Kohala Hospital

All Charges

Charge

Type

Setting

Price

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$480.28

Service Code	NDC 42023010401
Hospital Revenue Code	250
Min. Negotiated Rate	$240.14
Max. Negotiated Rate	$475.48
Rate for Payer: AlohaCare Medicaid	$240.14
Rate for Payer: AlohaCare Medicare	$432.25
Rate for Payer: Cash Price	$312.18
Rate for Payer: Devoted Health Medicare	$475.48
Rate for Payer: Hawaii Medical Service Association Medicare	$432.25
Rate for Payer: Hawaii Western Management Group Commercial	$456.27
Rate for Payer: Health Management Network Commercial	$408.24
Rate for Payer: Humana Medicare	$432.25
Rate for Payer: Kaiser Permanente Commercial	$432.25
Rate for Payer: Kaiser Permanente Medicaid	$244.94
Rate for Payer: Kaiser Permanente Medicare	$432.25
Rate for Payer: MDX Hawaii PPO	$465.87
Rate for Payer: Ohana Health Plan Medicaid	$432.25
Rate for Payer: Ohana Health Plan Medicare	$432.25
Rate for Payer: UnitedHealthcare Medicaid	$288.17
Rate for Payer: UnitedHealthcare Medicare	$432.25
Rate for Payer: University Health Alliance Commercial	$350.08

TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRADERM SOLN

Facility

$480.28

Service Code	NDC 42023010401
Hospital Revenue Code	250
Min. Negotiated Rate	$408.24
Max. Negotiated Rate	$465.87
Rate for Payer: Cash Price	$312.18
Rate for Payer: Health Management Network Commercial	$408.24
Rate for Payer: Kaiser Permanente Commercial	$432.25
Rate for Payer: MDX Hawaii PPO	$465.87

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$71,911.87

Service Code	MSDRG 278
Min. Negotiated Rate	$71,911.87
Max. Negotiated Rate	$71,911.87
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$71,911.87

Service Code	MSDRG 279
Min. Negotiated Rate	$71,911.87
Max. Negotiated Rate	$71,911.87
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$19,625.26

Service Code	MSDRG 383
Min. Negotiated Rate	$19,625.26
Max. Negotiated Rate	$19,625.26
Rate for Payer: Hawaii Medical Service Association Commercial	$19,625.26

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$19,625.26

Service Code	MSDRG 384
Min. Negotiated Rate	$19,625.26
Max. Negotiated Rate	$19,625.26
Rate for Payer: Hawaii Medical Service Association Commercial	$19,625.26

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$36,643.29

Service Code	MSDRG 256
Min. Negotiated Rate	$36,643.29
Max. Negotiated Rate	$36,643.29
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$36,643.29

Service Code	MSDRG 255
Min. Negotiated Rate	$36,643.29
Max. Negotiated Rate	$36,643.29
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$36,643.29

Service Code	MSDRG 257
Min. Negotiated Rate	$36,643.29
Max. Negotiated Rate	$36,643.29
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29

URETHRAL PROCEDURES WITH CC/MCC

Facility

$35,505.60

Service Code	MSDRG 671
Min. Negotiated Rate	$35,505.60
Max. Negotiated Rate	$35,505.60
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60

URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$35,505.60

Service Code	MSDRG 672
Min. Negotiated Rate	$35,505.60
Max. Negotiated Rate	$35,505.60
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60

URETHRAL STRICTURE

Facility

$5,190.74

Service Code	MSDRG 697
Min. Negotiated Rate	$5,190.74
Max. Negotiated Rate	$5,190.74
Rate for Payer: Hawaii Medical Service Association Commercial	$5,190.74

URINARY STONES WITH MCC

Facility

$12,538.36

Service Code	MSDRG 693
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$12,538.36
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36

URINARY STONES WITHOUT MCC

Facility

$11,708.79

Service Code	MSDRG 694
Min. Negotiated Rate	$11,708.79
Max. Negotiated Rate	$11,708.79
Rate for Payer: Hawaii Medical Service Association Commercial	$11,708.79

URSODIOL 300 MG PO CAP

Facility

$45.15

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$44.70
Rate for Payer: AlohaCare Medicaid	$22.57
Rate for Payer: AlohaCare Medicare	$40.63
Rate for Payer: Cash Price	$29.35
Rate for Payer: Devoted Health Medicare	$44.70
Rate for Payer: Hawaii Medical Service Association Medicare	$40.63
Rate for Payer: Hawaii Western Management Group Commercial	$42.89
Rate for Payer: Health Management Network Commercial	$38.38
Rate for Payer: Humana Medicare	$40.63
Rate for Payer: Kaiser Permanente Commercial	$40.63
Rate for Payer: Kaiser Permanente Medicaid	$23.03
Rate for Payer: Kaiser Permanente Medicare	$40.63
Rate for Payer: MDX Hawaii PPO	$43.80
Rate for Payer: Ohana Health Plan Medicaid	$40.63
Rate for Payer: Ohana Health Plan Medicare	$40.63
Rate for Payer: UnitedHealthcare Medicare	$40.63
Rate for Payer: University Health Alliance Commercial	$32.91

URSODIOL 300 MG PO CAP

Facility

$45.15

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$43.80
Rate for Payer: Cash Price	$29.35
Rate for Payer: Health Management Network Commercial	$38.38
Rate for Payer: Kaiser Permanente Commercial	$40.63
Rate for Payer: MDX Hawaii PPO	$43.80

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$22,279.88

Service Code	MSDRG 742
Min. Negotiated Rate	$22,279.88
Max. Negotiated Rate	$22,279.88
Rate for Payer: Hawaii Medical Service Association Commercial	$22,279.88

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$20,028.19

Service Code	MSDRG 743
Min. Negotiated Rate	$20,028.19
Max. Negotiated Rate	$20,028.19
Rate for Payer: Hawaii Medical Service Association Commercial	$20,028.19

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$36,074.44

Service Code	MSDRG 740
Min. Negotiated Rate	$36,074.44
Max. Negotiated Rate	$36,074.44
Rate for Payer: Hawaii Medical Service Association Commercial	$36,074.44

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$37,496.56

Service Code	MSDRG 739
Min. Negotiated Rate	$37,496.56
Max. Negotiated Rate	$37,496.56
Rate for Payer: Hawaii Medical Service Association Commercial	$37,496.56

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$25,835.18

Service Code	MSDRG 741
Min. Negotiated Rate	$25,835.18
Max. Negotiated Rate	$25,835.18
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$45,626.35

Service Code	MSDRG 737
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$45,626.35

Service Code	MSDRG 736
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$45,626.35

Service Code	MSDRG 738
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$26,451.43

Service Code	MSDRG 746
Min. Negotiated Rate	$26,451.43
Max. Negotiated Rate	$26,451.43
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43

Know your out-of-pocket cost for care.

All Charges