Kohala Hospital

All Charges

Charge

Type

Setting

Price

CHLORPROMAZINE 10 MG PO TABLET

Facility

$23.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$23.03
Rate for Payer: Cash Price	$15.43
Rate for Payer: Health Management Network Commercial	$20.18
Rate for Payer: Kaiser Permanente Commercial	$21.37
Rate for Payer: MDX Hawaii PPO	$23.03

CHLORPROMAZINE 10 MG PO TABLET

Facility

$23.74

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$23.50
Rate for Payer: AlohaCare Medicaid	$11.87
Rate for Payer: AlohaCare Medicare	$21.37
Rate for Payer: Cash Price	$15.43
Rate for Payer: Devoted Health Medicare	$23.50
Rate for Payer: Hawaii Medical Service Association Medicare	$21.37
Rate for Payer: Hawaii Western Management Group Commercial	$22.55
Rate for Payer: Health Management Network Commercial	$20.18
Rate for Payer: Humana Medicare	$21.37
Rate for Payer: Kaiser Permanente Commercial	$21.37
Rate for Payer: Kaiser Permanente Medicaid	$12.11
Rate for Payer: Kaiser Permanente Medicare	$21.37
Rate for Payer: MDX Hawaii PPO	$23.03
Rate for Payer: Ohana Health Plan Medicaid	$21.37
Rate for Payer: Ohana Health Plan Medicare	$21.37
Rate for Payer: UnitedHealthcare Medicare	$21.37
Rate for Payer: University Health Alliance Commercial	$17.30

CHLORPROMAZINE 25 MG/ML INJ SOLN

Facility

$155.05

Service Code	HCPCS J3230
Hospital Revenue Code	250
Min. Negotiated Rate	$131.79
Max. Negotiated Rate	$150.40
Rate for Payer: Cash Price	$100.78
Rate for Payer: Health Management Network Commercial	$131.79
Rate for Payer: Kaiser Permanente Commercial	$139.54
Rate for Payer: MDX Hawaii PPO	$150.40

CHLORPROMAZINE 25 MG/ML INJ SOLN

Facility

$155.05

Service Code	HCPCS J3230
Hospital Revenue Code	636
Min. Negotiated Rate	$27.07
Max. Negotiated Rate	$153.50
Rate for Payer: AlohaCare Medicaid	$77.53
Rate for Payer: AlohaCare Medicare	$139.54
Rate for Payer: Cash Price	$100.78
Rate for Payer: Cash Price	$100.78
Rate for Payer: Devoted Health Medicare	$153.50
Rate for Payer: Hawaii Medical Service Association ABD	$27.07
Rate for Payer: Hawaii Medical Service Association Medicare	$139.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.07
Rate for Payer: Hawaii Western Management Group Commercial	$147.30
Rate for Payer: Health Management Network Commercial	$131.79
Rate for Payer: Humana Medicare	$139.54
Rate for Payer: Kaiser Permanente Commercial	$139.54
Rate for Payer: Kaiser Permanente Medicaid	$79.08
Rate for Payer: Kaiser Permanente Medicare	$139.54
Rate for Payer: MDX Hawaii PPO	$150.40
Rate for Payer: Ohana Health Plan Medicaid	$139.54
Rate for Payer: Ohana Health Plan Medicare	$139.54
Rate for Payer: UnitedHealthcare Medicaid	$93.03
Rate for Payer: UnitedHealthcare Medicare	$139.54
Rate for Payer: University Health Alliance Commercial	$113.02

CHLORPROMAZINE 25 MG PO TABLET

Facility

$44.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$30.26
Rate for Payer: Cash Price	$29.77
Rate for Payer: Health Management Network Commercial	$39.58
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Health Management Network Commercial	$38.93
Rate for Payer: Kaiser Permanente Commercial	$41.22
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Commercial	$41.90
Rate for Payer: MDX Hawaii PPO	$45.16
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: MDX Hawaii PPO	$44.43

CHLORPROMAZINE 25 MG PO TABLET

Facility

$44.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$43.56
Rate for Payer: AlohaCare Medicaid	$22.00
Rate for Payer: AlohaCare Medicaid	$23.28
Rate for Payer: AlohaCare Medicaid	$22.90
Rate for Payer: AlohaCare Medicare	$41.22
Rate for Payer: AlohaCare Medicare	$39.60
Rate for Payer: AlohaCare Medicare	$41.90
Rate for Payer: Cash Price	$30.26
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$29.77
Rate for Payer: Devoted Health Medicare	$45.34
Rate for Payer: Devoted Health Medicare	$43.56
Rate for Payer: Devoted Health Medicare	$46.09
Rate for Payer: Hawaii Medical Service Association Medicare	$41.90
Rate for Payer: Hawaii Medical Service Association Medicare	$39.60
Rate for Payer: Hawaii Medical Service Association Medicare	$41.22
Rate for Payer: Hawaii Western Management Group Commercial	$44.23
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Hawaii Western Management Group Commercial	$43.51
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Health Management Network Commercial	$38.93
Rate for Payer: Health Management Network Commercial	$39.58
Rate for Payer: Humana Medicare	$41.22
Rate for Payer: Humana Medicare	$41.90
Rate for Payer: Humana Medicare	$39.60
Rate for Payer: Kaiser Permanente Commercial	$41.22
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Commercial	$41.90
Rate for Payer: Kaiser Permanente Medicaid	$23.75
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicaid	$23.36
Rate for Payer: Kaiser Permanente Medicare	$39.60
Rate for Payer: Kaiser Permanente Medicare	$41.22
Rate for Payer: Kaiser Permanente Medicare	$41.90
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: MDX Hawaii PPO	$44.43
Rate for Payer: MDX Hawaii PPO	$45.16
Rate for Payer: Ohana Health Plan Medicaid	$41.22
Rate for Payer: Ohana Health Plan Medicaid	$39.60
Rate for Payer: Ohana Health Plan Medicaid	$41.90
Rate for Payer: Ohana Health Plan Medicare	$39.60
Rate for Payer: Ohana Health Plan Medicare	$41.22
Rate for Payer: Ohana Health Plan Medicare	$41.90
Rate for Payer: UnitedHealthcare Medicare	$39.60
Rate for Payer: UnitedHealthcare Medicare	$41.90
Rate for Payer: UnitedHealthcare Medicare	$41.22
Rate for Payer: University Health Alliance Commercial	$33.38
Rate for Payer: University Health Alliance Commercial	$32.07
Rate for Payer: University Health Alliance Commercial	$33.94

CHLORPROMAZINE 50 MG PO TABLET

Facility

$59.78

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$50.81
Max. Negotiated Rate	$57.99
Rate for Payer: Cash Price	$38.86
Rate for Payer: Cash Price	$38.37
Rate for Payer: Health Management Network Commercial	$50.81
Rate for Payer: Health Management Network Commercial	$50.18
Rate for Payer: Kaiser Permanente Commercial	$53.80
Rate for Payer: Kaiser Permanente Commercial	$53.13
Rate for Payer: MDX Hawaii PPO	$57.26
Rate for Payer: MDX Hawaii PPO	$57.99

CHLORPROMAZINE 50 MG PO TABLET

Facility

$59.03

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$58.44
Rate for Payer: AlohaCare Medicaid	$29.52
Rate for Payer: AlohaCare Medicaid	$29.89
Rate for Payer: AlohaCare Medicare	$53.13
Rate for Payer: AlohaCare Medicare	$53.80
Rate for Payer: Cash Price	$38.86
Rate for Payer: Cash Price	$38.37
Rate for Payer: Devoted Health Medicare	$58.44
Rate for Payer: Devoted Health Medicare	$59.18
Rate for Payer: Hawaii Medical Service Association Medicare	$53.80
Rate for Payer: Hawaii Medical Service Association Medicare	$53.13
Rate for Payer: Hawaii Western Management Group Commercial	$56.79
Rate for Payer: Hawaii Western Management Group Commercial	$56.08
Rate for Payer: Health Management Network Commercial	$50.18
Rate for Payer: Health Management Network Commercial	$50.81
Rate for Payer: Humana Medicare	$53.80
Rate for Payer: Humana Medicare	$53.13
Rate for Payer: Kaiser Permanente Commercial	$53.13
Rate for Payer: Kaiser Permanente Commercial	$53.80
Rate for Payer: Kaiser Permanente Medicaid	$30.49
Rate for Payer: Kaiser Permanente Medicaid	$30.11
Rate for Payer: Kaiser Permanente Medicare	$53.80
Rate for Payer: Kaiser Permanente Medicare	$53.13
Rate for Payer: MDX Hawaii PPO	$57.99
Rate for Payer: MDX Hawaii PPO	$57.26
Rate for Payer: Ohana Health Plan Medicaid	$53.13
Rate for Payer: Ohana Health Plan Medicaid	$53.80
Rate for Payer: Ohana Health Plan Medicare	$53.13
Rate for Payer: Ohana Health Plan Medicare	$53.80
Rate for Payer: UnitedHealthcare Medicare	$53.13
Rate for Payer: UnitedHealthcare Medicare	$53.80
Rate for Payer: University Health Alliance Commercial	$43.57
Rate for Payer: University Health Alliance Commercial	$43.03

CHOLECALCIFEROL (VITAMIN D3) 1000 UNIT 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

CHOLECALCIFEROL (VITAMIN D3) 1000 UNIT 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

CHOLECALCIFEROL (VITAMIN D3) 5000 UNIT PO CAP

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

CHOLECALCIFEROL (VITAMIN D3) 5000 UNIT PO CAP

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

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$38,563.15

Service Code	MSDRG 415
Min. Negotiated Rate	$38,563.15
Max. Negotiated Rate	$38,563.15
Rate for Payer: Hawaii Medical Service Association Commercial	$38,563.15

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$41,431.10

Service Code	MSDRG 414
Min. Negotiated Rate	$41,431.10
Max. Negotiated Rate	$41,431.10
Rate for Payer: Hawaii Medical Service Association Commercial	$41,431.10

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$26,783.26

Service Code	MSDRG 416
Min. Negotiated Rate	$26,783.26
Max. Negotiated Rate	$26,783.26
Rate for Payer: Hawaii Medical Service Association Commercial	$26,783.26

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$41,881.43

Service Code	MSDRG 412
Min. Negotiated Rate	$41,881.43
Max. Negotiated Rate	$41,881.43
Rate for Payer: Hawaii Medical Service Association Commercial	$41,881.43

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$50,082.33

Service Code	MSDRG 411
Min. Negotiated Rate	$50,082.33
Max. Negotiated Rate	$50,082.33
Rate for Payer: Hawaii Medical Service Association Commercial	$50,082.33

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$33,704.24

Service Code	MSDRG 413
Min. Negotiated Rate	$33,704.24
Max. Negotiated Rate	$33,704.24
Rate for Payer: Hawaii Medical Service Association Commercial	$33,704.24

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM PO PWPK

Facility

$18.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$18.04
Rate for Payer: Cash Price	$12.09
Rate for Payer: Health Management Network Commercial	$15.81
Rate for Payer: Kaiser Permanente Commercial	$16.74
Rate for Payer: MDX Hawaii PPO	$18.04

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM PO PWPK

Facility

$18.60

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$18.41
Rate for Payer: AlohaCare Medicaid	$9.30
Rate for Payer: AlohaCare Medicare	$16.74
Rate for Payer: Cash Price	$12.09
Rate for Payer: Devoted Health Medicare	$18.41
Rate for Payer: Hawaii Medical Service Association Medicare	$16.74
Rate for Payer: Hawaii Western Management Group Commercial	$17.67
Rate for Payer: Health Management Network Commercial	$15.81
Rate for Payer: Humana Medicare	$16.74
Rate for Payer: Kaiser Permanente Commercial	$16.74
Rate for Payer: Kaiser Permanente Medicaid	$9.49
Rate for Payer: Kaiser Permanente Medicare	$16.74
Rate for Payer: MDX Hawaii PPO	$18.04
Rate for Payer: Ohana Health Plan Medicaid	$16.74
Rate for Payer: Ohana Health Plan Medicare	$16.74
Rate for Payer: UnitedHealthcare Medicare	$16.74
Rate for Payer: University Health Alliance Commercial	$13.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$18,487.56

Service Code	MSDRG 191
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$18,487.56

Service Code	MSDRG 190
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$18,487.56

Service Code	MSDRG 192
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CIPROFLOXACIN HCL 0.2 % OTIC DROPPERETTE

Facility

$68.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$44.43
Rate for Payer: Health Management Network Commercial	$58.10
Rate for Payer: Kaiser Permanente Commercial	$61.52
Rate for Payer: MDX Hawaii PPO	$66.30

CIPROFLOXACIN HCL 0.2 % OTIC DROPPERETTE

Facility

$68.35

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$34.17
Max. Negotiated Rate	$67.67
Rate for Payer: AlohaCare Medicaid	$34.17
Rate for Payer: AlohaCare Medicare	$61.52
Rate for Payer: Cash Price	$44.43
Rate for Payer: Devoted Health Medicare	$67.67
Rate for Payer: Hawaii Medical Service Association Medicare	$61.52
Rate for Payer: Hawaii Western Management Group Commercial	$64.93
Rate for Payer: Health Management Network Commercial	$58.10
Rate for Payer: Humana Medicare	$61.52
Rate for Payer: Kaiser Permanente Commercial	$61.52
Rate for Payer: Kaiser Permanente Medicaid	$34.86
Rate for Payer: Kaiser Permanente Medicare	$61.52
Rate for Payer: MDX Hawaii PPO	$66.30
Rate for Payer: Ohana Health Plan Medicaid	$61.52
Rate for Payer: Ohana Health Plan Medicare	$61.52
Rate for Payer: UnitedHealthcare Medicare	$61.52
Rate for Payer: University Health Alliance Commercial	$49.82

Know your out-of-pocket cost for care.

All Charges