health Management Network Commercial	$5.80
Rate for Payer: Humana Medicare	$6.14
Rate for Payer: Humana Medicare	$12.32
Rate for Payer: Kaiser Permanente Commercial	$12.32
Rate for Payer: Kaiser Permanente Commercial	$6.14
Rate for Payer: Kaiser Permanente Medicaid	$3.48
Rate for Payer: Kaiser Permanente Medicaid	$6.98
Rate for Payer: Kaiser Permanente Medicare	$6.14
Rate for Payer: Kaiser Permanente Medicare	$12.32
Rate for Payer: MDX Hawaii PPO	$6.62
Rate for Payer: MDX Hawaii PPO	$13.28
Rate for Payer: Ohana Health Plan Medicaid	$12.32
Rate for Payer: Ohana Health Plan Medicaid	$6.14
Rate for Payer: Ohana Health Plan Medicare	$12.32
Rate for Payer: Ohana Health Plan Medicare	$6.14
Rate for Payer: UnitedHealthcare Medicare	$12.32
Rate for Payer: UnitedHealthcare Medicare	$6.14
Rate for Payer: University Health Alliance Commercial	$4.97
Rate for Payer: University Health Alliance Commercial	$9.98

MISOPROSTOL 100 MCG PO TABLET

Facility

$6.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$6.62
Rate for Payer: Cash Price	$4.43
Rate for Payer: Cash Price	$8.90
Rate for Payer: Health Management Network Commercial	$5.80
Rate for Payer: Health Management Network Commercial	$11.64
Rate for Payer: Kaiser Permanente Commercial	$6.14
Rate for Payer: Kaiser Permanente Commercial	$12.32
Rate for Payer: MDX Hawaii PPO	$13.28
Rate for Payer: MDX Hawaii PPO	$6.62

MISOPROSTOL 200 MCG PO TABLET

Facility

$15.05

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$14.90
Rate for Payer: AlohaCare Medicaid	$7.53
Rate for Payer: AlohaCare Medicare	$13.54
Rate for Payer: Cash Price	$9.78
Rate for Payer: Devoted Health Medicare	$14.90
Rate for Payer: Hawaii Medical Service Association Medicare	$13.54
Rate for Payer: Hawaii Western Management Group Commercial	$14.30
Rate for Payer: Health Management Network Commercial	$12.79
Rate for Payer: Humana Medicare	$13.54
Rate for Payer: Kaiser Permanente Commercial	$13.54
Rate for Payer: Kaiser Permanente Medicaid	$7.68
Rate for Payer: Kaiser Permanente Medicare	$13.54
Rate for Payer: MDX Hawaii PPO	$14.60
Rate for Payer: Ohana Health Plan Medicaid	$13.54
Rate for Payer: Ohana Health Plan Medicare	$13.54
Rate for Payer: UnitedHealthcare Medicare	$13.54
Rate for Payer: University Health Alliance Commercial	$10.97

MISOPROSTOL 200 MCG PO TABLET

Facility

$15.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$14.60
Rate for Payer: Cash Price	$9.78
Rate for Payer: Health Management Network Commercial	$12.79
Rate for Payer: Kaiser Permanente Commercial	$13.54
Rate for Payer: MDX Hawaii PPO	$14.60

MONTELUKAST 10 MG PO TABLET

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.81
Rate for Payer: AlohaCare Medicaid	$0.92
Rate for Payer: AlohaCare Medicare	$1.65
Rate for Payer: Cash Price	$1.19
Rate for Payer: Devoted Health Medicare	$1.81
Rate for Payer: Hawaii Medical Service Association Medicare	$1.65
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Humana Medicare	$1.65
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: Kaiser Permanente Medicare	$1.65
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: Ohana Health Plan Medicaid	$1.65
Rate for Payer: Ohana Health Plan Medicare	$1.65
Rate for Payer: UnitedHealthcare Medicare	$1.65
Rate for Payer: University Health Alliance Commercial	$1.33

MONTELUKAST 10 MG PO TABLET

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: MDX Hawaii PPO	$1.78

MORPHINE 15 MG PO TAB IR

Facility

$5.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$4.87
Rate for Payer: Cash Price	$3.26
Rate for Payer: Health Management Network Commercial	$4.27
Rate for Payer: Kaiser Permanente Commercial	$4.52
Rate for Payer: MDX Hawaii PPO	$4.87

MORPHINE 15 MG PO TAB IR

Facility

$5.02

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$4.97
Rate for Payer: AlohaCare Medicaid	$2.51
Rate for Payer: AlohaCare Medicare	$4.52
Rate for Payer: Cash Price	$3.26
Rate for Payer: Devoted Health Medicare	$4.97
Rate for Payer: Hawaii Medical Service Association Medicare	$4.52
Rate for Payer: Hawaii Western Management Group Commercial	$4.77
Rate for Payer: Health Management Network Commercial	$4.27
Rate for Payer: Humana Medicare	$4.52
Rate for Payer: Kaiser Permanente Commercial	$4.52
Rate for Payer: Kaiser Permanente Medicaid	$2.56
Rate for Payer: Kaiser Permanente Medicare	$4.52
Rate for Payer: MDX Hawaii PPO	$4.87
Rate for Payer: Ohana Health Plan Medicaid	$4.52
Rate for Payer: Ohana Health Plan Medicare	$4.52
Rate for Payer: UnitedHealthcare Medicare	$4.52
Rate for Payer: University Health Alliance Commercial	$3.66

MORPHINE 15 MG PO TAB SR

Facility

$11.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$11.16
Rate for Payer: AlohaCare Medicaid	$5.63
Rate for Payer: AlohaCare Medicare	$10.14
Rate for Payer: Cash Price	$7.33
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Hawaii Medical Service Association Medicare	$10.14
Rate for Payer: Hawaii Western Management Group Commercial	$10.71
Rate for Payer: Health Management Network Commercial	$9.58
Rate for Payer: Humana Medicare	$10.14
Rate for Payer: Kaiser Permanente Commercial	$10.14
Rate for Payer: Kaiser Permanente Medicaid	$5.75
Rate for Payer: Kaiser Permanente Medicare	$10.14
Rate for Payer: MDX Hawaii PPO	$10.93
Rate for Payer: Ohana Health Plan Medicaid	$10.14
Rate for Payer: Ohana Health Plan Medicare	$10.14
Rate for Payer: UnitedHealthcare Medicare	$10.14
Rate for Payer: University Health Alliance Commercial	$8.21

MORPHINE 15 MG PO TAB SR

Facility

$11.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$10.93
Rate for Payer: Cash Price	$7.33
Rate for Payer: Health Management Network Commercial	$9.58
Rate for Payer: Kaiser Permanente Commercial	$10.14
Rate for Payer: MDX Hawaii PPO	$10.93

MORPHINE 2 MG/ML INJ 1 ML SYR

Facility

$15.85

Service Code	HCPCS J2272
Hospital Revenue Code	636
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.69
Rate for Payer: AlohaCare Medicaid	$7.92
Rate for Payer: AlohaCare Medicare	$14.27
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cash Price	$10.30
Rate for Payer: Devoted Health Medicare	$15.69
Rate for Payer: Hawaii Medical Service Association ABD	$8.13
Rate for Payer: Hawaii Medical Service Association Medicare	$14.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.13
Rate for Payer: Hawaii Western Management Group Commercial	$15.06
Rate for Payer: Health Management Network Commercial	$13.47
Rate for Payer: Humana Medicare	$14.27
Rate for Payer: Kaiser Permanente Commercial	$14.27
Rate for Payer: Kaiser Permanente Medicaid	$8.08
Rate for Payer: Kaiser Permanente Medicare	$14.27
Rate for Payer: MDX Hawaii PPO	$15.37
Rate for Payer: Ohana Health Plan Medicaid	$14.27
Rate for Payer: Ohana Health Plan Medicare	$14.27
Rate for Payer: UnitedHealthcare Medicaid	$9.51
Rate for Payer: UnitedHealthcare Medicare	$14.27
Rate for Payer: University Health Alliance Commercial	$11.55

MORPHINE 2 MG/ML INJ 1 ML SYR

Facility

$15.85

Service Code	HCPCS J2272
Hospital Revenue Code	250
Min. Negotiated Rate	$13.47
Max. Negotiated Rate	$15.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Health Management Network Commercial	$13.47
Rate for Payer: Kaiser Permanente Commercial	$14.27
Rate for Payer: MDX Hawaii PPO	$15.37

MORPHINE 2 MG/ML IV SYR

Facility

$11.76

Service Code	HCPCS J2270
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$5.88
Rate for Payer: AlohaCare Medicare	$10.58
Rate for Payer: Cash Price	$7.64
Rate for Payer: Cash Price	$7.64
Rate for Payer: Devoted Health Medicare	$11.64
Rate for Payer: Hawaii Medical Service Association ABD	$4.55
Rate for Payer: Hawaii Medical Service Association Medicare	$10.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$11.17
Rate for Payer: Health Management Network Commercial	$10.00
Rate for Payer: Humana Medicare	$10.58
Rate for Payer: Kaiser Permanente Commercial	$10.58
Rate for Payer: Kaiser Permanente Medicaid	$6.00
Rate for Payer: Kaiser Permanente Medicare	$10.58
Rate for Payer: MDX Hawaii PPO	$11.41
Rate for Payer: Ohana Health Plan Medicaid	$10.58
Rate for Payer: Ohana Health Plan Medicare	$10.58
Rate for Payer: UnitedHealthcare Medicaid	$7.06
Rate for Payer: UnitedHealthcare Medicare	$10.58
Rate for Payer: University Health Alliance Commercial	$8.57

MORPHINE 2 MG/ML IV SYR

Facility

$11.76

Service Code	HCPCS J2270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$11.41
Rate for Payer: Cash Price	$7.64
Rate for Payer: Health Management Network Commercial	$10.00
Rate for Payer: Kaiser Permanente Commercial	$10.58
Rate for Payer: MDX Hawaii PPO	$11.41

MORPHINE 30 MG PO TAB SR

Facility

$17.51

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$16.98
Rate for Payer: Cash Price	$11.38
Rate for Payer: Health Management Network Commercial	$14.88
Rate for Payer: Kaiser Permanente Commercial	$15.76
Rate for Payer: MDX Hawaii PPO	$16.98

MORPHINE 30 MG PO TAB SR

Facility

$17.51

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$17.33
Rate for Payer: AlohaCare Medicaid	$8.76
Rate for Payer: AlohaCare Medicare	$15.76
Rate for Payer: Cash Price	$11.38
Rate for Payer: Devoted Health Medicare	$17.33
Rate for Payer: Hawaii Medical Service Association Medicare	$15.76
Rate for Payer: Hawaii Western Management Group Commercial	$16.63
Rate for Payer: Health Management Network Commercial	$14.88
Rate for Payer: Humana Medicare	$15.76
Rate for Payer: Kaiser Permanente Commercial	$15.76
Rate for Payer: Kaiser Permanente Medicaid	$8.93
Rate for Payer: Kaiser Permanente Medicare	$15.76
Rate for Payer: MDX Hawaii PPO	$16.98
Rate for Payer: Ohana Health Plan Medicaid	$15.76
Rate for Payer: Ohana Health Plan Medicare	$15.76
Rate for Payer: UnitedHealthcare Medicare	$15.76
Rate for Payer: University Health Alliance Commercial	$12.76

MORPHINE 4 MG/ML INJ SYR

Facility

$15.85

Service Code	HCPCS J2272
Hospital Revenue Code	250
Min. Negotiated Rate	$13.47
Max. Negotiated Rate	$15.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Health Management Network Commercial	$13.47
Rate for Payer: Kaiser Permanente Commercial	$14.27
Rate for Payer: MDX Hawaii PPO	$15.37

MORPHINE 4 MG/ML INJ SYR

Facility

$15.85

Service Code	HCPCS J2272
Hospital Revenue Code	636
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.69
Rate for Payer: AlohaCare Medicaid	$7.92
Rate for Payer: AlohaCare Medicare	$14.27
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cash Price	$10.30
Rate for Payer: Devoted Health Medicare	$15.69
Rate for Payer: Hawaii Medical Service Association ABD	$8.13
Rate for Payer: Hawaii Medical Service Association Medicare	$14.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.13
Rate for Payer: Hawaii Western Management Group Commercial	$15.06
Rate for Payer: Health Management Network Commercial	$13.47
Rate for Payer: Humana Medicare	$14.27
Rate for Payer: Kaiser Permanente Commercial	$14.27
Rate for Payer: Kaiser Permanente Medicaid	$8.08
Rate for Payer: Kaiser Permanente Medicare	$14.27
Rate for Payer: MDX Hawaii PPO	$15.37
Rate for Payer: Ohana Health Plan Medicaid	$14.27
Rate for Payer: Ohana Health Plan Medicare	$14.27
Rate for Payer: UnitedHealthcare Medicaid	$9.51
Rate for Payer: UnitedHealthcare Medicare	$14.27
Rate for Payer: University Health Alliance Commercial	$11.55

MORPHINE 4 MG/ML IV SOLN

Facility

$13.79

Service Code	HCPCS J2270
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$13.65
Rate for Payer: AlohaCare Medicaid	$6.89
Rate for Payer: AlohaCare Medicare	$12.41
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cash Price	$8.96
Rate for Payer: Devoted Health Medicare	$13.65
Rate for Payer: Hawaii Medical Service Association ABD	$4.55
Rate for Payer: Hawaii Medical Service Association Medicare	$12.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$13.10
Rate for Payer: Health Management Network Commercial	$11.72
Rate for Payer: Humana Medicare	$12.41
Rate for Payer: Kaiser Permanente Commercial	$12.41
Rate for Payer: Kaiser Permanente Medicaid	$7.03
Rate for Payer: Kaiser Permanente Medicare	$12.41
Rate for Payer: MDX Hawaii PPO	$13.38
Rate for Payer: Ohana Health Plan Medicaid	$12.41
Rate for Payer: Ohana Health Plan Medicare	$12.41
Rate for Payer: UnitedHealthcare Medicaid	$8.27
Rate for Payer: UnitedHealthcare Medicare	$12.41
Rate for Payer: University Health Alliance Commercial	$10.05

MORPHINE 4 MG/ML IV SOLN

Facility

$13.79

Service Code	HCPCS J2270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$13.38
Rate for Payer: Cash Price	$8.96
Rate for Payer: Health Management Network Commercial	$11.72
Rate for Payer: Kaiser Permanente Commercial	$12.41
Rate for Payer: MDX Hawaii PPO	$13.38

MORPHINE 4 MG/ML IV SYR

Facility

$10.75

Service Code	HCPCS J2270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$10.43
Rate for Payer: Cash Price	$6.99
Rate for Payer: Health Management Network Commercial	$9.14
Rate for Payer: Kaiser Permanente Commercial	$9.68
Rate for Payer: MDX Hawaii PPO	$10.43

MORPHINE 4 MG/ML IV SYR

Facility

$10.75

Service Code	HCPCS J2270
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.64
Rate for Payer: AlohaCare Medicaid	$5.38
Rate for Payer: AlohaCare Medicare	$9.68
Rate for Payer: Cash Price	$6.99
Rate for Payer: Cash Price	$6.99
Rate for Payer: Devoted Health Medicare	$10.64
Rate for Payer: Hawaii Medical Service Association ABD	$4.55
Rate for Payer: Hawaii Medical Service Association Medicare	$9.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$10.21
Rate for Payer: Health Management Network Commercial	$9.14
Rate for Payer: Humana Medicare	$9.68
Rate for Payer: Kaiser Permanente Commercial	$9.68
Rate for Payer: Kaiser Permanente Medicaid	$5.48
Rate for Payer: Kaiser Permanente Medicare	$9.68
Rate for Payer: MDX Hawaii PPO	$10.43
Rate for Payer: Ohana Health Plan Medicaid	$9.68
Rate for Payer: Ohana Health Plan Medicare	$9.68
Rate for Payer: UnitedHealthcare Medicaid	$6.45
Rate for Payer: UnitedHealthcare Medicare	$9.68
Rate for Payer: University Health Alliance Commercial	$7.84

MORPHINE CONCENTRATE 20 (20 MG/ML) PO SOLN

Facility

$2.07

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.05
Rate for Payer: AlohaCare Medicaid	$1.03
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$1.35
Rate for Payer: Devoted Health Medicare	$2.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$1.97
Rate for Payer: Health Management Network Commercial	$1.76
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$1.86
Rate for Payer: Kaiser Permanente Medicaid	$1.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$2.01
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$1.51

Know your out-of-pocket cost for care.

All Charges