Kohala Hospital

All Charges

Charge

Type

Setting

Price

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487590199
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$13.66
Rate for Payer: AlohaCare Medicaid	$6.90
Rate for Payer: AlohaCare Medicare	$12.42
Rate for Payer: Cash Price	$8.97
Rate for Payer: Devoted Health Medicare	$13.66
Rate for Payer: Hawaii Medical Service Association Medicare	$12.42
Rate for Payer: Hawaii Western Management Group Commercial	$13.11
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Humana Medicare	$12.42
Rate for Payer: Kaiser Permanente Commercial	$12.42
Rate for Payer: Kaiser Permanente Medicaid	$7.04
Rate for Payer: Kaiser Permanente Medicare	$12.42
Rate for Payer: MDX Hawaii PPO	$13.39
Rate for Payer: Ohana Health Plan Medicaid	$12.42
Rate for Payer: Ohana Health Plan Medicare	$12.42
Rate for Payer: UnitedHealthcare Medicaid	$8.28
Rate for Payer: UnitedHealthcare Medicare	$12.42
Rate for Payer: University Health Alliance Commercial	$10.06

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487278401
Hospital Revenue Code	250
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Kaiser Permanente Commercial	$12.42
Rate for Payer: MDX Hawaii PPO	$13.39

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487590199
Hospital Revenue Code	250
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Kaiser Permanente Commercial	$12.42
Rate for Payer: MDX Hawaii PPO	$13.39

RACEPINEPHRINE 2.25 % INHAL NEBU

Facility

$13.80

Service Code	NDC 00487278401
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$13.66
Rate for Payer: AlohaCare Medicaid	$6.90
Rate for Payer: AlohaCare Medicare	$12.42
Rate for Payer: Cash Price	$8.97
Rate for Payer: Devoted Health Medicare	$13.66
Rate for Payer: Hawaii Medical Service Association Medicare	$12.42
Rate for Payer: Hawaii Western Management Group Commercial	$13.11
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Humana Medicare	$12.42
Rate for Payer: Kaiser Permanente Commercial	$12.42
Rate for Payer: Kaiser Permanente Medicaid	$7.04
Rate for Payer: Kaiser Permanente Medicare	$12.42
Rate for Payer: MDX Hawaii PPO	$13.39
Rate for Payer: Ohana Health Plan Medicaid	$12.42
Rate for Payer: Ohana Health Plan Medicare	$12.42
Rate for Payer: UnitedHealthcare Medicaid	$8.28
Rate for Payer: UnitedHealthcare Medicare	$12.42
Rate for Payer: University Health Alliance Commercial	$10.06

RADIOTHERAPY

Facility

$17,373.57

Service Code	MSDRG 849
Min. Negotiated Rate	$17,373.57
Max. Negotiated Rate	$17,373.57
Rate for Payer: Hawaii Medical Service Association Commercial	$17,373.57

RECTAL RESECTION WITH CC

Facility

$71,224.51

Service Code	MSDRG 333
Min. Negotiated Rate	$71,224.51
Max. Negotiated Rate	$71,224.51
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51

RECTAL RESECTION WITH MCC

Facility

$71,224.51

Service Code	MSDRG 332
Min. Negotiated Rate	$71,224.51
Max. Negotiated Rate	$71,224.51
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51

RECTAL RESECTION WITHOUT CC/MCC

Facility

$34,083.48

Service Code	MSDRG 334
Min. Negotiated Rate	$34,083.48
Max. Negotiated Rate	$34,083.48
Rate for Payer: Hawaii Medical Service Association Commercial	$34,083.48

RED BLOOD CELL DISORDERS WITH MCC

Facility

$31,049.62

Service Code	MSDRG 811
Min. Negotiated Rate	$31,049.62
Max. Negotiated Rate	$31,049.62
Rate for Payer: Hawaii Medical Service Association Commercial	$31,049.62

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$16,638.80

Service Code	MSDRG 812
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

REGADENOSON 0.4 MG/5 ML IV SYR

Facility

$603.67

Service Code	HCPCS J2785
Hospital Revenue Code	636
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$597.63
Rate for Payer: AlohaCare Medicaid	$301.83
Rate for Payer: AlohaCare Medicaid	$71.10
Rate for Payer: AlohaCare Medicare	$127.98
Rate for Payer: AlohaCare Medicare	$543.30
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$392.39
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$392.39
Rate for Payer: Devoted Health Medicare	$140.78
Rate for Payer: Devoted Health Medicare	$597.63
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Medicare	$127.98
Rate for Payer: Hawaii Medical Service Association Medicare	$543.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Western Management Group Commercial	$135.09
Rate for Payer: Hawaii Western Management Group Commercial	$573.49
Rate for Payer: Health Management Network Commercial	$513.12
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Humana Medicare	$127.98
Rate for Payer: Humana Medicare	$543.30
Rate for Payer: Kaiser Permanente Commercial	$543.30
Rate for Payer: Kaiser Permanente Commercial	$127.98
Rate for Payer: Kaiser Permanente Medicaid	$307.87
Rate for Payer: Kaiser Permanente Medicaid	$72.52
Rate for Payer: Kaiser Permanente Medicare	$543.30
Rate for Payer: Kaiser Permanente Medicare	$127.98
Rate for Payer: MDX Hawaii PPO	$585.56
Rate for Payer: MDX Hawaii PPO	$137.93
Rate for Payer: Ohana Health Plan Medicaid	$543.30
Rate for Payer: Ohana Health Plan Medicaid	$127.98
Rate for Payer: Ohana Health Plan Medicare	$543.30
Rate for Payer: Ohana Health Plan Medicare	$127.98
Rate for Payer: UnitedHealthcare Medicaid	$362.20
Rate for Payer: UnitedHealthcare Medicaid	$85.32
Rate for Payer: UnitedHealthcare Medicare	$127.98
Rate for Payer: UnitedHealthcare Medicare	$543.30
Rate for Payer: University Health Alliance Commercial	$440.02
Rate for Payer: University Health Alliance Commercial	$103.65

REGADENOSON 0.4 MG/5 ML IV SYR

Facility

$142.20

Service Code	HCPCS J2785
Hospital Revenue Code	250
Min. Negotiated Rate	$120.87
Max. Negotiated Rate	$137.93
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$392.39
Rate for Payer: Health Management Network Commercial	$513.12
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Kaiser Permanente Commercial	$127.98
Rate for Payer: Kaiser Permanente Commercial	$543.30
Rate for Payer: MDX Hawaii PPO	$137.93
Rate for Payer: MDX Hawaii PPO	$585.56

REHABILITATION WITH CC/MCC

Facility

$9,765.22

Service Code	MSDRG 945
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

REHABILITATION WITHOUT CC/MCC

Facility

$9,765.22

Service Code	MSDRG 946
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

REMDESIVIR 100 MG IV RECON.SOLN.

Facility

$1,590.90

Service Code	HCPCS J0248
Hospital Revenue Code	250
Min. Negotiated Rate	$1,352.27
Max. Negotiated Rate	$1,543.17
Rate for Payer: Cash Price	$1,034.08
Rate for Payer: Health Management Network Commercial	$1,352.27
Rate for Payer: Kaiser Permanente Commercial	$1,431.81
Rate for Payer: MDX Hawaii PPO	$1,543.17

REMDESIVIR 100 MG IV RECON.SOLN.

Facility

$1,590.90

Service Code	HCPCS J0248
Hospital Revenue Code	636
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$1,574.99
Rate for Payer: AlohaCare Medicaid	$795.45
Rate for Payer: AlohaCare Medicare	$1,431.81
Rate for Payer: Cash Price	$1,034.08
Rate for Payer: Cash Price	$1,034.08
Rate for Payer: Devoted Health Medicare	$1,574.99
Rate for Payer: Hawaii Medical Service Association ABD	$6.73
Rate for Payer: Hawaii Medical Service Association Commercial	$8.62
Rate for Payer: Hawaii Medical Service Association Medicare	$1,431.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.73
Rate for Payer: Hawaii Western Management Group Commercial	$1,511.36
Rate for Payer: Health Management Network Commercial	$1,352.27
Rate for Payer: Humana Medicare	$1,431.81
Rate for Payer: Kaiser Permanente Commercial	$1,431.81
Rate for Payer: Kaiser Permanente Medicaid	$811.36
Rate for Payer: Kaiser Permanente Medicare	$1,431.81
Rate for Payer: MDX Hawaii PPO	$1,543.17
Rate for Payer: Ohana Health Plan Medicaid	$1,431.81
Rate for Payer: Ohana Health Plan Medicare	$1,431.81
Rate for Payer: UnitedHealthcare Medicaid	$954.54
Rate for Payer: UnitedHealthcare Medicare	$1,431.81
Rate for Payer: University Health Alliance Commercial	$1,159.61

RENAL FAILURE WITH CC

Facility

$30,006.73

Service Code	MSDRG 683
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENAL FAILURE WITH MCC

Facility

$30,006.73

Service Code	MSDRG 682
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENAL FAILURE WITHOUT CC/MCC

Facility

$30,006.73

Service Code	MSDRG 684
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$42,142.16

Service Code	MSDRG 178
Min. Negotiated Rate	$42,142.16
Max. Negotiated Rate	$42,142.16
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$42,142.16

Service Code	MSDRG 177
Min. Negotiated Rate	$42,142.16
Max. Negotiated Rate	$42,142.16
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$33,277.61

Service Code	MSDRG 179
Min. Negotiated Rate	$33,277.61
Max. Negotiated Rate	$33,277.61
Rate for Payer: Hawaii Medical Service Association Commercial	$33,277.61

RESPIRATORY NEOPLASMS WITH CC

Facility

$35,932.23

Service Code	MSDRG 181
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITH MCC

Facility

$35,932.23

Service Code	MSDRG 180
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$35,932.23

Service Code	MSDRG 182
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

Know your out-of-pocket cost for care.

All Charges