Kohala Hospital

All Charges

Charge

Type

Setting

Price

ORBITAL PROCEDURES WITH CC/MCC

Facility

$19,103.81

Service Code	MSDRG 113
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: University Health Alliance Commercial	$10,400.00

ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$19,103.81

Service Code	MSDRG 114
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: University Health Alliance Commercial	$10,400.00

ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$25,669.27

Service Code	MSDRG 884
Min. Negotiated Rate	$25,669.27
Max. Negotiated Rate	$25,669.27
Rate for Payer: Hawaii Medical Service Association Commercial	$25,669.27

O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$51,717.76

Service Code	MSDRG 620
Min. Negotiated Rate	$51,717.76
Max. Negotiated Rate	$51,717.76
Rate for Payer: Hawaii Medical Service Association Commercial	$51,717.76

O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$51,717.76

Service Code	MSDRG 619
Min. Negotiated Rate	$51,717.76
Max. Negotiated Rate	$51,717.76
Rate for Payer: Hawaii Medical Service Association Commercial	$51,717.76

O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$51,504.45

Service Code	MSDRG 621
Min. Negotiated Rate	$51,504.45
Max. Negotiated Rate	$51,504.45
Rate for Payer: Hawaii Medical Service Association Commercial	$51,504.45

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$38,586.86

Service Code	MSDRG 940
Min. Negotiated Rate	$38,586.86
Max. Negotiated Rate	$38,586.86
Rate for Payer: Hawaii Medical Service Association Commercial	$38,586.86

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$38,586.86

Service Code	MSDRG 939
Min. Negotiated Rate	$38,586.86
Max. Negotiated Rate	$38,586.86
Rate for Payer: Hawaii Medical Service Association Commercial	$38,586.86

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$38,586.86

Service Code	MSDRG 941
Min. Negotiated Rate	$38,586.86
Max. Negotiated Rate	$38,586.86
Rate for Payer: Hawaii Medical Service Association Commercial	$38,586.86

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$85,990.86

Service Code	MSDRG 876
Min. Negotiated Rate	$85,990.86
Max. Negotiated Rate	$85,990.86
Rate for Payer: Hawaii Medical Service Association Commercial	$85,990.86

OSELTAMIVIR 30 MG PO CAP

Facility

$76.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$65.20
Max. Negotiated Rate	$74.41
Rate for Payer: Cash Price	$49.86
Rate for Payer: Health Management Network Commercial	$65.20
Rate for Payer: Kaiser Permanente Commercial	$69.04
Rate for Payer: MDX Hawaii PPO	$74.41

OSELTAMIVIR 30 MG PO CAP

Facility

$76.71

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$75.94
Rate for Payer: AlohaCare Medicaid	$38.35
Rate for Payer: AlohaCare Medicare	$69.04
Rate for Payer: Cash Price	$49.86
Rate for Payer: Devoted Health Medicare	$75.94
Rate for Payer: Hawaii Medical Service Association Medicare	$69.04
Rate for Payer: Hawaii Western Management Group Commercial	$72.87
Rate for Payer: Health Management Network Commercial	$65.20
Rate for Payer: Humana Medicare	$69.04
Rate for Payer: Kaiser Permanente Commercial	$69.04
Rate for Payer: Kaiser Permanente Medicaid	$39.12
Rate for Payer: Kaiser Permanente Medicare	$69.04
Rate for Payer: MDX Hawaii PPO	$74.41
Rate for Payer: Ohana Health Plan Medicaid	$69.04
Rate for Payer: Ohana Health Plan Medicare	$69.04
Rate for Payer: UnitedHealthcare Medicare	$69.04
Rate for Payer: University Health Alliance Commercial	$55.91

OSELTAMIVIR 6 MG/ML PO SUSR (PER BOTTLE) WHR

Facility

$580.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$493.47
Max. Negotiated Rate	$563.13
Rate for Payer: Cash Price	$377.36
Rate for Payer: Cash Price	$376.95
Rate for Payer: Health Management Network Commercial	$493.47
Rate for Payer: Health Management Network Commercial	$492.94
Rate for Payer: Kaiser Permanente Commercial	$522.50
Rate for Payer: Kaiser Permanente Commercial	$521.94
Rate for Payer: MDX Hawaii PPO	$562.53
Rate for Payer: MDX Hawaii PPO	$563.13

OSELTAMIVIR 6 MG/ML PO SUSR (PER BOTTLE) WHR

Facility

$579.93

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$289.96
Max. Negotiated Rate	$574.13
Rate for Payer: AlohaCare Medicaid	$289.96
Rate for Payer: AlohaCare Medicaid	$290.27
Rate for Payer: AlohaCare Medicare	$521.94
Rate for Payer: AlohaCare Medicare	$522.50
Rate for Payer: Cash Price	$377.36
Rate for Payer: Cash Price	$376.95
Rate for Payer: Devoted Health Medicare	$574.13
Rate for Payer: Devoted Health Medicare	$574.74
Rate for Payer: Hawaii Medical Service Association Medicare	$522.50
Rate for Payer: Hawaii Medical Service Association Medicare	$521.94
Rate for Payer: Hawaii Western Management Group Commercial	$551.52
Rate for Payer: Hawaii Western Management Group Commercial	$550.93
Rate for Payer: Health Management Network Commercial	$492.94
Rate for Payer: Health Management Network Commercial	$493.47
Rate for Payer: Humana Medicare	$522.50
Rate for Payer: Humana Medicare	$521.94
Rate for Payer: Kaiser Permanente Commercial	$521.94
Rate for Payer: Kaiser Permanente Commercial	$522.50
Rate for Payer: Kaiser Permanente Medicaid	$296.08
Rate for Payer: Kaiser Permanente Medicaid	$295.76
Rate for Payer: Kaiser Permanente Medicare	$522.50
Rate for Payer: Kaiser Permanente Medicare	$521.94
Rate for Payer: MDX Hawaii PPO	$563.13
Rate for Payer: MDX Hawaii PPO	$562.53
Rate for Payer: Ohana Health Plan Medicaid	$521.94
Rate for Payer: Ohana Health Plan Medicaid	$522.50
Rate for Payer: Ohana Health Plan Medicare	$521.94
Rate for Payer: Ohana Health Plan Medicare	$522.50
Rate for Payer: UnitedHealthcare Medicare	$521.94
Rate for Payer: UnitedHealthcare Medicare	$522.50
Rate for Payer: University Health Alliance Commercial	$423.16
Rate for Payer: University Health Alliance Commercial	$422.71

OSELTAMIVIR 75 MG PO CAP

Facility

$82.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

OSELTAMIVIR 75 MG PO CAP

Facility

$82.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$81.18
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$73.80
Rate for Payer: Cash Price	$53.30
Rate for Payer: Devoted Health Medicare	$81.18
Rate for Payer: Hawaii Medical Service Association Medicare	$73.80
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$73.80
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$73.80
Rate for Payer: Ohana Health Plan Medicare	$73.80
Rate for Payer: UnitedHealthcare Medicare	$73.80
Rate for Payer: University Health Alliance Commercial	$59.77

OSTEOMYELITIS WITH CC

Facility

$39,013.49

Service Code	MSDRG 540
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOMYELITIS WITH MCC

Facility

$39,013.49

Service Code	MSDRG 539
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$39,013.49

Service Code	MSDRG 541
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$10,618.50

Service Code	MSDRG 818
Min. Negotiated Rate	$10,618.50
Max. Negotiated Rate	$10,618.50
Rate for Payer: Hawaii Medical Service Association Commercial	$10,618.50

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$10,618.50

Service Code	MSDRG 817
Min. Negotiated Rate	$10,618.50
Max. Negotiated Rate	$10,618.50
Rate for Payer: Hawaii Medical Service Association Commercial	$10,618.50

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$10,334.07

Service Code	MSDRG 819
Min. Negotiated Rate	$10,334.07
Max. Negotiated Rate	$10,334.07
Rate for Payer: Hawaii Medical Service Association Commercial	$10,334.07

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$9,314.89

Service Code	MSDRG 832
Min. Negotiated Rate	$9,314.89
Max. Negotiated Rate	$9,314.89
Rate for Payer: Hawaii Medical Service Association Commercial	$9,314.89

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$9,314.89

Service Code	MSDRG 831
Min. Negotiated Rate	$9,314.89
Max. Negotiated Rate	$9,314.89
Rate for Payer: Hawaii Medical Service Association Commercial	$9,314.89

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,172.67

Service Code	MSDRG 833
Min. Negotiated Rate	$9,172.67
Max. Negotiated Rate	$9,172.67
Rate for Payer: Hawaii Medical Service Association Commercial	$9,172.67

Know your out-of-pocket cost for care.

All Charges