Kohala Hospital

All Charges

Charge

Type

Setting

Price

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$34,652.32

Service Code	MSDRG 546
Min. Negotiated Rate	$34,652.32
Max. Negotiated Rate	$34,652.32
Rate for Payer: Hawaii Medical Service Association Commercial	$34,652.32

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$40,032.68

Service Code	MSDRG 545
Min. Negotiated Rate	$40,032.68
Max. Negotiated Rate	$40,032.68
Rate for Payer: Hawaii Medical Service Association Commercial	$40,032.68

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,295.67

Service Code	MSDRG 547
Min. Negotiated Rate	$29,295.67
Max. Negotiated Rate	$29,295.67
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$127,327.14

Service Code	MSDRG 233
Min. Negotiated Rate	$127,327.14
Max. Negotiated Rate	$127,327.14
Rate for Payer: Hawaii Medical Service Association Commercial	$127,327.14

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$111,754.93

Service Code	MSDRG 234
Min. Negotiated Rate	$111,754.93
Max. Negotiated Rate	$111,754.93
Rate for Payer: Hawaii Medical Service Association Commercial	$111,754.93

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$97,201.90

Service Code	MSDRG 235
Min. Negotiated Rate	$97,201.90
Max. Negotiated Rate	$97,201.90
Rate for Payer: Hawaii Medical Service Association Commercial	$97,201.90

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$90,375.73

Service Code	MSDRG 236
Min. Negotiated Rate	$90,375.73
Max. Negotiated Rate	$90,375.73
Rate for Payer: Hawaii Medical Service Association Commercial	$90,375.73

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$140,505.46

Service Code	MSDRG 231
Min. Negotiated Rate	$140,505.46
Max. Negotiated Rate	$140,505.46
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$140,505.46

Service Code	MSDRG 232
Min. Negotiated Rate	$140,505.46
Max. Negotiated Rate	$140,505.46
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$40,483.02

Service Code	MSDRG 323
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 324
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$38,112.82

Service Code	MSDRG 325
Min. Negotiated Rate	$38,112.82
Max. Negotiated Rate	$38,112.82
Rate for Payer: Hawaii Medical Service Association Commercial	$38,112.82

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$24,507.87

Service Code	MSDRG 073
Min. Negotiated Rate	$24,507.87
Max. Negotiated Rate	$24,507.87
Rate for Payer: Hawaii Medical Service Association Commercial	$24,507.87

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$22,327.28

Service Code	MSDRG 074
Min. Negotiated Rate	$22,327.28
Max. Negotiated Rate	$22,327.28
Rate for Payer: Hawaii Medical Service Association Commercial	$22,327.28

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$89,095.82

Service Code	MSDRG 026
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$89,095.82

Service Code	MSDRG 025
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$76,652.27

Service Code	MSDRG 027
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$76,652.27
Rate for Payer: Hawaii Medical Service Association Commercial	$76,652.27
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$224,860.87

Service Code	MSDRG 955
Min. Negotiated Rate	$224,860.87
Max. Negotiated Rate	$224,860.87
Rate for Payer: Hawaii Medical Service Association Commercial	$224,860.87

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$104,857.65

Service Code	MSDRG 023
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$104,857.65
Rate for Payer: Hawaii Medical Service Association Commercial	$104,857.65
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$99,927.63

Service Code	MSDRG 024
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$99,927.63
Rate for Payer: Hawaii Medical Service Association Commercial	$99,927.63
Rate for Payer: University Health Alliance Commercial	$10,400.00

CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLN

Facility

$18.77

Service Code	HCPCS J3420
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$18.21
Rate for Payer: Cash Price	$12.20
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Kaiser Permanente Commercial	$16.89
Rate for Payer: MDX Hawaii PPO	$18.21

CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLN

Facility

$18.77

Service Code	HCPCS J3420
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$18.58
Rate for Payer: AlohaCare Medicaid	$9.38
Rate for Payer: AlohaCare Medicare	$16.89
Rate for Payer: Cash Price	$12.20
Rate for Payer: Cash Price	$12.20
Rate for Payer: Devoted Health Medicare	$18.58
Rate for Payer: Hawaii Medical Service Association ABD	$0.95
Rate for Payer: Hawaii Medical Service Association Medicare	$16.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.95
Rate for Payer: Hawaii Western Management Group Commercial	$17.83
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Humana Medicare	$16.89
Rate for Payer: Kaiser Permanente Commercial	$16.89
Rate for Payer: Kaiser Permanente Medicaid	$9.57
Rate for Payer: Kaiser Permanente Medicare	$16.89
Rate for Payer: MDX Hawaii PPO	$18.21
Rate for Payer: Ohana Health Plan Medicaid	$16.89
Rate for Payer: Ohana Health Plan Medicare	$16.89
Rate for Payer: UnitedHealthcare Medicaid	$11.26
Rate for Payer: UnitedHealthcare Medicare	$16.89
Rate for Payer: University Health Alliance Commercial	$13.68

CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG PO TABLET

Facility

$1.96

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$0.98
Rate for Payer: AlohaCare Medicare	$1.76
Rate for Payer: Cash Price	$1.27
Rate for Payer: Devoted Health Medicare	$1.94
Rate for Payer: Hawaii Medical Service Association Medicare	$1.76
Rate for Payer: Hawaii Western Management Group Commercial	$1.86
Rate for Payer: Health Management Network Commercial	$1.67
Rate for Payer: Humana Medicare	$1.76
Rate for Payer: Kaiser Permanente Commercial	$1.76
Rate for Payer: Kaiser Permanente Medicaid	$1.00
Rate for Payer: Kaiser Permanente Medicare	$1.76
Rate for Payer: MDX Hawaii PPO	$1.90
Rate for Payer: Ohana Health Plan Medicaid	$1.76
Rate for Payer: Ohana Health Plan Medicare	$1.76
Rate for Payer: UnitedHealthcare Medicare	$1.76
Rate for Payer: University Health Alliance Commercial	$1.43

CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG PO TABLET

Facility

$1.96

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Management Network Commercial	$1.67
Rate for Payer: Kaiser Permanente Commercial	$1.76
Rate for Payer: MDX Hawaii PPO	$1.90

CYCLOBENZAPRINE 10 MG 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

Know your out-of-pocket cost for care.

All Charges