Kohala Hospital

All Charges

Charge

Type

Setting

Price

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$32.02

Service Code	NDC 83634040110
Hospital Revenue Code	250
Min. Negotiated Rate	$16.01
Max. Negotiated Rate	$31.70
Rate for Payer: AlohaCare Medicaid	$16.01
Rate for Payer: AlohaCare Medicare	$28.82
Rate for Payer: Cash Price	$20.81
Rate for Payer: Devoted Health Medicare	$31.70
Rate for Payer: Hawaii Medical Service Association Medicare	$28.82
Rate for Payer: Hawaii Western Management Group Commercial	$30.42
Rate for Payer: Health Management Network Commercial	$27.22
Rate for Payer: Humana Medicare	$28.82
Rate for Payer: Kaiser Permanente Commercial	$28.82
Rate for Payer: Kaiser Permanente Medicaid	$16.33
Rate for Payer: Kaiser Permanente Medicare	$28.82
Rate for Payer: MDX Hawaii PPO	$31.06
Rate for Payer: Ohana Health Plan Medicaid	$28.82
Rate for Payer: Ohana Health Plan Medicare	$28.82
Rate for Payer: UnitedHealthcare Medicaid	$19.21
Rate for Payer: UnitedHealthcare Medicare	$28.82
Rate for Payer: University Health Alliance Commercial	$23.34

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$21.09

Service Code	NDC 25021041510
Hospital Revenue Code	250
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$20.88
Rate for Payer: AlohaCare Medicaid	$10.54
Rate for Payer: AlohaCare Medicare	$18.98
Rate for Payer: Cash Price	$13.71
Rate for Payer: Devoted Health Medicare	$20.88
Rate for Payer: Hawaii Medical Service Association Medicare	$18.98
Rate for Payer: Hawaii Western Management Group Commercial	$20.04
Rate for Payer: Health Management Network Commercial	$17.93
Rate for Payer: Humana Medicare	$18.98
Rate for Payer: Kaiser Permanente Commercial	$18.98
Rate for Payer: Kaiser Permanente Medicaid	$10.76
Rate for Payer: Kaiser Permanente Medicare	$18.98
Rate for Payer: MDX Hawaii PPO	$20.46
Rate for Payer: Ohana Health Plan Medicaid	$18.98
Rate for Payer: Ohana Health Plan Medicare	$18.98
Rate for Payer: UnitedHealthcare Medicaid	$12.65
Rate for Payer: UnitedHealthcare Medicare	$18.98
Rate for Payer: University Health Alliance Commercial	$15.37

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$41.52

Service Code	NDC 81284061110
Hospital Revenue Code	250
Min. Negotiated Rate	$35.29
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Kaiser Permanente Commercial	$37.37
Rate for Payer: MDX Hawaii PPO	$40.27

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$41.52

Service Code	NDC 81284061110
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$41.10
Rate for Payer: AlohaCare Medicaid	$20.76
Rate for Payer: AlohaCare Medicare	$37.37
Rate for Payer: Cash Price	$26.99
Rate for Payer: Devoted Health Medicare	$41.10
Rate for Payer: Hawaii Medical Service Association Medicare	$37.37
Rate for Payer: Hawaii Western Management Group Commercial	$39.44
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Humana Medicare	$37.37
Rate for Payer: Kaiser Permanente Commercial	$37.37
Rate for Payer: Kaiser Permanente Medicaid	$21.18
Rate for Payer: Kaiser Permanente Medicare	$37.37
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: Ohana Health Plan Medicaid	$37.37
Rate for Payer: Ohana Health Plan Medicare	$37.37
Rate for Payer: UnitedHealthcare Medicaid	$24.91
Rate for Payer: UnitedHealthcare Medicare	$37.37
Rate for Payer: University Health Alliance Commercial	$30.26

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$32.02

Service Code	NDC 83634040110
Hospital Revenue Code	250
Min. Negotiated Rate	$27.22
Max. Negotiated Rate	$31.06
Rate for Payer: Cash Price	$20.81
Rate for Payer: Health Management Network Commercial	$27.22
Rate for Payer: Kaiser Permanente Commercial	$28.82
Rate for Payer: MDX Hawaii PPO	$31.06

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$21.09

Service Code	NDC 25021041510
Hospital Revenue Code	250
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$20.46
Rate for Payer: Cash Price	$13.71
Rate for Payer: Health Management Network Commercial	$17.93
Rate for Payer: Kaiser Permanente Commercial	$18.98
Rate for Payer: MDX Hawaii PPO	$20.46

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$38.62

Service Code	NDC 39822100001
Hospital Revenue Code	250
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$37.46
Rate for Payer: Cash Price	$25.10
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: Kaiser Permanente Commercial	$34.76
Rate for Payer: MDX Hawaii PPO	$37.46

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$38.62

Service Code	NDC 39822100001
Hospital Revenue Code	250
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$38.23
Rate for Payer: AlohaCare Medicaid	$19.31
Rate for Payer: AlohaCare Medicare	$34.76
Rate for Payer: Cash Price	$25.10
Rate for Payer: Devoted Health Medicare	$38.23
Rate for Payer: Hawaii Medical Service Association Medicare	$34.76
Rate for Payer: Hawaii Western Management Group Commercial	$36.69
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: Humana Medicare	$34.76
Rate for Payer: Kaiser Permanente Commercial	$34.76
Rate for Payer: Kaiser Permanente Medicaid	$19.70
Rate for Payer: Kaiser Permanente Medicare	$34.76
Rate for Payer: MDX Hawaii PPO	$37.46
Rate for Payer: Ohana Health Plan Medicaid	$34.76
Rate for Payer: Ohana Health Plan Medicare	$34.76
Rate for Payer: UnitedHealthcare Medicaid	$23.17
Rate for Payer: UnitedHealthcare Medicare	$34.76
Rate for Payer: University Health Alliance Commercial	$28.15

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$41.52

Service Code	NDC 81284061100
Hospital Revenue Code	250
Min. Negotiated Rate	$35.29
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Kaiser Permanente Commercial	$37.37
Rate for Payer: MDX Hawaii PPO	$40.27

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$41.52

Service Code	NDC 81284061100
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$41.10
Rate for Payer: AlohaCare Medicaid	$20.76
Rate for Payer: AlohaCare Medicare	$37.37
Rate for Payer: Cash Price	$26.99
Rate for Payer: Devoted Health Medicare	$41.10
Rate for Payer: Hawaii Medical Service Association Medicare	$37.37
Rate for Payer: Hawaii Western Management Group Commercial	$39.44
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Humana Medicare	$37.37
Rate for Payer: Kaiser Permanente Commercial	$37.37
Rate for Payer: Kaiser Permanente Medicaid	$21.18
Rate for Payer: Kaiser Permanente Medicare	$37.37
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: Ohana Health Plan Medicaid	$37.37
Rate for Payer: Ohana Health Plan Medicare	$37.37
Rate for Payer: UnitedHealthcare Medicaid	$24.91
Rate for Payer: UnitedHealthcare Medicare	$37.37
Rate for Payer: University Health Alliance Commercial	$30.26

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$32.02

Service Code	NDC 83634040141
Hospital Revenue Code	250
Min. Negotiated Rate	$16.01
Max. Negotiated Rate	$31.70
Rate for Payer: AlohaCare Medicaid	$16.01
Rate for Payer: AlohaCare Medicare	$28.82
Rate for Payer: Cash Price	$20.81
Rate for Payer: Devoted Health Medicare	$31.70
Rate for Payer: Hawaii Medical Service Association Medicare	$28.82
Rate for Payer: Hawaii Western Management Group Commercial	$30.42
Rate for Payer: Health Management Network Commercial	$27.22
Rate for Payer: Humana Medicare	$28.82
Rate for Payer: Kaiser Permanente Commercial	$28.82
Rate for Payer: Kaiser Permanente Medicaid	$16.33
Rate for Payer: Kaiser Permanente Medicare	$28.82
Rate for Payer: MDX Hawaii PPO	$31.06
Rate for Payer: Ohana Health Plan Medicaid	$28.82
Rate for Payer: Ohana Health Plan Medicare	$28.82
Rate for Payer: UnitedHealthcare Medicaid	$19.21
Rate for Payer: UnitedHealthcare Medicare	$28.82
Rate for Payer: University Health Alliance Commercial	$23.34

TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE

Facility

$32.02

Service Code	NDC 83634040141
Hospital Revenue Code	250
Min. Negotiated Rate	$27.22
Max. Negotiated Rate	$31.06
Rate for Payer: Cash Price	$20.81
Rate for Payer: Health Management Network Commercial	$27.22
Rate for Payer: Kaiser Permanente Commercial	$28.82
Rate for Payer: MDX Hawaii PPO	$31.06

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$17,468.37

Service Code	MSDRG 069
Min. Negotiated Rate	$17,468.37
Max. Negotiated Rate	$17,468.37
Rate for Payer: Hawaii Medical Service Association Commercial	$17,468.37

TRANSURETHRAL PROCEDURES WITH CC

Facility

$21,165.89

Service Code	MSDRG 669
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$21,165.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$21,165.89

Service Code	MSDRG 668
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$21,165.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,771.98

Service Code	MSDRG 670
Min. Negotiated Rate	$18,771.98
Max. Negotiated Rate	$18,771.98
Rate for Payer: Hawaii Medical Service Association Commercial	$18,771.98

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$17,681.69

Service Code	MSDRG 713
Min. Negotiated Rate	$17,681.69
Max. Negotiated Rate	$17,681.69
Rate for Payer: Hawaii Medical Service Association Commercial	$17,681.69

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$14,007.88

Service Code	MSDRG 714
Min. Negotiated Rate	$14,007.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88

TRAUMATIC INJURY WITH MCC

Facility

$14,861.15

Service Code	MSDRG 913
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC INJURY WITHOUT MCC

Facility

$14,861.15

Service Code	MSDRG 914
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$16,709.91

Service Code	MSDRG 086
Min. Negotiated Rate	$16,709.91
Max. Negotiated Rate	$16,709.91
Rate for Payer: Hawaii Medical Service Association Commercial	$16,709.91

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$37,757.29

Service Code	MSDRG 083
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$58,235.81

Service Code	MSDRG 085
Min. Negotiated Rate	$58,235.81
Max. Negotiated Rate	$58,235.81
Rate for Payer: Hawaii Medical Service Association Commercial	$58,235.81

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$37,757.29

Service Code	MSDRG 082
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,216.68

Service Code	MSDRG 087
Min. Negotiated Rate	$15,216.68
Max. Negotiated Rate	$15,216.68
Rate for Payer: Hawaii Medical Service Association Commercial	$15,216.68

Know your out-of-pocket cost for care.

All Charges