Kohala Hospital

All Charges

Charge

Type

Setting

Price

DULOXETINE 60 MG PO CAP DR EC

Facility

$47.58

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$23.79
Max. Negotiated Rate	$47.10
Rate for Payer: AlohaCare Medicaid	$23.79
Rate for Payer: AlohaCare Medicare	$42.82
Rate for Payer: Cash Price	$30.93
Rate for Payer: Devoted Health Medicare	$47.10
Rate for Payer: Hawaii Medical Service Association Medicare	$42.82
Rate for Payer: Hawaii Western Management Group Commercial	$45.20
Rate for Payer: Health Management Network Commercial	$40.44
Rate for Payer: Humana Medicare	$42.82
Rate for Payer: Kaiser Permanente Commercial	$42.82
Rate for Payer: Kaiser Permanente Medicaid	$24.27
Rate for Payer: Kaiser Permanente Medicare	$42.82
Rate for Payer: MDX Hawaii PPO	$46.15
Rate for Payer: Ohana Health Plan Medicaid	$42.82
Rate for Payer: Ohana Health Plan Medicare	$42.82
Rate for Payer: UnitedHealthcare Medicare	$42.82
Rate for Payer: University Health Alliance Commercial	$34.68

DUTASTERIDE 0.5 MG PO CAP

Facility

$38.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$33.03
Max. Negotiated Rate	$37.69
Rate for Payer: Cash Price	$25.26
Rate for Payer: Cash Price	$25.27
Rate for Payer: Health Management Network Commercial	$33.03
Rate for Payer: Health Management Network Commercial	$33.04
Rate for Payer: Kaiser Permanente Commercial	$34.97
Rate for Payer: Kaiser Permanente Commercial	$34.98
Rate for Payer: MDX Hawaii PPO	$37.70
Rate for Payer: MDX Hawaii PPO	$37.69

DUTASTERIDE 0.5 MG PO CAP

Facility

$38.87

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$19.43
Max. Negotiated Rate	$38.48
Rate for Payer: AlohaCare Medicaid	$19.43
Rate for Payer: AlohaCare Medicaid	$19.43
Rate for Payer: AlohaCare Medicare	$34.97
Rate for Payer: AlohaCare Medicare	$34.98
Rate for Payer: Cash Price	$25.26
Rate for Payer: Cash Price	$25.27
Rate for Payer: Devoted Health Medicare	$38.48
Rate for Payer: Devoted Health Medicare	$38.47
Rate for Payer: Hawaii Medical Service Association Medicare	$34.97
Rate for Payer: Hawaii Medical Service Association Medicare	$34.98
Rate for Payer: Hawaii Western Management Group Commercial	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$36.93
Rate for Payer: Health Management Network Commercial	$33.04
Rate for Payer: Health Management Network Commercial	$33.03
Rate for Payer: Humana Medicare	$34.98
Rate for Payer: Humana Medicare	$34.97
Rate for Payer: Kaiser Permanente Commercial	$34.97
Rate for Payer: Kaiser Permanente Commercial	$34.98
Rate for Payer: Kaiser Permanente Medicaid	$19.82
Rate for Payer: Kaiser Permanente Medicaid	$19.82
Rate for Payer: Kaiser Permanente Medicare	$34.97
Rate for Payer: Kaiser Permanente Medicare	$34.98
Rate for Payer: MDX Hawaii PPO	$37.69
Rate for Payer: MDX Hawaii PPO	$37.70
Rate for Payer: Ohana Health Plan Medicaid	$34.97
Rate for Payer: Ohana Health Plan Medicaid	$34.98
Rate for Payer: Ohana Health Plan Medicare	$34.97
Rate for Payer: Ohana Health Plan Medicare	$34.98
Rate for Payer: UnitedHealthcare Medicare	$34.98
Rate for Payer: UnitedHealthcare Medicare	$34.97
Rate for Payer: University Health Alliance Commercial	$28.33
Rate for Payer: University Health Alliance Commercial	$28.33

DYSEQUILIBRIUM

Facility

$12,727.97

Service Code	MSDRG 149
Min. Negotiated Rate	$12,727.97
Max. Negotiated Rate	$12,727.97
Rate for Payer: Hawaii Medical Service Association Commercial	$12,727.97

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$35,363.38

Service Code	MSDRG 147
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$35,363.38

Service Code	MSDRG 146
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$35,363.38

Service Code	MSDRG 148
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$466,787.19

Service Code	MSDRG 003
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$466,787.19
Rate for Payer: Hawaii Medical Service Association Commercial	$466,787.19
Rate for Payer: University Health Alliance Commercial	$10,400.00

EMPAGLIFLOZIN 10 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$89.14
Max. Negotiated Rate	$101.72
Rate for Payer: Cash Price	$68.17
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: Kaiser Permanente Commercial	$94.38
Rate for Payer: MDX Hawaii PPO	$101.72

EMPAGLIFLOZIN 10 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$52.44
Max. Negotiated Rate	$103.82
Rate for Payer: AlohaCare Medicaid	$52.44
Rate for Payer: AlohaCare Medicare	$94.38
Rate for Payer: Cash Price	$68.17
Rate for Payer: Devoted Health Medicare	$103.82
Rate for Payer: Hawaii Medical Service Association Medicare	$94.38
Rate for Payer: Hawaii Western Management Group Commercial	$99.63
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: Humana Medicare	$94.38
Rate for Payer: Kaiser Permanente Commercial	$94.38
Rate for Payer: Kaiser Permanente Medicaid	$53.48
Rate for Payer: Kaiser Permanente Medicare	$94.38
Rate for Payer: MDX Hawaii PPO	$101.72
Rate for Payer: Ohana Health Plan Medicaid	$94.38
Rate for Payer: Ohana Health Plan Medicare	$94.38
Rate for Payer: UnitedHealthcare Medicare	$94.38
Rate for Payer: University Health Alliance Commercial	$76.44

EMPAGLIFLOZIN 25 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$52.44
Max. Negotiated Rate	$103.82
Rate for Payer: AlohaCare Medicaid	$52.44
Rate for Payer: AlohaCare Medicare	$94.38
Rate for Payer: Cash Price	$68.17
Rate for Payer: Devoted Health Medicare	$103.82
Rate for Payer: Hawaii Medical Service Association Medicare	$94.38
Rate for Payer: Hawaii Western Management Group Commercial	$99.63
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: Humana Medicare	$94.38
Rate for Payer: Kaiser Permanente Commercial	$94.38
Rate for Payer: Kaiser Permanente Medicaid	$53.48
Rate for Payer: Kaiser Permanente Medicare	$94.38
Rate for Payer: MDX Hawaii PPO	$101.72
Rate for Payer: Ohana Health Plan Medicaid	$94.38
Rate for Payer: Ohana Health Plan Medicare	$94.38
Rate for Payer: UnitedHealthcare Medicare	$94.38
Rate for Payer: University Health Alliance Commercial	$76.44

EMPAGLIFLOZIN 25 MG PO TABLET

Facility

$104.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$89.14
Max. Negotiated Rate	$101.72
Rate for Payer: Cash Price	$68.17
Rate for Payer: Health Management Network Commercial	$89.14
Rate for Payer: Kaiser Permanente Commercial	$94.38
Rate for Payer: MDX Hawaii PPO	$101.72

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978601
Hospital Revenue Code	250
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$54.91
Rate for Payer: AlohaCare Medicaid	$27.73
Rate for Payer: AlohaCare Medicare	$49.91
Rate for Payer: Cash Price	$36.05
Rate for Payer: Devoted Health Medicare	$54.91
Rate for Payer: Hawaii Medical Service Association Medicare	$49.91
Rate for Payer: Hawaii Western Management Group Commercial	$52.69
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: Humana Medicare	$49.91
Rate for Payer: Kaiser Permanente Commercial	$49.91
Rate for Payer: Kaiser Permanente Medicaid	$28.28
Rate for Payer: Kaiser Permanente Medicare	$49.91
Rate for Payer: MDX Hawaii PPO	$53.80
Rate for Payer: Ohana Health Plan Medicaid	$49.91
Rate for Payer: Ohana Health Plan Medicare	$49.91
Rate for Payer: UnitedHealthcare Medicaid	$33.28
Rate for Payer: UnitedHealthcare Medicare	$49.91
Rate for Payer: University Health Alliance Commercial	$40.42

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978610
Hospital Revenue Code	250
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$54.91
Rate for Payer: AlohaCare Medicaid	$27.73
Rate for Payer: AlohaCare Medicare	$49.91
Rate for Payer: Cash Price	$36.05
Rate for Payer: Devoted Health Medicare	$54.91
Rate for Payer: Hawaii Medical Service Association Medicare	$49.91
Rate for Payer: Hawaii Western Management Group Commercial	$52.69
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: Humana Medicare	$49.91
Rate for Payer: Kaiser Permanente Commercial	$49.91
Rate for Payer: Kaiser Permanente Medicaid	$28.28
Rate for Payer: Kaiser Permanente Medicare	$49.91
Rate for Payer: MDX Hawaii PPO	$53.80
Rate for Payer: Ohana Health Plan Medicaid	$49.91
Rate for Payer: Ohana Health Plan Medicare	$49.91
Rate for Payer: UnitedHealthcare Medicaid	$33.28
Rate for Payer: UnitedHealthcare Medicare	$49.91
Rate for Payer: University Health Alliance Commercial	$40.42

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978610
Hospital Revenue Code	250
Min. Negotiated Rate	$47.14
Max. Negotiated Rate	$53.80
Rate for Payer: Cash Price	$36.05
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: Kaiser Permanente Commercial	$49.91
Rate for Payer: MDX Hawaii PPO	$53.80

ENALAPRILAT 1.25 MG/ML IV SOLN

Facility

$55.46

Service Code	NDC 00143978601
Hospital Revenue Code	250
Min. Negotiated Rate	$47.14
Max. Negotiated Rate	$53.80
Rate for Payer: Cash Price	$36.05
Rate for Payer: Health Management Network Commercial	$47.14
Rate for Payer: Kaiser Permanente Commercial	$49.91
Rate for Payer: MDX Hawaii PPO	$53.80

ENDOCRINE DISORDERS WITH CC

Facility

$19,388.24

Service Code	MSDRG 644
Min. Negotiated Rate	$19,388.24
Max. Negotiated Rate	$19,388.24
Rate for Payer: Hawaii Medical Service Association Commercial	$19,388.24

ENDOCRINE DISORDERS WITH MCC

Facility

$19,388.24

Service Code	MSDRG 643
Min. Negotiated Rate	$19,388.24
Max. Negotiated Rate	$19,388.24
Rate for Payer: Hawaii Medical Service Association Commercial	$19,388.24

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 645
Min. Negotiated Rate	$16,781.02
Max. Negotiated Rate	$16,781.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$96,040.50

Service Code	MSDRG 213
Min. Negotiated Rate	$96,040.50
Max. Negotiated Rate	$96,040.50
Rate for Payer: Hawaii Medical Service Association Commercial	$96,040.50

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$92,366.69

Service Code	MSDRG 266
Min. Negotiated Rate	$92,366.69
Max. Negotiated Rate	$92,366.69
Rate for Payer: Hawaii Medical Service Association Commercial	$92,366.69

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$80,444.59

Service Code	MSDRG 267
Min. Negotiated Rate	$80,444.59
Max. Negotiated Rate	$80,444.59
Rate for Payer: Hawaii Medical Service Association Commercial	$80,444.59

ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYR

Facility

$54.68

Service Code	HCPCS J1650
Hospital Revenue Code	250
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$53.04
Rate for Payer: Cash Price	$35.54
Rate for Payer: Health Management Network Commercial	$46.48
Rate for Payer: Kaiser Permanente Commercial	$49.21
Rate for Payer: MDX Hawaii PPO	$53.04

ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYR

Facility

$54.68

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$54.13
Rate for Payer: AlohaCare Medicaid	$27.34
Rate for Payer: AlohaCare Medicare	$49.21
Rate for Payer: Cash Price	$35.54
Rate for Payer: Cash Price	$35.54
Rate for Payer: Devoted Health Medicare	$54.13
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$49.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$51.95
Rate for Payer: Health Management Network Commercial	$46.48
Rate for Payer: Humana Medicare	$49.21
Rate for Payer: Kaiser Permanente Commercial	$49.21
Rate for Payer: Kaiser Permanente Medicaid	$27.89
Rate for Payer: Kaiser Permanente Medicare	$49.21
Rate for Payer: MDX Hawaii PPO	$53.04
Rate for Payer: Ohana Health Plan Medicaid	$49.21
Rate for Payer: Ohana Health Plan Medicare	$49.21
Rate for Payer: UnitedHealthcare Medicaid	$32.81
Rate for Payer: UnitedHealthcare Medicare	$49.21
Rate for Payer: University Health Alliance Commercial	$39.86

ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYR

Facility

$111.15

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$110.04
Rate for Payer: AlohaCare Medicaid	$55.58
Rate for Payer: AlohaCare Medicare	$100.03
Rate for Payer: Cash Price	$72.25
Rate for Payer: Cash Price	$72.25
Rate for Payer: Devoted Health Medicare	$110.04
Rate for Payer: Hawaii Medical Service Association ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$100.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$105.59
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Humana Medicare	$100.03
Rate for Payer: Kaiser Permanente Commercial	$100.03
Rate for Payer: Kaiser Permanente Medicaid	$56.69
Rate for Payer: Kaiser Permanente Medicare	$100.03
Rate for Payer: MDX Hawaii PPO	$107.82
Rate for Payer: Ohana Health Plan Medicaid	$100.03
Rate for Payer: Ohana Health Plan Medicare	$100.03
Rate for Payer: UnitedHealthcare Medicaid	$66.69
Rate for Payer: UnitedHealthcare Medicare	$100.03
Rate for Payer: University Health Alliance Commercial	$81.02

Know your out-of-pocket cost for care.

All Charges