Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

fentaNYL citrate 100 mcg / 2 mL Inj Sol [KMC]

Facility

$5.23

Service Code	HCPCS J3010
Hospital Revenue Code	636
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.40
Rate for Payer: Health Management Network Commercial	$4.45
Rate for Payer: Kaiser Permanente Commercial	$4.71
Rate for Payer: MDX Hawaii PPO	$5.07

fentaNYL citrate 100 mcg / 2 mL Inj Sol [KMC]

Facility

$5.23

Service Code	HCPCS J3010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$5.07
Rate for Payer: AlohaCare Medicaid	$2.62
Rate for Payer: AlohaCare Medicare	$2.20
Rate for Payer: Cash Price	$3.40
Rate for Payer: Cash Price	$3.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.81
Rate for Payer: Devoted Health Medicare	$2.20
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.97
Rate for Payer: Health Management Network Commercial	$4.45
Rate for Payer: Humana Medicare	$2.20
Rate for Payer: Kaiser Permanente Commercial	$4.71
Rate for Payer: Kaiser Permanente Medicaid	$2.67
Rate for Payer: Kaiser Permanente Medicare	$2.20
Rate for Payer: MDX Hawaii PPO	$5.07
Rate for Payer: Ohana Health Plan Medicaid	$2.20
Rate for Payer: Ohana Health Plan Medicare	$2.20
Rate for Payer: UnitedHealthcare Medicaid	$3.14
Rate for Payer: UnitedHealthcare Medicare	$2.20
Rate for Payer: University Health Alliance Commercial	$3.81

ferric carboxymaltose 750 mg /15 mL Soln [KMC]

Facility

$440.40

Service Code	HCPCS J1439
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$427.19
Rate for Payer: AlohaCare Medicaid	$220.20
Rate for Payer: AlohaCare Medicare	$184.97
Rate for Payer: Cash Price	$286.26
Rate for Payer: Cash Price	$286.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$405.17
Rate for Payer: Devoted Health Medicare	$184.97
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.14
Rate for Payer: Hawaii Medical Service Association Commercial	$1.38
Rate for Payer: Hawaii Medical Service Association Medicare	$184.97
Rate for Payer: Hawaii Western Management Group Commercial	$418.38
Rate for Payer: Health Management Network Commercial	$374.34
Rate for Payer: Humana Medicare	$184.97
Rate for Payer: Kaiser Permanente Commercial	$396.36
Rate for Payer: Kaiser Permanente Medicaid	$224.60
Rate for Payer: Kaiser Permanente Medicare	$184.97
Rate for Payer: MDX Hawaii PPO	$427.19
Rate for Payer: Ohana Health Plan Medicaid	$184.97
Rate for Payer: Ohana Health Plan Medicare	$184.97
Rate for Payer: UnitedHealthcare Medicaid	$264.24
Rate for Payer: UnitedHealthcare Medicare	$184.97
Rate for Payer: University Health Alliance Commercial	$321.01

ferric carboxymaltose 750 mg /15 mL Soln [KMC]

Facility

$440.40

Service Code	HCPCS J1439
Hospital Revenue Code	636
Min. Negotiated Rate	$374.34
Max. Negotiated Rate	$427.19
Rate for Payer: Cash Price	$286.26
Rate for Payer: Health Management Network Commercial	$374.34
Rate for Payer: Kaiser Permanente Commercial	$396.36
Rate for Payer: MDX Hawaii PPO	$427.19

Ferritin

Facility

$150.00

Service Code	HCPCS 82728
Hospital Charge Code	422827280
Hospital Revenue Code	301
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

Ferritin

Facility

$150.00

Service Code	HCPCS 82728
Hospital Charge Code	422827280
Hospital Revenue Code	301
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.00
Rate for Payer: Devoted Health Medicare	$63.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$17.04
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$29.56

Ferritin DLS

Facility

$150.00

Service Code	HCPCS 82728
Hospital Charge Code	422827285
Hospital Revenue Code	301
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.00
Rate for Payer: Devoted Health Medicare	$63.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$17.04
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$29.56

Ferritin DLS

Facility

$150.00

Service Code	HCPCS 82728
Hospital Charge Code	422827285
Hospital Revenue Code	301
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

ferrous gluconate 324 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 69367016504
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

ferrous gluconate 324 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 69367016504
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

ferrous sulfate 300 mg/5 mL Liq [KMC]

Facility

$3.57

Service Code	NDC 50268033624
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.32
Rate for Payer: Health Management Network Commercial	$3.03
Rate for Payer: Kaiser Permanente Commercial	$3.21
Rate for Payer: MDX Hawaii PPO	$3.46

ferrous sulfate 300 mg/5 mL Liq [KMC]

Facility

$3.57

Service Code	NDC 50268033624
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.46
Rate for Payer: AlohaCare Medicaid	$1.78
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$2.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.28
Rate for Payer: Devoted Health Medicare	$1.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$3.39
Rate for Payer: Health Management Network Commercial	$3.03
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$3.21
Rate for Payer: Kaiser Permanente Medicaid	$1.82
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$3.46
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$2.14
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.60

ferrous sulfate 325 mg FC Tab [KMC]

Facility

$3.00

Service Code	NDC 00904759060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

ferrous sulfate 325 mg FC Tab [KMC]

Facility

$3.00

Service Code	NDC 00904759060
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

ferrous sulfate 45 mg ER tab [KMC]

Facility

$3.00

Service Code	NDC 00067434730
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

ferrous sulfate 45 mg ER tab [KMC]

Facility

$3.00

Service Code	NDC 00067434730
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

ferumoxytol (FERAHEME) 510 mg/17 mL Soln [KMC]

Facility

$327.20

Service Code	HCPCS Q0138
Hospital Revenue Code	637
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$317.38
Rate for Payer: AlohaCare Medicaid	$163.60
Rate for Payer: AlohaCare Medicare	$137.42
Rate for Payer: Cash Price	$212.68
Rate for Payer: Cash Price	$212.68
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$301.02
Rate for Payer: Devoted Health Medicare	$137.42
Rate for Payer: Hawaii Medical Service Association Commercial	$0.29
Rate for Payer: Hawaii Medical Service Association Medicare	$137.42
Rate for Payer: Hawaii Western Management Group Commercial	$310.84
Rate for Payer: Health Management Network Commercial	$278.12
Rate for Payer: Humana Medicare	$137.42
Rate for Payer: Kaiser Permanente Commercial	$294.48
Rate for Payer: Kaiser Permanente Medicaid	$166.87
Rate for Payer: Kaiser Permanente Medicare	$137.42
Rate for Payer: MDX Hawaii PPO	$317.38
Rate for Payer: Ohana Health Plan Medicaid	$137.42
Rate for Payer: Ohana Health Plan Medicare	$137.42
Rate for Payer: UnitedHealthcare Medicaid	$0.23
Rate for Payer: UnitedHealthcare Medicare	$137.42
Rate for Payer: University Health Alliance Commercial	$238.50

ferumoxytol (FERAHEME) 510 mg/17 mL Soln [KMC]

Facility

$327.20

Service Code	HCPCS Q0138
Hospital Revenue Code	637
Min. Negotiated Rate	$278.12
Max. Negotiated Rate	$317.38
Rate for Payer: Cash Price	$212.68
Rate for Payer: Health Management Network Commercial	$278.12
Rate for Payer: Kaiser Permanente Commercial	$294.48
Rate for Payer: MDX Hawaii PPO	$317.38

Fetal biophysical profile; with non-stress testing

Facility

$218.00

Service Code	HCPCS 76818
Hospital Charge Code	424768189
Hospital Revenue Code	972
Min. Negotiated Rate	$53.40
Max. Negotiated Rate	$241.61
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$96.60
Rate for Payer: AlohaCare Medicare	$91.56
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$211.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$200.56
Rate for Payer: Devoted Health Medicare	$91.56
Rate for Payer: Devoted Health Medicare	$96.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.40
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.40
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$91.56
Rate for Payer: Hawaii Medical Service Association Medicare	$96.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$91.56
Rate for Payer: Humana Medicare	$96.60
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$96.60
Rate for Payer: Kaiser Permanente Medicare	$91.56
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$91.56
Rate for Payer: Ohana Health Plan Medicaid	$96.60
Rate for Payer: Ohana Health Plan Medicare	$91.56
Rate for Payer: Ohana Health Plan Medicare	$96.60
Rate for Payer: UnitedHealthcare Medicaid	$53.40
Rate for Payer: UnitedHealthcare Medicaid	$53.40
Rate for Payer: UnitedHealthcare Medicare	$96.60
Rate for Payer: UnitedHealthcare Medicare	$91.56
Rate for Payer: University Health Alliance Commercial	$241.61
Rate for Payer: University Health Alliance Commercial	$241.61

Fetal biophysical profile; with non-stress testing

Facility

$230.00

Service Code	HCPCS 76818
Hospital Charge Code	424768189
Hospital Revenue Code	972
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$141.70
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: MDX Hawaii PPO	$223.10

FEVER AND INFLAMMATORY CONDITIONS

Facility

$22,564.30

Service Code	MSDRG 864
Min. Negotiated Rate	$22,564.30
Max. Negotiated Rate	$22,564.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30

fexofenadine 180 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 49348096856
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

fexofenadine 180 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 49348096856
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

fexofenadine 60 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 55111078301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

fexofenadine 60 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 55111078301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

Know your out-of-pocket cost for care.

All Charges