Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Omega-3 1000mg gel [KMC]

Facility

$3.00

Service Code	NDC 04746900928
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

Omega-3 1000mg gel [KMC]

Facility

$3.00

Service Code	NDC 04746900928
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

omeprazole 20 mg EC Cap [KMC]

Facility

$3.00

Service Code	NDC 59651000290
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

omeprazole 20 mg EC Cap [KMC]

Facility

$3.00

Service Code	NDC 59651000290
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

ondansetron 4 mg / 2 mL Inj Sol [KMC]

Facility

$2.28

Service Code	HCPCS J2405
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$2.21
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Management Network Commercial	$1.94
Rate for Payer: Kaiser Permanente Commercial	$2.05
Rate for Payer: MDX Hawaii PPO	$2.21

ondansetron 4 mg / 2 mL Inj Sol [KMC]

Facility

$2.28

Service Code	HCPCS J2405
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$2.21
Rate for Payer: AlohaCare Medicaid	$1.14
Rate for Payer: AlohaCare Medicare	$0.96
Rate for Payer: Cash Price	$1.48
Rate for Payer: Cash Price	$1.48
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.10
Rate for Payer: Devoted Health Medicare	$0.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$0.96
Rate for Payer: Hawaii Western Management Group Commercial	$2.17
Rate for Payer: Health Management Network Commercial	$1.94
Rate for Payer: Humana Medicare	$0.96
Rate for Payer: Kaiser Permanente Commercial	$2.05
Rate for Payer: Kaiser Permanente Medicaid	$1.16
Rate for Payer: Kaiser Permanente Medicare	$0.96
Rate for Payer: MDX Hawaii PPO	$2.21
Rate for Payer: Ohana Health Plan Medicaid	$0.96
Rate for Payer: Ohana Health Plan Medicare	$0.96
Rate for Payer: UnitedHealthcare Medicaid	$1.37
Rate for Payer: UnitedHealthcare Medicare	$0.96
Rate for Payer: University Health Alliance Commercial	$1.66

ondansetron 4 mg Dis Tab [KMC]

Facility

$89.13

Service Code	HCPCS S0119
Hospital Revenue Code	637
Min. Negotiated Rate	$75.76
Max. Negotiated Rate	$86.46
Rate for Payer: Cash Price	$57.93
Rate for Payer: Health Management Network Commercial	$75.76
Rate for Payer: Kaiser Permanente Commercial	$80.22
Rate for Payer: MDX Hawaii PPO	$86.46

ondansetron 4 mg Dis Tab [KMC]

Facility

$89.13

Service Code	HCPCS S0119
Hospital Revenue Code	637
Min. Negotiated Rate	$37.43
Max. Negotiated Rate	$86.46
Rate for Payer: AlohaCare Medicaid	$44.56
Rate for Payer: AlohaCare Medicare	$37.43
Rate for Payer: Cash Price	$57.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$82.00
Rate for Payer: Devoted Health Medicare	$37.43
Rate for Payer: Hawaii Medical Service Association Medicare	$37.43
Rate for Payer: Hawaii Western Management Group Commercial	$84.67
Rate for Payer: Health Management Network Commercial	$75.76
Rate for Payer: Humana Medicare	$37.43
Rate for Payer: Kaiser Permanente Commercial	$80.22
Rate for Payer: Kaiser Permanente Medicaid	$45.46
Rate for Payer: Kaiser Permanente Medicare	$37.43
Rate for Payer: MDX Hawaii PPO	$86.46
Rate for Payer: Ohana Health Plan Medicaid	$37.43
Rate for Payer: Ohana Health Plan Medicare	$37.43
Rate for Payer: UnitedHealthcare Medicare	$37.43
Rate for Payer: University Health Alliance Commercial	$64.97

OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE FINGE

Facility

$10,275.00

Service Code	HCPCS 26765
Hospital Charge Code	440267650
Hospital Revenue Code	450
Min. Negotiated Rate	$8,733.75
Max. Negotiated Rate	$9,966.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: MDX Hawaii PPO	$9,966.75

OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE FINGE

Facility

$10,275.00

Service Code	HCPCS 26765
Hospital Charge Code	440267650
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$5,137.50
Rate for Payer: AlohaCare Medicare	$4,315.50
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9,453.00
Rate for Payer: Devoted Health Medicare	$4,315.50
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	$4,315.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,761.25
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Humana Medicare	$4,315.50
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,315.50
Rate for Payer: MDX Hawaii PPO	$9,966.75
Rate for Payer: Ohana Health Plan Medicaid	$4,315.50
Rate for Payer: Ohana Health Plan Medicare	$4,315.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,315.50
Rate for Payer: University Health Alliance Commercial	$10,679.55

OPEN TREATMENT OF FRACTURE GREAT TOE, PHALANX, OR

Facility

$10,275.00

Service Code	HCPCS 28505
Hospital Charge Code	440285050
Hospital Revenue Code	450
Min. Negotiated Rate	$8,733.75
Max. Negotiated Rate	$9,966.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: MDX Hawaii PPO	$9,966.75

OPEN TREATMENT OF FRACTURE GREAT TOE, PHALANX, OR

Facility

$10,275.00

Service Code	HCPCS 28505
Hospital Charge Code	440285050
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$9,966.75
Rate for Payer: AlohaCare Medicaid	$5,137.50
Rate for Payer: AlohaCare Medicare	$4,315.50
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9,453.00
Rate for Payer: Devoted Health Medicare	$4,315.50
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	$4,315.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,761.25
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Humana Medicare	$4,315.50
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,315.50
Rate for Payer: MDX Hawaii PPO	$9,966.75
Rate for Payer: Ohana Health Plan Medicaid	$4,315.50
Rate for Payer: Ohana Health Plan Medicare	$4,315.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,315.50
Rate for Payer: University Health Alliance Commercial	$6,743.44

OPEN TREATMENT OF FRACTURE PHALANX OR PHALANGES OT

Facility

$10,275.00

Service Code	HCPCS 28525
Hospital Charge Code	440285250
Hospital Revenue Code	450
Min. Negotiated Rate	$8,733.75
Max. Negotiated Rate	$9,966.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: MDX Hawaii PPO	$9,966.75

OPEN TREATMENT OF FRACTURE PHALANX OR PHALANGES OT

Facility

$10,275.00

Service Code	HCPCS 28525
Hospital Charge Code	440285250
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$9,966.75
Rate for Payer: AlohaCare Medicaid	$5,137.50
Rate for Payer: AlohaCare Medicare	$4,315.50
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9,453.00
Rate for Payer: Devoted Health Medicare	$4,315.50
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	$4,315.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,761.25
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Humana Medicare	$4,315.50
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,315.50
Rate for Payer: MDX Hawaii PPO	$9,966.75
Rate for Payer: Ohana Health Plan Medicaid	$4,315.50
Rate for Payer: Ohana Health Plan Medicare	$4,315.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,315.50
Rate for Payer: University Health Alliance Commercial	$6,743.44

Open Tx of interphalangeal joint dislocation

Facility

$10,275.00

Service Code	HCPCS 28675
Hospital Charge Code	440286750
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$9,966.75
Rate for Payer: AlohaCare Medicaid	$5,137.50
Rate for Payer: AlohaCare Medicare	$4,315.50
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9,453.00
Rate for Payer: Devoted Health Medicare	$4,315.50
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	$4,315.50
Rate for Payer: Hawaii Western Management Group Commercial	$9,761.25
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Humana Medicare	$4,315.50
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,315.50
Rate for Payer: MDX Hawaii PPO	$9,966.75
Rate for Payer: Ohana Health Plan Medicaid	$4,315.50
Rate for Payer: Ohana Health Plan Medicare	$4,315.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,315.50
Rate for Payer: University Health Alliance Commercial	$6,743.44

Open Tx of interphalangeal joint dislocation

Facility

$10,275.00

Service Code	HCPCS 28675
Hospital Charge Code	440286750
Hospital Revenue Code	450
Min. Negotiated Rate	$8,733.75
Max. Negotiated Rate	$9,966.75
Rate for Payer: Cash Price	$6,678.75
Rate for Payer: Health Management Network Commercial	$8,733.75
Rate for Payer: Kaiser Permanente Commercial	$9,247.50
Rate for Payer: MDX Hawaii PPO	$9,966.75

OPHTHALMIC ULTRASOUND B SCAN

Facility

$311.00

Service Code	HCPCS 76512
Hospital Charge Code	424765120
Hospital Revenue Code	402
Min. Negotiated Rate	$264.35
Max. Negotiated Rate	$301.67
Rate for Payer: Cash Price	$202.15
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: Kaiser Permanente Commercial	$279.90
Rate for Payer: MDX Hawaii PPO	$301.67

OPHTHALMIC ULTRASOUND B SCAN

Facility

$311.00

Service Code	HCPCS 76512
Hospital Charge Code	424765120
Hospital Revenue Code	402
Min. Negotiated Rate	$47.80
Max. Negotiated Rate	$301.67
Rate for Payer: AlohaCare Medicaid	$155.50
Rate for Payer: AlohaCare Medicare	$130.62
Rate for Payer: Cash Price	$202.15
Rate for Payer: Cash Price	$202.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$286.12
Rate for Payer: Devoted Health Medicare	$130.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$47.80
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$130.62
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: Humana Medicare	$130.62
Rate for Payer: Kaiser Permanente Commercial	$279.90
Rate for Payer: Kaiser Permanente Medicaid	$158.61
Rate for Payer: Kaiser Permanente Medicare	$130.62
Rate for Payer: MDX Hawaii PPO	$301.67
Rate for Payer: Ohana Health Plan Medicaid	$130.62
Rate for Payer: Ohana Health Plan Medicare	$130.62
Rate for Payer: UnitedHealthcare Medicaid	$47.80
Rate for Payer: UnitedHealthcare Medicare	$130.62
Rate for Payer: University Health Alliance Commercial	$200.08

OPHTHALMIC US FB LOCLIZATN

Facility

$311.00

Service Code	HCPCS 76529
Hospital Charge Code	424765290
Hospital Revenue Code	402
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$301.67
Rate for Payer: AlohaCare Medicaid	$155.50
Rate for Payer: AlohaCare Medicare	$130.62
Rate for Payer: Cash Price	$202.15
Rate for Payer: Cash Price	$202.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$286.12
Rate for Payer: Devoted Health Medicare	$130.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$30.00
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$130.62
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: Humana Medicare	$130.62
Rate for Payer: Kaiser Permanente Commercial	$279.90
Rate for Payer: Kaiser Permanente Medicaid	$158.61
Rate for Payer: Kaiser Permanente Medicare	$130.62
Rate for Payer: MDX Hawaii PPO	$301.67
Rate for Payer: Ohana Health Plan Medicaid	$130.62
Rate for Payer: Ohana Health Plan Medicare	$130.62
Rate for Payer: UnitedHealthcare Medicaid	$30.00
Rate for Payer: UnitedHealthcare Medicare	$130.62
Rate for Payer: University Health Alliance Commercial	$141.32

OPHTHALMIC US FB LOCLIZATN

Facility

$311.00

Service Code	HCPCS 76529
Hospital Charge Code	424765290
Hospital Revenue Code	402
Min. Negotiated Rate	$264.35
Max. Negotiated Rate	$301.67
Rate for Payer: Cash Price	$202.15
Rate for Payer: Health Management Network Commercial	$264.35
Rate for Payer: Kaiser Permanente Commercial	$279.90
Rate for Payer: MDX Hawaii PPO	$301.67

OPSITE 2X3

Facility

$4.00

Hospital Charge Code	8226
Hospital Revenue Code	270
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.68
Rate for Payer: Cash Price	$2.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.68
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.68
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.68
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.68
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.68
Rate for Payer: Ohana Health Plan Medicare	$1.68
Rate for Payer: UnitedHealthcare Medicare	$1.68
Rate for Payer: University Health Alliance Commercial	$2.92

OPSITE 2X3

Facility

$4.00

Hospital Charge Code	8226
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

OPSITE 4X6

Facility

$3.00

Hospital Charge Code	8227
Hospital Revenue Code	270
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

OPSITE 4X6

Facility

$3.00

Hospital Charge Code	8227
Hospital Revenue Code	270
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

OPTIC FORAMINA

Facility

$340.00

Service Code	HCPCS 70190
Hospital Charge Code	424701900
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$142.80
Rate for Payer: Cash Price	$221.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$312.80
Rate for Payer: Devoted Health Medicare	$142.80
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$142.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$142.80
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$142.80
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$142.80
Rate for Payer: Ohana Health Plan Medicare	$142.80
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$142.80
Rate for Payer: University Health Alliance Commercial	$72.13

Know your out-of-pocket cost for care.

All Charges