Kohala Hospital

All Charges

Charge

Type

Setting

Price

CLOTRIMAZOLE 10 MG MM TROCHE

Facility

$8.88

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$8.79
Rate for Payer: AlohaCare Medicaid	$4.44
Rate for Payer: AlohaCare Medicare	$7.99
Rate for Payer: Cash Price	$5.77
Rate for Payer: Devoted Health Medicare	$8.79
Rate for Payer: Hawaii Medical Service Association Medicare	$7.99
Rate for Payer: Hawaii Western Management Group Commercial	$8.44
Rate for Payer: Health Management Network Commercial	$7.55
Rate for Payer: Humana Medicare	$7.99
Rate for Payer: Kaiser Permanente Commercial	$7.99
Rate for Payer: Kaiser Permanente Medicaid	$4.53
Rate for Payer: Kaiser Permanente Medicare	$7.99
Rate for Payer: MDX Hawaii PPO	$8.61
Rate for Payer: Ohana Health Plan Medicaid	$7.99
Rate for Payer: Ohana Health Plan Medicare	$7.99
Rate for Payer: UnitedHealthcare Medicare	$7.99
Rate for Payer: University Health Alliance Commercial	$6.47

CLOTRIMAZOLE 1 % TOP CR

Facility

$220.33

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$110.17
Max. Negotiated Rate	$218.13
Rate for Payer: AlohaCare Medicaid	$110.17
Rate for Payer: AlohaCare Medicaid	$25.37
Rate for Payer: AlohaCare Medicaid	$20.02
Rate for Payer: AlohaCare Medicare	$36.03
Rate for Payer: AlohaCare Medicare	$198.30
Rate for Payer: AlohaCare Medicare	$45.67
Rate for Payer: Cash Price	$32.98
Rate for Payer: Cash Price	$143.21
Rate for Payer: Cash Price	$26.02
Rate for Payer: Devoted Health Medicare	$39.63
Rate for Payer: Devoted Health Medicare	$218.13
Rate for Payer: Devoted Health Medicare	$50.23
Rate for Payer: Hawaii Medical Service Association Medicare	$45.67
Rate for Payer: Hawaii Medical Service Association Medicare	$198.30
Rate for Payer: Hawaii Medical Service Association Medicare	$36.03
Rate for Payer: Hawaii Western Management Group Commercial	$48.20
Rate for Payer: Hawaii Western Management Group Commercial	$209.31
Rate for Payer: Hawaii Western Management Group Commercial	$38.03
Rate for Payer: Health Management Network Commercial	$187.28
Rate for Payer: Health Management Network Commercial	$34.03
Rate for Payer: Health Management Network Commercial	$43.13
Rate for Payer: Humana Medicare	$36.03
Rate for Payer: Humana Medicare	$45.67
Rate for Payer: Humana Medicare	$198.30
Rate for Payer: Kaiser Permanente Commercial	$36.03
Rate for Payer: Kaiser Permanente Commercial	$198.30
Rate for Payer: Kaiser Permanente Commercial	$45.67
Rate for Payer: Kaiser Permanente Medicaid	$25.88
Rate for Payer: Kaiser Permanente Medicaid	$112.37
Rate for Payer: Kaiser Permanente Medicaid	$20.42
Rate for Payer: Kaiser Permanente Medicare	$198.30
Rate for Payer: Kaiser Permanente Medicare	$36.03
Rate for Payer: Kaiser Permanente Medicare	$45.67
Rate for Payer: MDX Hawaii PPO	$213.72
Rate for Payer: MDX Hawaii PPO	$38.83
Rate for Payer: MDX Hawaii PPO	$49.22
Rate for Payer: Ohana Health Plan Medicaid	$36.03
Rate for Payer: Ohana Health Plan Medicaid	$198.30
Rate for Payer: Ohana Health Plan Medicaid	$45.67
Rate for Payer: Ohana Health Plan Medicare	$198.30
Rate for Payer: Ohana Health Plan Medicare	$36.03
Rate for Payer: Ohana Health Plan Medicare	$45.67
Rate for Payer: UnitedHealthcare Medicare	$198.30
Rate for Payer: UnitedHealthcare Medicare	$45.67
Rate for Payer: UnitedHealthcare Medicare	$36.03
Rate for Payer: University Health Alliance Commercial	$29.18
Rate for Payer: University Health Alliance Commercial	$160.60
Rate for Payer: University Health Alliance Commercial	$36.98

CLOTRIMAZOLE 1 % TOP CR

Facility

$40.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$38.83
Rate for Payer: Cash Price	$26.02
Rate for Payer: Cash Price	$143.21
Rate for Payer: Cash Price	$32.98
Rate for Payer: Health Management Network Commercial	$43.13
Rate for Payer: Health Management Network Commercial	$187.28
Rate for Payer: Health Management Network Commercial	$34.03
Rate for Payer: Kaiser Permanente Commercial	$45.67
Rate for Payer: Kaiser Permanente Commercial	$198.30
Rate for Payer: Kaiser Permanente Commercial	$36.03
Rate for Payer: MDX Hawaii PPO	$38.83
Rate for Payer: MDX Hawaii PPO	$213.72
Rate for Payer: MDX Hawaii PPO	$49.22

CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CR

Facility

$178.41

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$89.20
Max. Negotiated Rate	$176.63
Rate for Payer: AlohaCare Medicaid	$89.20
Rate for Payer: AlohaCare Medicare	$160.57
Rate for Payer: Cash Price	$115.97
Rate for Payer: Devoted Health Medicare	$176.63
Rate for Payer: Hawaii Medical Service Association Medicare	$160.57
Rate for Payer: Hawaii Western Management Group Commercial	$169.49
Rate for Payer: Health Management Network Commercial	$151.65
Rate for Payer: Humana Medicare	$160.57
Rate for Payer: Kaiser Permanente Commercial	$160.57
Rate for Payer: Kaiser Permanente Medicaid	$90.99
Rate for Payer: Kaiser Permanente Medicare	$160.57
Rate for Payer: MDX Hawaii PPO	$173.06
Rate for Payer: Ohana Health Plan Medicaid	$160.57
Rate for Payer: Ohana Health Plan Medicare	$160.57
Rate for Payer: UnitedHealthcare Medicare	$160.57
Rate for Payer: University Health Alliance Commercial	$130.04

CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CR

Facility

$178.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$151.65
Max. Negotiated Rate	$173.06
Rate for Payer: Cash Price	$115.97
Rate for Payer: Health Management Network Commercial	$151.65
Rate for Payer: Kaiser Permanente Commercial	$160.57
Rate for Payer: MDX Hawaii PPO	$173.06

COAGULATION DISORDERS

Facility

$32,258.42

Service Code	MSDRG 813
Min. Negotiated Rate	$32,258.42
Max. Negotiated Rate	$32,258.42
Rate for Payer: Hawaii Medical Service Association Commercial	$32,258.42

COLCHICINE 0.6 MG PO TABLET

Facility

$44.41

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$43.97
Rate for Payer: AlohaCare Medicaid	$22.20
Rate for Payer: AlohaCare Medicaid	$21.09
Rate for Payer: AlohaCare Medicare	$37.96
Rate for Payer: AlohaCare Medicare	$39.97
Rate for Payer: Cash Price	$27.42
Rate for Payer: Cash Price	$28.87
Rate for Payer: Devoted Health Medicare	$41.76
Rate for Payer: Devoted Health Medicare	$43.97
Rate for Payer: Hawaii Medical Service Association Medicare	$39.97
Rate for Payer: Hawaii Medical Service Association Medicare	$37.96
Rate for Payer: Hawaii Western Management Group Commercial	$42.19
Rate for Payer: Hawaii Western Management Group Commercial	$40.07
Rate for Payer: Health Management Network Commercial	$35.85
Rate for Payer: Health Management Network Commercial	$37.75
Rate for Payer: Humana Medicare	$37.96
Rate for Payer: Humana Medicare	$39.97
Rate for Payer: Kaiser Permanente Commercial	$37.96
Rate for Payer: Kaiser Permanente Commercial	$39.97
Rate for Payer: Kaiser Permanente Medicaid	$21.51
Rate for Payer: Kaiser Permanente Medicaid	$22.65
Rate for Payer: Kaiser Permanente Medicare	$39.97
Rate for Payer: Kaiser Permanente Medicare	$37.96
Rate for Payer: MDX Hawaii PPO	$43.08
Rate for Payer: MDX Hawaii PPO	$40.91
Rate for Payer: Ohana Health Plan Medicaid	$37.96
Rate for Payer: Ohana Health Plan Medicaid	$39.97
Rate for Payer: Ohana Health Plan Medicare	$37.96
Rate for Payer: Ohana Health Plan Medicare	$39.97
Rate for Payer: UnitedHealthcare Medicare	$37.96
Rate for Payer: UnitedHealthcare Medicare	$39.97
Rate for Payer: University Health Alliance Commercial	$30.75
Rate for Payer: University Health Alliance Commercial	$32.37

COLCHICINE 0.6 MG PO TABLET

Facility

$44.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$37.75
Max. Negotiated Rate	$43.08
Rate for Payer: Cash Price	$28.87
Rate for Payer: Cash Price	$27.42
Rate for Payer: Health Management Network Commercial	$35.85
Rate for Payer: Health Management Network Commercial	$37.75
Rate for Payer: Kaiser Permanente Commercial	$37.96
Rate for Payer: Kaiser Permanente Commercial	$39.97
Rate for Payer: MDX Hawaii PPO	$43.08
Rate for Payer: MDX Hawaii PPO	$40.91

COLESTIPOL 1 GRAM PO TABLET

Facility

$27.63

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.49
Max. Negotiated Rate	$26.80
Rate for Payer: Cash Price	$17.96
Rate for Payer: Health Management Network Commercial	$23.49
Rate for Payer: Kaiser Permanente Commercial	$24.87
Rate for Payer: MDX Hawaii PPO	$26.80

COLESTIPOL 1 GRAM PO TABLET

Facility

$27.63

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$27.35
Rate for Payer: AlohaCare Medicaid	$13.81
Rate for Payer: AlohaCare Medicare	$24.87
Rate for Payer: Cash Price	$17.96
Rate for Payer: Devoted Health Medicare	$27.35
Rate for Payer: Hawaii Medical Service Association Medicare	$24.87
Rate for Payer: Hawaii Western Management Group Commercial	$26.25
Rate for Payer: Health Management Network Commercial	$23.49
Rate for Payer: Humana Medicare	$24.87
Rate for Payer: Kaiser Permanente Commercial	$24.87
Rate for Payer: Kaiser Permanente Medicaid	$14.09
Rate for Payer: Kaiser Permanente Medicare	$24.87
Rate for Payer: MDX Hawaii PPO	$26.80
Rate for Payer: Ohana Health Plan Medicaid	$24.87
Rate for Payer: Ohana Health Plan Medicare	$24.87
Rate for Payer: UnitedHealthcare Medicare	$24.87
Rate for Payer: University Health Alliance Commercial	$20.14

COLLAGENASE 250 UNIT/G TOP OINT 30 G

Facility

$899.05

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$449.52
Max. Negotiated Rate	$890.06
Rate for Payer: AlohaCare Medicaid	$449.52
Rate for Payer: AlohaCare Medicare	$809.14
Rate for Payer: Cash Price	$584.38
Rate for Payer: Devoted Health Medicare	$890.06
Rate for Payer: Hawaii Medical Service Association Medicare	$809.14
Rate for Payer: Hawaii Western Management Group Commercial	$854.10
Rate for Payer: Health Management Network Commercial	$764.19
Rate for Payer: Humana Medicare	$809.14
Rate for Payer: Kaiser Permanente Commercial	$809.14
Rate for Payer: Kaiser Permanente Medicaid	$458.52
Rate for Payer: Kaiser Permanente Medicare	$809.14
Rate for Payer: MDX Hawaii PPO	$872.08
Rate for Payer: Ohana Health Plan Medicaid	$809.14
Rate for Payer: Ohana Health Plan Medicare	$809.14
Rate for Payer: UnitedHealthcare Medicare	$809.14
Rate for Payer: University Health Alliance Commercial	$655.32

COLLAGENASE 250 UNIT/G TOP OINT 30 G

Facility

$899.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$764.19
Max. Negotiated Rate	$872.08
Rate for Payer: Cash Price	$584.38
Rate for Payer: Health Management Network Commercial	$764.19
Rate for Payer: Kaiser Permanente Commercial	$809.14
Rate for Payer: MDX Hawaii PPO	$872.08

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$115,594.65

Service Code	MSDRG 429
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$115,594.65

Service Code	MSDRG 430
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

COMPLEX AORTIC ARCH PROCEDURES

Facility

$193,360.92

Service Code	MSDRG 209
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

COMPLICATED PEPTIC ULCER WITH CC

Facility

$23,796.81

Service Code	MSDRG 381
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$23,796.81

Service Code	MSDRG 380
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$23,796.81

Service Code	MSDRG 382
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATIONS OF TREATMENT WITH CC

Facility

$27,826.15

Service Code	MSDRG 920
Min. Negotiated Rate	$27,826.15
Max. Negotiated Rate	$27,826.15
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$27,826.15

Service Code	MSDRG 919
Min. Negotiated Rate	$27,826.15
Max. Negotiated Rate	$27,826.15
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$15,761.83

Service Code	MSDRG 921
Min. Negotiated Rate	$15,761.83
Max. Negotiated Rate	$15,761.83
Rate for Payer: Hawaii Medical Service Association Commercial	$15,761.83

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$127,540.46

Service Code	MSDRG 212
Min. Negotiated Rate	$127,540.46
Max. Negotiated Rate	$127,540.46
Rate for Payer: Hawaii Medical Service Association Commercial	$127,540.46

CONCUSSION WITH CC

Facility

$22,493.20

Service Code	MSDRG 089
Min. Negotiated Rate	$22,493.20
Max. Negotiated Rate	$22,493.20
Rate for Payer: Hawaii Medical Service Association Commercial	$22,493.20

CONCUSSION WITH MCC

Facility

$22,493.20

Service Code	MSDRG 088
Min. Negotiated Rate	$22,493.20
Max. Negotiated Rate	$22,493.20
Rate for Payer: Hawaii Medical Service Association Commercial	$22,493.20

CONCUSSION WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 090
Min. Negotiated Rate	$16,781.02
Max. Negotiated Rate	$16,781.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02

Know your out-of-pocket cost for care.

All Charges