Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL

Professional

Both

$20.00

Service Code	HCPCS 93922 26
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$92.25
Rate for Payer: AlohaCare Medicaid	$92.25
Rate for Payer: AlohaCare Medicare	$11.63
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$12.79
Rate for Payer: Hawaii Medical Service Association Medicare	$11.63
Rate for Payer: Hawaii Western Management Group Commercial	$69.63
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$13.96
Rate for Payer: Kaiser Permanente Medicaid	$13.96
Rate for Payer: Kaiser Permanente Medicare	$13.96
Rate for Payer: Ohana Health Plan Medicaid	$92.25
Rate for Payer: Ohana Health Plan Medicare	$11.63
Rate for Payer: UnitedHealthcare Medicaid	$92.25
Rate for Payer: UnitedHealthcare Medicare	$11.63

PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL

Professional

Both

$262.00

Service Code	HCPCS 93922 TC
Min. Negotiated Rate	$69.63
Max. Negotiated Rate	$222.70
Rate for Payer: AlohaCare Medicaid	$92.25
Rate for Payer: AlohaCare Medicare	$80.90
Rate for Payer: Cash Price	$157.20
Rate for Payer: Cash Price	$157.20
Rate for Payer: Devoted Health Medicare	$88.99
Rate for Payer: Hawaii Medical Service Association Medicare	$80.90
Rate for Payer: Hawaii Western Management Group Commercial	$69.63
Rate for Payer: Health Management Network Commercial	$222.70
Rate for Payer: Kaiser Permanente Commercial	$97.08
Rate for Payer: Kaiser Permanente Medicaid	$97.08
Rate for Payer: Kaiser Permanente Medicare	$97.08
Rate for Payer: Ohana Health Plan Medicaid	$92.25
Rate for Payer: Ohana Health Plan Medicare	$80.90
Rate for Payer: UnitedHealthcare Medicaid	$92.25
Rate for Payer: UnitedHealthcare Medicare	$80.90

PR NON-PNEUM WALK BOOT PRE CST

Professional

Both

$326.00

Service Code	HCPCS L4386
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$277.10
Rate for Payer: AlohaCare Medicaid	$74.75
Rate for Payer: AlohaCare Medicare	$190.16
Rate for Payer: Cash Price	$195.60
Rate for Payer: Cash Price	$195.60
Rate for Payer: Devoted Health Medicare	$209.18
Rate for Payer: Hawaii Medical Service Association Medicare	$190.16
Rate for Payer: Hawaii Western Management Group Commercial	$124.58
Rate for Payer: Health Management Network Commercial	$277.10
Rate for Payer: Kaiser Permanente Commercial	$228.19
Rate for Payer: Kaiser Permanente Medicaid	$228.19
Rate for Payer: Kaiser Permanente Medicare	$228.19
Rate for Payer: Ohana Health Plan Medicaid	$74.75
Rate for Payer: Ohana Health Plan Medicare	$190.16
Rate for Payer: UnitedHealthcare Medicaid	$74.75
Rate for Payer: UnitedHealthcare Medicare	$190.16

PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN

Professional

Both

$41.68

Service Code	HCPCS 98971
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$35.43
Rate for Payer: AlohaCare Medicare	$19.26
Rate for Payer: Cash Price	$25.01
Rate for Payer: Cash Price	$25.01
Rate for Payer: Devoted Health Medicare	$21.19
Rate for Payer: Hawaii Medical Service Association Medicare	$19.26
Rate for Payer: Health Management Network Commercial	$35.43
Rate for Payer: Kaiser Permanente Commercial	$23.11
Rate for Payer: Kaiser Permanente Medicaid	$23.11
Rate for Payer: Kaiser Permanente Medicare	$23.11
Rate for Payer: Ohana Health Plan Medicare	$19.26
Rate for Payer: UnitedHealthcare Medicare	$19.26

PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN

Professional

Both

$61.95

Service Code	HCPCS 98972
Min. Negotiated Rate	$29.32
Max. Negotiated Rate	$52.66
Rate for Payer: AlohaCare Medicare	$29.32
Rate for Payer: Cash Price	$37.17
Rate for Payer: Cash Price	$37.17
Rate for Payer: Devoted Health Medicare	$32.25
Rate for Payer: Hawaii Medical Service Association ABD	$30.99
Rate for Payer: Hawaii Medical Service Association Medicare	$29.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.99
Rate for Payer: Health Management Network Commercial	$52.66
Rate for Payer: Kaiser Permanente Commercial	$35.18
Rate for Payer: Kaiser Permanente Medicaid	$35.18
Rate for Payer: Kaiser Permanente Medicare	$35.18
Rate for Payer: Ohana Health Plan Medicare	$29.32
Rate for Payer: UnitedHealthcare Medicare	$29.32
Rate for Payer: University Health Alliance Commercial	$38.16

PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN

Professional

Both

$22.26

Service Code	HCPCS 98970
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$18.92
Rate for Payer: AlohaCare Medicare	$10.44
Rate for Payer: Cash Price	$13.36
Rate for Payer: Cash Price	$13.36
Rate for Payer: Devoted Health Medicare	$11.48
Rate for Payer: Hawaii Medical Service Association Medicare	$10.44
Rate for Payer: Health Management Network Commercial	$18.92
Rate for Payer: Kaiser Permanente Commercial	$12.53
Rate for Payer: Kaiser Permanente Medicaid	$12.53
Rate for Payer: Kaiser Permanente Medicare	$12.53
Rate for Payer: Ohana Health Plan Medicare	$10.44
Rate for Payer: UnitedHealthcare Medicare	$10.44

PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS

Professional

Both

$454.00

Service Code	HCPCS 31267
Min. Negotiated Rate	$221.66
Max. Negotiated Rate	$411.58
Rate for Payer: AlohaCare Medicaid	$266.20
Rate for Payer: AlohaCare Medicare	$221.66
Rate for Payer: Cash Price	$272.40
Rate for Payer: Cash Price	$272.40
Rate for Payer: Devoted Health Medicare	$243.83
Rate for Payer: Hawaii Medical Service Association Medicare	$221.66
Rate for Payer: Hawaii Western Management Group Commercial	$411.58
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$265.99
Rate for Payer: Kaiser Permanente Medicaid	$265.99
Rate for Payer: Kaiser Permanente Medicare	$265.99
Rate for Payer: Ohana Health Plan Medicaid	$266.20
Rate for Payer: Ohana Health Plan Medicare	$221.66
Rate for Payer: UnitedHealthcare Medicaid	$266.20
Rate for Payer: UnitedHealthcare Medicare	$221.66

PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS

Professional

Both

$401.00

Service Code	HCPCS 31288
Min. Negotiated Rate	$196.09
Max. Negotiated Rate	$369.98
Rate for Payer: AlohaCare Medicaid	$234.89
Rate for Payer: AlohaCare Medicare	$196.09
Rate for Payer: Cash Price	$240.60
Rate for Payer: Cash Price	$240.60
Rate for Payer: Devoted Health Medicare	$215.70
Rate for Payer: Hawaii Medical Service Association Medicare	$196.09
Rate for Payer: Hawaii Western Management Group Commercial	$369.98
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: Kaiser Permanente Commercial	$235.31
Rate for Payer: Kaiser Permanente Medicaid	$235.31
Rate for Payer: Kaiser Permanente Medicare	$235.31
Rate for Payer: Ohana Health Plan Medicaid	$234.89
Rate for Payer: Ohana Health Plan Medicare	$196.09
Rate for Payer: UnitedHealthcare Medicaid	$234.89
Rate for Payer: UnitedHealthcare Medicare	$196.09

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN

Professional

Both

$67.88

Service Code	HCPCS 99447
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$57.70
Rate for Payer: AlohaCare Medicare	$31.95
Rate for Payer: Cash Price	$40.73
Rate for Payer: Cash Price	$40.73
Rate for Payer: Devoted Health Medicare	$35.15
Rate for Payer: Hawaii Medical Service Association Medicare	$31.95
Rate for Payer: Hawaii Western Management Group Commercial	$37.95
Rate for Payer: Health Management Network Commercial	$57.70
Rate for Payer: Kaiser Permanente Commercial	$38.34
Rate for Payer: Kaiser Permanente Medicaid	$38.34
Rate for Payer: Kaiser Permanente Medicare	$38.34
Rate for Payer: Ohana Health Plan Medicare	$31.95
Rate for Payer: UnitedHealthcare Medicare	$31.95

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN

Professional

Both

$101.64

Service Code	HCPCS 99448
Min. Negotiated Rate	$47.82
Max. Negotiated Rate	$86.39
Rate for Payer: AlohaCare Medicare	$47.82
Rate for Payer: Cash Price	$60.98
Rate for Payer: Cash Price	$60.98
Rate for Payer: Devoted Health Medicare	$52.60
Rate for Payer: Hawaii Medical Service Association Medicare	$47.82
Rate for Payer: Hawaii Western Management Group Commercial	$56.73
Rate for Payer: Health Management Network Commercial	$86.39
Rate for Payer: Kaiser Permanente Commercial	$57.38
Rate for Payer: Kaiser Permanente Medicaid	$57.38
Rate for Payer: Kaiser Permanente Medicare	$57.38
Rate for Payer: Ohana Health Plan Medicare	$47.82
Rate for Payer: UnitedHealthcare Medicare	$47.82

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN

Professional

Both

$136.40

Service Code	HCPCS 99449
Min. Negotiated Rate	$63.51
Max. Negotiated Rate	$115.94
Rate for Payer: AlohaCare Medicare	$63.51
Rate for Payer: Cash Price	$81.84
Rate for Payer: Cash Price	$81.84
Rate for Payer: Devoted Health Medicare	$69.86
Rate for Payer: Hawaii Medical Service Association Medicare	$63.51
Rate for Payer: Hawaii Western Management Group Commercial	$75.67
Rate for Payer: Health Management Network Commercial	$115.94
Rate for Payer: Kaiser Permanente Commercial	$76.21
Rate for Payer: Kaiser Permanente Medicaid	$76.21
Rate for Payer: Kaiser Permanente Medicare	$76.21
Rate for Payer: Ohana Health Plan Medicare	$63.51
Rate for Payer: UnitedHealthcare Medicare	$63.51

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN

Professional

Both

$33.78

Service Code	HCPCS 99446
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$28.71
Rate for Payer: AlohaCare Medicare	$15.88
Rate for Payer: Cash Price	$20.27
Rate for Payer: Cash Price	$20.27
Rate for Payer: Devoted Health Medicare	$17.47
Rate for Payer: Hawaii Medical Service Association Medicare	$15.88
Rate for Payer: Hawaii Western Management Group Commercial	$18.78
Rate for Payer: Health Management Network Commercial	$28.71
Rate for Payer: Kaiser Permanente Commercial	$19.06
Rate for Payer: Kaiser Permanente Medicaid	$19.06
Rate for Payer: Kaiser Permanente Medicare	$19.06
Rate for Payer: Ohana Health Plan Medicare	$15.88
Rate for Payer: UnitedHealthcare Medicare	$15.88

PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME

Professional

Both

$249.58

Service Code	HCPCS 99316
Min. Negotiated Rate	$73.13
Max. Negotiated Rate	$212.14
Rate for Payer: AlohaCare Medicaid	$133.44
Rate for Payer: AlohaCare Medicare	$119.07
Rate for Payer: Cash Price	$149.75
Rate for Payer: Cash Price	$149.75
Rate for Payer: Devoted Health Medicare	$130.98
Rate for Payer: Hawaii Medical Service Association Medicare	$119.07
Rate for Payer: Hawaii Western Management Group Commercial	$73.13
Rate for Payer: Health Management Network Commercial	$212.14
Rate for Payer: Kaiser Permanente Commercial	$142.88
Rate for Payer: Kaiser Permanente Medicaid	$142.88
Rate for Payer: Kaiser Permanente Medicare	$142.88
Rate for Payer: Ohana Health Plan Medicaid	$133.44
Rate for Payer: Ohana Health Plan Medicare	$119.07
Rate for Payer: UnitedHealthcare Medicaid	$133.44
Rate for Payer: UnitedHealthcare Medicare	$119.07

PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME

Professional

Both

$155.85

Service Code	HCPCS 99315
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$132.47
Rate for Payer: AlohaCare Medicaid	$83.54
Rate for Payer: AlohaCare Medicare	$74.63
Rate for Payer: Cash Price	$93.51
Rate for Payer: Cash Price	$93.51
Rate for Payer: Devoted Health Medicare	$82.09
Rate for Payer: Hawaii Medical Service Association Medicare	$74.63
Rate for Payer: Hawaii Western Management Group Commercial	$45.97
Rate for Payer: Health Management Network Commercial	$132.47
Rate for Payer: Kaiser Permanente Commercial	$89.56
Rate for Payer: Kaiser Permanente Medicaid	$89.56
Rate for Payer: Kaiser Permanente Medicare	$89.56
Rate for Payer: Ohana Health Plan Medicaid	$83.54
Rate for Payer: Ohana Health Plan Medicare	$74.63
Rate for Payer: UnitedHealthcare Medicaid	$83.54
Rate for Payer: UnitedHealthcare Medicare	$74.63

PR NUSHIELD 1 SQUARE CM

Professional

Both

$253.21

Service Code	HCPCS Q4160
Min. Negotiated Rate	$144.69
Max. Negotiated Rate	$215.23
Rate for Payer: AlohaCare Medicare	$144.69
Rate for Payer: Cash Price	$151.93
Rate for Payer: Cash Price	$151.93
Rate for Payer: Devoted Health Medicare	$159.16
Rate for Payer: Hawaii Medical Service Association Medicare	$144.69
Rate for Payer: Health Management Network Commercial	$215.23
Rate for Payer: Kaiser Permanente Commercial	$173.63
Rate for Payer: Kaiser Permanente Medicaid	$173.63
Rate for Payer: Kaiser Permanente Medicare	$173.63
Rate for Payer: Ohana Health Plan Medicare	$144.69
Rate for Payer: UnitedHealthcare Medicare	$144.69

PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

Professional

Both

$4,506.00

Service Code	HCPCS 59510
Min. Negotiated Rate	$1,448.98
Max. Negotiated Rate	$3,830.10
Rate for Payer: AlohaCare Medicaid	$2,656.47
Rate for Payer: AlohaCare Medicare	$2,382.05
Rate for Payer: Cash Price	$2,703.60
Rate for Payer: Cash Price	$2,703.60
Rate for Payer: Devoted Health Medicare	$2,620.26
Rate for Payer: Hawaii Medical Service Association Medicare	$2,382.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,448.98
Rate for Payer: Health Management Network Commercial	$3,830.10
Rate for Payer: Kaiser Permanente Commercial	$2,858.46
Rate for Payer: Kaiser Permanente Medicaid	$2,858.46
Rate for Payer: Kaiser Permanente Medicare	$2,858.46
Rate for Payer: Ohana Health Plan Medicaid	$2,656.47
Rate for Payer: Ohana Health Plan Medicare	$2,382.05
Rate for Payer: UnitedHealthcare Medicaid	$2,656.47
Rate for Payer: UnitedHealthcare Medicare	$2,382.05

PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM

Professional

Both

$4,089.00

Service Code	HCPCS 59400
Min. Negotiated Rate	$1,053.78
Max. Negotiated Rate	$3,475.65
Rate for Payer: AlohaCare Medicaid	$2,408.90
Rate for Payer: AlohaCare Medicare	$2,152.11
Rate for Payer: Cash Price	$2,453.40
Rate for Payer: Cash Price	$2,453.40
Rate for Payer: Devoted Health Medicare	$2,367.32
Rate for Payer: Hawaii Medical Service Association Medicare	$2,152.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,053.78
Rate for Payer: Health Management Network Commercial	$3,475.65
Rate for Payer: Kaiser Permanente Commercial	$2,582.53
Rate for Payer: Kaiser Permanente Medicaid	$2,582.53
Rate for Payer: Kaiser Permanente Medicare	$2,582.53
Rate for Payer: Ohana Health Plan Medicaid	$2,408.90
Rate for Payer: Ohana Health Plan Medicare	$2,152.11
Rate for Payer: UnitedHealthcare Medicaid	$2,408.90
Rate for Payer: UnitedHealthcare Medicare	$2,152.11

PROBE ARTHROSCOPIC AR-4070-01

Facility

$1,001.00

Hospital Revenue Code	272
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$600.60
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Kaiser Permanente Commercial	$900.90
Rate for Payer: MDX Hawaii PPO	$970.97

PROBE ARTHROSCOPIC AR-4070-01

Facility

$1,001.00

Hospital Revenue Code	272
Min. Negotiated Rate	$500.50
Max. Negotiated Rate	$970.97
Rate for Payer: AlohaCare Medicaid	$500.50
Rate for Payer: AlohaCare Medicare	$760.76
Rate for Payer: Cash Price	$600.60
Rate for Payer: Devoted Health Medicare	$840.84
Rate for Payer: Hawaii Medical Service Association Medicare	$760.76
Rate for Payer: Hawaii Western Management Group Commercial	$950.95
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Humana Medicare	$760.76
Rate for Payer: Kaiser Permanente Commercial	$900.90
Rate for Payer: Kaiser Permanente Medicaid	$510.51
Rate for Payer: Kaiser Permanente Medicare	$760.76
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: Ohana Health Plan Medicaid	$760.76
Rate for Payer: Ohana Health Plan Medicare	$760.76
Rate for Payer: UnitedHealthcare Medicare	$760.76
Rate for Payer: University Health Alliance Commercial	$729.63

PROBE BIOPLAR STIMULATOR

Facility

$704.00

Hospital Revenue Code	270
Min. Negotiated Rate	$352.00
Max. Negotiated Rate	$682.88
Rate for Payer: AlohaCare Medicaid	$352.00
Rate for Payer: AlohaCare Medicare	$535.04
Rate for Payer: Cash Price	$422.40
Rate for Payer: Devoted Health Medicare	$591.36
Rate for Payer: Hawaii Medical Service Association Medicare	$535.04
Rate for Payer: Hawaii Western Management Group Commercial	$668.80
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Humana Medicare	$535.04
Rate for Payer: Kaiser Permanente Commercial	$633.60
Rate for Payer: Kaiser Permanente Medicaid	$359.04
Rate for Payer: Kaiser Permanente Medicare	$535.04
Rate for Payer: MDX Hawaii PPO	$682.88
Rate for Payer: Ohana Health Plan Medicaid	$535.04
Rate for Payer: Ohana Health Plan Medicare	$535.04
Rate for Payer: UnitedHealthcare Medicare	$535.04
Rate for Payer: University Health Alliance Commercial	$513.15

PROBE BIOPLAR STIMULATOR

Facility

$704.00

Hospital Revenue Code	270
Min. Negotiated Rate	$598.40
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Kaiser Permanente Commercial	$633.60
Rate for Payer: MDX Hawaii PPO	$682.88

PROBE BIPOLAR GOLD 7FR

Facility

$640.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$620.80
Rate for Payer: AlohaCare Medicaid	$320.00
Rate for Payer: AlohaCare Medicare	$486.40
Rate for Payer: Cash Price	$384.00
Rate for Payer: Devoted Health Medicare	$537.60
Rate for Payer: Hawaii Medical Service Association Medicare	$486.40
Rate for Payer: Hawaii Western Management Group Commercial	$608.00
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: Humana Medicare	$486.40
Rate for Payer: Kaiser Permanente Commercial	$576.00
Rate for Payer: Kaiser Permanente Medicaid	$326.40
Rate for Payer: Kaiser Permanente Medicare	$486.40
Rate for Payer: MDX Hawaii PPO	$620.80
Rate for Payer: Ohana Health Plan Medicaid	$486.40
Rate for Payer: Ohana Health Plan Medicare	$486.40
Rate for Payer: UnitedHealthcare Medicare	$486.40
Rate for Payer: University Health Alliance Commercial	$466.50

PROBE BIPOLAR GOLD 7FR

Facility

$640.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$544.00
Max. Negotiated Rate	$620.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: Kaiser Permanente Commercial	$576.00
Rate for Payer: MDX Hawaii PPO	$620.80

PROBE GOLD ELECTRO 10FR

Facility

$585.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$351.00
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: MDX Hawaii PPO	$567.45

PROBE GOLD ELECTRO 10FR

Facility

$585.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$567.45
Rate for Payer: AlohaCare Medicaid	$292.50
Rate for Payer: AlohaCare Medicare	$444.60
Rate for Payer: Cash Price	$351.00
Rate for Payer: Devoted Health Medicare	$491.40
Rate for Payer: Hawaii Medical Service Association Medicare	$444.60
Rate for Payer: Hawaii Western Management Group Commercial	$555.75
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Humana Medicare	$444.60
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: Kaiser Permanente Medicaid	$298.35
Rate for Payer: Kaiser Permanente Medicare	$444.60
Rate for Payer: MDX Hawaii PPO	$567.45
Rate for Payer: Ohana Health Plan Medicaid	$444.60
Rate for Payer: Ohana Health Plan Medicare	$444.60
Rate for Payer: UnitedHealthcare Medicare	$444.60
Rate for Payer: University Health Alliance Commercial	$426.41

Know your out-of-pocket cost for care.

All Charges