Kohala Hospital

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$152,759.39

Service Code	MSDRG 957
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$152,759.39

Service Code	MSDRG 959
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$42,260.67

Service Code	MSDRG 803
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$42,260.67

Service Code	MSDRG 802
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$42,260.67

Service Code	MSDRG 804
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$20,454.83

Service Code	MSDRG 205
Min. Negotiated Rate	$20,454.83
Max. Negotiated Rate	$20,454.83
Rate for Payer: Hawaii Medical Service Association Commercial	$20,454.83

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$17,634.29

Service Code	MSDRG 206
Min. Negotiated Rate	$17,634.29
Max. Negotiated Rate	$17,634.29
Rate for Payer: Hawaii Medical Service Association Commercial	$17,634.29

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$60,511.21

Service Code	MSDRG 167
Min. Negotiated Rate	$60,511.21
Max. Negotiated Rate	$60,511.21
Rate for Payer: Hawaii Medical Service Association Commercial	$60,511.21

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$63,497.66

Service Code	MSDRG 166
Min. Negotiated Rate	$63,497.66
Max. Negotiated Rate	$63,497.66
Rate for Payer: Hawaii Medical Service Association Commercial	$63,497.66

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,232.45

Service Code	MSDRG 168
Min. Negotiated Rate	$43,232.45
Max. Negotiated Rate	$43,232.45
Rate for Payer: Hawaii Medical Service Association Commercial	$43,232.45

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$29,295.67

Service Code	MSDRG 580
Min. Negotiated Rate	$29,295.67
Max. Negotiated Rate	$29,295.67
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$46,811.45

Service Code	MSDRG 579
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,057.53

Service Code	MSDRG 581
Min. Negotiated Rate	$24,057.53
Max. Negotiated Rate	$24,057.53
Rate for Payer: Hawaii Medical Service Association Commercial	$24,057.53

OTHER VASCULAR PROCEDURES WITH CC

Facility

$67,550.70

Service Code	MSDRG 253
Min. Negotiated Rate	$67,550.70
Max. Negotiated Rate	$67,550.70
Rate for Payer: Hawaii Medical Service Association Commercial	$67,550.70

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$71,911.87

Service Code	MSDRG 252
Min. Negotiated Rate	$71,911.87
Max. Negotiated Rate	$71,911.87
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$48,826.12

Service Code	MSDRG 254
Min. Negotiated Rate	$48,826.12
Max. Negotiated Rate	$48,826.12
Rate for Payer: Hawaii Medical Service Association Commercial	$48,826.12

OTITIS MEDIA AND URI WITH MCC

Facility

$12,182.83

Service Code	MSDRG 152
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$10,547.39

Service Code	MSDRG 153
Min. Negotiated Rate	$10,547.39
Max. Negotiated Rate	$10,547.39
Rate for Payer: Hawaii Medical Service Association Commercial	$10,547.39

OXCARBAZEPINE 300 MG PO TAB (0.5 TAB) = 150 MG

Facility

$14.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$13.98
Rate for Payer: Cash Price	$9.37
Rate for Payer: Health Management Network Commercial	$12.25
Rate for Payer: Kaiser Permanente Commercial	$12.97
Rate for Payer: MDX Hawaii PPO	$13.98

OXCARBAZEPINE 300 MG PO TAB (0.5 TAB) = 150 MG

Facility

$14.41

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$14.27
Rate for Payer: AlohaCare Medicaid	$7.21
Rate for Payer: AlohaCare Medicare	$12.97
Rate for Payer: Cash Price	$9.37
Rate for Payer: Devoted Health Medicare	$14.27
Rate for Payer: Hawaii Medical Service Association Medicare	$12.97
Rate for Payer: Hawaii Western Management Group Commercial	$13.69
Rate for Payer: Health Management Network Commercial	$12.25
Rate for Payer: Humana Medicare	$12.97
Rate for Payer: Kaiser Permanente Commercial	$12.97
Rate for Payer: Kaiser Permanente Medicaid	$7.35
Rate for Payer: Kaiser Permanente Medicare	$12.97
Rate for Payer: MDX Hawaii PPO	$13.98
Rate for Payer: Ohana Health Plan Medicaid	$12.97
Rate for Payer: Ohana Health Plan Medicare	$12.97
Rate for Payer: UnitedHealthcare Medicare	$12.97
Rate for Payer: University Health Alliance Commercial	$10.50

OXCARBAZEPINE 300 MG PO TABLET

Facility

$4.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$4.52
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cash Price	$9.89
Rate for Payer: Cash Price	$9.37
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Health Management Network Commercial	$12.25
Rate for Payer: Health Management Network Commercial	$12.93
Rate for Payer: Kaiser Permanente Commercial	$13.69
Rate for Payer: Kaiser Permanente Commercial	$12.97
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: MDX Hawaii PPO	$14.75
Rate for Payer: MDX Hawaii PPO	$13.98
Rate for Payer: MDX Hawaii PPO	$4.52

OXCARBAZEPINE 300 MG PO TABLET

Facility

$4.66

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$4.61
Rate for Payer: AlohaCare Medicaid	$2.33
Rate for Payer: AlohaCare Medicaid	$7.21
Rate for Payer: AlohaCare Medicaid	$7.61
Rate for Payer: AlohaCare Medicare	$12.97
Rate for Payer: AlohaCare Medicare	$4.19
Rate for Payer: AlohaCare Medicare	$13.69
Rate for Payer: Cash Price	$9.89
Rate for Payer: Cash Price	$9.37
Rate for Payer: Cash Price	$3.03
Rate for Payer: Devoted Health Medicare	$15.06
Rate for Payer: Devoted Health Medicare	$14.27
Rate for Payer: Devoted Health Medicare	$4.61
Rate for Payer: Hawaii Medical Service Association Medicare	$12.97
Rate for Payer: Hawaii Medical Service Association Medicare	$13.69
Rate for Payer: Hawaii Medical Service Association Medicare	$4.19
Rate for Payer: Hawaii Western Management Group Commercial	$14.45
Rate for Payer: Hawaii Western Management Group Commercial	$4.43
Rate for Payer: Hawaii Western Management Group Commercial	$13.69
Rate for Payer: Health Management Network Commercial	$12.25
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Health Management Network Commercial	$12.93
Rate for Payer: Humana Medicare	$12.97
Rate for Payer: Humana Medicare	$13.69
Rate for Payer: Humana Medicare	$4.19
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: Kaiser Permanente Commercial	$12.97
Rate for Payer: Kaiser Permanente Commercial	$13.69
Rate for Payer: Kaiser Permanente Medicaid	$7.35
Rate for Payer: Kaiser Permanente Medicaid	$2.38
Rate for Payer: Kaiser Permanente Medicaid	$7.76
Rate for Payer: Kaiser Permanente Medicare	$12.97
Rate for Payer: Kaiser Permanente Medicare	$4.19
Rate for Payer: Kaiser Permanente Medicare	$13.69
Rate for Payer: MDX Hawaii PPO	$4.52
Rate for Payer: MDX Hawaii PPO	$14.75
Rate for Payer: MDX Hawaii PPO	$13.98
Rate for Payer: Ohana Health Plan Medicaid	$12.97
Rate for Payer: Ohana Health Plan Medicaid	$13.69
Rate for Payer: Ohana Health Plan Medicaid	$4.19
Rate for Payer: Ohana Health Plan Medicare	$12.97
Rate for Payer: Ohana Health Plan Medicare	$13.69
Rate for Payer: Ohana Health Plan Medicare	$4.19
Rate for Payer: UnitedHealthcare Medicare	$13.69
Rate for Payer: UnitedHealthcare Medicare	$4.19
Rate for Payer: UnitedHealthcare Medicare	$12.97
Rate for Payer: University Health Alliance Commercial	$3.40
Rate for Payer: University Health Alliance Commercial	$10.50
Rate for Payer: University Health Alliance Commercial	$11.09

OXCARBAZEPINE 600 MG PO TABLET

Facility

$27.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$27.11
Rate for Payer: Cash Price	$18.17
Rate for Payer: Health Management Network Commercial	$23.76
Rate for Payer: Kaiser Permanente Commercial	$25.16
Rate for Payer: MDX Hawaii PPO	$27.11

OXCARBAZEPINE 600 MG PO TABLET

Facility

$27.95

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$27.67
Rate for Payer: AlohaCare Medicaid	$13.97
Rate for Payer: AlohaCare Medicare	$25.16
Rate for Payer: Cash Price	$18.17
Rate for Payer: Devoted Health Medicare	$27.67
Rate for Payer: Hawaii Medical Service Association Medicare	$25.16
Rate for Payer: Hawaii Western Management Group Commercial	$26.55
Rate for Payer: Health Management Network Commercial	$23.76
Rate for Payer: Humana Medicare	$25.16
Rate for Payer: Kaiser Permanente Commercial	$25.16
Rate for Payer: Kaiser Permanente Medicaid	$14.25
Rate for Payer: Kaiser Permanente Medicare	$25.16
Rate for Payer: MDX Hawaii PPO	$27.11
Rate for Payer: Ohana Health Plan Medicaid	$25.16
Rate for Payer: Ohana Health Plan Medicare	$25.16
Rate for Payer: UnitedHealthcare Medicare	$25.16
Rate for Payer: University Health Alliance Commercial	$20.37

OXYBUTYNIN CHLORIDE 5 MG PO TABLET

Facility

$2.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.35
Rate for Payer: Cash Price	$1.57
Rate for Payer: Health Management Network Commercial	$2.06
Rate for Payer: Kaiser Permanente Commercial	$2.18
Rate for Payer: MDX Hawaii PPO	$2.35

Know your out-of-pocket cost for care.

All Charges