Kohala Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 1000 MG MISC SOL.TAB.

Facility

$1.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.54
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Management Network Commercial	$1.35
Rate for Payer: Kaiser Permanente Commercial	$1.43
Rate for Payer: MDX Hawaii PPO	$1.54

SODIUM CHLORIDE 3 % IV SOLP

Facility

$22.08

Service Code	HCPCS J7131
Hospital Revenue Code	636
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 3 % IV SOLP

Facility

$22.08

Service Code	HCPCS J7131
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 HYPOCHLORITE 0.25 % MISC SOLN

Facility

$88.50

Service Code	NDC 00436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$87.61
Rate for Payer: AlohaCare Medicaid	$44.25
Rate for Payer: AlohaCare Medicare	$79.65
Rate for Payer: Cash Price	$57.52
Rate for Payer: Devoted Health Medicare	$87.61
Rate for Payer: Hawaii Medical Service Association Medicare	$79.65
Rate for Payer: Hawaii Western Management Group Commercial	$84.08
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: Humana Medicare	$79.65
Rate for Payer: Kaiser Permanente Commercial	$79.65
Rate for Payer: Kaiser Permanente Medicaid	$45.13
Rate for Payer: Kaiser Permanente Medicare	$79.65
Rate for Payer: MDX Hawaii PPO	$85.84
Rate for Payer: Ohana Health Plan Medicaid	$79.65
Rate for Payer: Ohana Health Plan Medicare	$79.65
Rate for Payer: UnitedHealthcare Medicaid	$53.10
Rate for Payer: UnitedHealthcare Medicare	$79.65
Rate for Payer: University Health Alliance Commercial	$64.51

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$88.50

Service Code	NDC 00436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$75.22
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$57.52
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: Kaiser Permanente Commercial	$79.65
Rate for Payer: MDX Hawaii PPO	$85.84

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$106.16

Service Code	NDC 39328006325
Hospital Revenue Code	250
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$105.10
Rate for Payer: AlohaCare Medicaid	$53.08
Rate for Payer: AlohaCare Medicare	$95.54
Rate for Payer: Cash Price	$69.00
Rate for Payer: Devoted Health Medicare	$105.10
Rate for Payer: Hawaii Medical Service Association Medicare	$95.54
Rate for Payer: Hawaii Western Management Group Commercial	$100.85
Rate for Payer: Health Management Network Commercial	$90.24
Rate for Payer: Humana Medicare	$95.54
Rate for Payer: Kaiser Permanente Commercial	$95.54
Rate for Payer: Kaiser Permanente Medicaid	$54.14
Rate for Payer: Kaiser Permanente Medicare	$95.54
Rate for Payer: MDX Hawaii PPO	$102.98
Rate for Payer: Ohana Health Plan Medicaid	$95.54
Rate for Payer: Ohana Health Plan Medicare	$95.54
Rate for Payer: UnitedHealthcare Medicaid	$63.70
Rate for Payer: UnitedHealthcare Medicare	$95.54
Rate for Payer: University Health Alliance Commercial	$77.38

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$106.16

Service Code	NDC 39328006325
Hospital Revenue Code	250
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$102.98
Rate for Payer: Cash Price	$69.00
Rate for Payer: Health Management Network Commercial	$90.24
Rate for Payer: Kaiser Permanente Commercial	$95.54
Rate for Payer: MDX Hawaii PPO	$102.98

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

$117.36

Service Code	NDC 72485010501
Hospital Revenue Code	250
Min. Negotiated Rate	$99.76
Max. Negotiated Rate	$113.84
Rate for Payer: Cash Price	$76.28
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: Kaiser Permanente Commercial	$105.62
Rate for Payer: MDX Hawaii PPO	$113.84

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

$117.36

Service Code	NDC 72485010501
Hospital Revenue Code	250
Min. Negotiated Rate	$58.68
Max. Negotiated Rate	$116.19
Rate for Payer: AlohaCare Medicaid	$58.68
Rate for Payer: AlohaCare Medicare	$105.62
Rate for Payer: Cash Price	$76.28
Rate for Payer: Devoted Health Medicare	$116.19
Rate for Payer: Hawaii Medical Service Association Medicare	$105.62
Rate for Payer: Hawaii Western Management Group Commercial	$111.49
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: Humana Medicare	$105.62
Rate for Payer: Kaiser Permanente Commercial	$105.62
Rate for Payer: Kaiser Permanente Medicaid	$59.85
Rate for Payer: Kaiser Permanente Medicare	$105.62
Rate for Payer: MDX Hawaii PPO	$113.84
Rate for Payer: Ohana Health Plan Medicaid	$105.62
Rate for Payer: Ohana Health Plan Medicare	$105.62
Rate for Payer: UnitedHealthcare Medicaid	$70.42
Rate for Payer: UnitedHealthcare Medicare	$105.62
Rate for Payer: University Health Alliance Commercial	$85.54

SODIUM PHOSPHATES 19-7 GRAM/118 ML PR ENEMA

Facility

$11.02

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$10.91
Rate for Payer: AlohaCare Medicaid	$5.51
Rate for Payer: AlohaCare Medicare	$9.92
Rate for Payer: Cash Price	$7.16
Rate for Payer: Devoted Health Medicare	$10.91
Rate for Payer: Hawaii Medical Service Association Medicare	$9.92
Rate for Payer: Hawaii Western Management Group Commercial	$10.47
Rate for Payer: Health Management Network Commercial	$9.37
Rate for Payer: Humana Medicare	$9.92
Rate for Payer: Kaiser Permanente Commercial	$9.92
Rate for Payer: Kaiser Permanente Medicaid	$5.62
Rate for Payer: Kaiser Permanente Medicare	$9.92
Rate for Payer: MDX Hawaii PPO	$10.69
Rate for Payer: Ohana Health Plan Medicaid	$9.92
Rate for Payer: Ohana Health Plan Medicare	$9.92
Rate for Payer: UnitedHealthcare Medicare	$9.92
Rate for Payer: University Health Alliance Commercial	$8.03

SODIUM PHOSPHATES 19-7 GRAM/118 ML PR ENEMA

Facility

$11.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$10.69
Rate for Payer: Cash Price	$7.16
Rate for Payer: Health Management Network Commercial	$9.37
Rate for Payer: Kaiser Permanente Commercial	$9.92
Rate for Payer: MDX Hawaii PPO	$10.69

SODIUM PHOSPHATES 9.5-3.5 GRAM/59 ML PR ENEMA

Facility

$13.12

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$12.73
Rate for Payer: Cash Price	$8.53
Rate for Payer: Health Management Network Commercial	$11.15
Rate for Payer: Kaiser Permanente Commercial	$11.81
Rate for Payer: MDX Hawaii PPO	$12.73

SODIUM PHOSPHATES 9.5-3.5 GRAM/59 ML PR ENEMA

Facility

$13.12

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$12.99
Rate for Payer: AlohaCare Medicaid	$6.56
Rate for Payer: AlohaCare Medicare	$11.81
Rate for Payer: Cash Price	$8.53
Rate for Payer: Devoted Health Medicare	$12.99
Rate for Payer: Hawaii Medical Service Association Medicare	$11.81
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$11.15
Rate for Payer: Humana Medicare	$11.81
Rate for Payer: Kaiser Permanente Commercial	$11.81
Rate for Payer: Kaiser Permanente Medicaid	$6.69
Rate for Payer: Kaiser Permanente Medicare	$11.81
Rate for Payer: MDX Hawaii PPO	$12.73
Rate for Payer: Ohana Health Plan Medicaid	$11.81
Rate for Payer: Ohana Health Plan Medicare	$11.81
Rate for Payer: UnitedHealthcare Medicare	$11.81
Rate for Payer: University Health Alliance Commercial	$9.56

SODIUM POLYSTYRENE SULFONATE (SPS) 15 G/60 ML RECTAL SUSP (RECTAL USE ONLY)

Facility

$146.43

Service Code	NDC 46287000660
Hospital Revenue Code	637
Min. Negotiated Rate	$73.22
Max. Negotiated Rate	$144.97
Rate for Payer: AlohaCare Medicaid	$73.22
Rate for Payer: AlohaCare Medicare	$131.79
Rate for Payer: Cash Price	$95.18
Rate for Payer: Devoted Health Medicare	$144.97
Rate for Payer: Hawaii Medical Service Association Medicare	$131.79
Rate for Payer: Hawaii Western Management Group Commercial	$139.11
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Humana Medicare	$131.79
Rate for Payer: Kaiser Permanente Commercial	$131.79
Rate for Payer: Kaiser Permanente Medicaid	$74.68
Rate for Payer: Kaiser Permanente Medicare	$131.79
Rate for Payer: MDX Hawaii PPO	$142.04
Rate for Payer: Ohana Health Plan Medicaid	$131.79
Rate for Payer: Ohana Health Plan Medicare	$131.79
Rate for Payer: UnitedHealthcare Medicare	$131.79
Rate for Payer: University Health Alliance Commercial	$106.73

SODIUM POLYSTYRENE SULFONATE (SPS) 15 G/60 ML RECTAL SUSP (RECTAL USE ONLY)

Facility

$146.43

Service Code	NDC 46287000660
Hospital Revenue Code	250
Min. Negotiated Rate	$124.47
Max. Negotiated Rate	$142.04
Rate for Payer: Cash Price	$95.18
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Kaiser Permanente Commercial	$131.79
Rate for Payer: MDX Hawaii PPO	$142.04

SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML PO SUSP

Facility

$146.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$124.47
Max. Negotiated Rate	$142.04
Rate for Payer: Cash Price	$95.18
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Kaiser Permanente Commercial	$131.79
Rate for Payer: MDX Hawaii PPO	$142.04

SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML PO SUSP

Facility

$146.43

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$73.22
Max. Negotiated Rate	$144.97
Rate for Payer: AlohaCare Medicaid	$73.22
Rate for Payer: AlohaCare Medicare	$131.79
Rate for Payer: Cash Price	$95.18
Rate for Payer: Devoted Health Medicare	$144.97
Rate for Payer: Hawaii Medical Service Association Medicare	$131.79
Rate for Payer: Hawaii Western Management Group Commercial	$139.11
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Humana Medicare	$131.79
Rate for Payer: Kaiser Permanente Commercial	$131.79
Rate for Payer: Kaiser Permanente Medicaid	$74.68
Rate for Payer: Kaiser Permanente Medicare	$131.79
Rate for Payer: MDX Hawaii PPO	$142.04
Rate for Payer: Ohana Health Plan Medicaid	$131.79
Rate for Payer: Ohana Health Plan Medicare	$131.79
Rate for Payer: UnitedHealthcare Medicare	$131.79
Rate for Payer: University Health Alliance Commercial	$106.73

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PWPK

Facility

$136.90

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$68.45
Max. Negotiated Rate	$135.53
Rate for Payer: AlohaCare Medicaid	$68.45
Rate for Payer: AlohaCare Medicare	$123.21
Rate for Payer: Cash Price	$88.99
Rate for Payer: Devoted Health Medicare	$135.53
Rate for Payer: Hawaii Medical Service Association Medicare	$123.21
Rate for Payer: Hawaii Western Management Group Commercial	$130.06
Rate for Payer: Health Management Network Commercial	$116.36
Rate for Payer: Humana Medicare	$123.21
Rate for Payer: Kaiser Permanente Commercial	$123.21
Rate for Payer: Kaiser Permanente Medicaid	$69.82
Rate for Payer: Kaiser Permanente Medicare	$123.21
Rate for Payer: MDX Hawaii PPO	$132.79
Rate for Payer: Ohana Health Plan Medicaid	$123.21
Rate for Payer: Ohana Health Plan Medicare	$123.21
Rate for Payer: UnitedHealthcare Medicare	$123.21
Rate for Payer: University Health Alliance Commercial	$99.79

SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PWPK

Facility

$136.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$116.36
Max. Negotiated Rate	$132.79
Rate for Payer: Cash Price	$88.99
Rate for Payer: Health Management Network Commercial	$116.36
Rate for Payer: Kaiser Permanente Commercial	$123.21
Rate for Payer: MDX Hawaii PPO	$132.79

SOD PHOS DI, MONO-K PHOS MONO 250 MG PO TABLET

Facility

$2.81

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$2.78
Rate for Payer: Ohana Health Plan Medicaid	$2.53
Rate for Payer: AlohaCare Medicaid	$1.41
Rate for Payer: AlohaCare Medicaid	$1.35
Rate for Payer: AlohaCare Medicare	$2.44
Rate for Payer: AlohaCare Medicare	$2.53
Rate for Payer: Cash Price	$1.76
Rate for Payer: Cash Price	$1.83
Rate for Payer: Devoted Health Medicare	$2.78
Rate for Payer: Devoted Health Medicare	$2.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2.53
Rate for Payer: Hawaii Western Management Group Commercial	$2.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.67
Rate for Payer: Health Management Network Commercial	$2.39
Rate for Payer: Health Management Network Commercial	$2.30
Rate for Payer: Humana Medicare	$2.53
Rate for Payer: Humana Medicare	$2.44
Rate for Payer: Kaiser Permanente Commercial	$2.44
Rate for Payer: Kaiser Permanente Commercial	$2.53
Rate for Payer: Kaiser Permanente Medicaid	$1.43
Rate for Payer: Kaiser Permanente Medicaid	$1.38
Rate for Payer: Kaiser Permanente Medicare	$2.44
Rate for Payer: Kaiser Permanente Medicare	$2.53
Rate for Payer: MDX Hawaii PPO	$2.63
Rate for Payer: MDX Hawaii PPO	$2.73
Rate for Payer: Ohana Health Plan Medicaid	$2.44
Rate for Payer: Ohana Health Plan Medicare	$2.44
Rate for Payer: Ohana Health Plan Medicare	$2.53
Rate for Payer: UnitedHealthcare Medicare	$2.53
Rate for Payer: UnitedHealthcare Medicare	$2.44
Rate for Payer: University Health Alliance Commercial	$2.05
Rate for Payer: University Health Alliance Commercial	$1.98

SOD PHOS DI, MONO-K PHOS MONO 250 MG PO TABLET

Facility

$2.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.63
Rate for Payer: Cash Price	$1.76
Rate for Payer: Cash Price	$1.83
Rate for Payer: Health Management Network Commercial	$2.30
Rate for Payer: Health Management Network Commercial	$2.39
Rate for Payer: Kaiser Permanente Commercial	$2.44
Rate for Payer: Kaiser Permanente Commercial	$2.53
Rate for Payer: MDX Hawaii PPO	$2.73
Rate for Payer: MDX Hawaii PPO	$2.63

SOFT TISSUE PROCEDURES WITH CC

Facility

$46,408.52

Service Code	MSDRG 501
Min. Negotiated Rate	$46,408.52
Max. Negotiated Rate	$46,408.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52

SOFT TISSUE PROCEDURES WITH MCC

Facility

$46,408.52

Service Code	MSDRG 500
Min. Negotiated Rate	$46,408.52
Max. Negotiated Rate	$46,408.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$22,896.13

Service Code	MSDRG 502
Min. Negotiated Rate	$22,896.13
Max. Negotiated Rate	$22,896.13
Rate for Payer: Hawaii Medical Service Association Commercial	$22,896.13

SOTALOL 80 MG PO TABLET

Facility

$12.81

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$12.43
Rate for Payer: Cash Price	$8.33
Rate for Payer: Cash Price	$9.20
Rate for Payer: Health Management Network Commercial	$10.89
Rate for Payer: Health Management Network Commercial	$12.03
Rate for Payer: Kaiser Permanente Commercial	$12.73
Rate for Payer: Kaiser Permanente Commercial	$11.53
Rate for Payer: MDX Hawaii PPO	$13.73
Rate for Payer: MDX Hawaii PPO	$12.43

Know your out-of-pocket cost for care.

All Charges