Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS

Professional

Both

$42.46

Service Code	HCPCS 93272
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$36.09
Rate for Payer: AlohaCare Medicaid	$24.19
Rate for Payer: AlohaCare Medicare	$24.26
Rate for Payer: Cash Price	$25.48
Rate for Payer: Cash Price	$25.48
Rate for Payer: Devoted Health Medicare	$26.69
Rate for Payer: Hawaii Medical Service Association Medicare	$24.26
Rate for Payer: Hawaii Western Management Group Commercial	$33.14
Rate for Payer: Health Management Network Commercial	$36.09
Rate for Payer: Kaiser Permanente Commercial	$29.11
Rate for Payer: Kaiser Permanente Medicaid	$29.11
Rate for Payer: Kaiser Permanente Medicare	$29.11
Rate for Payer: Ohana Health Plan Medicaid	$24.19
Rate for Payer: Ohana Health Plan Medicare	$24.26
Rate for Payer: UnitedHealthcare Medicaid	$24.19
Rate for Payer: UnitedHealthcare Medicare	$24.26

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT

Professional

Both

$911.31

Service Code	HCPCS 41016
Min. Negotiated Rate	$229.32
Max. Negotiated Rate	$774.61
Rate for Payer: AlohaCare Medicaid	$366.26
Rate for Payer: AlohaCare Medicare	$340.74
Rate for Payer: Cash Price	$546.79
Rate for Payer: Cash Price	$546.79
Rate for Payer: Devoted Health Medicare	$374.81
Rate for Payer: Hawaii Medical Service Association ABD	$366.26
Rate for Payer: Hawaii Medical Service Association Commercial	$569.37
Rate for Payer: Hawaii Medical Service Association Medicare	$340.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$366.26
Rate for Payer: Hawaii Western Management Group Commercial	$229.32
Rate for Payer: Health Management Network Commercial	$774.61
Rate for Payer: Kaiser Permanente Commercial	$408.89
Rate for Payer: Kaiser Permanente Medicaid	$408.89
Rate for Payer: Kaiser Permanente Medicare	$408.89
Rate for Payer: Ohana Health Plan Medicaid	$366.26
Rate for Payer: Ohana Health Plan Medicare	$340.74
Rate for Payer: UnitedHealthcare Medicaid	$366.26
Rate for Payer: UnitedHealthcare Medicare	$340.74
Rate for Payer: University Health Alliance Commercial	$482.07

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB

Professional

Both

$903.00

Service Code	HCPCS 41017
Min. Negotiated Rate	$167.70
Max. Negotiated Rate	$767.55
Rate for Payer: AlohaCare Medicaid	$364.36
Rate for Payer: AlohaCare Medicare	$336.37
Rate for Payer: Cash Price	$541.80
Rate for Payer: Cash Price	$541.80
Rate for Payer: Devoted Health Medicare	$370.01
Rate for Payer: Hawaii Medical Service Association ABD	$364.36
Rate for Payer: Hawaii Medical Service Association Commercial	$560.13
Rate for Payer: Hawaii Medical Service Association Medicare	$336.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$364.36
Rate for Payer: Hawaii Western Management Group Commercial	$167.70
Rate for Payer: Health Management Network Commercial	$767.55
Rate for Payer: Kaiser Permanente Commercial	$403.64
Rate for Payer: Kaiser Permanente Medicaid	$403.64
Rate for Payer: Kaiser Permanente Medicare	$403.64
Rate for Payer: Ohana Health Plan Medicaid	$364.36
Rate for Payer: Ohana Health Plan Medicare	$336.37
Rate for Payer: UnitedHealthcare Medicaid	$364.36
Rate for Payer: UnitedHealthcare Medicare	$336.37
Rate for Payer: University Health Alliance Commercial	$474.24

PSEUDOEPHEDRINE 30 MG TABLET [6714]

Facility

$1.00

Service Code	NDC 00904699061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

PSEUDOEPHEDRINE 30 MG TABLET [6714]

Facility

$1.00

Service Code	NDC 00904699061
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

PS FEMORAL SZ #2 5515-F-202

Facility

$4,325.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,162.50
Max. Negotiated Rate	$4,195.25
Rate for Payer: AlohaCare Medicaid	$2,162.50
Rate for Payer: AlohaCare Medicare	$3,287.00
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Devoted Health Medicare	$3,633.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,287.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Humana Medicare	$3,287.00
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: Kaiser Permanente Medicaid	$2,205.75
Rate for Payer: Kaiser Permanente Medicare	$3,287.00
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: Ohana Health Plan Medicaid	$3,287.00
Rate for Payer: Ohana Health Plan Medicare	$3,287.00
Rate for Payer: UnitedHealthcare Medicare	$3,287.00
Rate for Payer: University Health Alliance Commercial	$2,422.00

PS FEMORAL SZ #2 5515-F-202

Facility

$4,325.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.00
Max. Negotiated Rate	$4,195.25
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: University Health Alliance Commercial	$2,422.00

PSN ALL POLY PAT PLY 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: AlohaCare Medicaid	$750.00
Rate for Payer: AlohaCare Medicare	$1,140.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Devoted Health Medicare	$1,260.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Humana Medicare	$1,140.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: Kaiser Permanente Medicare	$1,140.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: Ohana Health Plan Medicaid	$1,140.00
Rate for Payer: Ohana Health Plan Medicare	$1,140.00
Rate for Payer: UnitedHealthcare Medicare	$1,140.00
Rate for Payer: University Health Alliance Commercial	$840.00

PSN ALL POLY PAT PLY 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

PSN ALL POLY PAT PLY 32MM

Facility

$1,575.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

PSN ALL POLY PAT PLY 32MM

Facility

$1,575.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$1,197.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$1,323.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,197.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$1,197.00
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$1,197.00
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$1,197.00
Rate for Payer: Ohana Health Plan Medicare	$1,197.00
Rate for Payer: UnitedHealthcare Medicare	$1,197.00
Rate for Payer: University Health Alliance Commercial	$882.00

PSN ALL POLY PAT PLY 38MM

Facility

$1,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,309.50
Rate for Payer: AlohaCare Medicaid	$675.00
Rate for Payer: AlohaCare Medicare	$1,026.00
Rate for Payer: Cash Price	$810.00
Rate for Payer: Devoted Health Medicare	$1,134.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,026.00
Rate for Payer: Hawaii Western Management Group Commercial	$945.00
Rate for Payer: Health Management Network Commercial	$1,147.50
Rate for Payer: Humana Medicare	$1,026.00
Rate for Payer: Kaiser Permanente Commercial	$1,215.00
Rate for Payer: Kaiser Permanente Medicaid	$688.50
Rate for Payer: Kaiser Permanente Medicare	$1,026.00
Rate for Payer: MDX Hawaii PPO	$1,309.50
Rate for Payer: Ohana Health Plan Medicaid	$1,026.00
Rate for Payer: Ohana Health Plan Medicare	$1,026.00
Rate for Payer: UnitedHealthcare Medicare	$1,026.00
Rate for Payer: University Health Alliance Commercial	$756.00

PSN ALL POLY PAT PLY 38MM

Facility

$1,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$1,309.50
Rate for Payer: Cash Price	$810.00
Rate for Payer: Hawaii Western Management Group Commercial	$945.00
Rate for Payer: Health Management Network Commercial	$1,147.50
Rate for Payer: Kaiser Permanente Commercial	$1,215.00
Rate for Payer: MDX Hawaii PPO	$1,309.50
Rate for Payer: University Health Alliance Commercial	$756.00

PSN ALL POLY PAT VE 26MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 26MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$2,498.88
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$2,761.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,498.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$2,498.88
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$2,498.88
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$2,498.88
Rate for Payer: Ohana Health Plan Medicare	$2,498.88
Rate for Payer: UnitedHealthcare Medicare	$2,498.88
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 29MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 29MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$2,498.88
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$2,761.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,498.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$2,498.88
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$2,498.88
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$2,498.88
Rate for Payer: Ohana Health Plan Medicare	$2,498.88
Rate for Payer: UnitedHealthcare Medicare	$2,498.88
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 32MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$2,498.88
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$2,761.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,498.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$2,498.88
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$2,498.88
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$2,498.88
Rate for Payer: Ohana Health Plan Medicare	$2,498.88
Rate for Payer: UnitedHealthcare Medicare	$2,498.88
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 32MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 35MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 35MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$2,498.88
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$2,761.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,498.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$2,498.88
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$2,498.88
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$2,498.88
Rate for Payer: Ohana Health Plan Medicare	$2,498.88
Rate for Payer: UnitedHealthcare Medicare	$2,498.88
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 38MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 38MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$2,498.88
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$2,761.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,498.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$2,498.88
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$2,498.88
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$2,498.88
Rate for Payer: Ohana Health Plan Medicare	$2,498.88
Rate for Payer: UnitedHealthcare Medicare	$2,498.88
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 41MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

PSN ALL POLY PAT VE 41MM DIA

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$2,498.88
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$2,761.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,498.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$2,498.88
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$2,498.88
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$2,498.88
Rate for Payer: Ohana Health Plan Medicare	$2,498.88
Rate for Payer: UnitedHealthcare Medicare	$2,498.88
Rate for Payer: University Health Alliance Commercial	$1,841.28

Know your out-of-pocket cost for care.

All Charges