Kohala Hospital

All Charges

Charge

Type

Setting

Price

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 360
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE

Facility

$47,996.55

Service Code	MSDRG 318
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$58,093.60

Service Code	MSDRG 041
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$58,093.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,093.60
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$66,057.47

Service Code	MSDRG 040
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$66,057.47
Rate for Payer: Hawaii Medical Service Association Commercial	$66,057.47
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$50,106.03

Service Code	MSDRG 042
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$50,106.03
Rate for Payer: Hawaii Medical Service Association Commercial	$50,106.03
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$24,531.57

Service Code	MSDRG 300
Min. Negotiated Rate	$24,531.57
Max. Negotiated Rate	$24,531.57
Rate for Payer: Hawaii Medical Service Association Commercial	$24,531.57

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$26,024.80

Service Code	MSDRG 299
Min. Negotiated Rate	$26,024.80
Max. Negotiated Rate	$26,024.80
Rate for Payer: Hawaii Medical Service Association Commercial	$26,024.80

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$18,060.92

Service Code	MSDRG 301
Min. Negotiated Rate	$18,060.92
Max. Negotiated Rate	$18,060.92
Rate for Payer: Hawaii Medical Service Association Commercial	$18,060.92

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$53,400.61

Service Code	MSDRG 336
Min. Negotiated Rate	$53,400.61
Max. Negotiated Rate	$53,400.61
Rate for Payer: Hawaii Medical Service Association Commercial	$53,400.61

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$60,416.40

Service Code	MSDRG 335
Min. Negotiated Rate	$60,416.40
Max. Negotiated Rate	$60,416.40
Rate for Payer: Hawaii Medical Service Association Commercial	$60,416.40

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$32,779.87

Service Code	MSDRG 337
Min. Negotiated Rate	$32,779.87
Max. Negotiated Rate	$32,779.87
Rate for Payer: Hawaii Medical Service Association Commercial	$32,779.87

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$53,519.12

Service Code	MSDRG 243
Min. Negotiated Rate	$53,519.12
Max. Negotiated Rate	$53,519.12
Rate for Payer: Hawaii Medical Service Association Commercial	$53,519.12

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$71,580.04

Service Code	MSDRG 242
Min. Negotiated Rate	$71,580.04
Max. Negotiated Rate	$71,580.04
Rate for Payer: Hawaii Medical Service Association Commercial	$71,580.04

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$43,967.21

Service Code	MSDRG 244
Min. Negotiated Rate	$43,967.21
Max. Negotiated Rate	$43,967.21
Rate for Payer: Hawaii Medical Service Association Commercial	$43,967.21

PERMETHRIN 5 % TOP CR

Facility

$485.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$412.26
Max. Negotiated Rate	$470.46
Rate for Payer: Cash Price	$315.26
Rate for Payer: Cash Price	$316.31
Rate for Payer: Health Management Network Commercial	$413.64
Rate for Payer: Health Management Network Commercial	$412.26
Rate for Payer: Kaiser Permanente Commercial	$436.51
Rate for Payer: Kaiser Permanente Commercial	$437.97
Rate for Payer: MDX Hawaii PPO	$470.46
Rate for Payer: MDX Hawaii PPO	$472.03

PERMETHRIN 5 % TOP CR

Facility

$485.01

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$242.50
Max. Negotiated Rate	$480.16
Rate for Payer: AlohaCare Medicaid	$242.50
Rate for Payer: AlohaCare Medicaid	$243.31
Rate for Payer: AlohaCare Medicare	$436.51
Rate for Payer: AlohaCare Medicare	$437.97
Rate for Payer: Cash Price	$315.26
Rate for Payer: Cash Price	$316.31
Rate for Payer: Devoted Health Medicare	$480.16
Rate for Payer: Devoted Health Medicare	$481.76
Rate for Payer: Hawaii Medical Service Association Medicare	$437.97
Rate for Payer: Hawaii Medical Service Association Medicare	$436.51
Rate for Payer: Hawaii Western Management Group Commercial	$462.30
Rate for Payer: Hawaii Western Management Group Commercial	$460.76
Rate for Payer: Health Management Network Commercial	$412.26
Rate for Payer: Health Management Network Commercial	$413.64
Rate for Payer: Humana Medicare	$436.51
Rate for Payer: Humana Medicare	$437.97
Rate for Payer: Kaiser Permanente Commercial	$437.97
Rate for Payer: Kaiser Permanente Commercial	$436.51
Rate for Payer: Kaiser Permanente Medicaid	$247.36
Rate for Payer: Kaiser Permanente Medicaid	$248.18
Rate for Payer: Kaiser Permanente Medicare	$436.51
Rate for Payer: Kaiser Permanente Medicare	$437.97
Rate for Payer: MDX Hawaii PPO	$470.46
Rate for Payer: MDX Hawaii PPO	$472.03
Rate for Payer: Ohana Health Plan Medicaid	$436.51
Rate for Payer: Ohana Health Plan Medicaid	$437.97
Rate for Payer: Ohana Health Plan Medicare	$437.97
Rate for Payer: Ohana Health Plan Medicare	$436.51
Rate for Payer: UnitedHealthcare Medicare	$436.51
Rate for Payer: UnitedHealthcare Medicare	$437.97
Rate for Payer: University Health Alliance Commercial	$353.52
Rate for Payer: University Health Alliance Commercial	$354.70

PERPHENAZINE 4 MG PO TABLET

Facility

$13.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$12.80
Rate for Payer: Cash Price	$8.58
Rate for Payer: Cash Price	$7.55
Rate for Payer: Health Management Network Commercial	$11.22
Rate for Payer: Health Management Network Commercial	$9.88
Rate for Payer: Kaiser Permanente Commercial	$11.88
Rate for Payer: Kaiser Permanente Commercial	$10.46
Rate for Payer: MDX Hawaii PPO	$11.27
Rate for Payer: MDX Hawaii PPO	$12.80

PERPHENAZINE 4 MG PO TABLET

Facility

$11.62

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$11.50
Rate for Payer: Devoted Health Medicare	$13.07
Rate for Payer: AlohaCare Medicaid	$5.81
Rate for Payer: AlohaCare Medicaid	$6.60
Rate for Payer: AlohaCare Medicare	$10.46
Rate for Payer: AlohaCare Medicare	$11.88
Rate for Payer: Cash Price	$8.58
Rate for Payer: Cash Price	$7.55
Rate for Payer: Devoted Health Medicare	$11.50
Rate for Payer: Hawaii Medical Service Association Medicare	$11.88
Rate for Payer: Hawaii Medical Service Association Medicare	$10.46
Rate for Payer: Hawaii Western Management Group Commercial	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$11.04
Rate for Payer: Health Management Network Commercial	$9.88
Rate for Payer: Health Management Network Commercial	$11.22
Rate for Payer: Humana Medicare	$11.88
Rate for Payer: Humana Medicare	$10.46
Rate for Payer: Kaiser Permanente Commercial	$10.46
Rate for Payer: Kaiser Permanente Commercial	$11.88
Rate for Payer: Kaiser Permanente Medicaid	$6.73
Rate for Payer: Kaiser Permanente Medicaid	$5.93
Rate for Payer: Kaiser Permanente Medicare	$11.88
Rate for Payer: Kaiser Permanente Medicare	$10.46
Rate for Payer: MDX Hawaii PPO	$12.80
Rate for Payer: MDX Hawaii PPO	$11.27
Rate for Payer: Ohana Health Plan Medicaid	$10.46
Rate for Payer: Ohana Health Plan Medicaid	$11.88
Rate for Payer: Ohana Health Plan Medicare	$10.46
Rate for Payer: Ohana Health Plan Medicare	$11.88
Rate for Payer: UnitedHealthcare Medicare	$10.46
Rate for Payer: UnitedHealthcare Medicare	$11.88
Rate for Payer: University Health Alliance Commercial	$9.62
Rate for Payer: University Health Alliance Commercial	$8.47

PHENAZOPYRIDINE 100 MG PO TABLET

Facility

$14.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
Rate for Payer: Health Management Network Commercial	$12.67
Rate for Payer: Kaiser Permanente Commercial	$13.42
Rate for Payer: MDX Hawaii PPO	$14.46

PHENAZOPYRIDINE 100 MG PO TABLET

Facility

$14.91

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$14.76
Rate for Payer: AlohaCare Medicaid	$7.46
Rate for Payer: AlohaCare Medicare	$13.42
Rate for Payer: Cash Price	$9.69
Rate for Payer: Devoted Health Medicare	$14.76
Rate for Payer: Hawaii Medical Service Association Medicare	$13.42
Rate for Payer: Hawaii Western Management Group Commercial	$14.16
Rate for Payer: Health Management Network Commercial	$12.67
Rate for Payer: Humana Medicare	$13.42
Rate for Payer: Kaiser Permanente Commercial	$13.42
Rate for Payer: Kaiser Permanente Medicaid	$7.60
Rate for Payer: Kaiser Permanente Medicare	$13.42
Rate for Payer: MDX Hawaii PPO	$14.46
Rate for Payer: Ohana Health Plan Medicaid	$13.42
Rate for Payer: Ohana Health Plan Medicare	$13.42
Rate for Payer: UnitedHealthcare Medicare	$13.42
Rate for Payer: University Health Alliance Commercial	$10.87

PHENAZOPYRIDINE 200 MG PO TABLET

Facility

$22.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: Kaiser Permanente Commercial	$19.87
Rate for Payer: MDX Hawaii PPO	$21.42

PHENAZOPYRIDINE 200 MG PO TABLET

Facility

$22.08

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$21.86
Rate for Payer: AlohaCare Medicaid	$11.04
Rate for Payer: AlohaCare Medicare	$19.87
Rate for Payer: Cash Price	$14.35
Rate for Payer: Devoted Health Medicare	$21.86
Rate for Payer: Hawaii Medical Service Association Medicare	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$20.98
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: Humana Medicare	$19.87
Rate for Payer: Kaiser Permanente Commercial	$19.87
Rate for Payer: Kaiser Permanente Medicaid	$11.26
Rate for Payer: Kaiser Permanente Medicare	$19.87
Rate for Payer: MDX Hawaii PPO	$21.42
Rate for Payer: Ohana Health Plan Medicaid	$19.87
Rate for Payer: Ohana Health Plan Medicare	$19.87
Rate for Payer: UnitedHealthcare Medicare	$19.87
Rate for Payer: University Health Alliance Commercial	$16.09

PHENOBARBITAL 32.4 MG PO TABLET

Facility

$3.70

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.66
Rate for Payer: AlohaCare Medicaid	$1.85
Rate for Payer: AlohaCare Medicare	$3.33
Rate for Payer: Cash Price	$2.41
Rate for Payer: Devoted Health Medicare	$3.66
Rate for Payer: Hawaii Medical Service Association Medicare	$3.33
Rate for Payer: Hawaii Western Management Group Commercial	$3.52
Rate for Payer: Health Management Network Commercial	$3.15
Rate for Payer: Humana Medicare	$3.33
Rate for Payer: Kaiser Permanente Commercial	$3.33
Rate for Payer: Kaiser Permanente Medicaid	$1.89
Rate for Payer: Kaiser Permanente Medicare	$3.33
Rate for Payer: MDX Hawaii PPO	$3.59
Rate for Payer: Ohana Health Plan Medicaid	$3.33
Rate for Payer: Ohana Health Plan Medicare	$3.33
Rate for Payer: UnitedHealthcare Medicare	$3.33
Rate for Payer: University Health Alliance Commercial	$2.70

PHENOBARBITAL 32.4 MG PO TABLET

Facility

$3.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.59
Rate for Payer: Cash Price	$2.41
Rate for Payer: Health Management Network Commercial	$3.15
Rate for Payer: Kaiser Permanente Commercial	$3.33
Rate for Payer: MDX Hawaii PPO	$3.59

PHENOBARBITAL SODIUM 130 MG/ML INJ SOLN

Facility

$208.44

Service Code	HCPCS J2560
Hospital Revenue Code	250
Min. Negotiated Rate	$177.17
Max. Negotiated Rate	$202.19
Rate for Payer: Cash Price	$135.49
Rate for Payer: Health Management Network Commercial	$177.17
Rate for Payer: Kaiser Permanente Commercial	$187.60
Rate for Payer: MDX Hawaii PPO	$202.19

Know your out-of-pocket cost for care.

All Charges