Kohala Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.4 MG SL SUBL.TAB

Facility

$140.21

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$119.18
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$91.14
Rate for Payer: Cash Price	$92.12
Rate for Payer: Health Management Network Commercial	$119.18
Rate for Payer: Health Management Network Commercial	$120.47
Rate for Payer: Kaiser Permanente Commercial	$126.19
Rate for Payer: Kaiser Permanente Commercial	$127.56
Rate for Payer: MDX Hawaii PPO	$137.48
Rate for Payer: MDX Hawaii PPO	$136.00

NITROGLYCERIN 0.4 MG TRANSDERM PT24

Facility

$12.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.88
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$10.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Hawaii Medical Service Association Medicare	$10.80
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$10.80
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$10.80
Rate for Payer: Ohana Health Plan Medicare	$10.80
Rate for Payer: UnitedHealthcare Medicare	$10.80
Rate for Payer: University Health Alliance Commercial	$8.75

NITROGLYCERIN 0.4 MG TRANSDERM PT24

Facility

$12.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

NITROGLYCERIN 2 % TRANSDERM OINT

Facility

$16.72

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$16.55
Rate for Payer: AlohaCare Medicaid	$8.36
Rate for Payer: AlohaCare Medicare	$15.05
Rate for Payer: Cash Price	$10.87
Rate for Payer: Devoted Health Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association Medicare	$15.05
Rate for Payer: Hawaii Western Management Group Commercial	$15.88
Rate for Payer: Health Management Network Commercial	$14.21
Rate for Payer: Humana Medicare	$15.05
Rate for Payer: Kaiser Permanente Commercial	$15.05
Rate for Payer: Kaiser Permanente Medicaid	$8.53
Rate for Payer: Kaiser Permanente Medicare	$15.05
Rate for Payer: MDX Hawaii PPO	$16.22
Rate for Payer: Ohana Health Plan Medicaid	$15.05
Rate for Payer: Ohana Health Plan Medicare	$15.05
Rate for Payer: UnitedHealthcare Medicare	$15.05
Rate for Payer: University Health Alliance Commercial	$12.19

NITROGLYCERIN 2 % TRANSDERM OINT

Facility

$16.72

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$16.22
Rate for Payer: Cash Price	$10.87
Rate for Payer: Health Management Network Commercial	$14.21
Rate for Payer: Kaiser Permanente Commercial	$15.05
Rate for Payer: MDX Hawaii PPO	$16.22

NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) IV SOLN

Facility

$111.15

Service Code	HCPCS J2305
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$110.04
Rate for Payer: AlohaCare Medicaid	$55.58
Rate for Payer: AlohaCare Medicare	$100.03
Rate for Payer: Cash Price	$72.25
Rate for Payer: Cash Price	$72.25
Rate for Payer: Devoted Health Medicare	$110.04
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Medicare	$100.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.42
Rate for Payer: Hawaii Western Management Group Commercial	$105.59
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Humana Medicare	$100.03
Rate for Payer: Kaiser Permanente Commercial	$100.03
Rate for Payer: Kaiser Permanente Medicaid	$56.69
Rate for Payer: Kaiser Permanente Medicare	$100.03
Rate for Payer: MDX Hawaii PPO	$107.82
Rate for Payer: Ohana Health Plan Medicaid	$100.03
Rate for Payer: Ohana Health Plan Medicare	$100.03
Rate for Payer: UnitedHealthcare Medicaid	$66.69
Rate for Payer: UnitedHealthcare Medicare	$100.03
Rate for Payer: University Health Alliance Commercial	$81.02

NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) IV SOLN

Facility

$111.15

Service Code	HCPCS J2305
Hospital Revenue Code	250
Min. Negotiated Rate	$94.48
Max. Negotiated Rate	$107.82
Rate for Payer: Cash Price	$72.25
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Kaiser Permanente Commercial	$100.03
Rate for Payer: MDX Hawaii PPO	$107.82

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$37,543.97

Service Code	MSDRG 098
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$37,543.97

Service Code	MSDRG 097
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$37,543.97

Service Code	MSDRG 099
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$38,018.01

Service Code	MSDRG 988
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$38,018.01

Service Code	MSDRG 987
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$38,018.01

Service Code	MSDRG 989
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$15,998.85

Service Code	MSDRG 600
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$15,998.85

Service Code	MSDRG 601
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$32,566.55

Service Code	MSDRG 080
Min. Negotiated Rate	$32,566.55
Max. Negotiated Rate	$32,566.55
Rate for Payer: Hawaii Medical Service Association Commercial	$32,566.55

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$32,566.55

Service Code	MSDRG 081
Min. Negotiated Rate	$32,566.55
Max. Negotiated Rate	$32,566.55
Rate for Payer: Hawaii Medical Service Association Commercial	$32,566.55

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085200
Hospital Revenue Code	250
Min. Negotiated Rate	$92.11
Max. Negotiated Rate	$105.11
Rate for Payer: Cash Price	$70.43
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: Kaiser Permanente Commercial	$97.52
Rate for Payer: MDX Hawaii PPO	$105.11

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085200
Hospital Revenue Code	250
Min. Negotiated Rate	$54.18
Max. Negotiated Rate	$107.28
Rate for Payer: AlohaCare Medicaid	$54.18
Rate for Payer: AlohaCare Medicare	$97.52
Rate for Payer: Cash Price	$70.43
Rate for Payer: Devoted Health Medicare	$107.28
Rate for Payer: Hawaii Medical Service Association Medicare	$97.52
Rate for Payer: Hawaii Western Management Group Commercial	$102.94
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: Humana Medicare	$97.52
Rate for Payer: Kaiser Permanente Commercial	$97.52
Rate for Payer: Kaiser Permanente Medicaid	$55.26
Rate for Payer: Kaiser Permanente Medicare	$97.52
Rate for Payer: MDX Hawaii PPO	$105.11
Rate for Payer: Ohana Health Plan Medicaid	$97.52
Rate for Payer: Ohana Health Plan Medicare	$97.52
Rate for Payer: UnitedHealthcare Medicaid	$65.02
Rate for Payer: UnitedHealthcare Medicare	$97.52
Rate for Payer: University Health Alliance Commercial	$78.98

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085204
Hospital Revenue Code	250
Min. Negotiated Rate	$92.11
Max. Negotiated Rate	$105.11
Rate for Payer: Cash Price	$70.43
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: Kaiser Permanente Commercial	$97.52
Rate for Payer: MDX Hawaii PPO	$105.11

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085204
Hospital Revenue Code	250
Min. Negotiated Rate	$54.18
Max. Negotiated Rate	$107.28
Rate for Payer: AlohaCare Medicaid	$54.18
Rate for Payer: AlohaCare Medicare	$97.52
Rate for Payer: Cash Price	$70.43
Rate for Payer: Devoted Health Medicare	$107.28
Rate for Payer: Hawaii Medical Service Association Medicare	$97.52
Rate for Payer: Hawaii Western Management Group Commercial	$102.94
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: Humana Medicare	$97.52
Rate for Payer: Kaiser Permanente Commercial	$97.52
Rate for Payer: Kaiser Permanente Medicaid	$55.26
Rate for Payer: Kaiser Permanente Medicare	$97.52
Rate for Payer: MDX Hawaii PPO	$105.11
Rate for Payer: Ohana Health Plan Medicaid	$97.52
Rate for Payer: Ohana Health Plan Medicare	$97.52
Rate for Payer: UnitedHealthcare Medicaid	$65.02
Rate for Payer: UnitedHealthcare Medicare	$97.52
Rate for Payer: University Health Alliance Commercial	$78.98

NOREPINEPHRINE BITARTRATE-D5W 4 MG/250 ML (16 MCG/ML) IV SOLN

Facility

$111.15

Service Code	NDC 00338011220
Hospital Revenue Code	250
Min. Negotiated Rate	$55.58
Max. Negotiated Rate	$110.04
Rate for Payer: AlohaCare Medicaid	$55.58
Rate for Payer: AlohaCare Medicare	$100.03
Rate for Payer: Cash Price	$72.25
Rate for Payer: Devoted Health Medicare	$110.04
Rate for Payer: Hawaii Medical Service Association Medicare	$100.03
Rate for Payer: Hawaii Western Management Group Commercial	$105.59
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Humana Medicare	$100.03
Rate for Payer: Kaiser Permanente Commercial	$100.03
Rate for Payer: Kaiser Permanente Medicaid	$56.69
Rate for Payer: Kaiser Permanente Medicare	$100.03
Rate for Payer: MDX Hawaii PPO	$107.82
Rate for Payer: Ohana Health Plan Medicaid	$100.03
Rate for Payer: Ohana Health Plan Medicare	$100.03
Rate for Payer: UnitedHealthcare Medicaid	$66.69
Rate for Payer: UnitedHealthcare Medicare	$100.03
Rate for Payer: University Health Alliance Commercial	$81.02

NOREPINEPHRINE BITARTRATE-D5W 4 MG/250 ML (16 MCG/ML) IV SOLN

Facility

$111.15

Service Code	NDC 00338011220
Hospital Revenue Code	250
Min. Negotiated Rate	$94.48
Max. Negotiated Rate	$107.82
Rate for Payer: Cash Price	$72.25
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Kaiser Permanente Commercial	$100.03
Rate for Payer: MDX Hawaii PPO	$107.82

NOREPINEPHRINE BITARTRATE-NACL 16 MG/250 ML (64 MCG/ML) IV SOLN

Facility

$427.06

Service Code	NDC 44567064201
Hospital Revenue Code	250
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$414.25
Rate for Payer: Cash Price	$277.59
Rate for Payer: Health Management Network Commercial	$363.00
Rate for Payer: Kaiser Permanente Commercial	$384.35
Rate for Payer: MDX Hawaii PPO	$414.25

NOREPINEPHRINE BITARTRATE-NACL 16 MG/250 ML (64 MCG/ML) IV SOLN

Facility

$427.06

Service Code	NDC 44567064201
Hospital Revenue Code	250
Min. Negotiated Rate	$213.53
Max. Negotiated Rate	$422.79
Rate for Payer: AlohaCare Medicaid	$213.53
Rate for Payer: AlohaCare Medicare	$384.35
Rate for Payer: Cash Price	$277.59
Rate for Payer: Devoted Health Medicare	$422.79
Rate for Payer: Hawaii Medical Service Association Medicare	$384.35
Rate for Payer: Hawaii Western Management Group Commercial	$405.71
Rate for Payer: Health Management Network Commercial	$363.00
Rate for Payer: Humana Medicare	$384.35
Rate for Payer: Kaiser Permanente Commercial	$384.35
Rate for Payer: Kaiser Permanente Medicaid	$217.80
Rate for Payer: Kaiser Permanente Medicare	$384.35
Rate for Payer: MDX Hawaii PPO	$414.25
Rate for Payer: Ohana Health Plan Medicaid	$384.35
Rate for Payer: Ohana Health Plan Medicare	$384.35
Rate for Payer: UnitedHealthcare Medicaid	$256.24
Rate for Payer: UnitedHealthcare Medicare	$384.35
Rate for Payer: University Health Alliance Commercial	$311.28

Know your out-of-pocket cost for care.

All Charges