Kohala Hospital

All Charges

Charge

Type

Setting

Price

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$21,545.12

Service Code	MSDRG 863
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$37,899.50

Service Code	MSDRG 857
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$37,899.50

Service Code	MSDRG 856
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,899.50

Service Code	MSDRG 858
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$25,124.12

Service Code	MSDRG 769
Min. Negotiated Rate	$25,124.12
Max. Negotiated Rate	$25,124.12
Rate for Payer: Hawaii Medical Service Association Commercial	$25,124.12

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$9,599.31

Service Code	MSDRG 776
Min. Negotiated Rate	$9,599.31
Max. Negotiated Rate	$9,599.31
Rate for Payer: Hawaii Medical Service Association Commercial	$9,599.31

POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP

Facility

$43.46

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$43.03
Rate for Payer: AlohaCare Medicaid	$21.73
Rate for Payer: AlohaCare Medicaid	$28.98
Rate for Payer: AlohaCare Medicare	$39.11
Rate for Payer: AlohaCare Medicare	$52.16
Rate for Payer: Cash Price	$37.67
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$37.67
Rate for Payer: Devoted Health Medicare	$43.03
Rate for Payer: Devoted Health Medicare	$57.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$39.11
Rate for Payer: Hawaii Medical Service Association Medicare	$52.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Hawaii Western Management Group Commercial	$55.06
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Humana Medicare	$39.11
Rate for Payer: Humana Medicare	$52.16
Rate for Payer: Kaiser Permanente Commercial	$52.16
Rate for Payer: Kaiser Permanente Commercial	$39.11
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: Kaiser Permanente Medicaid	$29.56
Rate for Payer: Kaiser Permanente Medicare	$39.11
Rate for Payer: Kaiser Permanente Medicare	$52.16
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: Ohana Health Plan Medicaid	$52.16
Rate for Payer: Ohana Health Plan Medicaid	$39.11
Rate for Payer: Ohana Health Plan Medicare	$39.11
Rate for Payer: Ohana Health Plan Medicare	$52.16
Rate for Payer: UnitedHealthcare Medicaid	$34.78
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: UnitedHealthcare Medicare	$39.11
Rate for Payer: UnitedHealthcare Medicare	$52.16
Rate for Payer: University Health Alliance Commercial	$31.68
Rate for Payer: University Health Alliance Commercial	$42.25

POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP

Facility

$43.46

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$37.67
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Kaiser Permanente Commercial	$39.11
Rate for Payer: Kaiser Permanente Commercial	$52.16
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: MDX Hawaii PPO	$42.16

POTASSIUM CHLORIDE 10 MEQ PO CAP SR

Facility

$5.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$5.47
Rate for Payer: Cash Price	$3.67
Rate for Payer: Health Management Network Commercial	$4.79
Rate for Payer: Kaiser Permanente Commercial	$5.08
Rate for Payer: MDX Hawaii PPO	$5.47

POTASSIUM CHLORIDE 10 MEQ PO CAP SR

Facility

$5.64

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$5.58
Rate for Payer: AlohaCare Medicaid	$2.82
Rate for Payer: AlohaCare Medicare	$5.08
Rate for Payer: Cash Price	$3.67
Rate for Payer: Devoted Health Medicare	$5.58
Rate for Payer: Hawaii Medical Service Association Medicare	$5.08
Rate for Payer: Hawaii Western Management Group Commercial	$5.36
Rate for Payer: Health Management Network Commercial	$4.79
Rate for Payer: Humana Medicare	$5.08
Rate for Payer: Kaiser Permanente Commercial	$5.08
Rate for Payer: Kaiser Permanente Medicaid	$2.88
Rate for Payer: Kaiser Permanente Medicare	$5.08
Rate for Payer: MDX Hawaii PPO	$5.47
Rate for Payer: Ohana Health Plan Medicaid	$5.08
Rate for Payer: Ohana Health Plan Medicare	$5.08
Rate for Payer: UnitedHealthcare Medicare	$5.08
Rate for Payer: University Health Alliance Commercial	$4.11

POTASSIUM CHLORIDE 20 MEQ PO EXTENDED RELEASE TAB

Facility

$3.47

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.44
Rate for Payer: AlohaCare Medicaid	$1.74
Rate for Payer: AlohaCare Medicare	$3.12
Rate for Payer: Cash Price	$2.26
Rate for Payer: Devoted Health Medicare	$3.44
Rate for Payer: Hawaii Medical Service Association Medicare	$3.12
Rate for Payer: Hawaii Western Management Group Commercial	$3.30
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: Humana Medicare	$3.12
Rate for Payer: Kaiser Permanente Commercial	$3.12
Rate for Payer: Kaiser Permanente Medicaid	$1.77
Rate for Payer: Kaiser Permanente Medicare	$3.12
Rate for Payer: MDX Hawaii PPO	$3.37
Rate for Payer: Ohana Health Plan Medicaid	$3.12
Rate for Payer: Ohana Health Plan Medicare	$3.12
Rate for Payer: UnitedHealthcare Medicare	$3.12
Rate for Payer: University Health Alliance Commercial	$2.53

POTASSIUM CHLORIDE 20 MEQ PO EXTENDED RELEASE TAB

Facility

$3.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$3.37
Rate for Payer: Cash Price	$2.26
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: Kaiser Permanente Commercial	$3.12
Rate for Payer: MDX Hawaii PPO	$3.37

POTASSIUM CHLORIDE 20 MEQ PO PKT

Facility

$58.95

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$29.48
Max. Negotiated Rate	$58.36
Rate for Payer: AlohaCare Medicaid	$29.48
Rate for Payer: AlohaCare Medicaid	$4.31
Rate for Payer: AlohaCare Medicare	$53.05
Rate for Payer: AlohaCare Medicare	$7.76
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$38.32
Rate for Payer: Devoted Health Medicare	$58.36
Rate for Payer: Devoted Health Medicare	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$7.76
Rate for Payer: Hawaii Medical Service Association Medicare	$53.05
Rate for Payer: Hawaii Western Management Group Commercial	$8.19
Rate for Payer: Hawaii Western Management Group Commercial	$56.00
Rate for Payer: Health Management Network Commercial	$50.11
Rate for Payer: Health Management Network Commercial	$7.33
Rate for Payer: Humana Medicare	$7.76
Rate for Payer: Humana Medicare	$53.05
Rate for Payer: Kaiser Permanente Commercial	$53.05
Rate for Payer: Kaiser Permanente Commercial	$7.76
Rate for Payer: Kaiser Permanente Medicaid	$4.40
Rate for Payer: Kaiser Permanente Medicaid	$30.06
Rate for Payer: Kaiser Permanente Medicare	$7.76
Rate for Payer: Kaiser Permanente Medicare	$53.05
Rate for Payer: MDX Hawaii PPO	$8.36
Rate for Payer: MDX Hawaii PPO	$57.18
Rate for Payer: Ohana Health Plan Medicaid	$53.05
Rate for Payer: Ohana Health Plan Medicaid	$7.76
Rate for Payer: Ohana Health Plan Medicare	$53.05
Rate for Payer: Ohana Health Plan Medicare	$7.76
Rate for Payer: UnitedHealthcare Medicare	$53.05
Rate for Payer: UnitedHealthcare Medicare	$7.76
Rate for Payer: University Health Alliance Commercial	$6.28
Rate for Payer: University Health Alliance Commercial	$42.97

POTASSIUM CHLORIDE 20 MEQ PO PKT

Facility

$8.62

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$8.36
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$38.32
Rate for Payer: Health Management Network Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$50.11
Rate for Payer: Kaiser Permanente Commercial	$7.76
Rate for Payer: Kaiser Permanente Commercial	$53.05
Rate for Payer: MDX Hawaii PPO	$57.18
Rate for Payer: MDX Hawaii PPO	$8.36

POTASSIUM CHLORIDE-D5-0.2%NACL 20 MEQ/L IV SOLP

Facility

$48.29

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$47.81
Rate for Payer: AlohaCare Medicaid	$24.14
Rate for Payer: AlohaCare Medicare	$43.46
Rate for Payer: Cash Price	$31.39
Rate for Payer: Cash Price	$31.39
Rate for Payer: Devoted Health Medicare	$47.81
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$43.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$45.88
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Humana Medicare	$43.46
Rate for Payer: Kaiser Permanente Commercial	$43.46
Rate for Payer: Kaiser Permanente Medicaid	$24.63
Rate for Payer: Kaiser Permanente Medicare	$43.46
Rate for Payer: MDX Hawaii PPO	$46.84
Rate for Payer: Ohana Health Plan Medicaid	$43.46
Rate for Payer: Ohana Health Plan Medicare	$43.46
Rate for Payer: UnitedHealthcare Medicaid	$28.97
Rate for Payer: UnitedHealthcare Medicare	$43.46
Rate for Payer: University Health Alliance Commercial	$35.20

POTASSIUM CHLORIDE-D5-0.2%NACL 20 MEQ/L IV SOLP

Facility

$48.29

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$46.84
Rate for Payer: Cash Price	$31.39
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Kaiser Permanente Commercial	$43.46
Rate for Payer: MDX Hawaii PPO	$46.84

POTASSIUM CHLORIDE IN 5 % DEX 20 MEQ/L IV SOLP

Facility

$27.60

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$26.77
Rate for Payer: Cash Price	$17.94
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: Kaiser Permanente Commercial	$24.84
Rate for Payer: MDX Hawaii PPO	$26.77

POTASSIUM CHLORIDE IN 5 % DEX 20 MEQ/L IV SOLP

Facility

$27.60

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$27.32
Rate for Payer: AlohaCare Medicaid	$13.80
Rate for Payer: AlohaCare Medicare	$24.84
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$17.94
Rate for Payer: Devoted Health Medicare	$27.32
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$24.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$26.22
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: Humana Medicare	$24.84
Rate for Payer: Kaiser Permanente Commercial	$24.84
Rate for Payer: Kaiser Permanente Medicaid	$14.08
Rate for Payer: Kaiser Permanente Medicare	$24.84
Rate for Payer: MDX Hawaii PPO	$26.77
Rate for Payer: Ohana Health Plan Medicaid	$24.84
Rate for Payer: Ohana Health Plan Medicare	$24.84
Rate for Payer: UnitedHealthcare Medicaid	$16.56
Rate for Payer: UnitedHealthcare Medicare	$24.84
Rate for Payer: University Health Alliance Commercial	$20.12

POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV IVPB

Facility

$21.53

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$20.88
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cash Price	$17.58
Rate for Payer: Health Management Network Commercial	$18.30
Rate for Payer: Health Management Network Commercial	$22.99
Rate for Payer: Kaiser Permanente Commercial	$19.38
Rate for Payer: Kaiser Permanente Commercial	$24.34
Rate for Payer: MDX Hawaii PPO	$26.24
Rate for Payer: MDX Hawaii PPO	$20.88

POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV IVPB

Facility

$21.53

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$21.31
Rate for Payer: AlohaCare Medicaid	$10.77
Rate for Payer: AlohaCare Medicaid	$13.53
Rate for Payer: AlohaCare Medicare	$24.34
Rate for Payer: AlohaCare Medicare	$19.38
Rate for Payer: Cash Price	$17.58
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cash Price	$17.58
Rate for Payer: Devoted Health Medicare	$21.31
Rate for Payer: Devoted Health Medicare	$26.78
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$24.34
Rate for Payer: Hawaii Medical Service Association Medicare	$19.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$20.45
Rate for Payer: Hawaii Western Management Group Commercial	$25.70
Rate for Payer: Health Management Network Commercial	$22.99
Rate for Payer: Health Management Network Commercial	$18.30
Rate for Payer: Humana Medicare	$19.38
Rate for Payer: Humana Medicare	$24.34
Rate for Payer: Kaiser Permanente Commercial	$19.38
Rate for Payer: Kaiser Permanente Commercial	$24.34
Rate for Payer: Kaiser Permanente Medicaid	$13.80
Rate for Payer: Kaiser Permanente Medicaid	$10.98
Rate for Payer: Kaiser Permanente Medicare	$19.38
Rate for Payer: Kaiser Permanente Medicare	$24.34
Rate for Payer: MDX Hawaii PPO	$20.88
Rate for Payer: MDX Hawaii PPO	$26.24
Rate for Payer: Ohana Health Plan Medicaid	$24.34
Rate for Payer: Ohana Health Plan Medicaid	$19.38
Rate for Payer: Ohana Health Plan Medicare	$19.38
Rate for Payer: Ohana Health Plan Medicare	$24.34
Rate for Payer: UnitedHealthcare Medicaid	$16.23
Rate for Payer: UnitedHealthcare Medicaid	$12.92
Rate for Payer: UnitedHealthcare Medicare	$19.38
Rate for Payer: UnitedHealthcare Medicare	$24.34
Rate for Payer: University Health Alliance Commercial	$15.69
Rate for Payer: University Health Alliance Commercial	$19.72

POTASSIUM CHLORIDE IN WATER 20 MEQ/100 ML IV IVPB

Facility

$14.91

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
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: Cash Price	$9.69
Rate for Payer: Devoted Health Medicare	$14.76
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$13.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
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 Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$13.42
Rate for Payer: University Health Alliance Commercial	$10.87

POTASSIUM CHLORIDE IN WATER 20 MEQ/100 ML IV IVPB

Facility

$14.91

Service Code	HCPCS J3480
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

POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG PO PWPK

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.98
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.71
Rate for Payer: Cash Price	$1.96
Rate for Payer: Devoted Health Medicare	$2.98
Rate for Payer: Hawaii Medical Service Association Medicare	$2.71
Rate for Payer: Hawaii Western Management Group Commercial	$2.86
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: Humana Medicare	$2.71
Rate for Payer: Kaiser Permanente Commercial	$2.71
Rate for Payer: Kaiser Permanente Medicaid	$1.54
Rate for Payer: Kaiser Permanente Medicare	$2.71
Rate for Payer: MDX Hawaii PPO	$2.92
Rate for Payer: Ohana Health Plan Medicaid	$2.71
Rate for Payer: Ohana Health Plan Medicare	$2.71
Rate for Payer: UnitedHealthcare Medicare	$2.71
Rate for Payer: University Health Alliance Commercial	$2.19

POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG PO PWPK

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.96
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: Kaiser Permanente Commercial	$2.71
Rate for Payer: MDX Hawaii PPO	$2.92

POVIDONE-IODINE 10 % TOP SOLN

Facility

$11.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$11.61
Rate for Payer: AlohaCare Medicaid	$5.87
Rate for Payer: AlohaCare Medicare	$10.56
Rate for Payer: Cash Price	$7.62
Rate for Payer: Devoted Health Medicare	$11.61
Rate for Payer: Hawaii Medical Service Association Medicare	$10.56
Rate for Payer: Hawaii Western Management Group Commercial	$11.14
Rate for Payer: Health Management Network Commercial	$9.97
Rate for Payer: Humana Medicare	$10.56
Rate for Payer: Kaiser Permanente Commercial	$10.56
Rate for Payer: Kaiser Permanente Medicaid	$5.98
Rate for Payer: Kaiser Permanente Medicare	$10.56
Rate for Payer: MDX Hawaii PPO	$11.38
Rate for Payer: Ohana Health Plan Medicaid	$10.56
Rate for Payer: Ohana Health Plan Medicare	$10.56
Rate for Payer: UnitedHealthcare Medicaid	$7.04
Rate for Payer: UnitedHealthcare Medicare	$10.56
Rate for Payer: University Health Alliance Commercial	$8.55

Know your out-of-pocket cost for care.

All Charges