Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM

Professional

Both

$307.00

Service Code	HCPCS 12002
Hospital Revenue Code	361
Min. Negotiated Rate	$55.77
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$57.36
Rate for Payer: AlohaCare Medicare	$55.77
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$55.77
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$57.36
Rate for Payer: Hawaii Medical Service Association Commercial	$145.78
Rate for Payer: Hawaii Medical Service Association Medicare	$55.77
Rate for Payer: Hawaii Western Management Group Commercial	$111.28
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$66.92
Rate for Payer: Kaiser Permanente Medicaid	$66.92
Rate for Payer: Kaiser Permanente Medicare	$66.92
Rate for Payer: Ohana Health Plan Medicaid	$57.36
Rate for Payer: Ohana Health Plan Medicare	$55.77
Rate for Payer: UnitedHealthcare Medicaid	$57.36
Rate for Payer: UnitedHealthcare Medicare	$55.77
Rate for Payer: University Health Alliance Commercial	$140.00

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM

Professional

Both

$307.00

Service Code	HCPCS 12005
Hospital Revenue Code	361
Min. Negotiated Rate	$85.36
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$90.64
Rate for Payer: AlohaCare Medicare	$85.36
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$85.36
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$90.64
Rate for Payer: Hawaii Medical Service Association Commercial	$211.67
Rate for Payer: Hawaii Medical Service Association Medicare	$85.36
Rate for Payer: Hawaii Western Management Group Commercial	$174.46
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$102.43
Rate for Payer: Kaiser Permanente Medicaid	$102.43
Rate for Payer: Kaiser Permanente Medicare	$102.43
Rate for Payer: Ohana Health Plan Medicaid	$90.64
Rate for Payer: Ohana Health Plan Medicare	$85.36
Rate for Payer: UnitedHealthcare Medicaid	$90.64
Rate for Payer: UnitedHealthcare Medicare	$85.36
Rate for Payer: University Health Alliance Commercial	$106.30

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM

Professional

Both

$727.00

Service Code	HCPCS 12006
Hospital Revenue Code	361
Min. Negotiated Rate	$104.02
Max. Negotiated Rate	$617.95
Rate for Payer: AlohaCare Medicaid	$111.28
Rate for Payer: AlohaCare Medicare	$104.02
Rate for Payer: Cash Price	$472.55
Rate for Payer: Cash Price	$472.55
Rate for Payer: Devoted Health Medicare	$104.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$111.28
Rate for Payer: Hawaii Medical Service Association Commercial	$266.54
Rate for Payer: Hawaii Medical Service Association Medicare	$104.02
Rate for Payer: Hawaii Western Management Group Commercial	$169.52
Rate for Payer: Health Management Network Commercial	$617.95
Rate for Payer: Kaiser Permanente Commercial	$124.82
Rate for Payer: Kaiser Permanente Medicaid	$124.82
Rate for Payer: Kaiser Permanente Medicare	$124.82
Rate for Payer: Ohana Health Plan Medicaid	$111.28
Rate for Payer: Ohana Health Plan Medicare	$104.02
Rate for Payer: UnitedHealthcare Medicaid	$111.28
Rate for Payer: UnitedHealthcare Medicare	$104.02
Rate for Payer: University Health Alliance Commercial	$130.81

Sodium, 24 Hr Urine DLS

Facility

$47.00

Service Code	HCPCS 84300
Hospital Charge Code	422843005
Hospital Revenue Code	301
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$23.50
Rate for Payer: AlohaCare Medicare	$19.74
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$43.24
Rate for Payer: Devoted Health Medicare	$19.74
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.72
Rate for Payer: Hawaii Medical Service Association Commercial	$6.33
Rate for Payer: Hawaii Medical Service Association Medicare	$19.74
Rate for Payer: Hawaii Western Management Group Commercial	$5.06
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$19.74
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$19.74
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$19.74
Rate for Payer: Ohana Health Plan Medicare	$19.74
Rate for Payer: UnitedHealthcare Medicaid	$6.72
Rate for Payer: UnitedHealthcare Medicare	$19.74
Rate for Payer: University Health Alliance Commercial	$12.56

Sodium, 24 Hr Urine DLS

Facility

$47.00

Service Code	HCPCS 84300
Hospital Charge Code	422843005
Hospital Revenue Code	301
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$30.55
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: MDX Hawaii PPO	$45.59

sodium bicarbonate 4% (2.4 mEq/5 mL) soln [KMC]

Facility

$7.32

Service Code	NDC 00409660902
Hospital Revenue Code	250
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$7.10
Rate for Payer: AlohaCare Medicaid	$3.66
Rate for Payer: AlohaCare Medicare	$3.07
Rate for Payer: Cash Price	$4.76
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.73
Rate for Payer: Devoted Health Medicare	$3.07
Rate for Payer: Hawaii Medical Service Association Medicare	$3.07
Rate for Payer: Hawaii Western Management Group Commercial	$6.95
Rate for Payer: Health Management Network Commercial	$6.22
Rate for Payer: Humana Medicare	$3.07
Rate for Payer: Kaiser Permanente Commercial	$6.59
Rate for Payer: Kaiser Permanente Medicaid	$3.73
Rate for Payer: Kaiser Permanente Medicare	$3.07
Rate for Payer: MDX Hawaii PPO	$7.10
Rate for Payer: Ohana Health Plan Medicaid	$3.07
Rate for Payer: Ohana Health Plan Medicare	$3.07
Rate for Payer: UnitedHealthcare Medicaid	$4.39
Rate for Payer: UnitedHealthcare Medicare	$3.07
Rate for Payer: University Health Alliance Commercial	$5.34

sodium bicarbonate 4% (2.4 mEq/5 mL) soln [KMC]

Facility

$7.32

Service Code	NDC 00409660902
Hospital Revenue Code	250
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$7.10
Rate for Payer: Cash Price	$4.76
Rate for Payer: Health Management Network Commercial	$6.22
Rate for Payer: Kaiser Permanente Commercial	$6.59
Rate for Payer: MDX Hawaii PPO	$7.10

sodium bicarbonate 4.2% (5 mEq/10 mL) syringe [KMC]

Facility

$6.59

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$6.39
Rate for Payer: AlohaCare Medicaid	$3.29
Rate for Payer: AlohaCare Medicare	$2.77
Rate for Payer: Cash Price	$4.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.06
Rate for Payer: Devoted Health Medicare	$2.77
Rate for Payer: Hawaii Medical Service Association Medicare	$2.77
Rate for Payer: Hawaii Western Management Group Commercial	$6.26
Rate for Payer: Health Management Network Commercial	$5.60
Rate for Payer: Humana Medicare	$2.77
Rate for Payer: Kaiser Permanente Commercial	$5.93
Rate for Payer: Kaiser Permanente Medicaid	$3.36
Rate for Payer: Kaiser Permanente Medicare	$2.77
Rate for Payer: MDX Hawaii PPO	$6.39
Rate for Payer: Ohana Health Plan Medicaid	$2.77
Rate for Payer: Ohana Health Plan Medicare	$2.77
Rate for Payer: UnitedHealthcare Medicaid	$3.95
Rate for Payer: UnitedHealthcare Medicare	$2.77
Rate for Payer: University Health Alliance Commercial	$4.80

sodium bicarbonate 4.2% (5 mEq/10 mL) syringe [KMC]

Facility

$6.59

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$6.39
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Management Network Commercial	$5.60
Rate for Payer: Kaiser Permanente Commercial	$5.93
Rate for Payer: MDX Hawaii PPO	$6.39

sodium bicarbonate 650 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904726161
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

sodium bicarbonate 650 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904726161
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

sodium bicarbonate 8.4% (50 mEq/50 mL) soln [KMC]

Facility

$0.93

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.79
Rate for Payer: Kaiser Permanente Commercial	$0.84
Rate for Payer: MDX Hawaii PPO	$0.90

sodium bicarbonate 8.4% (50 mEq/50 mL) soln [KMC]

Facility

$0.93

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: AlohaCare Medicaid	$0.47
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: Cash Price	$0.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.86
Rate for Payer: Devoted Health Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$0.88
Rate for Payer: Health Management Network Commercial	$0.79
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Kaiser Permanente Commercial	$0.84
Rate for Payer: Kaiser Permanente Medicaid	$0.47
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: MDX Hawaii PPO	$0.90
Rate for Payer: Ohana Health Plan Medicaid	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicaid	$0.56
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: University Health Alliance Commercial	$0.68

Sodium Chloride 0.45% 1000 mL IV bag [KMC]

Facility

$0.03

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: AlohaCare Medicaid	$0.02
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.03
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.03
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.02

Sodium Chloride 0.45% 1000 mL IV bag [KMC]

Facility

$0.03

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: MDX Hawaii PPO	$0.03

sodium chloride 0.9% Inj Sol 10 mL [KMC]

Facility

$0.25

Service Code	NDC 08290306546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.24
Rate for Payer: Cash Price	$0.16
Rate for Payer: Health Management Network Commercial	$0.21
Rate for Payer: Kaiser Permanente Commercial	$0.23
Rate for Payer: MDX Hawaii PPO	$0.24

sodium chloride 0.9% Inj Sol 10 mL [KMC]

Facility

$0.25

Service Code	NDC 08290306546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: AlohaCare Medicaid	$0.13
Rate for Payer: AlohaCare Medicare	$0.11
Rate for Payer: Cash Price	$0.16
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.23
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Hawaii Medical Service Association Medicare	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$0.24
Rate for Payer: Health Management Network Commercial	$0.21
Rate for Payer: Humana Medicare	$0.11
Rate for Payer: Kaiser Permanente Commercial	$0.23
Rate for Payer: Kaiser Permanente Medicaid	$0.13
Rate for Payer: Kaiser Permanente Medicare	$0.11
Rate for Payer: MDX Hawaii PPO	$0.24
Rate for Payer: Ohana Health Plan Medicaid	$0.11
Rate for Payer: Ohana Health Plan Medicare	$0.11
Rate for Payer: UnitedHealthcare Medicaid	$0.15
Rate for Payer: UnitedHealthcare Medicare	$0.11
Rate for Payer: University Health Alliance Commercial	$0.18

sodium chloride 0.9% Irrigation Soln [KMC]

Facility

$0.04

Service Code	HCPCS J7050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.04
Rate for Payer: MDX Hawaii PPO	$0.04

sodium chloride 0.9% Irrigation Soln [KMC]

Facility

$0.04

Service Code	HCPCS J7050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.71
Rate for Payer: AlohaCare Medicaid	$0.02
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Medicare	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$0.04
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Humana Medicare	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.04
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: MDX Hawaii PPO	$0.04
Rate for Payer: Ohana Health Plan Medicaid	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.02
Rate for Payer: University Health Alliance Commercial	$0.03

sodium chloride 0.9% Nebulizer Soln 3 mL [KMC]

Facility

$0.37

Service Code	NDC 76204030003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.36
Rate for Payer: Cash Price	$0.24
Rate for Payer: Health Management Network Commercial	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.33
Rate for Payer: MDX Hawaii PPO	$0.36

sodium chloride 0.9% Nebulizer Soln 3 mL [KMC]

Facility

$0.37

Service Code	NDC 76204030003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: AlohaCare Medicaid	$0.19
Rate for Payer: AlohaCare Medicare	$0.16
Rate for Payer: Cash Price	$0.24
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.34
Rate for Payer: Devoted Health Medicare	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$0.35
Rate for Payer: Health Management Network Commercial	$0.31
Rate for Payer: Humana Medicare	$0.16
Rate for Payer: Kaiser Permanente Commercial	$0.33
Rate for Payer: Kaiser Permanente Medicaid	$0.19
Rate for Payer: Kaiser Permanente Medicare	$0.16
Rate for Payer: MDX Hawaii PPO	$0.36
Rate for Payer: Ohana Health Plan Medicaid	$0.16
Rate for Payer: Ohana Health Plan Medicare	$0.16
Rate for Payer: UnitedHealthcare Medicaid	$0.22
Rate for Payer: UnitedHealthcare Medicare	$0.16
Rate for Payer: University Health Alliance Commercial	$0.27

sodium chloride 1 g Tab [KMC]

Facility

$3.00

Service Code	NDC 00223176001
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

sodium chloride 1 g Tab [KMC]

Facility

$3.00

Service Code	NDC 00223176001
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

Sodium Chloride 3% (HYPERTONIC!) 500 mL bag [KMC]

Facility

$0.06

Service Code	HCPCS J7131
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Management Network Commercial	$0.05
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: MDX Hawaii PPO	$0.06

Sodium Chloride 3% (HYPERTONIC!) 500 mL bag [KMC]

Facility

$0.06

Service Code	HCPCS J7131
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: AlohaCare Medicaid	$0.03
Rate for Payer: AlohaCare Medicare	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.06
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$0.06
Rate for Payer: Health Management Network Commercial	$0.05
Rate for Payer: Humana Medicare	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: Kaiser Permanente Medicaid	$0.03
Rate for Payer: Kaiser Permanente Medicare	$0.03
Rate for Payer: MDX Hawaii PPO	$0.06
Rate for Payer: Ohana Health Plan Medicaid	$0.03
Rate for Payer: Ohana Health Plan Medicare	$0.03
Rate for Payer: UnitedHealthcare Medicaid	$0.04
Rate for Payer: UnitedHealthcare Medicare	$0.03
Rate for Payer: University Health Alliance Commercial	$0.04

Know your out-of-pocket cost for care.

All Charges