Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

INJ SING/MULT TRIG PT MUSCLE Charge

Facility

$1,035.00

Service Code	HCPCS 20552
Hospital Charge Code	440205520
Hospital Revenue Code	450
Min. Negotiated Rate	$879.75
Max. Negotiated Rate	$1,003.95
Rate for Payer: Cash Price	$672.75
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: Kaiser Permanente Commercial	$931.50
Rate for Payer: MDX Hawaii PPO	$1,003.95

INJ SING/MULT TRIG PT MUSCLE Charge

Facility

$1,035.00

Service Code	HCPCS 20552
Hospital Charge Code	440205520
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$517.50
Rate for Payer: AlohaCare Medicare	$434.70
Rate for Payer: Cash Price	$672.75
Rate for Payer: Cash Price	$672.75
Rate for Payer: Cash Price	$672.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$952.20
Rate for Payer: Devoted Health Medicare	$434.70
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$434.70
Rate for Payer: Hawaii Western Management Group Commercial	$983.25
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: Humana Medicare	$434.70
Rate for Payer: Kaiser Permanente Commercial	$931.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$434.70
Rate for Payer: MDX Hawaii PPO	$1,003.95
Rate for Payer: Ohana Health Plan Medicaid	$434.70
Rate for Payer: Ohana Health Plan Medicare	$434.70
Rate for Payer: UnitedHealthcare Medicare	$434.70
Rate for Payer: University Health Alliance Commercial	$4,035.20

INJ TESTOSTERO ENANTHATE 1MG

Professional

Both

$208.00

Service Code	HCPCS J3121
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$176.80
Rate for Payer: AlohaCare Medicare	$0.05
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Hawaii Medical Service Association Medicare	$0.05
Rate for Payer: Hawaii Western Management Group Commercial	$0.08
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$0.06
Rate for Payer: Kaiser Permanente Medicaid	$0.06
Rate for Payer: Kaiser Permanente Medicare	$0.06
Rate for Payer: Ohana Health Plan Medicare	$0.05
Rate for Payer: UnitedHealthcare Medicare	$0.05

INJ TESTOSTERONE CYPIONATE

Professional

Both

$107.00

Service Code	HCPCS J1071
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$90.95
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$69.55
Rate for Payer: Cash Price	$69.55
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Hawaii Medical Service Association Medicare	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$0.11
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.02

INSERTION DRUG DELIVERY IMPLANT

Professional

Both

$409.00

Service Code	HCPCS 11981
Hospital Revenue Code	361
Min. Negotiated Rate	$53.29
Max. Negotiated Rate	$347.65
Rate for Payer: AlohaCare Medicaid	$61.76
Rate for Payer: AlohaCare Medicare	$53.29
Rate for Payer: Cash Price	$265.85
Rate for Payer: Cash Price	$265.85
Rate for Payer: Devoted Health Medicare	$53.29
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$61.76
Rate for Payer: Hawaii Medical Service Association Commercial	$117.42
Rate for Payer: Hawaii Medical Service Association Medicare	$53.29
Rate for Payer: Hawaii Western Management Group Commercial	$119.08
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$63.95
Rate for Payer: Kaiser Permanente Medicaid	$63.95
Rate for Payer: Kaiser Permanente Medicare	$63.95
Rate for Payer: Ohana Health Plan Medicaid	$61.76
Rate for Payer: Ohana Health Plan Medicare	$53.29
Rate for Payer: UnitedHealthcare Medicaid	$61.76
Rate for Payer: UnitedHealthcare Medicare	$53.29
Rate for Payer: University Health Alliance Commercial	$67.44

INSERTION INTRAUTERINE DEVICE IUD

Professional

Both

$330.00

Service Code	HCPCS 58300
Hospital Revenue Code	361
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$280.50
Rate for Payer: AlohaCare Medicaid	$50.40
Rate for Payer: Cash Price	$214.50
Rate for Payer: Cash Price	$214.50
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$50.40
Rate for Payer: Hawaii Medical Service Association Commercial	$89.36
Rate for Payer: Hawaii Western Management Group Commercial	$137.02
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Ohana Health Plan Medicaid	$50.40
Rate for Payer: UnitedHealthcare Medicaid	$50.40

INSERTION OR REPLACEMENT OF SINGLE CHAMBER CARDIAC

Facility

$23,496.00

Service Code	HCPCS 33210
Hospital Charge Code	440332100
Hospital Revenue Code	450
Min. Negotiated Rate	$19,971.60
Max. Negotiated Rate	$22,791.12
Rate for Payer: Cash Price	$15,272.40
Rate for Payer: Health Management Network Commercial	$19,971.60
Rate for Payer: Kaiser Permanente Commercial	$21,146.40
Rate for Payer: MDX Hawaii PPO	$22,791.12

INSERTION OR REPLACEMENT OF SINGLE CHAMBER CARDIAC

Facility

$23,496.00

Service Code	HCPCS 33210
Hospital Charge Code	440332100
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$22,791.12
Rate for Payer: AlohaCare Medicaid	$11,748.00
Rate for Payer: AlohaCare Medicare	$9,868.32
Rate for Payer: Cash Price	$15,272.40
Rate for Payer: Cash Price	$15,272.40
Rate for Payer: Cash Price	$15,272.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21,616.32
Rate for Payer: Devoted Health Medicare	$9,868.32
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$9,868.32
Rate for Payer: Hawaii Western Management Group Commercial	$22,321.20
Rate for Payer: Health Management Network Commercial	$19,971.60
Rate for Payer: Humana Medicare	$9,868.32
Rate for Payer: Kaiser Permanente Commercial	$21,146.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,868.32
Rate for Payer: MDX Hawaii PPO	$22,791.12
Rate for Payer: Ohana Health Plan Medicaid	$9,868.32
Rate for Payer: Ohana Health Plan Medicare	$9,868.32
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$9,868.32
Rate for Payer: University Health Alliance Commercial	$17,126.23

Insert new catheter

Facility

$377.00

Service Code	HCPCS 51701
Hospital Charge Code	317517010
Hospital Revenue Code	450
Min. Negotiated Rate	$158.34
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$188.50
Rate for Payer: AlohaCare Medicare	$158.34
Rate for Payer: Cash Price	$245.05
Rate for Payer: Cash Price	$245.05
Rate for Payer: Cash Price	$245.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$346.84
Rate for Payer: Devoted Health Medicare	$158.34
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$158.34
Rate for Payer: Hawaii Western Management Group Commercial	$358.15
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Humana Medicare	$158.34
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$158.34
Rate for Payer: MDX Hawaii PPO	$365.69
Rate for Payer: Ohana Health Plan Medicaid	$158.34
Rate for Payer: Ohana Health Plan Medicare	$158.34
Rate for Payer: UnitedHealthcare Medicare	$158.34
Rate for Payer: University Health Alliance Commercial	$274.80

Insert new catheter

Facility

$377.00

Service Code	HCPCS 51701
Hospital Charge Code	317517010
Hospital Revenue Code	361
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$188.50
Rate for Payer: AlohaCare Medicare	$158.34
Rate for Payer: Cash Price	$245.05
Rate for Payer: Cash Price	$245.05
Rate for Payer: Cash Price	$245.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$346.84
Rate for Payer: Devoted Health Medicare	$158.34
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$158.34
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Humana Medicare	$158.34
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$158.34
Rate for Payer: MDX Hawaii PPO	$365.69
Rate for Payer: Ohana Health Plan Medicaid	$158.34
Rate for Payer: Ohana Health Plan Medicare	$158.34
Rate for Payer: UnitedHealthcare Medicaid	$19.82
Rate for Payer: UnitedHealthcare Medicare	$158.34
Rate for Payer: University Health Alliance Commercial	$274.80

Insert new catheter

Facility

$377.00

Service Code	HCPCS 51701
Hospital Charge Code	317517010
Hospital Revenue Code	450
Min. Negotiated Rate	$320.45
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$245.05
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: MDX Hawaii PPO	$365.69

Insert new catheter

Facility

$377.00

Service Code	HCPCS 51701
Hospital Charge Code	317517010
Hospital Revenue Code	361
Min. Negotiated Rate	$320.45
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$245.05
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: MDX Hawaii PPO	$365.69

INSERT TEMP BLADDER CATH ED Charge

Facility

$377.00

Service Code	HCPCS 51702
Hospital Charge Code	317517020
Hospital Revenue Code	361
Min. Negotiated Rate	$320.45
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$245.05
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: MDX Hawaii PPO	$365.69

INSERT TEMP BLADDER CATH ED Charge

Facility

$377.00

Service Code	HCPCS 51702
Hospital Charge Code	317517020
Hospital Revenue Code	361
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$188.50
Rate for Payer: AlohaCare Medicare	$158.34
Rate for Payer: Cash Price	$245.05
Rate for Payer: Cash Price	$245.05
Rate for Payer: Cash Price	$245.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$346.84
Rate for Payer: Devoted Health Medicare	$158.34
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$158.34
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Humana Medicare	$158.34
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$158.34
Rate for Payer: MDX Hawaii PPO	$365.69
Rate for Payer: Ohana Health Plan Medicaid	$158.34
Rate for Payer: Ohana Health Plan Medicare	$158.34
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$158.34
Rate for Payer: University Health Alliance Commercial	$274.80

insulin aspart 100 units/mL soln [KMC]

Facility

$89.41

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$86.73
Rate for Payer: AlohaCare Medicaid	$44.70
Rate for Payer: AlohaCare Medicare	$37.55
Rate for Payer: Cash Price	$58.12
Rate for Payer: Cash Price	$58.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$82.26
Rate for Payer: Devoted Health Medicare	$37.55
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$37.55
Rate for Payer: Hawaii Western Management Group Commercial	$84.94
Rate for Payer: Health Management Network Commercial	$76.00
Rate for Payer: Humana Medicare	$37.55
Rate for Payer: Kaiser Permanente Commercial	$80.47
Rate for Payer: Kaiser Permanente Medicaid	$45.60
Rate for Payer: Kaiser Permanente Medicare	$37.55
Rate for Payer: MDX Hawaii PPO	$86.73
Rate for Payer: Ohana Health Plan Medicaid	$37.55
Rate for Payer: Ohana Health Plan Medicare	$37.55
Rate for Payer: UnitedHealthcare Medicaid	$53.65
Rate for Payer: UnitedHealthcare Medicare	$37.55
Rate for Payer: University Health Alliance Commercial	$65.17

insulin aspart 100 units/mL soln [KMC]

Facility

$89.41

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$86.73
Rate for Payer: Cash Price	$58.12
Rate for Payer: Health Management Network Commercial	$76.00
Rate for Payer: Kaiser Permanente Commercial	$80.47
Rate for Payer: MDX Hawaii PPO	$86.73

insulin aspart-insulin aspart protamine 30 units-70 units/mL SubQ Susp 3 mL [KMC]

Facility

$94.57

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$91.73
Rate for Payer: AlohaCare Medicaid	$47.28
Rate for Payer: AlohaCare Medicare	$39.72
Rate for Payer: Cash Price	$61.47
Rate for Payer: Cash Price	$61.47
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$87.00
Rate for Payer: Devoted Health Medicare	$39.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$39.72
Rate for Payer: Hawaii Western Management Group Commercial	$89.84
Rate for Payer: Health Management Network Commercial	$80.38
Rate for Payer: Humana Medicare	$39.72
Rate for Payer: Kaiser Permanente Commercial	$85.11
Rate for Payer: Kaiser Permanente Medicaid	$48.23
Rate for Payer: Kaiser Permanente Medicare	$39.72
Rate for Payer: MDX Hawaii PPO	$91.73
Rate for Payer: Ohana Health Plan Medicaid	$39.72
Rate for Payer: Ohana Health Plan Medicare	$39.72
Rate for Payer: UnitedHealthcare Medicaid	$56.74
Rate for Payer: UnitedHealthcare Medicare	$39.72
Rate for Payer: University Health Alliance Commercial	$68.93

insulin aspart-insulin aspart protamine 30 units-70 units/mL SubQ Susp 3 mL [KMC]

Facility

$94.57

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$80.38
Max. Negotiated Rate	$91.73
Rate for Payer: Cash Price	$61.47
Rate for Payer: Health Management Network Commercial	$80.38
Rate for Payer: Kaiser Permanente Commercial	$85.11
Rate for Payer: MDX Hawaii PPO	$91.73

insulin degludec 100 units/mL Sol [KHKU]

Facility

$56.94

Service Code	NDC 73070040315
Hospital Revenue Code	250
Min. Negotiated Rate	$23.91
Max. Negotiated Rate	$55.23
Rate for Payer: AlohaCare Medicaid	$28.47
Rate for Payer: AlohaCare Medicare	$23.91
Rate for Payer: Cash Price	$37.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$52.38
Rate for Payer: Devoted Health Medicare	$23.91
Rate for Payer: Hawaii Medical Service Association Medicare	$23.91
Rate for Payer: Hawaii Western Management Group Commercial	$54.09
Rate for Payer: Health Management Network Commercial	$48.40
Rate for Payer: Humana Medicare	$23.91
Rate for Payer: Kaiser Permanente Commercial	$51.25
Rate for Payer: Kaiser Permanente Medicaid	$29.04
Rate for Payer: Kaiser Permanente Medicare	$23.91
Rate for Payer: MDX Hawaii PPO	$55.23
Rate for Payer: Ohana Health Plan Medicaid	$23.91
Rate for Payer: Ohana Health Plan Medicare	$23.91
Rate for Payer: UnitedHealthcare Medicaid	$34.16
Rate for Payer: UnitedHealthcare Medicare	$23.91
Rate for Payer: University Health Alliance Commercial	$41.50

insulin degludec 100 units/mL Sol [KHKU]

Facility

$56.94

Service Code	NDC 73070040315
Hospital Revenue Code	250
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$55.23
Rate for Payer: Cash Price	$37.01
Rate for Payer: Health Management Network Commercial	$48.40
Rate for Payer: Kaiser Permanente Commercial	$51.25
Rate for Payer: MDX Hawaii PPO	$55.23

insulin detemir 100 units/mL soln [KMC]

Facility

$88.23

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$85.58
Rate for Payer: AlohaCare Medicaid	$44.12
Rate for Payer: AlohaCare Medicare	$37.06
Rate for Payer: Cash Price	$57.35
Rate for Payer: Cash Price	$57.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.17
Rate for Payer: Devoted Health Medicare	$37.06
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$37.06
Rate for Payer: Hawaii Western Management Group Commercial	$83.82
Rate for Payer: Health Management Network Commercial	$75.00
Rate for Payer: Humana Medicare	$37.06
Rate for Payer: Kaiser Permanente Commercial	$79.41
Rate for Payer: Kaiser Permanente Medicaid	$45.00
Rate for Payer: Kaiser Permanente Medicare	$37.06
Rate for Payer: MDX Hawaii PPO	$85.58
Rate for Payer: Ohana Health Plan Medicaid	$37.06
Rate for Payer: Ohana Health Plan Medicare	$37.06
Rate for Payer: UnitedHealthcare Medicaid	$52.94
Rate for Payer: UnitedHealthcare Medicare	$37.06
Rate for Payer: University Health Alliance Commercial	$64.31

insulin detemir 100 units/mL soln [KMC]

Facility

$88.23

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$85.58
Rate for Payer: Cash Price	$57.35
Rate for Payer: Health Management Network Commercial	$75.00
Rate for Payer: Kaiser Permanente Commercial	$79.41
Rate for Payer: MDX Hawaii PPO	$85.58

Insulin DLS

Facility

$139.00

Service Code	HCPCS 83525
Hospital Charge Code	422835255
Hospital Revenue Code	301
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Insulin DLS

Facility

$139.00

Service Code	HCPCS 83525
Hospital Charge Code	422835255
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$58.38
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$127.88
Rate for Payer: Devoted Health Medicare	$58.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$14.29
Rate for Payer: Hawaii Medical Service Association Medicare	$58.38
Rate for Payer: Hawaii Western Management Group Commercial	$11.43
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$58.38
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$58.38
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$58.38
Rate for Payer: Ohana Health Plan Medicare	$58.38
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$58.38
Rate for Payer: University Health Alliance Commercial	$29.56

insulin glargine 100 units/mL soln [KMC]

Facility

$136.10

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$132.02
Rate for Payer: AlohaCare Medicaid	$68.05
Rate for Payer: AlohaCare Medicare	$57.16
Rate for Payer: Cash Price	$88.46
Rate for Payer: Cash Price	$88.46
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$125.21
Rate for Payer: Devoted Health Medicare	$57.16
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$57.16
Rate for Payer: Hawaii Western Management Group Commercial	$129.29
Rate for Payer: Health Management Network Commercial	$115.69
Rate for Payer: Humana Medicare	$57.16
Rate for Payer: Kaiser Permanente Commercial	$122.49
Rate for Payer: Kaiser Permanente Medicaid	$69.41
Rate for Payer: Kaiser Permanente Medicare	$57.16
Rate for Payer: MDX Hawaii PPO	$132.02
Rate for Payer: Ohana Health Plan Medicaid	$57.16
Rate for Payer: Ohana Health Plan Medicare	$57.16
Rate for Payer: UnitedHealthcare Medicaid	$81.66
Rate for Payer: UnitedHealthcare Medicare	$57.16
Rate for Payer: University Health Alliance Commercial	$99.20

Know your out-of-pocket cost for care.

All Charges