Kohala Hospital

All Charges

Charge

Type

Setting

Price

NP LOPERAMIDE 2 MG #8 CAP (WHR)

Facility

$49.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$41.71
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$31.90
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: Kaiser Permanente Commercial	$44.16
Rate for Payer: MDX Hawaii PPO	$47.60

NP LORAZEPAM 1 MG #5 TAB (WHR)

Facility

$23.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$22.44
Rate for Payer: Cash Price	$15.03
Rate for Payer: Health Management Network Commercial	$19.66
Rate for Payer: Kaiser Permanente Commercial	$20.82
Rate for Payer: MDX Hawaii PPO	$22.44

NP LORAZEPAM 1 MG #5 TAB (WHR)

Facility

$23.13

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$22.90
Rate for Payer: AlohaCare Medicaid	$11.56
Rate for Payer: AlohaCare Medicare	$20.82
Rate for Payer: Cash Price	$15.03
Rate for Payer: Devoted Health Medicare	$22.90
Rate for Payer: Hawaii Medical Service Association Medicare	$20.82
Rate for Payer: Hawaii Western Management Group Commercial	$21.97
Rate for Payer: Health Management Network Commercial	$19.66
Rate for Payer: Humana Medicare	$20.82
Rate for Payer: Kaiser Permanente Commercial	$20.82
Rate for Payer: Kaiser Permanente Medicaid	$11.80
Rate for Payer: Kaiser Permanente Medicare	$20.82
Rate for Payer: MDX Hawaii PPO	$22.44
Rate for Payer: Ohana Health Plan Medicaid	$20.82
Rate for Payer: Ohana Health Plan Medicare	$20.82
Rate for Payer: UnitedHealthcare Medicare	$20.82
Rate for Payer: University Health Alliance Commercial	$16.86

NP MECLIZINE 25 MG #4 TAB (WHR)

Facility

$18.91

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$18.72
Rate for Payer: AlohaCare Medicaid	$9.46
Rate for Payer: AlohaCare Medicare	$17.02
Rate for Payer: Cash Price	$12.29
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.96
Rate for Payer: Health Management Network Commercial	$16.07
Rate for Payer: Humana Medicare	$17.02
Rate for Payer: Kaiser Permanente Commercial	$17.02
Rate for Payer: Kaiser Permanente Medicaid	$9.64
Rate for Payer: Kaiser Permanente Medicare	$17.02
Rate for Payer: MDX Hawaii PPO	$18.34
Rate for Payer: Ohana Health Plan Medicaid	$17.02
Rate for Payer: Ohana Health Plan Medicare	$17.02
Rate for Payer: UnitedHealthcare Medicare	$17.02
Rate for Payer: University Health Alliance Commercial	$13.78

NP MECLIZINE 25 MG #4 TAB (WHR)

Facility

$18.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$18.34
Rate for Payer: Cash Price	$12.29
Rate for Payer: Health Management Network Commercial	$16.07
Rate for Payer: Kaiser Permanente Commercial	$17.02
Rate for Payer: MDX Hawaii PPO	$18.34

NP MORPHINE 15 MG #4 IR TAB (WHR)

Facility

$20.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$19.48
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Management Network Commercial	$17.07
Rate for Payer: Kaiser Permanente Commercial	$18.07
Rate for Payer: MDX Hawaii PPO	$19.48

NP MORPHINE 15 MG #4 IR TAB (WHR)

Facility

$20.08

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$19.88
Rate for Payer: AlohaCare Medicaid	$10.04
Rate for Payer: AlohaCare Medicare	$18.07
Rate for Payer: Cash Price	$13.05
Rate for Payer: Devoted Health Medicare	$19.88
Rate for Payer: Hawaii Medical Service Association Medicare	$18.07
Rate for Payer: Hawaii Western Management Group Commercial	$19.08
Rate for Payer: Health Management Network Commercial	$17.07
Rate for Payer: Humana Medicare	$18.07
Rate for Payer: Kaiser Permanente Commercial	$18.07
Rate for Payer: Kaiser Permanente Medicaid	$10.24
Rate for Payer: Kaiser Permanente Medicare	$18.07
Rate for Payer: MDX Hawaii PPO	$19.48
Rate for Payer: Ohana Health Plan Medicaid	$18.07
Rate for Payer: Ohana Health Plan Medicare	$18.07
Rate for Payer: UnitedHealthcare Medicare	$18.07
Rate for Payer: University Health Alliance Commercial	$14.64

NP NAPROXEN 250 MG #4 TAB (WHR)

Facility

$17.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$16.66
Rate for Payer: Cash Price	$11.17
Rate for Payer: Health Management Network Commercial	$14.60
Rate for Payer: Kaiser Permanente Commercial	$15.46
Rate for Payer: MDX Hawaii PPO	$16.66

NP NAPROXEN 250 MG #4 TAB (WHR)

Facility

$17.18

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$17.01
Rate for Payer: AlohaCare Medicaid	$8.59
Rate for Payer: AlohaCare Medicare	$15.46
Rate for Payer: Cash Price	$11.17
Rate for Payer: Devoted Health Medicare	$17.01
Rate for Payer: Hawaii Medical Service Association Medicare	$15.46
Rate for Payer: Hawaii Western Management Group Commercial	$16.32
Rate for Payer: Health Management Network Commercial	$14.60
Rate for Payer: Humana Medicare	$15.46
Rate for Payer: Kaiser Permanente Commercial	$15.46
Rate for Payer: Kaiser Permanente Medicaid	$8.76
Rate for Payer: Kaiser Permanente Medicare	$15.46
Rate for Payer: MDX Hawaii PPO	$16.66
Rate for Payer: Ohana Health Plan Medicaid	$15.46
Rate for Payer: Ohana Health Plan Medicare	$15.46
Rate for Payer: UnitedHealthcare Medicare	$15.46
Rate for Payer: University Health Alliance Commercial	$12.52

NP OXYCODONE 5 MG #5 (WHR)

Facility

$9.06

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$8.97
Rate for Payer: AlohaCare Medicaid	$4.53
Rate for Payer: AlohaCare Medicare	$8.15
Rate for Payer: Cash Price	$5.89
Rate for Payer: Devoted Health Medicare	$8.97
Rate for Payer: Hawaii Medical Service Association Medicare	$8.15
Rate for Payer: Hawaii Western Management Group Commercial	$8.61
Rate for Payer: Health Management Network Commercial	$7.70
Rate for Payer: Humana Medicare	$8.15
Rate for Payer: Kaiser Permanente Commercial	$8.15
Rate for Payer: Kaiser Permanente Medicaid	$4.62
Rate for Payer: Kaiser Permanente Medicare	$8.15
Rate for Payer: MDX Hawaii PPO	$8.79
Rate for Payer: Ohana Health Plan Medicaid	$8.15
Rate for Payer: Ohana Health Plan Medicare	$8.15
Rate for Payer: UnitedHealthcare Medicare	$8.15
Rate for Payer: University Health Alliance Commercial	$6.60

NP OXYCODONE 5 MG #5 (WHR)

Facility

$9.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$8.79
Rate for Payer: Cash Price	$5.89
Rate for Payer: Health Management Network Commercial	$7.70
Rate for Payer: Kaiser Permanente Commercial	$8.15
Rate for Payer: MDX Hawaii PPO	$8.79

NP PENICILLIN V POTASSIUM 500 MG #4 TAB (WHR)

Facility

$17.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$16.65
Rate for Payer: Cash Price	$11.15
Rate for Payer: Health Management Network Commercial	$14.59
Rate for Payer: Kaiser Permanente Commercial	$15.44
Rate for Payer: MDX Hawaii PPO	$16.65

NP PENICILLIN V POTASSIUM 500 MG #4 TAB (WHR)

Facility

$17.16

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$16.99
Rate for Payer: AlohaCare Medicaid	$8.58
Rate for Payer: AlohaCare Medicare	$15.44
Rate for Payer: Cash Price	$11.15
Rate for Payer: Devoted Health Medicare	$16.99
Rate for Payer: Hawaii Medical Service Association Medicare	$15.44
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$14.59
Rate for Payer: Humana Medicare	$15.44
Rate for Payer: Kaiser Permanente Commercial	$15.44
Rate for Payer: Kaiser Permanente Medicaid	$8.75
Rate for Payer: Kaiser Permanente Medicare	$15.44
Rate for Payer: MDX Hawaii PPO	$16.65
Rate for Payer: Ohana Health Plan Medicaid	$15.44
Rate for Payer: Ohana Health Plan Medicare	$15.44
Rate for Payer: UnitedHealthcare Medicare	$15.44
Rate for Payer: University Health Alliance Commercial	$12.51

NP PHENAZOPYRIDINE 200 MG #4 TAB (WHR)

Facility

$84.24

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$83.40
Rate for Payer: AlohaCare Medicaid	$42.12
Rate for Payer: AlohaCare Medicare	$75.82
Rate for Payer: Cash Price	$54.76
Rate for Payer: Devoted Health Medicare	$83.40
Rate for Payer: Hawaii Medical Service Association Medicare	$75.82
Rate for Payer: Hawaii Western Management Group Commercial	$80.03
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: Humana Medicare	$75.82
Rate for Payer: Kaiser Permanente Commercial	$75.82
Rate for Payer: Kaiser Permanente Medicaid	$42.96
Rate for Payer: Kaiser Permanente Medicare	$75.82
Rate for Payer: MDX Hawaii PPO	$81.71
Rate for Payer: Ohana Health Plan Medicaid	$75.82
Rate for Payer: Ohana Health Plan Medicare	$75.82
Rate for Payer: UnitedHealthcare Medicare	$75.82
Rate for Payer: University Health Alliance Commercial	$61.40

NP PHENAZOPYRIDINE 200 MG #4 TAB (WHR)

Facility

$84.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$71.60
Max. Negotiated Rate	$81.71
Rate for Payer: Cash Price	$54.76
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: Kaiser Permanente Commercial	$75.82
Rate for Payer: MDX Hawaii PPO	$81.71

NP PREDNISONE 20 MG #4 TAB (WHR)

Facility

$5.72

Service Code	HCPCS J7512
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$5.55
Rate for Payer: Cash Price	$3.72
Rate for Payer: Health Management Network Commercial	$4.86
Rate for Payer: Kaiser Permanente Commercial	$5.15
Rate for Payer: MDX Hawaii PPO	$5.55

NP PREDNISONE 20 MG #4 TAB (WHR)

Facility

$5.72

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$5.66
Rate for Payer: AlohaCare Medicaid	$2.86
Rate for Payer: AlohaCare Medicare	$5.15
Rate for Payer: Cash Price	$3.72
Rate for Payer: Cash Price	$3.72
Rate for Payer: Devoted Health Medicare	$5.66
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$5.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$5.43
Rate for Payer: Health Management Network Commercial	$4.86
Rate for Payer: Humana Medicare	$5.15
Rate for Payer: Kaiser Permanente Commercial	$5.15
Rate for Payer: Kaiser Permanente Medicaid	$2.92
Rate for Payer: Kaiser Permanente Medicare	$5.15
Rate for Payer: MDX Hawaii PPO	$5.55
Rate for Payer: Ohana Health Plan Medicaid	$5.15
Rate for Payer: Ohana Health Plan Medicare	$5.15
Rate for Payer: UnitedHealthcare Medicaid	$3.43
Rate for Payer: UnitedHealthcare Medicare	$5.15
Rate for Payer: University Health Alliance Commercial	$4.17

NP PREDNISONE 50 MG #4 TAB (WHR)

Facility

$8.99

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$8.90
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$8.09
Rate for Payer: Cash Price	$5.84
Rate for Payer: Cash Price	$5.84
Rate for Payer: Devoted Health Medicare	$8.90
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$8.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$8.54
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Humana Medicare	$8.09
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: Kaiser Permanente Medicaid	$4.58
Rate for Payer: Kaiser Permanente Medicare	$8.09
Rate for Payer: MDX Hawaii PPO	$8.72
Rate for Payer: Ohana Health Plan Medicaid	$8.09
Rate for Payer: Ohana Health Plan Medicare	$8.09
Rate for Payer: UnitedHealthcare Medicaid	$5.39
Rate for Payer: UnitedHealthcare Medicare	$8.09
Rate for Payer: University Health Alliance Commercial	$6.55

NP PREDNISONE 50 MG #4 TAB (WHR)

Facility

$8.99

Service Code	HCPCS J7512
Hospital Revenue Code	250
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$8.72
Rate for Payer: Cash Price	$5.84
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: MDX Hawaii PPO	$8.72

NP PROMETHAZINE 25 MG #2 SUPP (WHR)

Facility

$164.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$139.91
Max. Negotiated Rate	$159.66
Rate for Payer: Cash Price	$106.99
Rate for Payer: Health Management Network Commercial	$139.91
Rate for Payer: Kaiser Permanente Commercial	$148.14
Rate for Payer: MDX Hawaii PPO	$159.66

NP PROMETHAZINE 25 MG #2 SUPP (WHR)

Facility

$164.60

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$82.30
Max. Negotiated Rate	$162.95
Rate for Payer: AlohaCare Medicaid	$82.30
Rate for Payer: AlohaCare Medicare	$148.14
Rate for Payer: Cash Price	$106.99
Rate for Payer: Devoted Health Medicare	$162.95
Rate for Payer: Hawaii Medical Service Association Medicare	$148.14
Rate for Payer: Hawaii Western Management Group Commercial	$156.37
Rate for Payer: Health Management Network Commercial	$139.91
Rate for Payer: Humana Medicare	$148.14
Rate for Payer: Kaiser Permanente Commercial	$148.14
Rate for Payer: Kaiser Permanente Medicaid	$83.95
Rate for Payer: Kaiser Permanente Medicare	$148.14
Rate for Payer: MDX Hawaii PPO	$159.66
Rate for Payer: Ohana Health Plan Medicaid	$148.14
Rate for Payer: Ohana Health Plan Medicare	$148.14
Rate for Payer: UnitedHealthcare Medicare	$148.14
Rate for Payer: University Health Alliance Commercial	$119.98

NP PROMETHAZINE 25 MG #5 TAB (WHR)

Facility

$13.97

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$13.83
Rate for Payer: AlohaCare Medicaid	$6.99
Rate for Payer: AlohaCare Medicare	$12.57
Rate for Payer: Cash Price	$9.08
Rate for Payer: Devoted Health Medicare	$13.83
Rate for Payer: Hawaii Medical Service Association Medicare	$12.57
Rate for Payer: Hawaii Western Management Group Commercial	$13.27
Rate for Payer: Health Management Network Commercial	$11.87
Rate for Payer: Humana Medicare	$12.57
Rate for Payer: Kaiser Permanente Commercial	$12.57
Rate for Payer: Kaiser Permanente Medicaid	$7.12
Rate for Payer: Kaiser Permanente Medicare	$12.57
Rate for Payer: MDX Hawaii PPO	$13.55
Rate for Payer: Ohana Health Plan Medicaid	$12.57
Rate for Payer: Ohana Health Plan Medicare	$12.57
Rate for Payer: UnitedHealthcare Medicare	$12.57
Rate for Payer: University Health Alliance Commercial	$10.18

NP PROMETHAZINE 25 MG #5 TAB (WHR)

Facility

$13.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$13.55
Rate for Payer: Cash Price	$9.08
Rate for Payer: Health Management Network Commercial	$11.87
Rate for Payer: Kaiser Permanente Commercial	$12.57
Rate for Payer: MDX Hawaii PPO	$13.55

NP RALTEGRAVIR 400 MG #6 TAB (WHR)

Facility

$672.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$571.61
Max. Negotiated Rate	$652.31
Rate for Payer: Cash Price	$437.11
Rate for Payer: Health Management Network Commercial	$571.61
Rate for Payer: Kaiser Permanente Commercial	$605.23
Rate for Payer: MDX Hawaii PPO	$652.31

NP RALTEGRAVIR 400 MG #6 TAB (WHR)

Facility

$672.48

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$336.24
Max. Negotiated Rate	$665.76
Rate for Payer: Devoted Health Medicare	$665.76
Rate for Payer: AlohaCare Medicaid	$336.24
Rate for Payer: AlohaCare Medicare	$605.23
Rate for Payer: Cash Price	$437.11
Rate for Payer: Hawaii Medical Service Association Medicare	$605.23
Rate for Payer: Hawaii Western Management Group Commercial	$638.86
Rate for Payer: Health Management Network Commercial	$571.61
Rate for Payer: Humana Medicare	$605.23
Rate for Payer: Kaiser Permanente Commercial	$605.23
Rate for Payer: Kaiser Permanente Medicaid	$342.96
Rate for Payer: Kaiser Permanente Medicare	$605.23
Rate for Payer: MDX Hawaii PPO	$652.31
Rate for Payer: Ohana Health Plan Medicaid	$605.23
Rate for Payer: Ohana Health Plan Medicare	$605.23
Rate for Payer: UnitedHealthcare Medicare	$605.23
Rate for Payer: University Health Alliance Commercial	$490.17

Know your out-of-pocket cost for care.

All Charges