Kohala Hospital

All Charges

Charge

Type

Setting

Price

FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHAL HFAA

Facility

$983.37

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$491.69
Max. Negotiated Rate	$973.54
Rate for Payer: AlohaCare Medicaid	$491.69
Rate for Payer: AlohaCare Medicare	$885.03
Rate for Payer: Cash Price	$639.19
Rate for Payer: Devoted Health Medicare	$973.54
Rate for Payer: Hawaii Medical Service Association Medicare	$885.03
Rate for Payer: Hawaii Western Management Group Commercial	$934.20
Rate for Payer: Health Management Network Commercial	$835.86
Rate for Payer: Humana Medicare	$885.03
Rate for Payer: Kaiser Permanente Commercial	$885.03
Rate for Payer: Kaiser Permanente Medicaid	$501.52
Rate for Payer: Kaiser Permanente Medicare	$885.03
Rate for Payer: MDX Hawaii PPO	$953.87
Rate for Payer: Ohana Health Plan Medicaid	$885.03
Rate for Payer: Ohana Health Plan Medicare	$885.03
Rate for Payer: UnitedHealthcare Medicare	$885.03
Rate for Payer: University Health Alliance Commercial	$716.78

FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHAL HFAA

Facility

$983.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$835.86
Max. Negotiated Rate	$953.87
Rate for Payer: Cash Price	$639.19
Rate for Payer: Health Management Network Commercial	$835.86
Rate for Payer: Kaiser Permanente Commercial	$885.03
Rate for Payer: MDX Hawaii PPO	$953.87

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPSN

Facility

$470.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$400.06
Max. Negotiated Rate	$456.54
Rate for Payer: Cash Price	$305.93
Rate for Payer: Health Management Network Commercial	$400.06
Rate for Payer: Kaiser Permanente Commercial	$423.59
Rate for Payer: MDX Hawaii PPO	$456.54

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPSN

Facility

$470.66

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$235.33
Max. Negotiated Rate	$465.95
Rate for Payer: AlohaCare Medicaid	$235.33
Rate for Payer: AlohaCare Medicare	$423.59
Rate for Payer: Cash Price	$305.93
Rate for Payer: Devoted Health Medicare	$465.95
Rate for Payer: Hawaii Medical Service Association Medicare	$423.59
Rate for Payer: Hawaii Western Management Group Commercial	$447.13
Rate for Payer: Health Management Network Commercial	$400.06
Rate for Payer: Humana Medicare	$423.59
Rate for Payer: Kaiser Permanente Commercial	$423.59
Rate for Payer: Kaiser Permanente Medicaid	$240.04
Rate for Payer: Kaiser Permanente Medicare	$423.59
Rate for Payer: MDX Hawaii PPO	$456.54
Rate for Payer: Ohana Health Plan Medicaid	$423.59
Rate for Payer: Ohana Health Plan Medicare	$423.59
Rate for Payer: UnitedHealthcare Medicare	$423.59
Rate for Payer: University Health Alliance Commercial	$343.06

FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHAL DSDV

Facility

$1,757.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,493.90
Max. Negotiated Rate	$1,704.80
Rate for Payer: Cash Price	$1,142.39
Rate for Payer: Health Management Network Commercial	$1,493.90
Rate for Payer: Kaiser Permanente Commercial	$1,581.78
Rate for Payer: MDX Hawaii PPO	$1,704.80

FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHAL DSDV

Facility

$1,757.53

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$878.76
Max. Negotiated Rate	$1,739.95
Rate for Payer: AlohaCare Medicaid	$878.76
Rate for Payer: AlohaCare Medicare	$1,581.78
Rate for Payer: Cash Price	$1,142.39
Rate for Payer: Devoted Health Medicare	$1,739.95
Rate for Payer: Hawaii Medical Service Association Medicare	$1,581.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.65
Rate for Payer: Health Management Network Commercial	$1,493.90
Rate for Payer: Humana Medicare	$1,581.78
Rate for Payer: Kaiser Permanente Commercial	$1,581.78
Rate for Payer: Kaiser Permanente Medicaid	$896.34
Rate for Payer: Kaiser Permanente Medicare	$1,581.78
Rate for Payer: MDX Hawaii PPO	$1,704.80
Rate for Payer: Ohana Health Plan Medicaid	$1,581.78
Rate for Payer: Ohana Health Plan Medicare	$1,581.78
Rate for Payer: UnitedHealthcare Medicare	$1,581.78
Rate for Payer: University Health Alliance Commercial	$1,281.06

FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHAL DSDV

Facility

$2,181.45

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1,090.72
Max. Negotiated Rate	$2,159.64
Rate for Payer: AlohaCare Medicaid	$1,090.72
Rate for Payer: AlohaCare Medicare	$1,963.31
Rate for Payer: Cash Price	$1,417.94
Rate for Payer: Devoted Health Medicare	$2,159.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,963.31
Rate for Payer: Hawaii Western Management Group Commercial	$2,072.38
Rate for Payer: Health Management Network Commercial	$1,854.23
Rate for Payer: Humana Medicare	$1,963.31
Rate for Payer: Kaiser Permanente Commercial	$1,963.31
Rate for Payer: Kaiser Permanente Medicaid	$1,112.54
Rate for Payer: Kaiser Permanente Medicare	$1,963.31
Rate for Payer: MDX Hawaii PPO	$2,116.01
Rate for Payer: Ohana Health Plan Medicaid	$1,963.31
Rate for Payer: Ohana Health Plan Medicare	$1,963.31
Rate for Payer: UnitedHealthcare Medicare	$1,963.31
Rate for Payer: University Health Alliance Commercial	$1,590.06

FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHAL DSDV

Facility

$2,181.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,854.23
Max. Negotiated Rate	$2,116.01
Rate for Payer: Cash Price	$1,417.94
Rate for Payer: Health Management Network Commercial	$1,854.23
Rate for Payer: Kaiser Permanente Commercial	$1,963.31
Rate for Payer: MDX Hawaii PPO	$2,116.01

FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHAL DSDV

Facility

$2,865.94

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1,432.97
Max. Negotiated Rate	$2,837.28
Rate for Payer: AlohaCare Medicaid	$1,432.97
Rate for Payer: AlohaCare Medicare	$2,579.35
Rate for Payer: Cash Price	$1,862.86
Rate for Payer: Devoted Health Medicare	$2,837.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,579.35
Rate for Payer: Hawaii Western Management Group Commercial	$2,722.64
Rate for Payer: Health Management Network Commercial	$2,436.05
Rate for Payer: Humana Medicare	$2,579.35
Rate for Payer: Kaiser Permanente Commercial	$2,579.35
Rate for Payer: Kaiser Permanente Medicaid	$1,461.63
Rate for Payer: Kaiser Permanente Medicare	$2,579.35
Rate for Payer: MDX Hawaii PPO	$2,779.96
Rate for Payer: Ohana Health Plan Medicaid	$2,579.35
Rate for Payer: Ohana Health Plan Medicare	$2,579.35
Rate for Payer: UnitedHealthcare Medicare	$2,579.35
Rate for Payer: University Health Alliance Commercial	$2,088.98

FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHAL DSDV

Facility

$2,865.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2,436.05
Max. Negotiated Rate	$2,779.96
Rate for Payer: Cash Price	$1,862.86
Rate for Payer: Health Management Network Commercial	$2,436.05
Rate for Payer: Kaiser Permanente Commercial	$2,579.35
Rate for Payer: MDX Hawaii PPO	$2,779.96

FLU VAC TS 2025-26(6MOS UP)-PF 45 MCG (15 MCG X 3)/0.5 ML IM SYR

Facility

$99.72

Service Code	HCPCS 90656
Hospital Revenue Code	250
Min. Negotiated Rate	$84.76
Max. Negotiated Rate	$96.73
Rate for Payer: Cash Price	$64.82
Rate for Payer: Health Management Network Commercial	$84.76
Rate for Payer: Kaiser Permanente Commercial	$89.75
Rate for Payer: MDX Hawaii PPO	$96.73

FLU VAC TS 2025-26(6MOS UP)-PF 45 MCG (15 MCG X 3)/0.5 ML IM SYR

Facility

$99.72

Service Code	HCPCS 90656
Hospital Revenue Code	636
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$98.72
Rate for Payer: AlohaCare Medicaid	$49.86
Rate for Payer: AlohaCare Medicare	$89.75
Rate for Payer: Cash Price	$64.82
Rate for Payer: Cash Price	$64.82
Rate for Payer: Devoted Health Medicare	$98.72
Rate for Payer: Hawaii Medical Service Association ABD	$22.35
Rate for Payer: Hawaii Medical Service Association Medicare	$89.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$94.73
Rate for Payer: Health Management Network Commercial	$84.76
Rate for Payer: Humana Medicare	$89.75
Rate for Payer: Kaiser Permanente Commercial	$89.75
Rate for Payer: Kaiser Permanente Medicaid	$50.86
Rate for Payer: Kaiser Permanente Medicare	$89.75
Rate for Payer: MDX Hawaii PPO	$96.73
Rate for Payer: Ohana Health Plan Medicaid	$89.75
Rate for Payer: Ohana Health Plan Medicare	$89.75
Rate for Payer: UnitedHealthcare Medicaid	$59.83
Rate for Payer: UnitedHealthcare Medicare	$89.75
Rate for Payer: University Health Alliance Commercial	$72.69

FOLIC ACID 1 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

FOLIC ACID 1 MG 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

FOLIC ACID 5 MG/ML INJ SOLN

Facility

$162.90

Service Code	HCPCS J1808
Hospital Revenue Code	250
Min. Negotiated Rate	$138.47
Max. Negotiated Rate	$158.01
Rate for Payer: Cash Price	$105.88
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Kaiser Permanente Commercial	$146.61
Rate for Payer: MDX Hawaii PPO	$158.01

FOLIC ACID 5 MG/ML INJ SOLN

Facility

$162.90

Service Code	HCPCS J1808
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$161.27
Rate for Payer: AlohaCare Medicaid	$81.45
Rate for Payer: AlohaCare Medicare	$146.61
Rate for Payer: Cash Price	$105.88
Rate for Payer: Cash Price	$105.88
Rate for Payer: Devoted Health Medicare	$161.27
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Medicare	$146.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$154.75
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Humana Medicare	$146.61
Rate for Payer: Kaiser Permanente Commercial	$146.61
Rate for Payer: Kaiser Permanente Medicaid	$83.08
Rate for Payer: Kaiser Permanente Medicare	$146.61
Rate for Payer: MDX Hawaii PPO	$158.01
Rate for Payer: Ohana Health Plan Medicaid	$146.61
Rate for Payer: Ohana Health Plan Medicare	$146.61
Rate for Payer: UnitedHealthcare Medicaid	$97.74
Rate for Payer: UnitedHealthcare Medicare	$146.61
Rate for Payer: University Health Alliance Commercial	$118.74

FOOT PROCEDURES WITH CC

Facility

$23,227.96

Service Code	MSDRG 504
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$23,227.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96

FOOT PROCEDURES WITH MCC

Facility

$23,227.96

Service Code	MSDRG 503
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$23,227.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96

FOOT PROCEDURES WITHOUT CC/MCC

Facility

$23,227.96

Service Code	MSDRG 505
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$23,227.96
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96

FOSFOMYCIN TROMETHAMINE 3 GRAM PO PKT

Facility

$446.59

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$442.12
Rate for Payer: AlohaCare Medicaid	$223.29
Rate for Payer: AlohaCare Medicare	$401.93
Rate for Payer: Cash Price	$290.28
Rate for Payer: Devoted Health Medicare	$442.12
Rate for Payer: Hawaii Medical Service Association Medicare	$401.93
Rate for Payer: Hawaii Western Management Group Commercial	$424.26
Rate for Payer: Health Management Network Commercial	$379.60
Rate for Payer: Humana Medicare	$401.93
Rate for Payer: Kaiser Permanente Commercial	$401.93
Rate for Payer: Kaiser Permanente Medicaid	$227.76
Rate for Payer: Kaiser Permanente Medicare	$401.93
Rate for Payer: MDX Hawaii PPO	$433.19
Rate for Payer: Ohana Health Plan Medicaid	$401.93
Rate for Payer: Ohana Health Plan Medicare	$401.93
Rate for Payer: UnitedHealthcare Medicare	$401.93
Rate for Payer: University Health Alliance Commercial	$325.52

FOSFOMYCIN TROMETHAMINE 3 GRAM PO PKT

Facility

$446.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$433.19
Rate for Payer: Cash Price	$290.28
Rate for Payer: Health Management Network Commercial	$379.60
Rate for Payer: Kaiser Permanente Commercial	$401.93
Rate for Payer: MDX Hawaii PPO	$433.19

FOSPHENYTOIN 100 MG PE/2 ML INJ SOLN

Facility

$26.50

Service Code	HCPCS Q2009
Hospital Revenue Code	250
Min. Negotiated Rate	$22.52
Max. Negotiated Rate	$25.70
Rate for Payer: Cash Price	$17.23
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Kaiser Permanente Commercial	$23.85
Rate for Payer: MDX Hawaii PPO	$25.70

FOSPHENYTOIN 100 MG PE/2 ML INJ SOLN

Facility

$26.50

Service Code	HCPCS Q2009
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$26.23
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$23.85
Rate for Payer: Cash Price	$17.23
Rate for Payer: Cash Price	$17.23
Rate for Payer: Devoted Health Medicare	$26.23
Rate for Payer: Hawaii Medical Service Association Commercial	$1.66
Rate for Payer: Hawaii Medical Service Association Medicare	$23.85
Rate for Payer: Hawaii Western Management Group Commercial	$25.18
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Humana Medicare	$23.85
Rate for Payer: Kaiser Permanente Commercial	$23.85
Rate for Payer: Kaiser Permanente Medicaid	$13.52
Rate for Payer: Kaiser Permanente Medicare	$23.85
Rate for Payer: MDX Hawaii PPO	$25.70
Rate for Payer: Ohana Health Plan Medicaid	$23.85
Rate for Payer: Ohana Health Plan Medicare	$23.85
Rate for Payer: UnitedHealthcare Medicaid	$15.90
Rate for Payer: UnitedHealthcare Medicare	$23.85
Rate for Payer: University Health Alliance Commercial	$19.32

FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN

Facility

$491.82

Service Code	HCPCS Q2009
Hospital Revenue Code	250
Min. Negotiated Rate	$418.05
Max. Negotiated Rate	$477.07
Rate for Payer: Cash Price	$319.68
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: Kaiser Permanente Commercial	$442.64
Rate for Payer: MDX Hawaii PPO	$477.07

FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN

Facility

$491.82

Service Code	HCPCS Q2009
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$486.90
Rate for Payer: AlohaCare Medicaid	$245.91
Rate for Payer: AlohaCare Medicare	$442.64
Rate for Payer: Cash Price	$319.68
Rate for Payer: Cash Price	$319.68
Rate for Payer: Devoted Health Medicare	$486.90
Rate for Payer: Hawaii Medical Service Association Commercial	$1.66
Rate for Payer: Hawaii Medical Service Association Medicare	$442.64
Rate for Payer: Hawaii Western Management Group Commercial	$467.23
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: Humana Medicare	$442.64
Rate for Payer: Kaiser Permanente Commercial	$442.64
Rate for Payer: Kaiser Permanente Medicaid	$250.83
Rate for Payer: Kaiser Permanente Medicare	$442.64
Rate for Payer: MDX Hawaii PPO	$477.07
Rate for Payer: Ohana Health Plan Medicaid	$442.64
Rate for Payer: Ohana Health Plan Medicare	$442.64
Rate for Payer: UnitedHealthcare Medicaid	$295.09
Rate for Payer: UnitedHealthcare Medicare	$442.64
Rate for Payer: University Health Alliance Commercial	$358.49

Know your out-of-pocket cost for care.

All Charges