Kohala Hospital

All Charges

Charge

Type

Setting

Price

SOTALOL 80 MG PO TABLET

Facility

$14.15

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$14.01
Rate for Payer: AlohaCare Medicaid	$7.08
Rate for Payer: AlohaCare Medicaid	$6.41
Rate for Payer: AlohaCare Medicare	$12.73
Rate for Payer: AlohaCare Medicare	$11.53
Rate for Payer: Cash Price	$8.33
Rate for Payer: Cash Price	$9.20
Rate for Payer: Devoted Health Medicare	$12.68
Rate for Payer: Devoted Health Medicare	$14.01
Rate for Payer: Hawaii Medical Service Association Medicare	$11.53
Rate for Payer: Hawaii Medical Service Association Medicare	$12.73
Rate for Payer: Hawaii Western Management Group Commercial	$12.17
Rate for Payer: Hawaii Western Management Group Commercial	$13.44
Rate for Payer: Health Management Network Commercial	$12.03
Rate for Payer: Health Management Network Commercial	$10.89
Rate for Payer: Humana Medicare	$12.73
Rate for Payer: Humana Medicare	$11.53
Rate for Payer: Kaiser Permanente Commercial	$11.53
Rate for Payer: Kaiser Permanente Commercial	$12.73
Rate for Payer: Kaiser Permanente Medicaid	$6.53
Rate for Payer: Kaiser Permanente Medicaid	$7.22
Rate for Payer: Kaiser Permanente Medicare	$12.73
Rate for Payer: Kaiser Permanente Medicare	$11.53
Rate for Payer: MDX Hawaii PPO	$12.43
Rate for Payer: MDX Hawaii PPO	$13.73
Rate for Payer: Ohana Health Plan Medicaid	$12.73
Rate for Payer: Ohana Health Plan Medicaid	$11.53
Rate for Payer: Ohana Health Plan Medicare	$12.73
Rate for Payer: Ohana Health Plan Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicare	$12.73
Rate for Payer: University Health Alliance Commercial	$10.31
Rate for Payer: University Health Alliance Commercial	$9.34

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$34,581.22

Service Code	MSDRG 052
Min. Negotiated Rate	$34,581.22
Max. Negotiated Rate	$34,581.22
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$34,581.22

Service Code	MSDRG 053
Min. Negotiated Rate	$34,581.22
Max. Negotiated Rate	$34,581.22
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$137,281.98

Service Code	MSDRG 457
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$137,281.98

Service Code	MSDRG 456
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$137,281.98

Service Code	MSDRG 458
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$71,177.11

Service Code	MSDRG 029
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$71,177.11
Rate for Payer: Hawaii Medical Service Association Commercial	$71,177.11
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITH MCC

Facility

$86,038.26

Service Code	MSDRG 028
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$86,038.26
Rate for Payer: Hawaii Medical Service Association Commercial	$86,038.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$47,190.68

Service Code	MSDRG 030
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$47,190.68
Rate for Payer: Hawaii Medical Service Association Commercial	$47,190.68
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPIRONOLACTONE 100 MG PO TABLET

Facility

$7.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$7.63
Rate for Payer: Cash Price	$5.12
Rate for Payer: Cash Price	$3.82
Rate for Payer: Health Management Network Commercial	$6.69
Rate for Payer: Health Management Network Commercial	$5.00
Rate for Payer: Kaiser Permanente Commercial	$5.29
Rate for Payer: Kaiser Permanente Commercial	$7.08
Rate for Payer: MDX Hawaii PPO	$7.63
Rate for Payer: MDX Hawaii PPO	$5.70

SPIRONOLACTONE 100 MG PO TABLET

Facility

$7.87

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$7.79
Rate for Payer: AlohaCare Medicaid	$3.94
Rate for Payer: AlohaCare Medicaid	$2.94
Rate for Payer: AlohaCare Medicare	$5.29
Rate for Payer: AlohaCare Medicare	$7.08
Rate for Payer: Cash Price	$3.82
Rate for Payer: Cash Price	$5.12
Rate for Payer: Devoted Health Medicare	$7.79
Rate for Payer: Devoted Health Medicare	$5.82
Rate for Payer: Hawaii Medical Service Association Medicare	$5.29
Rate for Payer: Hawaii Medical Service Association Medicare	$7.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.48
Rate for Payer: Hawaii Western Management Group Commercial	$5.59
Rate for Payer: Health Management Network Commercial	$5.00
Rate for Payer: Health Management Network Commercial	$6.69
Rate for Payer: Humana Medicare	$7.08
Rate for Payer: Humana Medicare	$5.29
Rate for Payer: Kaiser Permanente Commercial	$5.29
Rate for Payer: Kaiser Permanente Commercial	$7.08
Rate for Payer: Kaiser Permanente Medicaid	$4.01
Rate for Payer: Kaiser Permanente Medicaid	$3.00
Rate for Payer: Kaiser Permanente Medicare	$5.29
Rate for Payer: Kaiser Permanente Medicare	$7.08
Rate for Payer: MDX Hawaii PPO	$5.70
Rate for Payer: MDX Hawaii PPO	$7.63
Rate for Payer: Ohana Health Plan Medicaid	$5.29
Rate for Payer: Ohana Health Plan Medicaid	$7.08
Rate for Payer: Ohana Health Plan Medicare	$5.29
Rate for Payer: Ohana Health Plan Medicare	$7.08
Rate for Payer: UnitedHealthcare Medicare	$5.29
Rate for Payer: UnitedHealthcare Medicare	$7.08
Rate for Payer: University Health Alliance Commercial	$4.29
Rate for Payer: University Health Alliance Commercial	$5.74

SPIRONOLACTONE 25 MG PO TAB (0.5 TAB) = 12.5 MG

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

SPIRONOLACTONE 25 MG PO TAB (0.5 TAB) = 12.5 MG

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

SPIRONOLACTONE 25 MG PO TABLET

Facility

$1.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.22
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Management Network Commercial	$1.07
Rate for Payer: Kaiser Permanente Commercial	$1.13
Rate for Payer: MDX Hawaii PPO	$1.22

SPIRONOLACTONE 25 MG PO TABLET

Facility

$1.26

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.25
Rate for Payer: AlohaCare Medicaid	$0.63
Rate for Payer: AlohaCare Medicare	$1.13
Rate for Payer: Cash Price	$0.82
Rate for Payer: Devoted Health Medicare	$1.25
Rate for Payer: Hawaii Medical Service Association Medicare	$1.13
Rate for Payer: Hawaii Western Management Group Commercial	$1.20
Rate for Payer: Health Management Network Commercial	$1.07
Rate for Payer: Humana Medicare	$1.13
Rate for Payer: Kaiser Permanente Commercial	$1.13
Rate for Payer: Kaiser Permanente Medicaid	$0.64
Rate for Payer: Kaiser Permanente Medicare	$1.13
Rate for Payer: MDX Hawaii PPO	$1.22
Rate for Payer: Ohana Health Plan Medicaid	$1.13
Rate for Payer: Ohana Health Plan Medicare	$1.13
Rate for Payer: UnitedHealthcare Medicare	$1.13
Rate for Payer: University Health Alliance Commercial	$0.92

SPLENIC PROCEDURES WITH CC

Facility

$43,730.19

Service Code	MSDRG 800
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$43,730.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19

SPLENIC PROCEDURES WITH MCC

Facility

$43,730.19

Service Code	MSDRG 799
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$43,730.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$43,730.19

Service Code	MSDRG 801
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$43,730.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$24,910.80

Service Code	MSDRG 537
Min. Negotiated Rate	$24,910.80
Max. Negotiated Rate	$24,910.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$24,910.80

Service Code	MSDRG 538
Min. Negotiated Rate	$24,910.80
Max. Negotiated Rate	$24,910.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$89,640.96

Service Code	MSDRG 327
Min. Negotiated Rate	$89,640.96
Max. Negotiated Rate	$89,640.96
Rate for Payer: Hawaii Medical Service Association Commercial	$89,640.96

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$126,639.79

Service Code	MSDRG 326
Min. Negotiated Rate	$126,639.79
Max. Negotiated Rate	$126,639.79
Rate for Payer: Hawaii Medical Service Association Commercial	$126,639.79

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$38,373.54

Service Code	MSDRG 328
Min. Negotiated Rate	$38,373.54
Max. Negotiated Rate	$38,373.54
Rate for Payer: Hawaii Medical Service Association Commercial	$38,373.54

SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML (20 MG/ML) IV SYR

Facility

$158.72

Service Code	HCPCS J0330
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$157.13
Rate for Payer: AlohaCare Medicaid	$79.36
Rate for Payer: AlohaCare Medicaid	$74.35
Rate for Payer: AlohaCare Medicare	$133.83
Rate for Payer: AlohaCare Medicare	$142.85
Rate for Payer: Cash Price	$103.17
Rate for Payer: Cash Price	$96.66
Rate for Payer: Cash Price	$96.66
Rate for Payer: Cash Price	$103.17
Rate for Payer: Devoted Health Medicare	$147.21
Rate for Payer: Devoted Health Medicare	$157.13
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$133.83
Rate for Payer: Hawaii Medical Service Association Medicare	$142.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$150.78
Rate for Payer: Hawaii Western Management Group Commercial	$141.26
Rate for Payer: Health Management Network Commercial	$126.39
Rate for Payer: Health Management Network Commercial	$134.91
Rate for Payer: Humana Medicare	$142.85
Rate for Payer: Humana Medicare	$133.83
Rate for Payer: Kaiser Permanente Commercial	$133.83
Rate for Payer: Kaiser Permanente Commercial	$142.85
Rate for Payer: Kaiser Permanente Medicaid	$80.95
Rate for Payer: Kaiser Permanente Medicaid	$75.84
Rate for Payer: Kaiser Permanente Medicare	$133.83
Rate for Payer: Kaiser Permanente Medicare	$142.85
Rate for Payer: MDX Hawaii PPO	$153.96
Rate for Payer: MDX Hawaii PPO	$144.24
Rate for Payer: Ohana Health Plan Medicaid	$133.83
Rate for Payer: Ohana Health Plan Medicaid	$142.85
Rate for Payer: Ohana Health Plan Medicare	$142.85
Rate for Payer: Ohana Health Plan Medicare	$133.83
Rate for Payer: UnitedHealthcare Medicaid	$95.23
Rate for Payer: UnitedHealthcare Medicaid	$89.22
Rate for Payer: UnitedHealthcare Medicare	$133.83
Rate for Payer: UnitedHealthcare Medicare	$142.85
Rate for Payer: University Health Alliance Commercial	$115.69
Rate for Payer: University Health Alliance Commercial	$108.39

SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML (20 MG/ML) IV SYR

Facility

$148.70

Service Code	HCPCS J0330
Hospital Revenue Code	250
Min. Negotiated Rate	$126.39
Max. Negotiated Rate	$144.24
Rate for Payer: Cash Price	$96.66
Rate for Payer: Cash Price	$103.17
Rate for Payer: Health Management Network Commercial	$126.39
Rate for Payer: Health Management Network Commercial	$134.91
Rate for Payer: Kaiser Permanente Commercial	$133.83
Rate for Payer: Kaiser Permanente Commercial	$142.85
Rate for Payer: MDX Hawaii PPO	$153.96
Rate for Payer: MDX Hawaii PPO	$144.24

Know your out-of-pocket cost for care.

All Charges