Kohala Hospital

All Charges

Charge

Type

Setting

Price

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$64,422.04

Service Code	MSDRG 789
Min. Negotiated Rate	$64,422.04
Max. Negotiated Rate	$64,422.04
Rate for Payer: Hawaii Medical Service Association Commercial	$64,422.04

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$4,029.34

Service Code	MSDRG 794
Min. Negotiated Rate	$4,029.34
Max. Negotiated Rate	$4,029.34
Rate for Payer: Hawaii Medical Service Association Commercial	$4,029.34

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$23,915.32

Service Code	MSDRG 054
Min. Negotiated Rate	$23,915.32
Max. Negotiated Rate	$23,915.32
Rate for Payer: Hawaii Medical Service Association Commercial	$23,915.32

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$23,678.30

Service Code	MSDRG 055
Min. Negotiated Rate	$23,678.30
Max. Negotiated Rate	$23,678.30
Rate for Payer: Hawaii Medical Service Association Commercial	$23,678.30

NEUROLOGICAL EYE DISORDERS

Facility

$16,638.80

Service Code	MSDRG 123
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

NEUROSES EXCEPT DEPRESSIVE

Facility

$9,528.20

Service Code	MSDRG 882
Min. Negotiated Rate	$9,528.20
Max. Negotiated Rate	$9,528.20
Rate for Payer: Hawaii Medical Service Association Commercial	$9,528.20

NICOTINE 14 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.35
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Kaiser Permanente Commercial	$8.84
Rate for Payer: MDX Hawaii PPO	$9.53

NICOTINE 14 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$9.72
Rate for Payer: AlohaCare Medicaid	$4.91
Rate for Payer: AlohaCare Medicare	$8.84
Rate for Payer: Cash Price	$6.38
Rate for Payer: Devoted Health Medicare	$9.72
Rate for Payer: Hawaii Medical Service Association Medicare	$8.84
Rate for Payer: Hawaii Western Management Group Commercial	$9.33
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Humana Medicare	$8.84
Rate for Payer: Kaiser Permanente Commercial	$8.84
Rate for Payer: Kaiser Permanente Medicaid	$5.01
Rate for Payer: Kaiser Permanente Medicare	$8.84
Rate for Payer: MDX Hawaii PPO	$9.53
Rate for Payer: Ohana Health Plan Medicaid	$8.84
Rate for Payer: Ohana Health Plan Medicare	$8.84
Rate for Payer: UnitedHealthcare Medicare	$8.84
Rate for Payer: University Health Alliance Commercial	$7.16

NICOTINE 21 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.35
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Kaiser Permanente Commercial	$8.84
Rate for Payer: MDX Hawaii PPO	$9.53

NICOTINE 21 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$9.72
Rate for Payer: AlohaCare Medicaid	$4.91
Rate for Payer: AlohaCare Medicare	$8.84
Rate for Payer: Cash Price	$6.38
Rate for Payer: Devoted Health Medicare	$9.72
Rate for Payer: Hawaii Medical Service Association Medicare	$8.84
Rate for Payer: Hawaii Western Management Group Commercial	$9.33
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Humana Medicare	$8.84
Rate for Payer: Kaiser Permanente Commercial	$8.84
Rate for Payer: Kaiser Permanente Medicaid	$5.01
Rate for Payer: Kaiser Permanente Medicare	$8.84
Rate for Payer: MDX Hawaii PPO	$9.53
Rate for Payer: Ohana Health Plan Medicaid	$8.84
Rate for Payer: Ohana Health Plan Medicare	$8.84
Rate for Payer: UnitedHealthcare Medicare	$8.84
Rate for Payer: University Health Alliance Commercial	$7.16

NICOTINE 7 MG/24 HR TRANSDERM PT24

Facility

$3.92

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$3.80
Rate for Payer: Cash Price	$2.55
Rate for Payer: Cash Price	$7.69
Rate for Payer: Health Management Network Commercial	$3.33
Rate for Payer: Health Management Network Commercial	$10.06
Rate for Payer: Kaiser Permanente Commercial	$3.53
Rate for Payer: Kaiser Permanente Commercial	$10.65
Rate for Payer: MDX Hawaii PPO	$11.48
Rate for Payer: MDX Hawaii PPO	$3.80

NICOTINE 7 MG/24 HR TRANSDERM PT24

Facility

$11.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$11.71
Rate for Payer: AlohaCare Medicaid	$5.92
Rate for Payer: AlohaCare Medicaid	$1.96
Rate for Payer: AlohaCare Medicare	$10.65
Rate for Payer: AlohaCare Medicare	$3.53
Rate for Payer: Cash Price	$2.55
Rate for Payer: Cash Price	$7.69
Rate for Payer: Devoted Health Medicare	$11.71
Rate for Payer: Devoted Health Medicare	$3.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3.53
Rate for Payer: Hawaii Medical Service Association Medicare	$10.65
Rate for Payer: Hawaii Western Management Group Commercial	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$11.24
Rate for Payer: Health Management Network Commercial	$10.06
Rate for Payer: Health Management Network Commercial	$3.33
Rate for Payer: Humana Medicare	$3.53
Rate for Payer: Humana Medicare	$10.65
Rate for Payer: Kaiser Permanente Commercial	$10.65
Rate for Payer: Kaiser Permanente Commercial	$3.53
Rate for Payer: Kaiser Permanente Medicaid	$2.00
Rate for Payer: Kaiser Permanente Medicaid	$6.03
Rate for Payer: Kaiser Permanente Medicare	$3.53
Rate for Payer: Kaiser Permanente Medicare	$10.65
Rate for Payer: MDX Hawaii PPO	$3.80
Rate for Payer: MDX Hawaii PPO	$11.48
Rate for Payer: Ohana Health Plan Medicaid	$10.65
Rate for Payer: Ohana Health Plan Medicaid	$3.53
Rate for Payer: Ohana Health Plan Medicare	$10.65
Rate for Payer: Ohana Health Plan Medicare	$3.53
Rate for Payer: UnitedHealthcare Medicare	$10.65
Rate for Payer: UnitedHealthcare Medicare	$3.53
Rate for Payer: University Health Alliance Commercial	$2.86
Rate for Payer: University Health Alliance Commercial	$8.62

NIFEDIPINE 10 MG PO CAP

Facility

$5.90

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$5.84
Rate for Payer: AlohaCare Medicaid	$2.95
Rate for Payer: AlohaCare Medicaid	$2.98
Rate for Payer: AlohaCare Medicare	$5.31
Rate for Payer: AlohaCare Medicare	$5.36
Rate for Payer: Cash Price	$3.87
Rate for Payer: Cash Price	$3.84
Rate for Payer: Devoted Health Medicare	$5.84
Rate for Payer: Devoted Health Medicare	$5.89
Rate for Payer: Hawaii Medical Service Association Medicare	$5.36
Rate for Payer: Hawaii Medical Service Association Medicare	$5.31
Rate for Payer: Hawaii Western Management Group Commercial	$5.65
Rate for Payer: Hawaii Western Management Group Commercial	$5.61
Rate for Payer: Health Management Network Commercial	$5.01
Rate for Payer: Health Management Network Commercial	$5.06
Rate for Payer: Humana Medicare	$5.36
Rate for Payer: Humana Medicare	$5.31
Rate for Payer: Kaiser Permanente Commercial	$5.31
Rate for Payer: Kaiser Permanente Commercial	$5.36
Rate for Payer: Kaiser Permanente Medicaid	$3.03
Rate for Payer: Kaiser Permanente Medicaid	$3.01
Rate for Payer: Kaiser Permanente Medicare	$5.36
Rate for Payer: Kaiser Permanente Medicare	$5.31
Rate for Payer: MDX Hawaii PPO	$5.77
Rate for Payer: MDX Hawaii PPO	$5.72
Rate for Payer: Ohana Health Plan Medicaid	$5.31
Rate for Payer: Ohana Health Plan Medicaid	$5.36
Rate for Payer: Ohana Health Plan Medicare	$5.31
Rate for Payer: Ohana Health Plan Medicare	$5.36
Rate for Payer: UnitedHealthcare Medicare	$5.31
Rate for Payer: UnitedHealthcare Medicare	$5.36
Rate for Payer: University Health Alliance Commercial	$4.34
Rate for Payer: University Health Alliance Commercial	$4.30

NIFEDIPINE 10 MG PO CAP

Facility

$5.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$5.77
Rate for Payer: Cash Price	$3.87
Rate for Payer: Cash Price	$3.84
Rate for Payer: Health Management Network Commercial	$5.06
Rate for Payer: Health Management Network Commercial	$5.01
Rate for Payer: Kaiser Permanente Commercial	$5.36
Rate for Payer: Kaiser Permanente Commercial	$5.31
Rate for Payer: MDX Hawaii PPO	$5.72
Rate for Payer: MDX Hawaii PPO	$5.77

NIFEDIPINE 30 MG PO TAB SUSTAINED RELEASE

Facility

$7.70

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$7.62
Rate for Payer: AlohaCare Medicaid	$3.85
Rate for Payer: AlohaCare Medicare	$6.93
Rate for Payer: Cash Price	$5.00
Rate for Payer: Devoted Health Medicare	$7.62
Rate for Payer: Hawaii Medical Service Association Medicare	$6.93
Rate for Payer: Hawaii Western Management Group Commercial	$7.32
Rate for Payer: Health Management Network Commercial	$6.54
Rate for Payer: Humana Medicare	$6.93
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$3.93
Rate for Payer: Kaiser Permanente Medicare	$6.93
Rate for Payer: MDX Hawaii PPO	$7.47
Rate for Payer: Ohana Health Plan Medicaid	$6.93
Rate for Payer: Ohana Health Plan Medicare	$6.93
Rate for Payer: UnitedHealthcare Medicare	$6.93
Rate for Payer: University Health Alliance Commercial	$5.61

NIFEDIPINE 30 MG PO TAB SUSTAINED RELEASE

Facility

$7.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$7.47
Rate for Payer: Cash Price	$5.00
Rate for Payer: Health Management Network Commercial	$6.54
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: MDX Hawaii PPO	$7.47

NIFEDIPINE 60 MG PO TAB SUSTAINED RELEASE

Facility

$13.71

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$13.57
Rate for Payer: AlohaCare Medicaid	$6.86
Rate for Payer: AlohaCare Medicare	$12.34
Rate for Payer: Cash Price	$8.91
Rate for Payer: Devoted Health Medicare	$13.57
Rate for Payer: Hawaii Medical Service Association Medicare	$12.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.02
Rate for Payer: Health Management Network Commercial	$11.65
Rate for Payer: Humana Medicare	$12.34
Rate for Payer: Kaiser Permanente Commercial	$12.34
Rate for Payer: Kaiser Permanente Medicaid	$6.99
Rate for Payer: Kaiser Permanente Medicare	$12.34
Rate for Payer: MDX Hawaii PPO	$13.30
Rate for Payer: Ohana Health Plan Medicaid	$12.34
Rate for Payer: Ohana Health Plan Medicare	$12.34
Rate for Payer: UnitedHealthcare Medicare	$12.34
Rate for Payer: University Health Alliance Commercial	$9.99

NIFEDIPINE 60 MG PO TAB SUSTAINED RELEASE

Facility

$13.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$13.30
Rate for Payer: Cash Price	$8.91
Rate for Payer: Health Management Network Commercial	$11.65
Rate for Payer: Kaiser Permanente Commercial	$12.34
Rate for Payer: MDX Hawaii PPO	$13.30

NITROFURANTOIN MONOHYD/M-CRYST 100 MG PO CAP

Facility

$22.55

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$22.32
Rate for Payer: AlohaCare Medicaid	$11.28
Rate for Payer: AlohaCare Medicare	$20.30
Rate for Payer: Cash Price	$14.66
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Hawaii Medical Service Association Medicare	$20.30
Rate for Payer: Hawaii Western Management Group Commercial	$21.42
Rate for Payer: Health Management Network Commercial	$19.17
Rate for Payer: Humana Medicare	$20.30
Rate for Payer: Kaiser Permanente Commercial	$20.30
Rate for Payer: Kaiser Permanente Medicaid	$11.50
Rate for Payer: Kaiser Permanente Medicare	$20.30
Rate for Payer: MDX Hawaii PPO	$21.87
Rate for Payer: Ohana Health Plan Medicaid	$20.30
Rate for Payer: Ohana Health Plan Medicare	$20.30
Rate for Payer: UnitedHealthcare Medicare	$20.30
Rate for Payer: University Health Alliance Commercial	$16.44

NITROFURANTOIN MONOHYD/M-CRYST 100 MG PO CAP

Facility

$22.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$21.87
Rate for Payer: Cash Price	$14.66
Rate for Payer: Health Management Network Commercial	$19.17
Rate for Payer: Kaiser Permanente Commercial	$20.30
Rate for Payer: MDX Hawaii PPO	$21.87

NITROGLYCERIN 0.1 MG TRANSDERM PT24

Facility

$10.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$10.17
Rate for Payer: AlohaCare Medicaid	$5.13
Rate for Payer: AlohaCare Medicare	$9.24
Rate for Payer: Cash Price	$6.68
Rate for Payer: Devoted Health Medicare	$10.17
Rate for Payer: Hawaii Medical Service Association Medicare	$9.24
Rate for Payer: Hawaii Western Management Group Commercial	$9.76
Rate for Payer: Health Management Network Commercial	$8.73
Rate for Payer: Humana Medicare	$9.24
Rate for Payer: Kaiser Permanente Commercial	$9.24
Rate for Payer: Kaiser Permanente Medicaid	$5.24
Rate for Payer: Kaiser Permanente Medicare	$9.24
Rate for Payer: MDX Hawaii PPO	$9.96
Rate for Payer: Ohana Health Plan Medicaid	$9.24
Rate for Payer: Ohana Health Plan Medicare	$9.24
Rate for Payer: UnitedHealthcare Medicare	$9.24
Rate for Payer: University Health Alliance Commercial	$7.49

NITROGLYCERIN 0.1 MG TRANSDERM PT24

Facility

$10.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$9.96
Rate for Payer: Cash Price	$6.68
Rate for Payer: Health Management Network Commercial	$8.73
Rate for Payer: Kaiser Permanente Commercial	$9.24
Rate for Payer: MDX Hawaii PPO	$9.96

NITROGLYCERIN 0.2 MG TRANSDERM PT24

Facility

$10.50

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$10.39
Rate for Payer: AlohaCare Medicaid	$5.25
Rate for Payer: AlohaCare Medicare	$9.45
Rate for Payer: Cash Price	$6.82
Rate for Payer: Devoted Health Medicare	$10.39
Rate for Payer: Hawaii Medical Service Association Medicare	$9.45
Rate for Payer: Hawaii Western Management Group Commercial	$9.97
Rate for Payer: Health Management Network Commercial	$8.93
Rate for Payer: Humana Medicare	$9.45
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$5.36
Rate for Payer: Kaiser Permanente Medicare	$9.45
Rate for Payer: MDX Hawaii PPO	$10.19
Rate for Payer: Ohana Health Plan Medicaid	$9.45
Rate for Payer: Ohana Health Plan Medicare	$9.45
Rate for Payer: UnitedHealthcare Medicare	$9.45
Rate for Payer: University Health Alliance Commercial	$7.65

NITROGLYCERIN 0.2 MG TRANSDERM PT24

Facility

$10.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$10.19
Rate for Payer: Cash Price	$6.82
Rate for Payer: Health Management Network Commercial	$8.93
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: MDX Hawaii PPO	$10.19

NITROGLYCERIN 0.4 MG SL SUBL.TAB

Facility

$141.73

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$70.86
Max. Negotiated Rate	$140.31
Rate for Payer: AlohaCare Medicaid	$70.86
Rate for Payer: AlohaCare Medicaid	$70.11
Rate for Payer: AlohaCare Medicare	$126.19
Rate for Payer: AlohaCare Medicare	$127.56
Rate for Payer: Cash Price	$91.14
Rate for Payer: Cash Price	$92.12
Rate for Payer: Devoted Health Medicare	$140.31
Rate for Payer: Devoted Health Medicare	$138.81
Rate for Payer: Hawaii Medical Service Association Medicare	$126.19
Rate for Payer: Hawaii Medical Service Association Medicare	$127.56
Rate for Payer: Hawaii Western Management Group Commercial	$133.20
Rate for Payer: Hawaii Western Management Group Commercial	$134.64
Rate for Payer: Health Management Network Commercial	$120.47
Rate for Payer: Health Management Network Commercial	$119.18
Rate for Payer: Humana Medicare	$127.56
Rate for Payer: Humana Medicare	$126.19
Rate for Payer: Kaiser Permanente Commercial	$126.19
Rate for Payer: Kaiser Permanente Commercial	$127.56
Rate for Payer: Kaiser Permanente Medicaid	$72.28
Rate for Payer: Kaiser Permanente Medicaid	$71.51
Rate for Payer: Kaiser Permanente Medicare	$126.19
Rate for Payer: Kaiser Permanente Medicare	$127.56
Rate for Payer: MDX Hawaii PPO	$136.00
Rate for Payer: MDX Hawaii PPO	$137.48
Rate for Payer: Ohana Health Plan Medicaid	$126.19
Rate for Payer: Ohana Health Plan Medicaid	$127.56
Rate for Payer: Ohana Health Plan Medicare	$126.19
Rate for Payer: Ohana Health Plan Medicare	$127.56
Rate for Payer: UnitedHealthcare Medicare	$127.56
Rate for Payer: UnitedHealthcare Medicare	$126.19
Rate for Payer: University Health Alliance Commercial	$103.31
Rate for Payer: University Health Alliance Commercial	$102.20

Know your out-of-pocket cost for care.

All Charges