Kohala Hospital

All Charges

Charge

Type

Setting

Price

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$80,800.12

Service Code	MSDRG 239
Min. Negotiated Rate	$80,800.12
Max. Negotiated Rate	$80,800.12
Rate for Payer: Hawaii Medical Service Association Commercial	$80,800.12

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$80,800.12

Service Code	MSDRG 241
Min. Negotiated Rate	$80,800.12
Max. Negotiated Rate	$80,800.12
Rate for Payer: Hawaii Medical Service Association Commercial	$80,800.12

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$40,696.33

Service Code	MSDRG 475
Min. Negotiated Rate	$40,696.33
Max. Negotiated Rate	$40,696.33
Rate for Payer: Hawaii Medical Service Association Commercial	$40,696.33

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$40,696.33

Service Code	MSDRG 474
Min. Negotiated Rate	$40,696.33
Max. Negotiated Rate	$40,696.33
Rate for Payer: Hawaii Medical Service Association Commercial	$40,696.33

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$40,696.33

Service Code	MSDRG 476
Min. Negotiated Rate	$40,696.33
Max. Negotiated Rate	$40,696.33
Rate for Payer: Hawaii Medical Service Association Commercial	$40,696.33

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$71,603.74

Service Code	MSDRG 617
Min. Negotiated Rate	$71,603.74
Max. Negotiated Rate	$71,603.74
Rate for Payer: Hawaii Medical Service Association Commercial	$71,603.74

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$71,603.74

Service Code	MSDRG 616
Min. Negotiated Rate	$71,603.74
Max. Negotiated Rate	$71,603.74
Rate for Payer: Hawaii Medical Service Association Commercial	$71,603.74

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$71,603.74

Service Code	MSDRG 618
Min. Negotiated Rate	$71,603.74
Max. Negotiated Rate	$71,603.74
Rate for Payer: Hawaii Medical Service Association Commercial	$71,603.74

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$22,872.43

Service Code	MSDRG 348
Min. Negotiated Rate	$22,872.43
Max. Negotiated Rate	$22,872.43
Rate for Payer: Hawaii Medical Service Association Commercial	$22,872.43

ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$28,513.51

Service Code	MSDRG 347
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$14,197.50

Service Code	MSDRG 349
Min. Negotiated Rate	$14,197.50
Max. Negotiated Rate	$14,197.50
Rate for Payer: Hawaii Medical Service Association Commercial	$14,197.50

ANASTROZOLE 1 MG PO TABLET

Facility

$11.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$11.10
Rate for Payer: Cash Price	$7.44
Rate for Payer: Health Management Network Commercial	$9.72
Rate for Payer: Kaiser Permanente Commercial	$10.30
Rate for Payer: MDX Hawaii PPO	$11.10

ANASTROZOLE 1 MG PO TABLET

Facility

$11.44

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$11.33
Rate for Payer: AlohaCare Medicaid	$5.72
Rate for Payer: AlohaCare Medicare	$10.30
Rate for Payer: Cash Price	$7.44
Rate for Payer: Devoted Health Medicare	$11.33
Rate for Payer: Hawaii Medical Service Association Medicare	$10.30
Rate for Payer: Hawaii Western Management Group Commercial	$10.87
Rate for Payer: Health Management Network Commercial	$9.72
Rate for Payer: Humana Medicare	$10.30
Rate for Payer: Kaiser Permanente Commercial	$10.30
Rate for Payer: Kaiser Permanente Medicaid	$5.83
Rate for Payer: Kaiser Permanente Medicare	$10.30
Rate for Payer: MDX Hawaii PPO	$11.10
Rate for Payer: Ohana Health Plan Medicaid	$10.30
Rate for Payer: Ohana Health Plan Medicare	$10.30
Rate for Payer: UnitedHealthcare Medicare	$10.30
Rate for Payer: University Health Alliance Commercial	$8.34

ANGINA PECTORIS

Facility

$12,704.27

Service Code	MSDRG 311
Min. Negotiated Rate	$12,704.27
Max. Negotiated Rate	$12,704.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12,704.27

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$111,280.89

Service Code	MSDRG 268
Min. Negotiated Rate	$111,280.89
Max. Negotiated Rate	$111,280.89
Rate for Payer: Hawaii Medical Service Association Commercial	$111,280.89

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$96,040.50

Service Code	MSDRG 269
Min. Negotiated Rate	$96,040.50
Max. Negotiated Rate	$96,040.50
Rate for Payer: Hawaii Medical Service Association Commercial	$96,040.50

APIXABAN 2.5 MG PO TABLET

Facility

$58.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$56.72
Rate for Payer: Cash Price	$38.01
Rate for Payer: Cash Price	$38.01
Rate for Payer: Health Management Network Commercial	$49.70
Rate for Payer: Health Management Network Commercial	$49.71
Rate for Payer: Kaiser Permanente Commercial	$52.63
Rate for Payer: Kaiser Permanente Commercial	$52.62
Rate for Payer: MDX Hawaii PPO	$56.73
Rate for Payer: MDX Hawaii PPO	$56.72

APIXABAN 2.5 MG PO TABLET

Facility

$58.48

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$57.90
Rate for Payer: AlohaCare Medicaid	$29.24
Rate for Payer: AlohaCare Medicaid	$29.23
Rate for Payer: AlohaCare Medicare	$52.63
Rate for Payer: AlohaCare Medicare	$52.62
Rate for Payer: Cash Price	$38.01
Rate for Payer: Cash Price	$38.01
Rate for Payer: Devoted Health Medicare	$57.89
Rate for Payer: Devoted Health Medicare	$57.90
Rate for Payer: Hawaii Medical Service Association Medicare	$52.62
Rate for Payer: Hawaii Medical Service Association Medicare	$52.63
Rate for Payer: Hawaii Western Management Group Commercial	$55.55
Rate for Payer: Hawaii Western Management Group Commercial	$55.56
Rate for Payer: Health Management Network Commercial	$49.71
Rate for Payer: Health Management Network Commercial	$49.70
Rate for Payer: Humana Medicare	$52.63
Rate for Payer: Humana Medicare	$52.62
Rate for Payer: Kaiser Permanente Commercial	$52.62
Rate for Payer: Kaiser Permanente Commercial	$52.63
Rate for Payer: Kaiser Permanente Medicaid	$29.82
Rate for Payer: Kaiser Permanente Medicaid	$29.82
Rate for Payer: Kaiser Permanente Medicare	$52.63
Rate for Payer: Kaiser Permanente Medicare	$52.62
Rate for Payer: MDX Hawaii PPO	$56.72
Rate for Payer: MDX Hawaii PPO	$56.73
Rate for Payer: Ohana Health Plan Medicaid	$52.63
Rate for Payer: Ohana Health Plan Medicaid	$52.62
Rate for Payer: Ohana Health Plan Medicare	$52.63
Rate for Payer: Ohana Health Plan Medicare	$52.62
Rate for Payer: UnitedHealthcare Medicare	$52.62
Rate for Payer: UnitedHealthcare Medicare	$52.63
Rate for Payer: University Health Alliance Commercial	$42.63
Rate for Payer: University Health Alliance Commercial	$42.62

APIXABAN 5 MG PO TABLET

Facility

$58.47

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$29.23
Max. Negotiated Rate	$57.89
Rate for Payer: AlohaCare Medicaid	$29.23
Rate for Payer: AlohaCare Medicaid	$29.24
Rate for Payer: AlohaCare Medicare	$52.62
Rate for Payer: AlohaCare Medicare	$52.63
Rate for Payer: Cash Price	$38.01
Rate for Payer: Cash Price	$38.01
Rate for Payer: Devoted Health Medicare	$57.89
Rate for Payer: Devoted Health Medicare	$57.90
Rate for Payer: Hawaii Medical Service Association Medicare	$52.63
Rate for Payer: Hawaii Medical Service Association Medicare	$52.62
Rate for Payer: Hawaii Western Management Group Commercial	$55.56
Rate for Payer: Hawaii Western Management Group Commercial	$55.55
Rate for Payer: Health Management Network Commercial	$49.70
Rate for Payer: Health Management Network Commercial	$49.71
Rate for Payer: Humana Medicare	$52.63
Rate for Payer: Humana Medicare	$52.62
Rate for Payer: Kaiser Permanente Commercial	$52.62
Rate for Payer: Kaiser Permanente Commercial	$52.63
Rate for Payer: Kaiser Permanente Medicaid	$29.82
Rate for Payer: Kaiser Permanente Medicaid	$29.82
Rate for Payer: Kaiser Permanente Medicare	$52.63
Rate for Payer: Kaiser Permanente Medicare	$52.62
Rate for Payer: MDX Hawaii PPO	$56.73
Rate for Payer: MDX Hawaii PPO	$56.72
Rate for Payer: Ohana Health Plan Medicaid	$52.62
Rate for Payer: Ohana Health Plan Medicaid	$52.63
Rate for Payer: Ohana Health Plan Medicare	$52.62
Rate for Payer: Ohana Health Plan Medicare	$52.63
Rate for Payer: UnitedHealthcare Medicare	$52.62
Rate for Payer: UnitedHealthcare Medicare	$52.63
Rate for Payer: University Health Alliance Commercial	$42.63
Rate for Payer: University Health Alliance Commercial	$42.62

APIXABAN 5 MG PO TABLET

Facility

$58.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$49.71
Max. Negotiated Rate	$56.73
Rate for Payer: Cash Price	$38.01
Rate for Payer: Cash Price	$38.01
Rate for Payer: Health Management Network Commercial	$49.71
Rate for Payer: Health Management Network Commercial	$49.70
Rate for Payer: Kaiser Permanente Commercial	$52.63
Rate for Payer: Kaiser Permanente Commercial	$52.62
Rate for Payer: MDX Hawaii PPO	$56.72
Rate for Payer: MDX Hawaii PPO	$56.73

APPENDIX PROCEDURES WITH CC

Facility

$31,689.57

Service Code	MSDRG 398
Min. Negotiated Rate	$31,689.57
Max. Negotiated Rate	$31,689.57
Rate for Payer: Hawaii Medical Service Association Commercial	$31,689.57

APPENDIX PROCEDURES WITH MCC

Facility

$34,320.50

Service Code	MSDRG 397
Min. Negotiated Rate	$34,320.50
Max. Negotiated Rate	$34,320.50
Rate for Payer: Hawaii Medical Service Association Commercial	$34,320.50

APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$23,654.60

Service Code	MSDRG 399
Min. Negotiated Rate	$23,654.60
Max. Negotiated Rate	$23,654.60
Rate for Payer: Hawaii Medical Service Association Commercial	$23,654.60

ARGATROBAN 100 MG/ML IV SOLN

Facility

$1,298.76

Service Code	HCPCS J0883
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1,285.77
Rate for Payer: AlohaCare Medicaid	$649.38
Rate for Payer: AlohaCare Medicare	$1,168.88
Rate for Payer: Cash Price	$844.19
Rate for Payer: Cash Price	$844.19
Rate for Payer: Devoted Health Medicare	$1,285.77
Rate for Payer: Hawaii Medical Service Association ABD	$0.74
Rate for Payer: Hawaii Medical Service Association Commercial	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1,168.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.82
Rate for Payer: Health Management Network Commercial	$1,103.95
Rate for Payer: Humana Medicare	$1,168.88
Rate for Payer: Kaiser Permanente Commercial	$1,168.88
Rate for Payer: Kaiser Permanente Medicaid	$662.37
Rate for Payer: Kaiser Permanente Medicare	$1,168.88
Rate for Payer: MDX Hawaii PPO	$1,259.80
Rate for Payer: Ohana Health Plan Medicaid	$1,168.88
Rate for Payer: Ohana Health Plan Medicare	$1,168.88
Rate for Payer: UnitedHealthcare Medicaid	$779.26
Rate for Payer: UnitedHealthcare Medicare	$1,168.88
Rate for Payer: University Health Alliance Commercial	$946.67

ARGATROBAN 100 MG/ML IV SOLN

Facility

$1,298.76

Service Code	HCPCS J0883
Hospital Revenue Code	250
Min. Negotiated Rate	$1,103.95
Max. Negotiated Rate	$1,259.80
Rate for Payer: Cash Price	$844.19
Rate for Payer: Health Management Network Commercial	$1,103.95
Rate for Payer: Kaiser Permanente Commercial	$1,168.88
Rate for Payer: MDX Hawaii PPO	$1,259.80

Know your out-of-pocket cost for care.

All Charges