Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

TSH DLS

Facility

$142.00

Service Code	HCPCS 84443
Hospital Charge Code	422844435
Hospital Revenue Code	301
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

TSH w/ reflex to Free T4 DLS

Facility

$150.00

Service Code	HCPCS 84443
Hospital Charge Code	422844435
Hospital Revenue Code	300
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

TSH w/ reflex to Free T4 DLS

Facility

$150.00

Service Code	HCPCS 84443
Hospital Charge Code	422844435
Hospital Revenue Code	300
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.00
Rate for Payer: Devoted Health Medicare	$63.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$43.42

TSH w/ Reflex to FT4

Facility

$150.00

Service Code	HCPCS 84443
Hospital Charge Code	422844430
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.00
Rate for Payer: Devoted Health Medicare	$63.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$43.42

TSH w/ Reflex to FT4

Facility

$150.00

Service Code	HCPCS 84443
Hospital Charge Code	422844430
Hospital Revenue Code	301
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [KMC]

Facility

$452.20

Service Code	NDC 49281075221
Hospital Revenue Code	250
Min. Negotiated Rate	$384.37
Max. Negotiated Rate	$438.63
Rate for Payer: Cash Price	$293.93
Rate for Payer: Health Management Network Commercial	$384.37
Rate for Payer: Kaiser Permanente Commercial	$406.98
Rate for Payer: MDX Hawaii PPO	$438.63

tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [KMC]

Facility

$452.20

Service Code	NDC 49281075221
Hospital Revenue Code	250
Min. Negotiated Rate	$189.92
Max. Negotiated Rate	$438.63
Rate for Payer: AlohaCare Medicaid	$226.10
Rate for Payer: AlohaCare Medicare	$189.92
Rate for Payer: Cash Price	$293.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$416.02
Rate for Payer: Devoted Health Medicare	$189.92
Rate for Payer: Hawaii Medical Service Association Medicare	$189.92
Rate for Payer: Hawaii Western Management Group Commercial	$429.59
Rate for Payer: Health Management Network Commercial	$384.37
Rate for Payer: Humana Medicare	$189.92
Rate for Payer: Kaiser Permanente Commercial	$406.98
Rate for Payer: Kaiser Permanente Medicaid	$230.62
Rate for Payer: Kaiser Permanente Medicare	$189.92
Rate for Payer: MDX Hawaii PPO	$438.63
Rate for Payer: Ohana Health Plan Medicaid	$189.92
Rate for Payer: Ohana Health Plan Medicare	$189.92
Rate for Payer: UnitedHealthcare Medicaid	$271.32
Rate for Payer: UnitedHealthcare Medicare	$189.92
Rate for Payer: University Health Alliance Commercial	$329.61

TX ANKLE DISLOCATION / ANESTH Charge

Facility

$5,895.00

Service Code	HCPCS 27842
Hospital Charge Code	440278420
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$5,718.15
Rate for Payer: AlohaCare Medicaid	$2,947.50
Rate for Payer: AlohaCare Medicare	$2,475.90
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,423.40
Rate for Payer: Devoted Health Medicare	$2,475.90
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	$2,475.90
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.25
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Humana Medicare	$2,475.90
Rate for Payer: Kaiser Permanente Commercial	$5,305.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,475.90
Rate for Payer: MDX Hawaii PPO	$5,718.15
Rate for Payer: Ohana Health Plan Medicaid	$2,475.90
Rate for Payer: Ohana Health Plan Medicare	$2,475.90
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,475.90
Rate for Payer: University Health Alliance Commercial	$4,035.20

TX ANKLE DISLOCATION / ANESTH Charge

Facility

$5,895.00

Service Code	HCPCS 27842
Hospital Charge Code	440278420
Hospital Revenue Code	450
Min. Negotiated Rate	$5,010.75
Max. Negotiated Rate	$5,718.15
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Kaiser Permanente Commercial	$5,305.50
Rate for Payer: MDX Hawaii PPO	$5,718.15

TX ANKLE DISLOCATION Charge

Facility

$887.00

Service Code	HCPCS 27840
Hospital Charge Code	440278400
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

TX ANKLE DISLOCATION Charge

Facility

$887.00

Service Code	HCPCS 27840
Hospital Charge Code	440278400
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TX CLSD KNEE DIS W/ANESTH Charge

Facility

$5,895.00

Service Code	HCPCS 27552
Hospital Charge Code	440275520
Hospital Revenue Code	450
Min. Negotiated Rate	$5,010.75
Max. Negotiated Rate	$5,718.15
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Kaiser Permanente Commercial	$5,305.50
Rate for Payer: MDX Hawaii PPO	$5,718.15

TX CLSD KNEE DIS W/ANESTH Charge

Facility

$5,895.00

Service Code	HCPCS 27552
Hospital Charge Code	440275520
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$5,718.15
Rate for Payer: AlohaCare Medicaid	$2,947.50
Rate for Payer: AlohaCare Medicare	$2,475.90
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Cash Price	$3,831.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,423.40
Rate for Payer: Devoted Health Medicare	$2,475.90
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	$2,475.90
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.25
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Humana Medicare	$2,475.90
Rate for Payer: Kaiser Permanente Commercial	$5,305.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,475.90
Rate for Payer: MDX Hawaii PPO	$5,718.15
Rate for Payer: Ohana Health Plan Medicaid	$2,475.90
Rate for Payer: Ohana Health Plan Medicare	$2,475.90
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,475.90
Rate for Payer: University Health Alliance Commercial	$4,035.20

TX ELBOW DISLOCATION CLOSED Charge

Facility

$887.00

Service Code	HCPCS 24600
Hospital Charge Code	440246000
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TX ELBOW DISLOCATION CLOSED Charge

Facility

$887.00

Service Code	HCPCS 24600
Hospital Charge Code	440246000
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

TX FX GREAT TOE CLOSED Charge

Facility

$554.00

Service Code	HCPCS 28490
Hospital Charge Code	440284900
Hospital Revenue Code	450
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

TX FX GREAT TOE CLOSED Charge

Facility

$554.00

Service Code	HCPCS 28490
Hospital Charge Code	440284900
Hospital Revenue Code	450
Min. Negotiated Rate	$232.68
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$232.68
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$509.68
Rate for Payer: Devoted Health Medicare	$232.68
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	$232.68
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$232.68
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$232.68
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$232.68
Rate for Payer: Ohana Health Plan Medicare	$232.68
Rate for Payer: UnitedHealthcare Medicare	$232.68
Rate for Payer: University Health Alliance Commercial	$5,160.40

TX KNUCKLE DISLOCATED-CLOSED Charge

Facility

$887.00

Service Code	HCPCS 26700
Hospital Charge Code	440267000
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TX KNUCKLE DISLOCATED-CLOSED Charge

Facility

$887.00

Service Code	HCPCS 26700
Hospital Charge Code	440267000
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

TX METATARSAL FX/MANIPULATION Charge

Facility

$887.00

Service Code	HCPCS 28475
Hospital Charge Code	440284750
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TX METATARSAL FX/MANIPULATION Charge

Facility

$887.00

Service Code	HCPCS 28475
Hospital Charge Code	440284750
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

Tx of Speech/Lang/Voice/Comm/Auditory Chg

Facility

$336.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	431925070
Hospital Revenue Code	441
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

Tx of Speech/Lang/Voice/Comm/Auditory Chg

Facility

$336.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	431925070
Hospital Revenue Code	441
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$325.92
Rate for Payer: AlohaCare Medicaid	$168.00
Rate for Payer: AlohaCare Medicare	$141.12
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$309.12
Rate for Payer: Devoted Health Medicare	$141.12
Rate for Payer: Hawaii Medical Service Association Medicare	$141.12
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Humana Medicare	$141.12
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: Kaiser Permanente Medicare	$141.12
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: Ohana Health Plan Medicaid	$141.12
Rate for Payer: Ohana Health Plan Medicare	$141.12
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: UnitedHealthcare Medicare	$141.12
Rate for Payer: University Health Alliance Commercial	$244.91

Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid

Facility

$336.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	431925070
Hospital Revenue Code	441
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid

Facility

$336.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	431925070
Hospital Revenue Code	441
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$325.92
Rate for Payer: AlohaCare Medicaid	$168.00
Rate for Payer: AlohaCare Medicare	$141.12
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$309.12
Rate for Payer: Devoted Health Medicare	$141.12
Rate for Payer: Hawaii Medical Service Association Medicare	$141.12
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Humana Medicare	$141.12
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: Kaiser Permanente Medicare	$141.12
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: Ohana Health Plan Medicaid	$141.12
Rate for Payer: Ohana Health Plan Medicare	$141.12
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: UnitedHealthcare Medicare	$141.12
Rate for Payer: University Health Alliance Commercial	$244.91

Know your out-of-pocket cost for care.

All Charges