Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

LURBINECTEDIN 4 MG/8 ML IV (WET SOLR VIAL) [430173604]

Facility

$10,400.00

Service Code	HCPCS J9223
Hospital Revenue Code	250
Min. Negotiated Rate	$8,840.00
Max. Negotiated Rate	$10,088.00
Rate for Payer: Cash Price	$6,240.00
Rate for Payer: Health Management Network Commercial	$8,840.00
Rate for Payer: Kaiser Permanente Commercial	$9,360.00
Rate for Payer: MDX Hawaii PPO	$10,088.00

LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [173604]

Facility

$10,400.00

Service Code	HCPCS J9223
Hospital Revenue Code	250
Min. Negotiated Rate	$8,840.00
Max. Negotiated Rate	$10,088.00
Rate for Payer: Cash Price	$6,240.00
Rate for Payer: Cash Price	$7,333.20
Rate for Payer: Health Management Network Commercial	$8,840.00
Rate for Payer: Health Management Network Commercial	$10,388.70
Rate for Payer: Kaiser Permanente Commercial	$9,360.00
Rate for Payer: Kaiser Permanente Commercial	$10,999.80
Rate for Payer: MDX Hawaii PPO	$11,855.34
Rate for Payer: MDX Hawaii PPO	$10,088.00

LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [173604]

Facility

$10,400.00

Service Code	HCPCS J9223
Hospital Revenue Code	636
Min. Negotiated Rate	$206.13
Max. Negotiated Rate	$10,088.00
Rate for Payer: AlohaCare Medicaid	$5,200.00
Rate for Payer: AlohaCare Medicaid	$6,111.00
Rate for Payer: AlohaCare Medicare	$9,288.72
Rate for Payer: AlohaCare Medicare	$7,904.00
Rate for Payer: Cash Price	$7,333.20
Rate for Payer: Cash Price	$6,240.00
Rate for Payer: Cash Price	$7,333.20
Rate for Payer: Cash Price	$6,240.00
Rate for Payer: Devoted Health Medicare	$8,736.00
Rate for Payer: Devoted Health Medicare	$10,266.48
Rate for Payer: Hawaii Medical Service Association ABD	$206.13
Rate for Payer: Hawaii Medical Service Association ABD	$206.13
Rate for Payer: Hawaii Medical Service Association Commercial	$265.12
Rate for Payer: Hawaii Medical Service Association Commercial	$265.12
Rate for Payer: Hawaii Medical Service Association Medicare	$9,288.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7,904.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$206.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$206.13
Rate for Payer: Hawaii Western Management Group Commercial	$9,880.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,610.90
Rate for Payer: Health Management Network Commercial	$10,388.70
Rate for Payer: Health Management Network Commercial	$8,840.00
Rate for Payer: Humana Medicare	$7,904.00
Rate for Payer: Humana Medicare	$9,288.72
Rate for Payer: Kaiser Permanente Commercial	$9,360.00
Rate for Payer: Kaiser Permanente Commercial	$10,999.80
Rate for Payer: Kaiser Permanente Medicaid	$6,233.22
Rate for Payer: Kaiser Permanente Medicaid	$5,304.00
Rate for Payer: Kaiser Permanente Medicare	$7,904.00
Rate for Payer: Kaiser Permanente Medicare	$9,288.72
Rate for Payer: MDX Hawaii PPO	$10,088.00
Rate for Payer: MDX Hawaii PPO	$11,855.34
Rate for Payer: Ohana Health Plan Medicaid	$9,288.72
Rate for Payer: Ohana Health Plan Medicaid	$7,904.00
Rate for Payer: Ohana Health Plan Medicare	$7,904.00
Rate for Payer: Ohana Health Plan Medicare	$9,288.72
Rate for Payer: UnitedHealthcare Medicaid	$7,333.20
Rate for Payer: UnitedHealthcare Medicaid	$6,240.00
Rate for Payer: UnitedHealthcare Medicare	$7,904.00
Rate for Payer: UnitedHealthcare Medicare	$9,288.72
Rate for Payer: University Health Alliance Commercial	$7,580.56
Rate for Payer: University Health Alliance Commercial	$8,908.62

LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION [170335]

Facility

$5,436.00

Service Code	HCPCS J0896
Hospital Revenue Code	250
Min. Negotiated Rate	$4,620.60
Max. Negotiated Rate	$5,272.92
Rate for Payer: Cash Price	$3,261.60
Rate for Payer: Health Management Network Commercial	$4,620.60
Rate for Payer: Kaiser Permanente Commercial	$4,892.40
Rate for Payer: MDX Hawaii PPO	$5,272.92

LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION [170335]

Facility

$5,436.00

Service Code	HCPCS J0896
Hospital Revenue Code	636
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$5,272.92
Rate for Payer: AlohaCare Medicaid	$2,718.00
Rate for Payer: AlohaCare Medicare	$4,131.36
Rate for Payer: Cash Price	$3,261.60
Rate for Payer: Cash Price	$3,261.60
Rate for Payer: Devoted Health Medicare	$4,566.24
Rate for Payer: Hawaii Medical Service Association ABD	$41.96
Rate for Payer: Hawaii Medical Service Association Commercial	$53.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4,131.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.96
Rate for Payer: Hawaii Western Management Group Commercial	$5,164.20
Rate for Payer: Health Management Network Commercial	$4,620.60
Rate for Payer: Humana Medicare	$4,131.36
Rate for Payer: Kaiser Permanente Commercial	$4,892.40
Rate for Payer: Kaiser Permanente Medicaid	$2,772.36
Rate for Payer: Kaiser Permanente Medicare	$4,131.36
Rate for Payer: MDX Hawaii PPO	$5,272.92
Rate for Payer: Ohana Health Plan Medicaid	$4,131.36
Rate for Payer: Ohana Health Plan Medicare	$4,131.36
Rate for Payer: UnitedHealthcare Medicaid	$3,261.60
Rate for Payer: UnitedHealthcare Medicare	$4,131.36
Rate for Payer: University Health Alliance Commercial	$3,962.30

LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION [170336]

Facility

$15,308.00

Service Code	HCPCS J0896
Hospital Revenue Code	250
Min. Negotiated Rate	$13,011.80
Max. Negotiated Rate	$14,848.76
Rate for Payer: Cash Price	$9,184.80
Rate for Payer: Health Management Network Commercial	$13,011.80
Rate for Payer: Kaiser Permanente Commercial	$13,777.20
Rate for Payer: MDX Hawaii PPO	$14,848.76

LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION [170336]

Facility

$15,308.00

Service Code	HCPCS J0896
Hospital Revenue Code	636
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$14,848.76
Rate for Payer: AlohaCare Medicaid	$7,654.00
Rate for Payer: AlohaCare Medicare	$11,634.08
Rate for Payer: Cash Price	$9,184.80
Rate for Payer: Cash Price	$9,184.80
Rate for Payer: Devoted Health Medicare	$12,858.72
Rate for Payer: Hawaii Medical Service Association ABD	$41.96
Rate for Payer: Hawaii Medical Service Association Commercial	$53.44
Rate for Payer: Hawaii Medical Service Association Medicare	$11,634.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.96
Rate for Payer: Hawaii Western Management Group Commercial	$14,542.60
Rate for Payer: Health Management Network Commercial	$13,011.80
Rate for Payer: Humana Medicare	$11,634.08
Rate for Payer: Kaiser Permanente Commercial	$13,777.20
Rate for Payer: Kaiser Permanente Medicaid	$7,807.08
Rate for Payer: Kaiser Permanente Medicare	$11,634.08
Rate for Payer: MDX Hawaii PPO	$14,848.76
Rate for Payer: Ohana Health Plan Medicaid	$11,634.08
Rate for Payer: Ohana Health Plan Medicare	$11,634.08
Rate for Payer: UnitedHealthcare Medicaid	$9,184.80
Rate for Payer: UnitedHealthcare Medicare	$11,634.08
Rate for Payer: University Health Alliance Commercial	$11,158.00

LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION [151258]

Facility

$310.00

Service Code	NDC 69488000301
Hospital Revenue Code	343
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$300.70
Rate for Payer: AlohaCare Medicaid	$155.00
Rate for Payer: AlohaCare Medicare	$235.60
Rate for Payer: Cash Price	$186.00
Rate for Payer: Devoted Health Medicare	$260.40
Rate for Payer: Hawaii Medical Service Association Medicare	$235.60
Rate for Payer: Hawaii Western Management Group Commercial	$294.50
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Humana Medicare	$235.60
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: Kaiser Permanente Medicaid	$158.10
Rate for Payer: Kaiser Permanente Medicare	$235.60
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: Ohana Health Plan Medicaid	$235.60
Rate for Payer: Ohana Health Plan Medicare	$235.60
Rate for Payer: UnitedHealthcare Medicare	$235.60
Rate for Payer: University Health Alliance Commercial	$225.96

LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION [151258]

Facility

$310.00

Service Code	NDC 69488000301
Hospital Revenue Code	343
Min. Negotiated Rate	$263.50
Max. Negotiated Rate	$300.70
Rate for Payer: Cash Price	$186.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: MDX Hawaii PPO	$300.70

LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [184179]

Facility

$445.00

Service Code	NDC 69488001061
Hospital Revenue Code	343
Min. Negotiated Rate	$378.25
Max. Negotiated Rate	$431.65
Rate for Payer: Cash Price	$267.00
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Kaiser Permanente Commercial	$400.50
Rate for Payer: MDX Hawaii PPO	$431.65

LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN [184179]

Facility

$445.00

Service Code	NDC 69488001061
Hospital Revenue Code	343
Min. Negotiated Rate	$222.50
Max. Negotiated Rate	$431.65
Rate for Payer: AlohaCare Medicaid	$222.50
Rate for Payer: AlohaCare Medicare	$338.20
Rate for Payer: Cash Price	$267.00
Rate for Payer: Devoted Health Medicare	$373.80
Rate for Payer: Hawaii Medical Service Association Medicare	$338.20
Rate for Payer: Hawaii Western Management Group Commercial	$422.75
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Humana Medicare	$338.20
Rate for Payer: Kaiser Permanente Commercial	$400.50
Rate for Payer: Kaiser Permanente Medicaid	$226.95
Rate for Payer: Kaiser Permanente Medicare	$338.20
Rate for Payer: MDX Hawaii PPO	$431.65
Rate for Payer: Ohana Health Plan Medicaid	$338.20
Rate for Payer: Ohana Health Plan Medicare	$338.20
Rate for Payer: UnitedHealthcare Medicare	$338.20
Rate for Payer: University Health Alliance Commercial	$324.36

LUTONIX 018 DCB 5X300

Facility

$4,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,450.00
Max. Negotiated Rate	$4,753.00
Rate for Payer: AlohaCare Medicaid	$2,450.00
Rate for Payer: AlohaCare Medicare	$3,724.00
Rate for Payer: Cash Price	$2,940.00
Rate for Payer: Devoted Health Medicare	$4,116.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,724.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$4,165.00
Rate for Payer: Humana Medicare	$3,724.00
Rate for Payer: Kaiser Permanente Commercial	$4,410.00
Rate for Payer: Kaiser Permanente Medicaid	$2,499.00
Rate for Payer: Kaiser Permanente Medicare	$3,724.00
Rate for Payer: MDX Hawaii PPO	$4,753.00
Rate for Payer: Ohana Health Plan Medicaid	$3,724.00
Rate for Payer: Ohana Health Plan Medicare	$3,724.00
Rate for Payer: UnitedHealthcare Medicare	$3,724.00
Rate for Payer: University Health Alliance Commercial	$3,571.61

LUTONIX 018 DCB 5X300

Facility

$4,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$4,165.00
Max. Negotiated Rate	$4,753.00
Rate for Payer: Cash Price	$2,940.00
Rate for Payer: Health Management Network Commercial	$4,165.00
Rate for Payer: Kaiser Permanente Commercial	$4,410.00
Rate for Payer: MDX Hawaii PPO	$4,753.00

LUTONIX 018 DCB 6X300

Facility

$4,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$4,165.00
Max. Negotiated Rate	$4,753.00
Rate for Payer: Cash Price	$2,940.00
Rate for Payer: Health Management Network Commercial	$4,165.00
Rate for Payer: Kaiser Permanente Commercial	$4,410.00
Rate for Payer: MDX Hawaii PPO	$4,753.00

LUTONIX 018 DCB 6X300

Facility

$4,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,450.00
Max. Negotiated Rate	$4,753.00
Rate for Payer: AlohaCare Medicaid	$2,450.00
Rate for Payer: AlohaCare Medicare	$3,724.00
Rate for Payer: Cash Price	$2,940.00
Rate for Payer: Devoted Health Medicare	$4,116.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,724.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$4,165.00
Rate for Payer: Humana Medicare	$3,724.00
Rate for Payer: Kaiser Permanente Commercial	$4,410.00
Rate for Payer: Kaiser Permanente Medicaid	$2,499.00
Rate for Payer: Kaiser Permanente Medicare	$3,724.00
Rate for Payer: MDX Hawaii PPO	$4,753.00
Rate for Payer: Ohana Health Plan Medicaid	$3,724.00
Rate for Payer: Ohana Health Plan Medicare	$3,724.00
Rate for Payer: UnitedHealthcare Medicare	$3,724.00
Rate for Payer: University Health Alliance Commercial	$3,571.61

LUTONIX 035 DCB 6X80

Facility

$3,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: AlohaCare Medicaid	$1,950.00
Rate for Payer: AlohaCare Medicare	$2,964.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Devoted Health Medicare	$3,276.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,964.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,705.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Humana Medicare	$2,964.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: Kaiser Permanente Medicaid	$1,989.00
Rate for Payer: Kaiser Permanente Medicare	$2,964.00
Rate for Payer: MDX Hawaii PPO	$3,783.00
Rate for Payer: Ohana Health Plan Medicaid	$2,964.00
Rate for Payer: Ohana Health Plan Medicare	$2,964.00
Rate for Payer: UnitedHealthcare Medicare	$2,964.00
Rate for Payer: University Health Alliance Commercial	$2,842.71

LUTONIX 035 DCB 6X80

Facility

$3,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,315.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: MDX Hawaii PPO	$3,783.00

LUTONIX 035 DCB 7X80

Facility

$3,300.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,805.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00

LUTONIX 035 DCB 7X80

Facility

$3,300.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,135.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$2,405.37

LUTONIX 035 DCB OTW 10X40

Facility

$3,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,315.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: MDX Hawaii PPO	$3,783.00

LUTONIX 035 DCB OTW 10X40

Facility

$3,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: AlohaCare Medicaid	$1,950.00
Rate for Payer: AlohaCare Medicare	$2,964.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Devoted Health Medicare	$3,276.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,964.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,705.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Humana Medicare	$2,964.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: Kaiser Permanente Medicaid	$1,989.00
Rate for Payer: Kaiser Permanente Medicare	$2,964.00
Rate for Payer: MDX Hawaii PPO	$3,783.00
Rate for Payer: Ohana Health Plan Medicaid	$2,964.00
Rate for Payer: Ohana Health Plan Medicare	$2,964.00
Rate for Payer: UnitedHealthcare Medicare	$2,964.00
Rate for Payer: University Health Alliance Commercial	$2,842.71

LUTONIX 035 DCB OTW 12X40

Facility

$3,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,315.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: MDX Hawaii PPO	$3,783.00

LUTONIX 035 DCB OTW 12X40

Facility

$3,900.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: AlohaCare Medicaid	$1,950.00
Rate for Payer: AlohaCare Medicare	$2,964.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Devoted Health Medicare	$3,276.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,964.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,705.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Humana Medicare	$2,964.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: Kaiser Permanente Medicaid	$1,989.00
Rate for Payer: Kaiser Permanente Medicare	$2,964.00
Rate for Payer: MDX Hawaii PPO	$3,783.00
Rate for Payer: Ohana Health Plan Medicaid	$2,964.00
Rate for Payer: Ohana Health Plan Medicare	$2,964.00
Rate for Payer: UnitedHealthcare Medicare	$2,964.00
Rate for Payer: University Health Alliance Commercial	$2,842.71

LUTONIX 035 DCB OTW 7X40

Facility

$3,300.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,805.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00

LUTONIX 035 DCB OTW 7X40

Facility

$3,300.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,135.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$2,405.37

Know your out-of-pocket cost for care.

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