Kohala Hospital

All Charges

Charge

Type

Setting

Price

SODIUM BICARBONATE 650 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87

SODIUM BICARBONATE 650 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYR

Facility

$99.56

Service Code	NDC 76329335201
Hospital Revenue Code	250
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$96.57
Rate for Payer: Cash Price	$64.71
Rate for Payer: Health Management Network Commercial	$84.63
Rate for Payer: Kaiser Permanente Commercial	$89.60
Rate for Payer: MDX Hawaii PPO	$96.57

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYR

Facility

$99.56

Service Code	NDC 76329335201
Hospital Revenue Code	250
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$98.56
Rate for Payer: AlohaCare Medicaid	$49.78
Rate for Payer: AlohaCare Medicare	$89.60
Rate for Payer: Cash Price	$64.71
Rate for Payer: Devoted Health Medicare	$98.56
Rate for Payer: Hawaii Medical Service Association Medicare	$89.60
Rate for Payer: Hawaii Western Management Group Commercial	$94.58
Rate for Payer: Health Management Network Commercial	$84.63
Rate for Payer: Humana Medicare	$89.60
Rate for Payer: Kaiser Permanente Commercial	$89.60
Rate for Payer: Kaiser Permanente Medicaid	$50.78
Rate for Payer: Kaiser Permanente Medicare	$89.60
Rate for Payer: MDX Hawaii PPO	$96.57
Rate for Payer: Ohana Health Plan Medicaid	$89.60
Rate for Payer: Ohana Health Plan Medicare	$89.60
Rate for Payer: UnitedHealthcare Medicaid	$59.74
Rate for Payer: UnitedHealthcare Medicare	$89.60
Rate for Payer: University Health Alliance Commercial	$72.57

SODIUM CHLORIDE 0.45 % 0.45 % IV SOLP

Facility

$22.08

Service Code	NDC 00264780200
Hospital Revenue Code	250
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 Medicaid	$13.25
Rate for Payer: UnitedHealthcare Medicare	$19.87
Rate for Payer: University Health Alliance Commercial	$16.09

SODIUM CHLORIDE 0.45 % 0.45 % IV SOLP

Facility

$22.08

Service Code	NDC 00264780200
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

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$4.39

Service Code	NDC 00378698789
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$4.26
Rate for Payer: Cash Price	$2.85
Rate for Payer: Health Management Network Commercial	$3.73
Rate for Payer: Kaiser Permanente Commercial	$3.95
Rate for Payer: MDX Hawaii PPO	$4.26

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$1.96

Service Code	NDC 00378698601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$0.98
Rate for Payer: AlohaCare Medicare	$1.76
Rate for Payer: Cash Price	$1.27
Rate for Payer: Devoted Health Medicare	$1.94
Rate for Payer: Hawaii Medical Service Association Medicare	$1.76
Rate for Payer: Hawaii Western Management Group Commercial	$1.86
Rate for Payer: Health Management Network Commercial	$1.67
Rate for Payer: Humana Medicare	$1.76
Rate for Payer: Kaiser Permanente Commercial	$1.76
Rate for Payer: Kaiser Permanente Medicaid	$1.00
Rate for Payer: Kaiser Permanente Medicare	$1.76
Rate for Payer: MDX Hawaii PPO	$1.90
Rate for Payer: Ohana Health Plan Medicaid	$1.76
Rate for Payer: Ohana Health Plan Medicare	$1.76
Rate for Payer: UnitedHealthcare Medicaid	$1.18
Rate for Payer: UnitedHealthcare Medicare	$1.76
Rate for Payer: University Health Alliance Commercial	$1.43

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$1.96

Service Code	NDC 00378698601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Management Network Commercial	$1.67
Rate for Payer: Kaiser Permanente Commercial	$1.76
Rate for Payer: MDX Hawaii PPO	$1.90

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$4.39

Service Code	NDC 00378698789
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$4.35
Rate for Payer: AlohaCare Medicaid	$2.19
Rate for Payer: AlohaCare Medicare	$3.95
Rate for Payer: Cash Price	$2.85
Rate for Payer: Devoted Health Medicare	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.95
Rate for Payer: Hawaii Western Management Group Commercial	$4.17
Rate for Payer: Health Management Network Commercial	$3.73
Rate for Payer: Humana Medicare	$3.95
Rate for Payer: Kaiser Permanente Commercial	$3.95
Rate for Payer: Kaiser Permanente Medicaid	$2.24
Rate for Payer: Kaiser Permanente Medicare	$3.95
Rate for Payer: MDX Hawaii PPO	$4.26
Rate for Payer: Ohana Health Plan Medicaid	$3.95
Rate for Payer: Ohana Health Plan Medicare	$3.95
Rate for Payer: UnitedHealthcare Medicaid	$2.63
Rate for Payer: UnitedHealthcare Medicare	$3.95
Rate for Payer: University Health Alliance Commercial	$3.20

SODIUM CHLORIDE 0.9 % IV BASE SOLP 1000 ML

Facility

$16.56

Service Code	HCPCS J7030
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$14.90
Rate for Payer: MDX Hawaii PPO	$16.06

SODIUM CHLORIDE 0.9 % IV BASE SOLP 1000 ML

Facility

$16.56

Service Code	HCPCS J7030
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$16.39
Rate for Payer: AlohaCare Medicaid	$8.28
Rate for Payer: AlohaCare Medicare	$14.90
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$10.76
Rate for Payer: Devoted Health Medicare	$16.39
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Medicare	$14.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Humana Medicare	$14.90
Rate for Payer: Kaiser Permanente Commercial	$14.90
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: Kaiser Permanente Medicare	$14.90
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: Ohana Health Plan Medicaid	$14.90
Rate for Payer: Ohana Health Plan Medicare	$14.90
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: UnitedHealthcare Medicare	$14.90
Rate for Payer: University Health Alliance Commercial	$12.07

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180032
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

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$15.18

Service Code	HCPCS J7050
Hospital Revenue Code	250
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$14.72
Rate for Payer: Cash Price	$9.87
Rate for Payer: Health Management Network Commercial	$12.90
Rate for Payer: Kaiser Permanente Commercial	$13.66
Rate for Payer: MDX Hawaii PPO	$14.72

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$15.18

Service Code	HCPCS J7050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$15.03
Rate for Payer: AlohaCare Medicaid	$7.59
Rate for Payer: AlohaCare Medicare	$13.66
Rate for Payer: Cash Price	$9.87
Rate for Payer: Cash Price	$9.87
Rate for Payer: Devoted Health Medicare	$15.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Medicare	$13.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Western Management Group Commercial	$14.42
Rate for Payer: Health Management Network Commercial	$12.90
Rate for Payer: Humana Medicare	$13.66
Rate for Payer: Kaiser Permanente Commercial	$13.66
Rate for Payer: Kaiser Permanente Medicaid	$7.74
Rate for Payer: Kaiser Permanente Medicare	$13.66
Rate for Payer: MDX Hawaii PPO	$14.72
Rate for Payer: Ohana Health Plan Medicaid	$13.66
Rate for Payer: Ohana Health Plan Medicare	$13.66
Rate for Payer: UnitedHealthcare Medicaid	$9.11
Rate for Payer: UnitedHealthcare Medicare	$13.66
Rate for Payer: University Health Alliance Commercial	$11.06

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$19.32

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$19.13
Rate for Payer: AlohaCare Medicaid	$9.66
Rate for Payer: AlohaCare Medicare	$17.39
Rate for Payer: Cash Price	$12.56
Rate for Payer: Cash Price	$12.56
Rate for Payer: Devoted Health Medicare	$19.13
Rate for Payer: Hawaii Medical Service Association ABD	$1.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.38
Rate for Payer: Hawaii Western Management Group Commercial	$18.35
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: Humana Medicare	$17.39
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: Kaiser Permanente Medicaid	$9.85
Rate for Payer: Kaiser Permanente Medicare	$17.39
Rate for Payer: MDX Hawaii PPO	$18.74
Rate for Payer: Ohana Health Plan Medicaid	$17.39
Rate for Payer: Ohana Health Plan Medicare	$17.39
Rate for Payer: UnitedHealthcare Medicaid	$11.59
Rate for Payer: UnitedHealthcare Medicare	$17.39
Rate for Payer: University Health Alliance Commercial	$14.08

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$16.56

Service Code	NDC 00264780009
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$14.90
Rate for Payer: MDX Hawaii PPO	$16.06

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180031
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

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$28.98

Service Code	NDC 00990798361
Hospital Revenue Code	636
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$28.69
Rate for Payer: AlohaCare Medicaid	$14.49
Rate for Payer: AlohaCare Medicare	$26.08
Rate for Payer: Cash Price	$18.84
Rate for Payer: Devoted Health Medicare	$28.69
Rate for Payer: Hawaii Medical Service Association Medicare	$26.08
Rate for Payer: Hawaii Western Management Group Commercial	$27.53
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Humana Medicare	$26.08
Rate for Payer: Kaiser Permanente Commercial	$26.08
Rate for Payer: Kaiser Permanente Medicaid	$14.78
Rate for Payer: Kaiser Permanente Medicare	$26.08
Rate for Payer: MDX Hawaii PPO	$28.11
Rate for Payer: Ohana Health Plan Medicaid	$26.08
Rate for Payer: Ohana Health Plan Medicare	$26.08
Rate for Payer: UnitedHealthcare Medicaid	$17.39
Rate for Payer: UnitedHealthcare Medicare	$26.08
Rate for Payer: University Health Alliance Commercial	$21.12

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$28.98

Service Code	NDC 00990798361
Hospital Revenue Code	250
Min. Negotiated Rate	$24.63
Max. Negotiated Rate	$28.11
Rate for Payer: Cash Price	$18.84
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Kaiser Permanente Commercial	$26.08
Rate for Payer: MDX Hawaii PPO	$28.11

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$16.56

Service Code	NDC 00264780009
Hospital Revenue Code	636
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$16.39
Rate for Payer: AlohaCare Medicaid	$8.28
Rate for Payer: AlohaCare Medicare	$14.90
Rate for Payer: Cash Price	$10.76
Rate for Payer: Devoted Health Medicare	$16.39
Rate for Payer: Hawaii Medical Service Association Medicare	$14.90
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Humana Medicare	$14.90
Rate for Payer: Kaiser Permanente Commercial	$14.90
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: Kaiser Permanente Medicare	$14.90
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: Ohana Health Plan Medicaid	$14.90
Rate for Payer: Ohana Health Plan Medicare	$14.90
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: UnitedHealthcare Medicare	$14.90
Rate for Payer: University Health Alliance Commercial	$12.07

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$19.32

Service Code	HCPCS J7040
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$12.56
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: MDX Hawaii PPO	$18.74

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180032
Hospital Revenue Code	636
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 Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$13.42
Rate for Payer: University Health Alliance Commercial	$10.87

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180031
Hospital Revenue Code	636
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 Medicaid	$8.95
Rate for Payer: UnitedHealthcare Medicare	$13.42
Rate for Payer: University Health Alliance Commercial	$10.87

SODIUM CHLORIDE 1000 MG MISC SOL.TAB.

Facility

$1.59

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.57
Rate for Payer: AlohaCare Medicaid	$0.80
Rate for Payer: AlohaCare Medicare	$1.43
Rate for Payer: Cash Price	$1.03
Rate for Payer: Devoted Health Medicare	$1.57
Rate for Payer: Hawaii Medical Service Association Medicare	$1.43
Rate for Payer: Hawaii Western Management Group Commercial	$1.51
Rate for Payer: Health Management Network Commercial	$1.35
Rate for Payer: Humana Medicare	$1.43
Rate for Payer: Kaiser Permanente Commercial	$1.43
Rate for Payer: Kaiser Permanente Medicaid	$0.81
Rate for Payer: Kaiser Permanente Medicare	$1.43
Rate for Payer: MDX Hawaii PPO	$1.54
Rate for Payer: Ohana Health Plan Medicaid	$1.43
Rate for Payer: Ohana Health Plan Medicare	$1.43
Rate for Payer: UnitedHealthcare Medicare	$1.43
Rate for Payer: University Health Alliance Commercial	$1.16

Know your out-of-pocket cost for care.

All Charges