Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

NPWT WHITE FOAM DRESSING

Facility

$13.00

Hospital Charge Code	8810
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$5.46
Rate for Payer: Cash Price	$8.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.96
Rate for Payer: Devoted Health Medicare	$5.46
Rate for Payer: Hawaii Medical Service Association Medicare	$5.46
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$5.46
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$5.46
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$5.46
Rate for Payer: Ohana Health Plan Medicare	$5.46
Rate for Payer: UnitedHealthcare Medicare	$5.46
Rate for Payer: University Health Alliance Commercial	$9.48

NPWT Y CONNECTOR

Facility

$24.00

Hospital Charge Code	8816
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

NPWT Y CONNECTOR

Facility

$24.00

Hospital Charge Code	8816
Hospital Revenue Code	270
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$10.08
Rate for Payer: Cash Price	$15.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.08
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$10.08
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$10.08
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$10.08
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$10.08
Rate for Payer: Ohana Health Plan Medicare	$10.08
Rate for Payer: UnitedHealthcare Medicare	$10.08
Rate for Payer: University Health Alliance Commercial	$17.49

NSG FACILITY CARE INIT 25 MIN

Professional

Both

$138.00

Service Code	HCPCS 99307
Hospital Charge Code	435993070
Hospital Revenue Code	987
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$117.30
Rate for Payer: AlohaCare Medicaid	$41.45
Rate for Payer: AlohaCare Medicare	$38.02
Rate for Payer: Cash Price	$89.70
Rate for Payer: Cash Price	$89.70
Rate for Payer: Devoted Health Medicare	$38.02
Rate for Payer: Hawaii Medical Service Association Medicare	$38.02
Rate for Payer: Hawaii Western Management Group Commercial	$27.59
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$45.62
Rate for Payer: Kaiser Permanente Medicaid	$45.62
Rate for Payer: Kaiser Permanente Medicare	$45.62
Rate for Payer: Ohana Health Plan Medicaid	$41.45
Rate for Payer: Ohana Health Plan Medicare	$38.02
Rate for Payer: UnitedHealthcare Medicaid	$41.45
Rate for Payer: UnitedHealthcare Medicare	$38.02

N-Terminal pro B-Type Natriuretic Peptide

Facility

$301.00

Service Code	HCPCS 83880
Hospital Charge Code	422838800
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$126.42
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.92
Rate for Payer: Devoted Health Medicare	$126.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$28.46
Rate for Payer: Hawaii Medical Service Association Commercial	$49.08
Rate for Payer: Hawaii Medical Service Association Medicare	$126.42
Rate for Payer: Hawaii Western Management Group Commercial	$39.26
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$126.42
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$126.42
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$126.42
Rate for Payer: Ohana Health Plan Medicare	$126.42
Rate for Payer: UnitedHealthcare Medicaid	$28.46
Rate for Payer: UnitedHealthcare Medicare	$126.42
Rate for Payer: University Health Alliance Commercial	$87.75

N-Terminal pro B-Type Natriuretic Peptide

Facility

$301.00

Service Code	HCPCS 83880
Hospital Charge Code	422838800
Hospital Revenue Code	301
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

Nurs Facility Discharge 30 min or less - 99315

Professional

Both

$224.00

Service Code	HCPCS 99315
Hospital Charge Code	435993150
Hospital Revenue Code	987
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$190.40
Rate for Payer: AlohaCare Medicaid	$83.54
Rate for Payer: AlohaCare Medicare	$74.63
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Devoted Health Medicare	$74.63
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	$190.40
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

NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME

Professional

Both

$306.00

Service Code	HCPCS 99316
Hospital Revenue Code	525
Min. Negotiated Rate	$73.13
Max. Negotiated Rate	$290.48
Rate for Payer: AlohaCare Medicaid	$133.44
Rate for Payer: AlohaCare Medicare	$119.07
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Devoted Health Medicare	$119.07
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Western Management Group Commercial	$73.13
Rate for Payer: Health Management Network Commercial	$260.10
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$142.88
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: Ohana Health Plan Medicaid	$133.44
Rate for Payer: Ohana Health Plan Medicare	$119.07
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME

Professional

Both

$314.00

Service Code	HCPCS 99315
Hospital Revenue Code	525
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$290.48
Rate for Payer: AlohaCare Medicaid	$83.54
Rate for Payer: AlohaCare Medicare	$74.63
Rate for Payer: Cash Price	$204.10
Rate for Payer: Cash Price	$204.10
Rate for Payer: Cash Price	$204.10
Rate for Payer: Devoted Health Medicare	$74.63
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Western Management Group Commercial	$45.97
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$89.56
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: Ohana Health Plan Medicaid	$83.54
Rate for Payer: Ohana Health Plan Medicare	$74.63
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

nystatin 100,000 units/g top powder [KMC]

Facility

$9.99

Service Code	NDC 00832046515
Hospital Revenue Code	250
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$9.69
Rate for Payer: Cash Price	$6.49
Rate for Payer: Health Management Network Commercial	$8.49
Rate for Payer: Kaiser Permanente Commercial	$8.99
Rate for Payer: MDX Hawaii PPO	$9.69

nystatin 100,000 units/g top powder [KMC]

Facility

$9.99

Service Code	NDC 00832046515
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.69
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$4.20
Rate for Payer: Cash Price	$6.49
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.19
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$9.49
Rate for Payer: Health Management Network Commercial	$8.49
Rate for Payer: Humana Medicare	$4.20
Rate for Payer: Kaiser Permanente Commercial	$8.99
Rate for Payer: Kaiser Permanente Medicaid	$5.09
Rate for Payer: Kaiser Permanente Medicare	$4.20
Rate for Payer: MDX Hawaii PPO	$9.69
Rate for Payer: Ohana Health Plan Medicaid	$4.20
Rate for Payer: Ohana Health Plan Medicare	$4.20
Rate for Payer: UnitedHealthcare Medicaid	$5.99
Rate for Payer: UnitedHealthcare Medicare	$4.20
Rate for Payer: University Health Alliance Commercial	$7.28

nystatin 100,000 units/mL oral susp [KMC]

Facility

$0.96

Service Code	NDC 69315050460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.93
Rate for Payer: AlohaCare Medicaid	$0.48
Rate for Payer: AlohaCare Medicare	$0.40
Rate for Payer: Cash Price	$0.62
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.88
Rate for Payer: Devoted Health Medicare	$0.40
Rate for Payer: Hawaii Medical Service Association Medicare	$0.40
Rate for Payer: Hawaii Western Management Group Commercial	$0.91
Rate for Payer: Health Management Network Commercial	$0.82
Rate for Payer: Humana Medicare	$0.40
Rate for Payer: Kaiser Permanente Commercial	$0.86
Rate for Payer: Kaiser Permanente Medicaid	$0.49
Rate for Payer: Kaiser Permanente Medicare	$0.40
Rate for Payer: MDX Hawaii PPO	$0.93
Rate for Payer: Ohana Health Plan Medicaid	$0.40
Rate for Payer: Ohana Health Plan Medicare	$0.40
Rate for Payer: UnitedHealthcare Medicaid	$0.58
Rate for Payer: UnitedHealthcare Medicare	$0.40
Rate for Payer: University Health Alliance Commercial	$0.70

nystatin 100,000 units/mL oral susp [KMC]

Facility

$0.96

Service Code	NDC 69315050460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.62
Rate for Payer: Health Management Network Commercial	$0.82
Rate for Payer: Kaiser Permanente Commercial	$0.86
Rate for Payer: MDX Hawaii PPO	$0.93

nystatin topical 100,000 units/gm Cream [KMC]

Facility

$3.50

Service Code	NDC 45802005911
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.28
Rate for Payer: Health Management Network Commercial	$2.98
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: MDX Hawaii PPO	$3.40

nystatin topical 100,000 units/gm Cream [KMC]

Facility

$3.50

Service Code	NDC 45802005911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.40
Rate for Payer: AlohaCare Medicaid	$1.75
Rate for Payer: AlohaCare Medicare	$1.47
Rate for Payer: Cash Price	$2.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.22
Rate for Payer: Devoted Health Medicare	$1.47
Rate for Payer: Hawaii Medical Service Association Medicare	$1.47
Rate for Payer: Hawaii Western Management Group Commercial	$3.33
Rate for Payer: Health Management Network Commercial	$2.98
Rate for Payer: Humana Medicare	$1.47
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$1.78
Rate for Payer: Kaiser Permanente Medicare	$1.47
Rate for Payer: MDX Hawaii PPO	$3.40
Rate for Payer: Ohana Health Plan Medicaid	$1.47
Rate for Payer: Ohana Health Plan Medicare	$1.47
Rate for Payer: UnitedHealthcare Medicaid	$2.10
Rate for Payer: UnitedHealthcare Medicare	$1.47
Rate for Payer: University Health Alliance Commercial	$2.55

nystatin-triamcinolone Top Cream [KMC]

Facility

$21.27

Service Code	NDC 51672126302
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$20.63
Rate for Payer: AlohaCare Medicaid	$10.63
Rate for Payer: AlohaCare Medicare	$8.93
Rate for Payer: Cash Price	$13.83
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19.57
Rate for Payer: Devoted Health Medicare	$8.93
Rate for Payer: Hawaii Medical Service Association Medicare	$8.93
Rate for Payer: Hawaii Western Management Group Commercial	$20.21
Rate for Payer: Health Management Network Commercial	$18.08
Rate for Payer: Humana Medicare	$8.93
Rate for Payer: Kaiser Permanente Commercial	$19.14
Rate for Payer: Kaiser Permanente Medicaid	$10.85
Rate for Payer: Kaiser Permanente Medicare	$8.93
Rate for Payer: MDX Hawaii PPO	$20.63
Rate for Payer: Ohana Health Plan Medicaid	$8.93
Rate for Payer: Ohana Health Plan Medicare	$8.93
Rate for Payer: UnitedHealthcare Medicaid	$12.76
Rate for Payer: UnitedHealthcare Medicare	$8.93
Rate for Payer: University Health Alliance Commercial	$15.50

nystatin-triamcinolone Top Cream [KMC]

Facility

$21.27

Service Code	NDC 51672126302
Hospital Revenue Code	250
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$20.63
Rate for Payer: Cash Price	$13.83
Rate for Payer: Health Management Network Commercial	$18.08
Rate for Payer: Kaiser Permanente Commercial	$19.14
Rate for Payer: MDX Hawaii PPO	$20.63

O2 CONNECTING TUBING

Facility

$395.00

Hospital Charge Code	8224
Hospital Revenue Code	270
Min. Negotiated Rate	$165.90
Max. Negotiated Rate	$383.15
Rate for Payer: AlohaCare Medicaid	$197.50
Rate for Payer: AlohaCare Medicare	$165.90
Rate for Payer: Cash Price	$256.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$363.40
Rate for Payer: Devoted Health Medicare	$165.90
Rate for Payer: Hawaii Medical Service Association Medicare	$165.90
Rate for Payer: Hawaii Western Management Group Commercial	$375.25
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Humana Medicare	$165.90
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: Kaiser Permanente Medicaid	$201.45
Rate for Payer: Kaiser Permanente Medicare	$165.90
Rate for Payer: MDX Hawaii PPO	$383.15
Rate for Payer: Ohana Health Plan Medicaid	$165.90
Rate for Payer: Ohana Health Plan Medicare	$165.90
Rate for Payer: UnitedHealthcare Medicare	$165.90
Rate for Payer: University Health Alliance Commercial	$287.92

O2 CONNECTING TUBING

Facility

$395.00

Hospital Charge Code	8224
Hospital Revenue Code	270
Min. Negotiated Rate	$335.75
Max. Negotiated Rate	$383.15
Rate for Payer: Cash Price	$256.75
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: MDX Hawaii PPO	$383.15

OB Panel with HIV 1/2 Ag/Ab, Reflex DLS

Facility

$261.00

Service Code	HCPCS 80081
Hospital Charge Code	422800815
Hospital Revenue Code	300
Min. Negotiated Rate	$61.18
Max. Negotiated Rate	$253.17
Rate for Payer: AlohaCare Medicaid	$130.50
Rate for Payer: AlohaCare Medicare	$109.62
Rate for Payer: Cash Price	$169.65
Rate for Payer: Cash Price	$169.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$240.12
Rate for Payer: Devoted Health Medicare	$109.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$61.18
Rate for Payer: Hawaii Medical Service Association Commercial	$93.58
Rate for Payer: Hawaii Medical Service Association Medicare	$109.62
Rate for Payer: Hawaii Western Management Group Commercial	$74.86
Rate for Payer: Health Management Network Commercial	$221.85
Rate for Payer: Humana Medicare	$109.62
Rate for Payer: Kaiser Permanente Commercial	$234.90
Rate for Payer: Kaiser Permanente Medicaid	$133.11
Rate for Payer: Kaiser Permanente Medicare	$109.62
Rate for Payer: MDX Hawaii PPO	$253.17
Rate for Payer: Ohana Health Plan Medicaid	$109.62
Rate for Payer: Ohana Health Plan Medicare	$109.62
Rate for Payer: UnitedHealthcare Medicaid	$61.18
Rate for Payer: UnitedHealthcare Medicare	$109.62
Rate for Payer: University Health Alliance Commercial	$190.24

OB Panel with HIV 1/2 Ag/Ab, Reflex DLS

Facility

$261.00

Service Code	HCPCS 80081
Hospital Charge Code	422800815
Hospital Revenue Code	300
Min. Negotiated Rate	$221.85
Max. Negotiated Rate	$253.17
Rate for Payer: Cash Price	$169.65
Rate for Payer: Health Management Network Commercial	$221.85
Rate for Payer: Kaiser Permanente Commercial	$234.90
Rate for Payer: MDX Hawaii PPO	$253.17

OBS CARE BY FAC EA HR

Facility

$149.00

Hospital Charge Code	762G03780
Hospital Revenue Code	762
Min. Negotiated Rate	$62.58
Max. Negotiated Rate	$1,200.00
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$62.58
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$137.08
Rate for Payer: Devoted Health Medicare	$62.58
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$280.95
Rate for Payer: Hawaii Medical Service Association Commercial	$1,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.58
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$62.58
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$62.58
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$62.58
Rate for Payer: Ohana Health Plan Medicare	$62.58
Rate for Payer: UnitedHealthcare Medicare	$62.58
Rate for Payer: University Health Alliance Commercial	$108.61

OBS CARE BY FAC EA HR

Facility

$149.00

Hospital Charge Code	762G03780
Hospital Revenue Code	762
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

Observation Care Discharge - 99217

Professional

Both

$222.00

Service Code	HCPCS 99217
Hospital Charge Code	435992170
Hospital Revenue Code	987
Min. Negotiated Rate	$65.40
Max. Negotiated Rate	$188.70
Rate for Payer: Cash Price	$144.30
Rate for Payer: Cash Price	$144.30
Rate for Payer: Hawaii Western Management Group Commercial	$65.40
Rate for Payer: Health Management Network Commercial	$188.70

Observation / Same Day Inpatient Care Level 3 - 99

Professional

Both

$656.00

Service Code	HCPCS 99236
Hospital Charge Code	435992360
Hospital Revenue Code	987
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$557.60
Rate for Payer: AlohaCare Medicaid	$208.78
Rate for Payer: AlohaCare Medicare	$189.32
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Devoted Health Medicare	$189.32
Rate for Payer: Hawaii Medical Service Association Medicare	$189.32
Rate for Payer: Hawaii Western Management Group Commercial	$164.50
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: Kaiser Permanente Commercial	$227.18
Rate for Payer: Kaiser Permanente Medicaid	$227.18
Rate for Payer: Kaiser Permanente Medicare	$227.18
Rate for Payer: Ohana Health Plan Medicaid	$208.78
Rate for Payer: Ohana Health Plan Medicare	$189.32
Rate for Payer: UnitedHealthcare Medicaid	$208.78
Rate for Payer: UnitedHealthcare Medicare	$189.32

Know your out-of-pocket cost for care.

All Charges