Kohala Hospital

All Charges

Charge

Type

Setting

Price

NP CLINDAMYCIN 150 MG #8 CAP (WHR)

Facility

$27.69

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$27.41
Rate for Payer: AlohaCare Medicaid	$13.85
Rate for Payer: AlohaCare Medicare	$24.92
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$27.41
Rate for Payer: Hawaii Medical Service Association Medicare	$24.92
Rate for Payer: Hawaii Western Management Group Commercial	$26.31
Rate for Payer: Health Management Network Commercial	$23.54
Rate for Payer: Humana Medicare	$24.92
Rate for Payer: Kaiser Permanente Commercial	$24.92
Rate for Payer: Kaiser Permanente Medicaid	$14.12
Rate for Payer: Kaiser Permanente Medicare	$24.92
Rate for Payer: MDX Hawaii PPO	$26.86
Rate for Payer: Ohana Health Plan Medicaid	$24.92
Rate for Payer: Ohana Health Plan Medicare	$24.92
Rate for Payer: UnitedHealthcare Medicare	$24.92
Rate for Payer: University Health Alliance Commercial	$20.18

NP CLINDAMYCIN 150 MG #8 CAP (WHR)

Facility

$27.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$26.86
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$23.54
Rate for Payer: Kaiser Permanente Commercial	$24.92
Rate for Payer: MDX Hawaii PPO	$26.86

NP CLINDAMYCIN 300 MG #4 CAP (WHR)

Facility

$28.66

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$28.37
Rate for Payer: AlohaCare Medicaid	$14.33
Rate for Payer: AlohaCare Medicare	$25.79
Rate for Payer: Cash Price	$18.63
Rate for Payer: Devoted Health Medicare	$28.37
Rate for Payer: Hawaii Medical Service Association Medicare	$25.79
Rate for Payer: Hawaii Western Management Group Commercial	$27.23
Rate for Payer: Health Management Network Commercial	$24.36
Rate for Payer: Humana Medicare	$25.79
Rate for Payer: Kaiser Permanente Commercial	$25.79
Rate for Payer: Kaiser Permanente Medicaid	$14.62
Rate for Payer: Kaiser Permanente Medicare	$25.79
Rate for Payer: MDX Hawaii PPO	$27.80
Rate for Payer: Ohana Health Plan Medicaid	$25.79
Rate for Payer: Ohana Health Plan Medicare	$25.79
Rate for Payer: UnitedHealthcare Medicare	$25.79
Rate for Payer: University Health Alliance Commercial	$20.89

NP CLINDAMYCIN 300 MG #4 CAP (WHR)

Facility

$28.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$27.80
Rate for Payer: Cash Price	$18.63
Rate for Payer: Health Management Network Commercial	$24.36
Rate for Payer: Kaiser Permanente Commercial	$25.79
Rate for Payer: MDX Hawaii PPO	$27.80

NP CYCLOBENZAPRINE 10 MG #3 TAB (WHR)

Facility

$3.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.44
Rate for Payer: Cash Price	$2.31
Rate for Payer: Health Management Network Commercial	$3.02
Rate for Payer: Kaiser Permanente Commercial	$3.19
Rate for Payer: MDX Hawaii PPO	$3.44

NP CYCLOBENZAPRINE 10 MG #3 TAB (WHR)

Facility

$3.55

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$3.51
Rate for Payer: AlohaCare Medicaid	$1.77
Rate for Payer: AlohaCare Medicare	$3.19
Rate for Payer: Cash Price	$2.31
Rate for Payer: Devoted Health Medicare	$3.51
Rate for Payer: Hawaii Medical Service Association Medicare	$3.19
Rate for Payer: Hawaii Western Management Group Commercial	$3.37
Rate for Payer: Health Management Network Commercial	$3.02
Rate for Payer: Humana Medicare	$3.19
Rate for Payer: Kaiser Permanente Commercial	$3.19
Rate for Payer: Kaiser Permanente Medicaid	$1.81
Rate for Payer: Kaiser Permanente Medicare	$3.19
Rate for Payer: MDX Hawaii PPO	$3.44
Rate for Payer: Ohana Health Plan Medicaid	$3.19
Rate for Payer: Ohana Health Plan Medicare	$3.19
Rate for Payer: UnitedHealthcare Medicare	$3.19
Rate for Payer: University Health Alliance Commercial	$2.59

NP DIAZEPAM 5 MG #5 TAB (WHR)

Facility

$8.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$5.76
Rate for Payer: Health Management Network Commercial	$7.53
Rate for Payer: Kaiser Permanente Commercial	$7.97
Rate for Payer: MDX Hawaii PPO	$8.59

NP DIAZEPAM 5 MG #5 TAB (WHR)

Facility

$8.86

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$8.77
Rate for Payer: AlohaCare Medicaid	$4.43
Rate for Payer: AlohaCare Medicare	$7.97
Rate for Payer: Cash Price	$5.76
Rate for Payer: Devoted Health Medicare	$8.77
Rate for Payer: Hawaii Medical Service Association Medicare	$7.97
Rate for Payer: Hawaii Western Management Group Commercial	$8.42
Rate for Payer: Health Management Network Commercial	$7.53
Rate for Payer: Humana Medicare	$7.97
Rate for Payer: Kaiser Permanente Commercial	$7.97
Rate for Payer: Kaiser Permanente Medicaid	$4.52
Rate for Payer: Kaiser Permanente Medicare	$7.97
Rate for Payer: MDX Hawaii PPO	$8.59
Rate for Payer: Ohana Health Plan Medicaid	$7.97
Rate for Payer: Ohana Health Plan Medicare	$7.97
Rate for Payer: UnitedHealthcare Medicare	$7.97
Rate for Payer: University Health Alliance Commercial	$6.46

NP DIPHENHYDRAMINE 25 MG #4 CAP (WHR)

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: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

NP DIPHENHYDRAMINE 25 MG #4 CAP (WHR)

Facility

$1.20

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

NP DIPHENHYDRAMINE 50 MG #4 CAP (WHR)

Facility

$1.20

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

NP DIPHENHYDRAMINE 50 MG #4 CAP (WHR)

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: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

NP DOXYCYCLINE 100 MG #2 TAB (WHR)

Facility

$64.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$63.63
Rate for Payer: AlohaCare Medicaid	$32.13
Rate for Payer: AlohaCare Medicare	$57.84
Rate for Payer: Cash Price	$41.78
Rate for Payer: Devoted Health Medicare	$63.63
Rate for Payer: Hawaii Medical Service Association Medicare	$57.84
Rate for Payer: Hawaii Western Management Group Commercial	$61.06
Rate for Payer: Health Management Network Commercial	$54.63
Rate for Payer: Humana Medicare	$57.84
Rate for Payer: Kaiser Permanente Commercial	$57.84
Rate for Payer: Kaiser Permanente Medicaid	$32.78
Rate for Payer: Kaiser Permanente Medicare	$57.84
Rate for Payer: MDX Hawaii PPO	$62.34
Rate for Payer: Ohana Health Plan Medicaid	$57.84
Rate for Payer: Ohana Health Plan Medicare	$57.84
Rate for Payer: UnitedHealthcare Medicare	$57.84
Rate for Payer: University Health Alliance Commercial	$46.85

NP DOXYCYCLINE 100 MG #2 TAB (WHR)

Facility

$64.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$54.63
Max. Negotiated Rate	$62.34
Rate for Payer: Cash Price	$41.78
Rate for Payer: Health Management Network Commercial	$54.63
Rate for Payer: Kaiser Permanente Commercial	$57.84
Rate for Payer: MDX Hawaii PPO	$62.34

NP EPINEPHRINE 0.15 MG/0.15 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1,252.91
Rate for Payer: AlohaCare Medicaid	$632.78
Rate for Payer: AlohaCare Medicare	$1,139.01
Rate for Payer: Cash Price	$822.62
Rate for Payer: Cash Price	$822.62
Rate for Payer: Devoted Health Medicare	$1,252.91
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,139.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,202.29
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: Humana Medicare	$1,139.01
Rate for Payer: Kaiser Permanente Commercial	$1,139.01
Rate for Payer: Kaiser Permanente Medicaid	$645.44
Rate for Payer: Kaiser Permanente Medicare	$1,139.01
Rate for Payer: MDX Hawaii PPO	$1,227.60
Rate for Payer: Ohana Health Plan Medicaid	$1,139.01
Rate for Payer: Ohana Health Plan Medicare	$1,139.01
Rate for Payer: UnitedHealthcare Medicaid	$759.34
Rate for Payer: UnitedHealthcare Medicare	$1,139.01
Rate for Payer: University Health Alliance Commercial	$922.47

NP EPINEPHRINE 0.15 MG/0.15 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$1,075.73
Max. Negotiated Rate	$1,227.60
Rate for Payer: Cash Price	$822.62
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: Kaiser Permanente Commercial	$1,139.01
Rate for Payer: MDX Hawaii PPO	$1,227.60

NP EPINEPHRINE 0.3 MG/0.3 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$1,075.73
Max. Negotiated Rate	$1,227.60
Rate for Payer: Cash Price	$822.62
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: Kaiser Permanente Commercial	$1,139.01
Rate for Payer: MDX Hawaii PPO	$1,227.60

NP EPINEPHRINE 0.3 MG/0.3 ML SYRINGE (EPIPEN) #2 (WHR)

Facility

$1,265.57

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1,252.91
Rate for Payer: AlohaCare Medicaid	$632.78
Rate for Payer: AlohaCare Medicare	$1,139.01
Rate for Payer: Cash Price	$822.62
Rate for Payer: Cash Price	$822.62
Rate for Payer: Devoted Health Medicare	$1,252.91
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,139.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,202.29
Rate for Payer: Health Management Network Commercial	$1,075.73
Rate for Payer: Humana Medicare	$1,139.01
Rate for Payer: Kaiser Permanente Commercial	$1,139.01
Rate for Payer: Kaiser Permanente Medicaid	$645.44
Rate for Payer: Kaiser Permanente Medicare	$1,139.01
Rate for Payer: MDX Hawaii PPO	$1,227.60
Rate for Payer: Ohana Health Plan Medicaid	$1,139.01
Rate for Payer: Ohana Health Plan Medicare	$1,139.01
Rate for Payer: UnitedHealthcare Medicaid	$759.34
Rate for Payer: UnitedHealthcare Medicare	$1,139.01
Rate for Payer: University Health Alliance Commercial	$922.47

NP HYDROCODONE-ACETAMINOPHEN 5-325 MG #5 TAB (WHR)

Facility

$21.95

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$21.73
Rate for Payer: AlohaCare Medicaid	$10.97
Rate for Payer: AlohaCare Medicare	$19.75
Rate for Payer: Cash Price	$14.27
Rate for Payer: Devoted Health Medicare	$21.73
Rate for Payer: Hawaii Medical Service Association Medicare	$19.75
Rate for Payer: Hawaii Western Management Group Commercial	$20.85
Rate for Payer: Health Management Network Commercial	$18.66
Rate for Payer: Humana Medicare	$19.75
Rate for Payer: Kaiser Permanente Commercial	$19.75
Rate for Payer: Kaiser Permanente Medicaid	$11.19
Rate for Payer: Kaiser Permanente Medicare	$19.75
Rate for Payer: MDX Hawaii PPO	$21.29
Rate for Payer: Ohana Health Plan Medicaid	$19.75
Rate for Payer: Ohana Health Plan Medicare	$19.75
Rate for Payer: UnitedHealthcare Medicare	$19.75
Rate for Payer: University Health Alliance Commercial	$16.00

NP HYDROCODONE-ACETAMINOPHEN 5-325 MG #5 TAB (WHR)

Facility

$21.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.66
Max. Negotiated Rate	$21.29
Rate for Payer: Cash Price	$14.27
Rate for Payer: Health Management Network Commercial	$18.66
Rate for Payer: Kaiser Permanente Commercial	$19.75
Rate for Payer: MDX Hawaii PPO	$21.29

NP HYDROXYZINE HCL 25 MG #8 TAB (WHR)

Facility

$11.18

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$11.07
Rate for Payer: AlohaCare Medicaid	$5.59
Rate for Payer: AlohaCare Medicare	$10.06
Rate for Payer: Cash Price	$7.27
Rate for Payer: Devoted Health Medicare	$11.07
Rate for Payer: Hawaii Medical Service Association Medicare	$10.06
Rate for Payer: Hawaii Western Management Group Commercial	$10.62
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Humana Medicare	$10.06
Rate for Payer: Kaiser Permanente Commercial	$10.06
Rate for Payer: Kaiser Permanente Medicaid	$5.70
Rate for Payer: Kaiser Permanente Medicare	$10.06
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: Ohana Health Plan Medicaid	$10.06
Rate for Payer: Ohana Health Plan Medicare	$10.06
Rate for Payer: UnitedHealthcare Medicare	$10.06
Rate for Payer: University Health Alliance Commercial	$8.15

NP HYDROXYZINE HCL 25 MG #8 TAB (WHR)

Facility

$11.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$10.84
Rate for Payer: Cash Price	$7.27
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Kaiser Permanente Commercial	$10.06
Rate for Payer: MDX Hawaii PPO	$10.84

NP IBUPROFEN 400 MG #8 TAB (WHR)

Facility

$3.05

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$3.02
Rate for Payer: AlohaCare Medicaid	$1.52
Rate for Payer: AlohaCare Medicare	$2.75
Rate for Payer: Cash Price	$1.98
Rate for Payer: Devoted Health Medicare	$3.02
Rate for Payer: Hawaii Medical Service Association Medicare	$2.75
Rate for Payer: Hawaii Western Management Group Commercial	$2.90
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: Humana Medicare	$2.75
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: Kaiser Permanente Medicare	$2.75
Rate for Payer: MDX Hawaii PPO	$2.96
Rate for Payer: Ohana Health Plan Medicaid	$2.75
Rate for Payer: Ohana Health Plan Medicare	$2.75
Rate for Payer: UnitedHealthcare Medicare	$2.75
Rate for Payer: University Health Alliance Commercial	$2.22

NP IBUPROFEN 400 MG #8 TAB (WHR)

Facility

$3.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.96
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: MDX Hawaii PPO	$2.96

NP LOPERAMIDE 2 MG #8 CAP (WHR)

Facility

$49.07

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$24.54
Max. Negotiated Rate	$48.58
Rate for Payer: Devoted Health Medicare	$48.58
Rate for Payer: AlohaCare Medicaid	$24.54
Rate for Payer: AlohaCare Medicare	$44.16
Rate for Payer: Cash Price	$31.90
Rate for Payer: Hawaii Medical Service Association Medicare	$44.16
Rate for Payer: Hawaii Western Management Group Commercial	$46.62
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: Humana Medicare	$44.16
Rate for Payer: Kaiser Permanente Commercial	$44.16
Rate for Payer: Kaiser Permanente Medicaid	$25.03
Rate for Payer: Kaiser Permanente Medicare	$44.16
Rate for Payer: MDX Hawaii PPO	$47.60
Rate for Payer: Ohana Health Plan Medicaid	$44.16
Rate for Payer: Ohana Health Plan Medicare	$44.16
Rate for Payer: UnitedHealthcare Medicare	$44.16
Rate for Payer: University Health Alliance Commercial	$35.77

Know your out-of-pocket cost for care.

All Charges