Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

MA Mammogram Diagnostic Bilateral

Facility

$504.00

Service Code	HCPCS G0204
Hospital Charge Code	424G02040
Hospital Revenue Code	403
Min. Negotiated Rate	$211.68
Max. Negotiated Rate	$488.88
Rate for Payer: AlohaCare Medicaid	$252.00
Rate for Payer: AlohaCare Medicare	$211.68
Rate for Payer: Cash Price	$327.60
Rate for Payer: Cash Price	$327.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$463.68
Rate for Payer: Devoted Health Medicare	$211.68
Rate for Payer: Hawaii Medical Service Association Medicare	$211.68
Rate for Payer: Hawaii Western Management Group Commercial	$478.80
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: Humana Medicare	$211.68
Rate for Payer: Kaiser Permanente Commercial	$453.60
Rate for Payer: Kaiser Permanente Medicaid	$257.04
Rate for Payer: Kaiser Permanente Medicare	$211.68
Rate for Payer: MDX Hawaii PPO	$488.88
Rate for Payer: Ohana Health Plan Medicaid	$211.68
Rate for Payer: Ohana Health Plan Medicare	$211.68
Rate for Payer: UnitedHealthcare Medicare	$211.68
Rate for Payer: University Health Alliance Commercial	$307.49

MA Mammogram Diagnostic Left

Facility

$78.00

Service Code	HCPCS G0206
Hospital Charge Code	424G02069
Hospital Revenue Code	972
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

MA Mammogram Diagnostic Left

Facility

$78.00

Service Code	HCPCS G0206
Hospital Charge Code	424G02069
Hospital Revenue Code	972
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$245.42
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$32.76
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$71.76
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$32.76
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$32.76
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$32.76
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$32.76
Rate for Payer: Ohana Health Plan Medicare	$32.76
Rate for Payer: UnitedHealthcare Medicare	$32.76
Rate for Payer: University Health Alliance Commercial	$245.42

MA Mammogram Diagnostic Right

Facility

$78.00

Service Code	HCPCS G2026
Hospital Charge Code	424G02069
Hospital Revenue Code	972
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$32.76
Rate for Payer: Cash Price	$50.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$71.76
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$32.76
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$32.76
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$32.76
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$32.76
Rate for Payer: Ohana Health Plan Medicare	$32.76
Rate for Payer: UnitedHealthcare Medicare	$32.76
Rate for Payer: University Health Alliance Commercial	$56.85

MA Mammogram Diagnostic Right

Facility

$78.00

Service Code	HCPCS G2026
Hospital Charge Code	424G02069
Hospital Revenue Code	972
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

MA Mammogram Diagnostic Right

Facility

$352.00

Service Code	HCPCS G0206
Hospital Charge Code	424G02060
Hospital Revenue Code	403
Min. Negotiated Rate	$299.20
Max. Negotiated Rate	$341.44
Rate for Payer: Cash Price	$228.80
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: MDX Hawaii PPO	$341.44

MA Mammogram Diagnostic Right

Facility

$352.00

Service Code	HCPCS G0206
Hospital Charge Code	424G02060
Hospital Revenue Code	403
Min. Negotiated Rate	$147.84
Max. Negotiated Rate	$341.44
Rate for Payer: AlohaCare Medicaid	$176.00
Rate for Payer: AlohaCare Medicare	$147.84
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$323.84
Rate for Payer: Devoted Health Medicare	$147.84
Rate for Payer: Hawaii Medical Service Association Medicare	$147.84
Rate for Payer: Hawaii Western Management Group Commercial	$334.40
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Humana Medicare	$147.84
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: Kaiser Permanente Medicaid	$179.52
Rate for Payer: Kaiser Permanente Medicare	$147.84
Rate for Payer: MDX Hawaii PPO	$341.44
Rate for Payer: Ohana Health Plan Medicaid	$147.84
Rate for Payer: Ohana Health Plan Medicare	$147.84
Rate for Payer: UnitedHealthcare Medicare	$147.84
Rate for Payer: University Health Alliance Commercial	$245.42

MA Mammogram Diagnostic Unilateral

Facility

$352.00

Service Code	HCPCS G0206
Hospital Charge Code	424G02060
Hospital Revenue Code	403
Min. Negotiated Rate	$299.20
Max. Negotiated Rate	$341.44
Rate for Payer: Cash Price	$228.80
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: MDX Hawaii PPO	$341.44

MA Mammogram Diagnostic Unilateral

Facility

$352.00

Service Code	HCPCS G0206
Hospital Charge Code	424G02060
Hospital Revenue Code	403
Min. Negotiated Rate	$147.84
Max. Negotiated Rate	$341.44
Rate for Payer: AlohaCare Medicaid	$176.00
Rate for Payer: AlohaCare Medicare	$147.84
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$323.84
Rate for Payer: Devoted Health Medicare	$147.84
Rate for Payer: Hawaii Medical Service Association Medicare	$147.84
Rate for Payer: Hawaii Western Management Group Commercial	$334.40
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Humana Medicare	$147.84
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: Kaiser Permanente Medicaid	$179.52
Rate for Payer: Kaiser Permanente Medicare	$147.84
Rate for Payer: MDX Hawaii PPO	$341.44
Rate for Payer: Ohana Health Plan Medicaid	$147.84
Rate for Payer: Ohana Health Plan Medicare	$147.84
Rate for Payer: UnitedHealthcare Medicare	$147.84
Rate for Payer: University Health Alliance Commercial	$245.42

MA Mammogram Routine Screening Bilat

Facility

$390.00

Service Code	HCPCS 77067
Hospital Charge Code	424770670
Hospital Revenue Code	403
Min. Negotiated Rate	$80.77
Max. Negotiated Rate	$378.30
Rate for Payer: AlohaCare Medicaid	$195.00
Rate for Payer: AlohaCare Medicare	$163.80
Rate for Payer: Cash Price	$253.50
Rate for Payer: Cash Price	$253.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$358.80
Rate for Payer: Devoted Health Medicare	$163.80
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$80.77
Rate for Payer: Hawaii Medical Service Association Medicare	$163.80
Rate for Payer: Hawaii Western Management Group Commercial	$370.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Humana Medicare	$163.80
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: Kaiser Permanente Medicaid	$198.90
Rate for Payer: Kaiser Permanente Medicare	$163.80
Rate for Payer: MDX Hawaii PPO	$378.30
Rate for Payer: Ohana Health Plan Medicaid	$163.80
Rate for Payer: Ohana Health Plan Medicare	$163.80
Rate for Payer: UnitedHealthcare Medicaid	$85.27
Rate for Payer: UnitedHealthcare Medicare	$163.80
Rate for Payer: University Health Alliance Commercial	$285.53

MA Mammogram Routine Screening Bilat

Facility

$390.00

Service Code	HCPCS 77067
Hospital Charge Code	424770670
Hospital Revenue Code	403
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$253.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: MDX Hawaii PPO	$378.30

MANDIBLE COMP MIN 4 VWS

Facility

$581.00

Service Code	HCPCS 70110
Hospital Charge Code	424701100
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$78.16

MANDIBLE COMP MIN 4 VWS

Facility

$581.00

Service Code	HCPCS 70110
Hospital Charge Code	424701100
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

MANDIBLE PART LESS THAN 4 VWS

Facility

$369.00

Service Code	HCPCS 70100
Hospital Charge Code	424701000
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$61.70

MANDIBLE PART LESS THAN 4 VWS

Facility

$369.00

Service Code	HCPCS 70100
Hospital Charge Code	424701000
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

Manipulation/mobilization of secretions

Facility

$302.00

Service Code	HCPCS 94667
Hospital Charge Code	429946670
Hospital Revenue Code	410
Min. Negotiated Rate	$256.70
Max. Negotiated Rate	$292.94
Rate for Payer: Cash Price	$196.30
Rate for Payer: Health Management Network Commercial	$256.70
Rate for Payer: Kaiser Permanente Commercial	$271.80
Rate for Payer: MDX Hawaii PPO	$292.94

Manipulation/mobilization of secretions

Facility

$302.00

Service Code	HCPCS 94667
Hospital Charge Code	429946670
Hospital Revenue Code	410
Min. Negotiated Rate	$20.34
Max. Negotiated Rate	$292.94
Rate for Payer: AlohaCare Medicaid	$151.00
Rate for Payer: AlohaCare Medicare	$126.84
Rate for Payer: Cash Price	$196.30
Rate for Payer: Cash Price	$196.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$277.84
Rate for Payer: Devoted Health Medicare	$126.84
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$126.84
Rate for Payer: Hawaii Western Management Group Commercial	$286.90
Rate for Payer: Health Management Network Commercial	$256.70
Rate for Payer: Humana Medicare	$126.84
Rate for Payer: Kaiser Permanente Commercial	$271.80
Rate for Payer: Kaiser Permanente Medicaid	$154.02
Rate for Payer: Kaiser Permanente Medicare	$126.84
Rate for Payer: MDX Hawaii PPO	$292.94
Rate for Payer: Ohana Health Plan Medicaid	$126.84
Rate for Payer: Ohana Health Plan Medicare	$126.84
Rate for Payer: UnitedHealthcare Medicaid	$20.34
Rate for Payer: UnitedHealthcare Medicare	$126.84
Rate for Payer: University Health Alliance Commercial	$220.13

MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ

Professional

Both

$145.00

Service Code	HCPCS 94668
Hospital Revenue Code	410
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$44.54
Rate for Payer: AlohaCare Medicare	$44.06
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$44.06
Rate for Payer: Hawaii Medical Service Association Medicare	$44.06
Rate for Payer: Hawaii Western Management Group Commercial	$11.56
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$52.87
Rate for Payer: Kaiser Permanente Medicaid	$52.87
Rate for Payer: Kaiser Permanente Medicare	$52.87
Rate for Payer: Ohana Health Plan Medicaid	$44.54
Rate for Payer: Ohana Health Plan Medicare	$44.06
Rate for Payer: UnitedHealthcare Medicaid	$44.54
Rate for Payer: UnitedHealthcare Medicare	$44.06

MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL

Professional

Both

$287.00

Service Code	HCPCS 94667
Hospital Revenue Code	410
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$243.95
Rate for Payer: AlohaCare Medicaid	$28.29
Rate for Payer: AlohaCare Medicare	$30.77
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Devoted Health Medicare	$30.77
Rate for Payer: Hawaii Medical Service Association Medicare	$30.77
Rate for Payer: Hawaii Western Management Group Commercial	$24.84
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Kaiser Permanente Commercial	$36.92
Rate for Payer: Kaiser Permanente Medicaid	$36.92
Rate for Payer: Kaiser Permanente Medicare	$36.92
Rate for Payer: Ohana Health Plan Medicaid	$28.29
Rate for Payer: Ohana Health Plan Medicare	$30.77
Rate for Payer: UnitedHealthcare Medicaid	$28.29
Rate for Payer: UnitedHealthcare Medicare	$30.77

mannitol 100 gm/500 mL (20%) IV bag [KMC]

Facility

$0.18

Service Code	HCPCS J2150
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$2.24
Rate for Payer: AlohaCare Medicaid	$0.09
Rate for Payer: AlohaCare Medicare	$0.08
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cash Price	$0.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.24
Rate for Payer: Hawaii Medical Service Association Medicare	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$0.17
Rate for Payer: Health Management Network Commercial	$0.15
Rate for Payer: Humana Medicare	$0.08
Rate for Payer: Kaiser Permanente Commercial	$0.16
Rate for Payer: Kaiser Permanente Medicaid	$0.09
Rate for Payer: Kaiser Permanente Medicare	$0.08
Rate for Payer: MDX Hawaii PPO	$0.17
Rate for Payer: Ohana Health Plan Medicaid	$0.08
Rate for Payer: Ohana Health Plan Medicare	$0.08
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicare	$0.08
Rate for Payer: University Health Alliance Commercial	$0.13

mannitol 100 gm/500 mL (20%) IV bag [KMC]

Facility

$0.18

Service Code	HCPCS J2150
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.17
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Management Network Commercial	$0.15
Rate for Payer: Kaiser Permanente Commercial	$0.16
Rate for Payer: MDX Hawaii PPO	$0.17

mannitol 25% Sol [KMC]

Facility

$0.47

Service Code	HCPCS J2150
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$2.24
Rate for Payer: AlohaCare Medicaid	$0.24
Rate for Payer: AlohaCare Medicare	$0.20
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cash Price	$0.31
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.43
Rate for Payer: Devoted Health Medicare	$0.20
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.24
Rate for Payer: Hawaii Medical Service Association Medicare	$0.20
Rate for Payer: Hawaii Western Management Group Commercial	$0.45
Rate for Payer: Health Management Network Commercial	$0.40
Rate for Payer: Humana Medicare	$0.20
Rate for Payer: Kaiser Permanente Commercial	$0.42
Rate for Payer: Kaiser Permanente Medicaid	$0.24
Rate for Payer: Kaiser Permanente Medicare	$0.20
Rate for Payer: MDX Hawaii PPO	$0.46
Rate for Payer: Ohana Health Plan Medicaid	$0.20
Rate for Payer: Ohana Health Plan Medicare	$0.20
Rate for Payer: UnitedHealthcare Medicaid	$0.28
Rate for Payer: UnitedHealthcare Medicare	$0.20
Rate for Payer: University Health Alliance Commercial	$0.34

mannitol 25% Sol [KMC]

Facility

$0.47

Service Code	HCPCS J2150
Hospital Revenue Code	636
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.46
Rate for Payer: Cash Price	$0.31
Rate for Payer: Health Management Network Commercial	$0.40
Rate for Payer: Kaiser Permanente Commercial	$0.42
Rate for Payer: MDX Hawaii PPO	$0.46

Manual Diff 3

Facility

$57.00

Service Code	HCPCS 85007
Hospital Charge Code	422850070
Hospital Revenue Code	305
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$37.05
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

Manual Diff 3

Facility

$57.00

Service Code	HCPCS 85007
Hospital Charge Code	422850070
Hospital Revenue Code	305
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$23.94
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$52.44
Rate for Payer: Devoted Health Medicare	$23.94
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.76
Rate for Payer: Hawaii Medical Service Association Commercial	$4.75
Rate for Payer: Hawaii Medical Service Association Medicare	$23.94
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$23.94
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$23.94
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$23.94
Rate for Payer: Ohana Health Plan Medicare	$23.94
Rate for Payer: UnitedHealthcare Medicaid	$4.76
Rate for Payer: UnitedHealthcare Medicare	$23.94
Rate for Payer: University Health Alliance Commercial	$8.90

Know your out-of-pocket cost for care.

All Charges