Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

rivaroxaban 10 mg Tab UD [KMC]

Facility

$42.46

Service Code	NDC 50458058010
Hospital Revenue Code	250
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$41.19
Rate for Payer: AlohaCare Medicaid	$21.23
Rate for Payer: AlohaCare Medicare	$17.83
Rate for Payer: Cash Price	$27.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$39.06
Rate for Payer: Devoted Health Medicare	$17.83
Rate for Payer: Hawaii Medical Service Association Medicare	$17.83
Rate for Payer: Hawaii Western Management Group Commercial	$40.34
Rate for Payer: Health Management Network Commercial	$36.09
Rate for Payer: Humana Medicare	$17.83
Rate for Payer: Kaiser Permanente Commercial	$38.21
Rate for Payer: Kaiser Permanente Medicaid	$21.65
Rate for Payer: Kaiser Permanente Medicare	$17.83
Rate for Payer: MDX Hawaii PPO	$41.19
Rate for Payer: Ohana Health Plan Medicaid	$17.83
Rate for Payer: Ohana Health Plan Medicare	$17.83
Rate for Payer: UnitedHealthcare Medicaid	$25.48
Rate for Payer: UnitedHealthcare Medicare	$17.83
Rate for Payer: University Health Alliance Commercial	$30.95

rivaroxaban 10 mg Tab UD [KMC]

Facility

$42.46

Service Code	NDC 50458058010
Hospital Revenue Code	250
Min. Negotiated Rate	$36.09
Max. Negotiated Rate	$41.19
Rate for Payer: Cash Price	$27.60
Rate for Payer: Health Management Network Commercial	$36.09
Rate for Payer: Kaiser Permanente Commercial	$38.21
Rate for Payer: MDX Hawaii PPO	$41.19

rivaroxaban 15 mg Tab [KMC]

Facility

$42.46

Service Code	NDC 50458057830
Hospital Revenue Code	250
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$41.19
Rate for Payer: AlohaCare Medicaid	$21.23
Rate for Payer: AlohaCare Medicare	$17.83
Rate for Payer: Cash Price	$27.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$39.06
Rate for Payer: Devoted Health Medicare	$17.83
Rate for Payer: Hawaii Medical Service Association Medicare	$17.83
Rate for Payer: Hawaii Western Management Group Commercial	$40.34
Rate for Payer: Health Management Network Commercial	$36.09
Rate for Payer: Humana Medicare	$17.83
Rate for Payer: Kaiser Permanente Commercial	$38.21
Rate for Payer: Kaiser Permanente Medicaid	$21.65
Rate for Payer: Kaiser Permanente Medicare	$17.83
Rate for Payer: MDX Hawaii PPO	$41.19
Rate for Payer: Ohana Health Plan Medicaid	$17.83
Rate for Payer: Ohana Health Plan Medicare	$17.83
Rate for Payer: UnitedHealthcare Medicaid	$25.48
Rate for Payer: UnitedHealthcare Medicare	$17.83
Rate for Payer: University Health Alliance Commercial	$30.95

rivaroxaban 15 mg Tab [KMC]

Facility

$42.46

Service Code	NDC 50458057830
Hospital Revenue Code	250
Min. Negotiated Rate	$36.09
Max. Negotiated Rate	$41.19
Rate for Payer: Cash Price	$27.60
Rate for Payer: Health Management Network Commercial	$36.09
Rate for Payer: Kaiser Permanente Commercial	$38.21
Rate for Payer: MDX Hawaii PPO	$41.19

rivaroxaban 20 mg Tab [KMC]

Facility

$50.35

Service Code	NDC 50458057990
Hospital Revenue Code	250
Min. Negotiated Rate	$42.80
Max. Negotiated Rate	$48.84
Rate for Payer: Cash Price	$32.73
Rate for Payer: Health Management Network Commercial	$42.80
Rate for Payer: Kaiser Permanente Commercial	$45.31
Rate for Payer: MDX Hawaii PPO	$48.84

rivaroxaban 20 mg Tab [KMC]

Facility

$50.35

Service Code	NDC 50458057990
Hospital Revenue Code	250
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$48.84
Rate for Payer: AlohaCare Medicaid	$25.18
Rate for Payer: AlohaCare Medicare	$21.15
Rate for Payer: Cash Price	$32.73
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.32
Rate for Payer: Devoted Health Medicare	$21.15
Rate for Payer: Hawaii Medical Service Association Medicare	$21.15
Rate for Payer: Hawaii Western Management Group Commercial	$47.83
Rate for Payer: Health Management Network Commercial	$42.80
Rate for Payer: Humana Medicare	$21.15
Rate for Payer: Kaiser Permanente Commercial	$45.31
Rate for Payer: Kaiser Permanente Medicaid	$25.68
Rate for Payer: Kaiser Permanente Medicare	$21.15
Rate for Payer: MDX Hawaii PPO	$48.84
Rate for Payer: Ohana Health Plan Medicaid	$21.15
Rate for Payer: Ohana Health Plan Medicare	$21.15
Rate for Payer: UnitedHealthcare Medicaid	$30.21
Rate for Payer: UnitedHealthcare Medicare	$21.15
Rate for Payer: University Health Alliance Commercial	$36.70

rivaroxaban 2.5 mg Tab [KMC]

Facility

$41.01

Service Code	NDC 68180070906
Hospital Revenue Code	250
Min. Negotiated Rate	$34.86
Max. Negotiated Rate	$39.78
Rate for Payer: Cash Price	$26.66
Rate for Payer: Health Management Network Commercial	$34.86
Rate for Payer: Kaiser Permanente Commercial	$36.91
Rate for Payer: MDX Hawaii PPO	$39.78

rivaroxaban 2.5 mg Tab [KMC]

Facility

$41.01

Service Code	NDC 68180070906
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$39.78
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$17.22
Rate for Payer: Cash Price	$26.66
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.73
Rate for Payer: Devoted Health Medicare	$17.22
Rate for Payer: Hawaii Medical Service Association Medicare	$17.22
Rate for Payer: Hawaii Western Management Group Commercial	$38.96
Rate for Payer: Health Management Network Commercial	$34.86
Rate for Payer: Humana Medicare	$17.22
Rate for Payer: Kaiser Permanente Commercial	$36.91
Rate for Payer: Kaiser Permanente Medicaid	$20.92
Rate for Payer: Kaiser Permanente Medicare	$17.22
Rate for Payer: MDX Hawaii PPO	$39.78
Rate for Payer: Ohana Health Plan Medicaid	$17.22
Rate for Payer: Ohana Health Plan Medicare	$17.22
Rate for Payer: UnitedHealthcare Medicaid	$24.61
Rate for Payer: UnitedHealthcare Medicare	$17.22
Rate for Payer: University Health Alliance Commercial	$29.89

rivastigmine 4.6 mg/24 hr ER

Facility

$109.76

Service Code	NDC 00078050115
Hospital Revenue Code	250
Min. Negotiated Rate	$46.10
Max. Negotiated Rate	$106.47
Rate for Payer: AlohaCare Medicaid	$54.88
Rate for Payer: AlohaCare Medicare	$46.10
Rate for Payer: Cash Price	$71.34
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$100.98
Rate for Payer: Devoted Health Medicare	$46.10
Rate for Payer: Hawaii Medical Service Association Medicare	$46.10
Rate for Payer: Hawaii Western Management Group Commercial	$104.27
Rate for Payer: Health Management Network Commercial	$93.30
Rate for Payer: Humana Medicare	$46.10
Rate for Payer: Kaiser Permanente Commercial	$98.78
Rate for Payer: Kaiser Permanente Medicaid	$55.98
Rate for Payer: Kaiser Permanente Medicare	$46.10
Rate for Payer: MDX Hawaii PPO	$106.47
Rate for Payer: Ohana Health Plan Medicaid	$46.10
Rate for Payer: Ohana Health Plan Medicare	$46.10
Rate for Payer: UnitedHealthcare Medicaid	$65.86
Rate for Payer: UnitedHealthcare Medicare	$46.10
Rate for Payer: University Health Alliance Commercial	$80.00

rivastigmine 4.6 mg/24 hr ER

Facility

$109.76

Service Code	NDC 00078050115
Hospital Revenue Code	250
Min. Negotiated Rate	$93.30
Max. Negotiated Rate	$106.47
Rate for Payer: Cash Price	$71.34
Rate for Payer: Health Management Network Commercial	$93.30
Rate for Payer: Kaiser Permanente Commercial	$98.78
Rate for Payer: MDX Hawaii PPO	$106.47

rivastigmine 6 mg Cap [KMC]

Facility

$16.97

Service Code	NDC 55111035560
Hospital Revenue Code	250
Min. Negotiated Rate	$14.42
Max. Negotiated Rate	$16.46
Rate for Payer: Cash Price	$11.03
Rate for Payer: Health Management Network Commercial	$14.42
Rate for Payer: Kaiser Permanente Commercial	$15.27
Rate for Payer: MDX Hawaii PPO	$16.46

rivastigmine 6 mg Cap [KMC]

Facility

$16.97

Service Code	NDC 55111035560
Hospital Revenue Code	250
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$16.46
Rate for Payer: AlohaCare Medicaid	$8.48
Rate for Payer: AlohaCare Medicare	$7.13
Rate for Payer: Cash Price	$11.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.61
Rate for Payer: Devoted Health Medicare	$7.13
Rate for Payer: Hawaii Medical Service Association Medicare	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$16.12
Rate for Payer: Health Management Network Commercial	$14.42
Rate for Payer: Humana Medicare	$7.13
Rate for Payer: Kaiser Permanente Commercial	$15.27
Rate for Payer: Kaiser Permanente Medicaid	$8.65
Rate for Payer: Kaiser Permanente Medicare	$7.13
Rate for Payer: MDX Hawaii PPO	$16.46
Rate for Payer: Ohana Health Plan Medicaid	$7.13
Rate for Payer: Ohana Health Plan Medicare	$7.13
Rate for Payer: UnitedHealthcare Medicaid	$10.18
Rate for Payer: UnitedHealthcare Medicare	$7.13
Rate for Payer: University Health Alliance Commercial	$12.37

rivastigmine 9.5 mg/24 hr ER [KMC]

Facility

$67.59

Service Code	NDC 00781730931
Hospital Revenue Code	250
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$65.56
Rate for Payer: Cash Price	$43.93
Rate for Payer: Health Management Network Commercial	$57.45
Rate for Payer: Kaiser Permanente Commercial	$60.83
Rate for Payer: MDX Hawaii PPO	$65.56

rivastigmine 9.5 mg/24 hr ER [KMC]

Facility

$67.59

Service Code	NDC 00781730931
Hospital Revenue Code	250
Min. Negotiated Rate	$28.39
Max. Negotiated Rate	$65.56
Rate for Payer: AlohaCare Medicaid	$33.80
Rate for Payer: AlohaCare Medicare	$28.39
Rate for Payer: Cash Price	$43.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$62.18
Rate for Payer: Devoted Health Medicare	$28.39
Rate for Payer: Hawaii Medical Service Association Medicare	$28.39
Rate for Payer: Hawaii Western Management Group Commercial	$64.21
Rate for Payer: Health Management Network Commercial	$57.45
Rate for Payer: Humana Medicare	$28.39
Rate for Payer: Kaiser Permanente Commercial	$60.83
Rate for Payer: Kaiser Permanente Medicaid	$34.47
Rate for Payer: Kaiser Permanente Medicare	$28.39
Rate for Payer: MDX Hawaii PPO	$65.56
Rate for Payer: Ohana Health Plan Medicaid	$28.39
Rate for Payer: Ohana Health Plan Medicare	$28.39
Rate for Payer: UnitedHealthcare Medicaid	$40.55
Rate for Payer: UnitedHealthcare Medicare	$28.39
Rate for Payer: University Health Alliance Commercial	$49.27

RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP

Professional

Both

$1,031.00

Service Code	HCPCS 20525
Hospital Revenue Code	361
Min. Negotiated Rate	$186.68
Max. Negotiated Rate	$876.35
Rate for Payer: AlohaCare Medicaid	$254.47
Rate for Payer: AlohaCare Medicare	$236.99
Rate for Payer: Cash Price	$670.15
Rate for Payer: Cash Price	$670.15
Rate for Payer: Devoted Health Medicare	$236.99
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$254.47
Rate for Payer: Hawaii Medical Service Association Commercial	$393.14
Rate for Payer: Hawaii Medical Service Association Medicare	$236.99
Rate for Payer: Hawaii Western Management Group Commercial	$186.68
Rate for Payer: Health Management Network Commercial	$876.35
Rate for Payer: Kaiser Permanente Commercial	$284.39
Rate for Payer: Kaiser Permanente Medicaid	$284.39
Rate for Payer: Kaiser Permanente Medicare	$284.39
Rate for Payer: Ohana Health Plan Medicaid	$254.47
Rate for Payer: Ohana Health Plan Medicare	$236.99
Rate for Payer: UnitedHealthcare Medicaid	$254.47
Rate for Payer: UnitedHealthcare Medicare	$236.99
Rate for Payer: University Health Alliance Commercial	$332.85

RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10

Professional

Both

$112.00

Service Code	HCPCS 11201
Hospital Revenue Code	361
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$95.20
Rate for Payer: AlohaCare Medicaid	$16.33
Rate for Payer: AlohaCare Medicare	$12.97
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Devoted Health Medicare	$12.97
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.33
Rate for Payer: Hawaii Medical Service Association Medicare	$12.97
Rate for Payer: Hawaii Western Management Group Commercial	$19.24
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$15.56
Rate for Payer: Kaiser Permanente Medicaid	$15.56
Rate for Payer: Kaiser Permanente Medicare	$15.56
Rate for Payer: Ohana Health Plan Medicaid	$16.33
Rate for Payer: Ohana Health Plan Medicare	$12.97
Rate for Payer: UnitedHealthcare Medicaid	$16.33
Rate for Payer: UnitedHealthcare Medicare	$12.97
Rate for Payer: University Health Alliance Commercial	$18.87

RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15

Professional

Both

$307.00

Service Code	HCPCS 11200
Hospital Revenue Code	361
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$82.52
Rate for Payer: AlohaCare Medicare	$73.46
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$73.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$82.52
Rate for Payer: Hawaii Medical Service Association Medicare	$73.46
Rate for Payer: Hawaii Western Management Group Commercial	$47.58
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$88.15
Rate for Payer: Kaiser Permanente Medicaid	$88.15
Rate for Payer: Kaiser Permanente Medicare	$88.15
Rate for Payer: Ohana Health Plan Medicaid	$82.52
Rate for Payer: Ohana Health Plan Medicare	$73.46
Rate for Payer: UnitedHealthcare Medicaid	$82.52
Rate for Payer: UnitedHealthcare Medicare	$73.46
Rate for Payer: University Health Alliance Commercial	$90.04

RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT

Professional

Both

$449.00

Service Code	HCPCS 11983
Hospital Revenue Code	361
Min. Negotiated Rate	$86.17
Max. Negotiated Rate	$381.65
Rate for Payer: AlohaCare Medicaid	$101.67
Rate for Payer: AlohaCare Medicare	$86.17
Rate for Payer: Cash Price	$291.85
Rate for Payer: Cash Price	$291.85
Rate for Payer: Devoted Health Medicare	$86.17
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$101.67
Rate for Payer: Hawaii Medical Service Association Commercial	$251.90
Rate for Payer: Hawaii Medical Service Association Medicare	$86.17
Rate for Payer: Hawaii Western Management Group Commercial	$222.82
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: Kaiser Permanente Commercial	$103.40
Rate for Payer: Kaiser Permanente Medicaid	$103.40
Rate for Payer: Kaiser Permanente Medicare	$103.40
Rate for Payer: Ohana Health Plan Medicaid	$101.67
Rate for Payer: Ohana Health Plan Medicare	$86.17
Rate for Payer: UnitedHealthcare Medicaid	$101.67
Rate for Payer: UnitedHealthcare Medicare	$86.17
Rate for Payer: University Health Alliance Commercial	$110.49

rocuronium 10 mg/mL IV Sol [KMC]

Facility

$1.92

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: AlohaCare Medicaid	$0.96
Rate for Payer: AlohaCare Medicare	$0.81
Rate for Payer: Cash Price	$1.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.77
Rate for Payer: Devoted Health Medicare	$0.81
Rate for Payer: Hawaii Medical Service Association Medicare	$0.81
Rate for Payer: Hawaii Western Management Group Commercial	$1.82
Rate for Payer: Health Management Network Commercial	$1.63
Rate for Payer: Humana Medicare	$0.81
Rate for Payer: Kaiser Permanente Commercial	$1.73
Rate for Payer: Kaiser Permanente Medicaid	$0.98
Rate for Payer: Kaiser Permanente Medicare	$0.81
Rate for Payer: MDX Hawaii PPO	$1.86
Rate for Payer: Ohana Health Plan Medicaid	$0.81
Rate for Payer: Ohana Health Plan Medicare	$0.81
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: UnitedHealthcare Medicare	$0.81
Rate for Payer: University Health Alliance Commercial	$1.40

rocuronium 10 mg/mL IV Sol [KMC]

Facility

$1.92

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.86
Rate for Payer: Cash Price	$1.25
Rate for Payer: Health Management Network Commercial	$1.63
Rate for Payer: Kaiser Permanente Commercial	$1.73
Rate for Payer: MDX Hawaii PPO	$1.86

roflumilast 500 mcg Tab [KMC]

Facility

$60.24

Service Code	NDC 59651027590
Hospital Revenue Code	250
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$58.43
Rate for Payer: AlohaCare Medicaid	$30.12
Rate for Payer: AlohaCare Medicare	$25.30
Rate for Payer: Cash Price	$39.16
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$55.42
Rate for Payer: Devoted Health Medicare	$25.30
Rate for Payer: Hawaii Medical Service Association Medicare	$25.30
Rate for Payer: Hawaii Western Management Group Commercial	$57.23
Rate for Payer: Health Management Network Commercial	$51.20
Rate for Payer: Humana Medicare	$25.30
Rate for Payer: Kaiser Permanente Commercial	$54.22
Rate for Payer: Kaiser Permanente Medicaid	$30.72
Rate for Payer: Kaiser Permanente Medicare	$25.30
Rate for Payer: MDX Hawaii PPO	$58.43
Rate for Payer: Ohana Health Plan Medicaid	$25.30
Rate for Payer: Ohana Health Plan Medicare	$25.30
Rate for Payer: UnitedHealthcare Medicaid	$36.14
Rate for Payer: UnitedHealthcare Medicare	$25.30
Rate for Payer: University Health Alliance Commercial	$43.91

roflumilast 500 mcg Tab [KMC]

Facility

$60.24

Service Code	NDC 59651027590
Hospital Revenue Code	250
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$58.43
Rate for Payer: Cash Price	$39.16
Rate for Payer: Health Management Network Commercial	$51.20
Rate for Payer: Kaiser Permanente Commercial	$54.22
Rate for Payer: MDX Hawaii PPO	$58.43

ROM Each Extremity/Trunk Charges

Facility

$179.00

Service Code	HCPCS 95851 GO
Hospital Charge Code	426958510
Hospital Revenue Code	430
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

ROM Each Extremity/Trunk Charges

Facility

$179.00

Service Code	HCPCS 95851 GO
Hospital Charge Code	426958510
Hospital Revenue Code	430
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$7.89
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

ROM Hand Charges

Facility

$179.00

Service Code	HCPCS 95852 GO
Hospital Charge Code	432958520
Hospital Revenue Code	430
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$5.33
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Know your out-of-pocket cost for care.

All Charges