Kohala Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$193,360.92

Service Code	MSDRG 216
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$193,360.92

Service Code	MSDRG 218
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$125,762.81

Service Code	MSDRG 220
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$125,762.81

Service Code	MSDRG 219
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$125,762.81

Service Code	MSDRG 221
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$10,400.00

Service Code	MSDRG 035
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$10,400.00

Service Code	MSDRG 034
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$10,400.00

Service Code	MSDRG 036
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

CARVEDILOL 12.5 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$11.45
Rate for Payer: Cash Price	$7.67
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Kaiser Permanente Commercial	$10.62
Rate for Payer: MDX Hawaii PPO	$11.45

CARVEDILOL 12.5 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$11.68
Rate for Payer: AlohaCare Medicaid	$5.90
Rate for Payer: AlohaCare Medicare	$10.62
Rate for Payer: Cash Price	$7.67
Rate for Payer: Devoted Health Medicare	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$10.62
Rate for Payer: Hawaii Western Management Group Commercial	$11.21
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Humana Medicare	$10.62
Rate for Payer: Kaiser Permanente Commercial	$10.62
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: Kaiser Permanente Medicare	$10.62
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: Ohana Health Plan Medicaid	$10.62
Rate for Payer: Ohana Health Plan Medicare	$10.62
Rate for Payer: UnitedHealthcare Medicare	$10.62
Rate for Payer: University Health Alliance Commercial	$8.60

CARVEDILOL 3.125 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$7.67
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$10.62
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: MDX Hawaii PPO	$1.16

CARVEDILOL 3.125 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$11.68
Rate for Payer: AlohaCare Medicaid	$5.90
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$10.62
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$7.67
Rate for Payer: Devoted Health Medicare	$11.68
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Medical Service Association Medicare	$10.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.21
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Humana Medicare	$10.62
Rate for Payer: Kaiser Permanente Commercial	$10.62
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: Kaiser Permanente Medicare	$10.62
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: Ohana Health Plan Medicaid	$10.62
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$10.62
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$10.62
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$8.60

CARVEDILOL 6.25 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$7.67
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$10.62
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: MDX Hawaii PPO	$1.16

CARVEDILOL 6.25 MG PO TABLET

Facility

$11.80

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$11.68
Rate for Payer: AlohaCare Medicaid	$5.90
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$10.62
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$7.67
Rate for Payer: Devoted Health Medicare	$11.68
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Medical Service Association Medicare	$10.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.21
Rate for Payer: Health Management Network Commercial	$10.03
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Humana Medicare	$10.62
Rate for Payer: Kaiser Permanente Commercial	$10.62
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: Kaiser Permanente Medicare	$10.62
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$11.45
Rate for Payer: Ohana Health Plan Medicaid	$10.62
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$10.62
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$10.62
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$8.60

CASPOFUNGIN 50 MG IV RECON.SOLN.

Facility

$939.62

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$798.68
Max. Negotiated Rate	$911.43
Rate for Payer: Cash Price	$610.75
Rate for Payer: Health Management Network Commercial	$798.68
Rate for Payer: Kaiser Permanente Commercial	$845.66
Rate for Payer: MDX Hawaii PPO	$911.43

CASPOFUNGIN 50 MG IV RECON.SOLN.

Facility

$939.62

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$930.22
Rate for Payer: AlohaCare Medicaid	$469.81
Rate for Payer: AlohaCare Medicare	$845.66
Rate for Payer: Cash Price	$610.75
Rate for Payer: Cash Price	$610.75
Rate for Payer: Devoted Health Medicare	$930.22
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Medicare	$845.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$892.64
Rate for Payer: Health Management Network Commercial	$798.68
Rate for Payer: Humana Medicare	$845.66
Rate for Payer: Kaiser Permanente Commercial	$845.66
Rate for Payer: Kaiser Permanente Medicaid	$479.21
Rate for Payer: Kaiser Permanente Medicare	$845.66
Rate for Payer: MDX Hawaii PPO	$911.43
Rate for Payer: Ohana Health Plan Medicaid	$845.66
Rate for Payer: Ohana Health Plan Medicare	$845.66
Rate for Payer: UnitedHealthcare Medicaid	$563.77
Rate for Payer: UnitedHealthcare Medicare	$845.66
Rate for Payer: University Health Alliance Commercial	$684.89

CASPOFUNGIN 70 MG IV RECON.SOLN.

Facility

$496.91

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$491.94
Rate for Payer: AlohaCare Medicaid	$248.46
Rate for Payer: AlohaCare Medicare	$447.22
Rate for Payer: Cash Price	$322.99
Rate for Payer: Cash Price	$322.99
Rate for Payer: Devoted Health Medicare	$491.94
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Medicare	$447.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$472.06
Rate for Payer: Health Management Network Commercial	$422.37
Rate for Payer: Humana Medicare	$447.22
Rate for Payer: Kaiser Permanente Commercial	$447.22
Rate for Payer: Kaiser Permanente Medicaid	$253.42
Rate for Payer: Kaiser Permanente Medicare	$447.22
Rate for Payer: MDX Hawaii PPO	$482.00
Rate for Payer: Ohana Health Plan Medicaid	$447.22
Rate for Payer: Ohana Health Plan Medicare	$447.22
Rate for Payer: UnitedHealthcare Medicaid	$298.15
Rate for Payer: UnitedHealthcare Medicare	$447.22
Rate for Payer: University Health Alliance Commercial	$362.20

CASPOFUNGIN 70 MG IV RECON.SOLN.

Facility

$496.91

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$422.37
Max. Negotiated Rate	$482.00
Rate for Payer: Cash Price	$322.99
Rate for Payer: Health Management Network Commercial	$422.37
Rate for Payer: Kaiser Permanente Commercial	$447.22
Rate for Payer: MDX Hawaii PPO	$482.00

CATHETER COUDE 16FR 0168L16 [2700361]

Facility

$70.21

Service Code	HCPCS A4340
Hospital Charge Code	2700361.0
Hospital Revenue Code	272
Min. Negotiated Rate	$59.68
Max. Negotiated Rate	$68.10
Rate for Payer: Cash Price	$45.64
Rate for Payer: Health Management Network Commercial	$59.68
Rate for Payer: Kaiser Permanente Commercial	$63.19
Rate for Payer: MDX Hawaii PPO	$68.10

CATHETER COUDE 16FR 0168L16 [2700361]

Facility

$70.21

Service Code	HCPCS A4340
Hospital Charge Code	2700361.0
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$69.51
Rate for Payer: AlohaCare Medicaid	$35.10
Rate for Payer: AlohaCare Medicare	$63.19
Rate for Payer: Cash Price	$45.64
Rate for Payer: Cash Price	$45.64
Rate for Payer: Devoted Health Medicare	$69.51
Rate for Payer: Hawaii Medical Service Association Medicare	$63.19
Rate for Payer: Hawaii Western Management Group Commercial	$66.70
Rate for Payer: Health Management Network Commercial	$59.68
Rate for Payer: Humana Medicare	$63.19
Rate for Payer: Kaiser Permanente Commercial	$63.19
Rate for Payer: Kaiser Permanente Medicaid	$35.81
Rate for Payer: Kaiser Permanente Medicare	$63.19
Rate for Payer: MDX Hawaii PPO	$68.10
Rate for Payer: Ohana Health Plan Medicaid	$63.19
Rate for Payer: Ohana Health Plan Medicare	$63.19
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: UnitedHealthcare Medicare	$63.19
Rate for Payer: University Health Alliance Commercial	$51.18

CATHETER COUDE 18F 0168L18 [2700362]

Facility

$73.19

Service Code	HCPCS A4340
Hospital Charge Code	2700362.0
Hospital Revenue Code	272
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$70.99
Rate for Payer: Cash Price	$47.57
Rate for Payer: Health Management Network Commercial	$62.21
Rate for Payer: Kaiser Permanente Commercial	$65.87
Rate for Payer: MDX Hawaii PPO	$70.99

CATHETER COUDE 18F 0168L18 [2700362]

Facility

$73.19

Service Code	HCPCS A4340
Hospital Charge Code	2700362.0
Hospital Revenue Code	272
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$72.46
Rate for Payer: AlohaCare Medicaid	$36.59
Rate for Payer: AlohaCare Medicare	$65.87
Rate for Payer: Cash Price	$47.57
Rate for Payer: Cash Price	$47.57
Rate for Payer: Devoted Health Medicare	$72.46
Rate for Payer: Hawaii Medical Service Association Medicare	$65.87
Rate for Payer: Hawaii Western Management Group Commercial	$69.53
Rate for Payer: Health Management Network Commercial	$62.21
Rate for Payer: Humana Medicare	$65.87
Rate for Payer: Kaiser Permanente Commercial	$65.87
Rate for Payer: Kaiser Permanente Medicaid	$37.33
Rate for Payer: Kaiser Permanente Medicare	$65.87
Rate for Payer: MDX Hawaii PPO	$70.99
Rate for Payer: Ohana Health Plan Medicaid	$65.87
Rate for Payer: Ohana Health Plan Medicare	$65.87
Rate for Payer: UnitedHealthcare Medicaid	$18.18
Rate for Payer: UnitedHealthcare Medicare	$65.87
Rate for Payer: University Health Alliance Commercial	$53.35

Catheter Foley 22fr 3way 30cc 0167SI22 [2700414]

Facility

$102.17

Service Code	HCPCS A4346
Hospital Charge Code	2700414.0
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$101.15
Rate for Payer: AlohaCare Medicaid	$51.09
Rate for Payer: AlohaCare Medicare	$91.95
Rate for Payer: Cash Price	$66.41
Rate for Payer: Cash Price	$66.41
Rate for Payer: Devoted Health Medicare	$101.15
Rate for Payer: Hawaii Medical Service Association Medicare	$91.95
Rate for Payer: Hawaii Western Management Group Commercial	$97.06
Rate for Payer: Health Management Network Commercial	$86.84
Rate for Payer: Humana Medicare	$91.95
Rate for Payer: Kaiser Permanente Commercial	$91.95
Rate for Payer: Kaiser Permanente Medicaid	$52.11
Rate for Payer: Kaiser Permanente Medicare	$91.95
Rate for Payer: MDX Hawaii PPO	$99.10
Rate for Payer: Ohana Health Plan Medicaid	$91.95
Rate for Payer: Ohana Health Plan Medicare	$91.95
Rate for Payer: UnitedHealthcare Medicaid	$12.30
Rate for Payer: UnitedHealthcare Medicare	$91.95
Rate for Payer: University Health Alliance Commercial	$74.47

Catheter Foley 22fr 3way 30cc 0167SI22 [2700414]

Facility

$102.17

Service Code	HCPCS A4346
Hospital Charge Code	2700414.0
Hospital Revenue Code	272
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$99.10
Rate for Payer: Cash Price	$66.41
Rate for Payer: Health Management Network Commercial	$86.84
Rate for Payer: Kaiser Permanente Commercial	$91.95
Rate for Payer: MDX Hawaii PPO	$99.10

CEFAZOLIN 1 G (50 MG/ML) RECON.SOLN FOR NON-INJ USE

Facility

$7.56

Service Code	NDC 00143992490
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$7.33
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Kaiser Permanente Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.33

Know your out-of-pocket cost for care.

All Charges