Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CRUTCHES LG

Facility

$56.00

Hospital Charge Code	8404
Hospital Revenue Code	270
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

CRUTCHES MED

Facility

$520.00

Hospital Charge Code	8405
Hospital Revenue Code	270
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$338.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: Kaiser Permanente Commercial	$468.00
Rate for Payer: MDX Hawaii PPO	$504.40

CRUTCHES MED

Facility

$520.00

Hospital Charge Code	8405
Hospital Revenue Code	270
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$504.40
Rate for Payer: AlohaCare Medicaid	$260.00
Rate for Payer: AlohaCare Medicare	$218.40
Rate for Payer: Cash Price	$338.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$478.40
Rate for Payer: Devoted Health Medicare	$218.40
Rate for Payer: Hawaii Medical Service Association Medicare	$218.40
Rate for Payer: Hawaii Western Management Group Commercial	$494.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: Humana Medicare	$218.40
Rate for Payer: Kaiser Permanente Commercial	$468.00
Rate for Payer: Kaiser Permanente Medicaid	$265.20
Rate for Payer: Kaiser Permanente Medicare	$218.40
Rate for Payer: MDX Hawaii PPO	$504.40
Rate for Payer: Ohana Health Plan Medicaid	$218.40
Rate for Payer: Ohana Health Plan Medicare	$218.40
Rate for Payer: UnitedHealthcare Medicare	$218.40
Rate for Payer: University Health Alliance Commercial	$379.03

CRUTCHES SM

Facility

$19.00

Hospital Charge Code	8406
Hospital Revenue Code	270
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$12.35
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

CRUTCHES SM

Facility

$19.00

Hospital Charge Code	8406
Hospital Revenue Code	270
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$7.98
Rate for Payer: Cash Price	$12.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$17.48
Rate for Payer: Devoted Health Medicare	$7.98
Rate for Payer: Hawaii Medical Service Association Medicare	$7.98
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$7.98
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$7.98
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$7.98
Rate for Payer: Ohana Health Plan Medicare	$7.98
Rate for Payer: UnitedHealthcare Medicare	$7.98
Rate for Payer: University Health Alliance Commercial	$13.85

Cryptosporidium Detection by IF DLS

Facility

$202.00

Service Code	HCPCS 87328
Hospital Charge Code	422873285
Hospital Revenue Code	306
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$131.30
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: MDX Hawaii PPO	$195.94

Cryptosporidium Detection by IF DLS

Facility

$202.00

Service Code	HCPCS 87328
Hospital Charge Code	422873285
Hospital Revenue Code	306
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$101.00
Rate for Payer: AlohaCare Medicare	$84.84
Rate for Payer: Cash Price	$131.30
Rate for Payer: Cash Price	$131.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$185.84
Rate for Payer: Devoted Health Medicare	$84.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$17.27
Rate for Payer: Hawaii Medical Service Association Medicare	$84.84
Rate for Payer: Hawaii Western Management Group Commercial	$13.82
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$84.84
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$84.84
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$84.84
Rate for Payer: Ohana Health Plan Medicare	$84.84
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$84.84
Rate for Payer: University Health Alliance Commercial	$31.01

CSF Culture & Gram Stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

CSF Culture & Gram Stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$54.18
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$118.68
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.18
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$54.18
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$54.18
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$54.18
Rate for Payer: Ohana Health Plan Medicare	$54.18
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$54.18
Rate for Payer: University Health Alliance Commercial	$22.26

CT ABD AND PELVIS W CON

Facility

$2,686.00

Service Code	HCPCS 74177
Hospital Charge Code	424741770
Hospital Revenue Code	352
Min. Negotiated Rate	$180.62
Max. Negotiated Rate	$2,605.42
Rate for Payer: AlohaCare Medicaid	$1,343.00
Rate for Payer: AlohaCare Medicare	$1,128.12
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,471.12
Rate for Payer: Devoted Health Medicare	$1,128.12
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$180.62
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$1,128.12
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Humana Medicare	$1,128.12
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: Kaiser Permanente Medicaid	$1,369.86
Rate for Payer: Kaiser Permanente Medicare	$1,128.12
Rate for Payer: MDX Hawaii PPO	$2,605.42
Rate for Payer: Ohana Health Plan Medicaid	$1,128.12
Rate for Payer: Ohana Health Plan Medicare	$1,128.12
Rate for Payer: UnitedHealthcare Medicaid	$180.62
Rate for Payer: UnitedHealthcare Medicare	$1,128.12
Rate for Payer: University Health Alliance Commercial	$727.57

CT ABD AND PELVIS W CON

Facility

$2,686.00

Service Code	HCPCS 74177
Hospital Charge Code	424741770
Hospital Revenue Code	352
Min. Negotiated Rate	$2,283.10
Max. Negotiated Rate	$2,605.42
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: MDX Hawaii PPO	$2,605.42

CT ABD AND PELVIS WO CON

Facility

$1,680.00

Service Code	HCPCS 74176
Hospital Charge Code	424741760
Hospital Revenue Code	352
Min. Negotiated Rate	$94.66
Max. Negotiated Rate	$1,629.60
Rate for Payer: AlohaCare Medicaid	$840.00
Rate for Payer: AlohaCare Medicare	$705.60
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,545.60
Rate for Payer: Devoted Health Medicare	$705.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$94.66
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$705.60
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Humana Medicare	$705.60
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: Kaiser Permanente Medicare	$705.60
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: Ohana Health Plan Medicaid	$705.60
Rate for Payer: Ohana Health Plan Medicare	$705.60
Rate for Payer: UnitedHealthcare Medicaid	$94.66
Rate for Payer: UnitedHealthcare Medicare	$705.60
Rate for Payer: University Health Alliance Commercial	$454.47

CT ABD AND PELVIS WO CON

Facility

$1,680.00

Service Code	HCPCS 74176
Hospital Charge Code	424741760
Hospital Revenue Code	352
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: MDX Hawaii PPO	$1,629.60

CT ABD AND PELVIS WOW CON

Facility

$2,686.00

Service Code	HCPCS 74178
Hospital Charge Code	424741780
Hospital Revenue Code	352
Min. Negotiated Rate	$2,283.10
Max. Negotiated Rate	$2,605.42
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: MDX Hawaii PPO	$2,605.42

CT ABD AND PELVIS WOW CON

Facility

$2,686.00

Service Code	HCPCS 74178
Hospital Charge Code	424741780
Hospital Revenue Code	352
Min. Negotiated Rate	$238.75
Max. Negotiated Rate	$2,605.42
Rate for Payer: AlohaCare Medicaid	$1,343.00
Rate for Payer: AlohaCare Medicare	$1,128.12
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,471.12
Rate for Payer: Devoted Health Medicare	$1,128.12
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$238.75
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$1,128.12
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Humana Medicare	$1,128.12
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: Kaiser Permanente Medicaid	$1,369.86
Rate for Payer: Kaiser Permanente Medicare	$1,128.12
Rate for Payer: MDX Hawaii PPO	$2,605.42
Rate for Payer: Ohana Health Plan Medicaid	$1,128.12
Rate for Payer: Ohana Health Plan Medicare	$1,128.12
Rate for Payer: UnitedHealthcare Medicaid	$238.75
Rate for Payer: UnitedHealthcare Medicare	$1,128.12
Rate for Payer: University Health Alliance Commercial	$924.87

CT ABD W CON

Facility

$1,652.00

Service Code	HCPCS 74160
Hospital Charge Code	424741600
Hospital Revenue Code	352
Min. Negotiated Rate	$1,404.20
Max. Negotiated Rate	$1,602.44
Rate for Payer: Cash Price	$1,073.80
Rate for Payer: Health Management Network Commercial	$1,404.20
Rate for Payer: Kaiser Permanente Commercial	$1,486.80
Rate for Payer: MDX Hawaii PPO	$1,602.44

CT ABD W CON

Facility

$1,652.00

Service Code	HCPCS 74160
Hospital Charge Code	424741600
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,602.44
Rate for Payer: AlohaCare Medicaid	$826.00
Rate for Payer: AlohaCare Medicare	$693.84
Rate for Payer: Cash Price	$1,073.80
Rate for Payer: Cash Price	$1,073.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,519.84
Rate for Payer: Devoted Health Medicare	$693.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$225.48
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$693.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,404.20
Rate for Payer: Humana Medicare	$693.84
Rate for Payer: Kaiser Permanente Commercial	$1,486.80
Rate for Payer: Kaiser Permanente Medicaid	$842.52
Rate for Payer: Kaiser Permanente Medicare	$693.84
Rate for Payer: MDX Hawaii PPO	$1,602.44
Rate for Payer: Ohana Health Plan Medicaid	$693.84
Rate for Payer: Ohana Health Plan Medicare	$693.84
Rate for Payer: UnitedHealthcare Medicaid	$225.48
Rate for Payer: UnitedHealthcare Medicare	$693.84
Rate for Payer: University Health Alliance Commercial	$691.79

CT ABD WO CON

Facility

$1,218.00

Service Code	HCPCS 74150
Hospital Charge Code	424741500
Hospital Revenue Code	352
Min. Negotiated Rate	$1,035.30
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$791.70
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: MDX Hawaii PPO	$1,181.46

CT ABD WO CON

Facility

$1,218.00

Service Code	HCPCS 74150
Hospital Charge Code	424741500
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,181.46
Rate for Payer: AlohaCare Medicaid	$609.00
Rate for Payer: AlohaCare Medicare	$511.56
Rate for Payer: Cash Price	$791.70
Rate for Payer: Cash Price	$791.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,120.56
Rate for Payer: Devoted Health Medicare	$511.56
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$186.48
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$511.56
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Humana Medicare	$511.56
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: Kaiser Permanente Medicaid	$621.18
Rate for Payer: Kaiser Permanente Medicare	$511.56
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: Ohana Health Plan Medicaid	$511.56
Rate for Payer: Ohana Health Plan Medicare	$511.56
Rate for Payer: UnitedHealthcare Medicaid	$186.48
Rate for Payer: UnitedHealthcare Medicare	$511.56
Rate for Payer: University Health Alliance Commercial	$505.20

CT ABD WO W CON FS

Facility

$1,966.00

Service Code	HCPCS 74170
Hospital Charge Code	424741700
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,907.02
Rate for Payer: AlohaCare Medicaid	$983.00
Rate for Payer: AlohaCare Medicare	$825.72
Rate for Payer: Cash Price	$1,277.90
Rate for Payer: Cash Price	$1,277.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,808.72
Rate for Payer: Devoted Health Medicare	$825.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$279.37
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$825.72
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,671.10
Rate for Payer: Humana Medicare	$825.72
Rate for Payer: Kaiser Permanente Commercial	$1,769.40
Rate for Payer: Kaiser Permanente Medicaid	$1,002.66
Rate for Payer: Kaiser Permanente Medicare	$825.72
Rate for Payer: MDX Hawaii PPO	$1,907.02
Rate for Payer: Ohana Health Plan Medicaid	$825.72
Rate for Payer: Ohana Health Plan Medicare	$825.72
Rate for Payer: UnitedHealthcare Medicaid	$279.37
Rate for Payer: UnitedHealthcare Medicare	$825.72
Rate for Payer: University Health Alliance Commercial	$803.12

CT ABD WO W CON FS

Facility

$1,966.00

Service Code	HCPCS 74170
Hospital Charge Code	424741700
Hospital Revenue Code	352
Min. Negotiated Rate	$1,671.10
Max. Negotiated Rate	$1,907.02
Rate for Payer: Cash Price	$1,277.90
Rate for Payer: Health Management Network Commercial	$1,671.10
Rate for Payer: Kaiser Permanente Commercial	$1,769.40
Rate for Payer: MDX Hawaii PPO	$1,907.02

CT Angiography Abdomen/Pelvis

Facility

$2,686.00

Service Code	HCPCS 74174
Hospital Charge Code	424741740
Hospital Revenue Code	352
Min. Negotiated Rate	$316.18
Max. Negotiated Rate	$2,605.42
Rate for Payer: AlohaCare Medicaid	$1,343.00
Rate for Payer: AlohaCare Medicare	$1,128.12
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,471.12
Rate for Payer: Devoted Health Medicare	$1,128.12
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$316.18
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$1,128.12
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Humana Medicare	$1,128.12
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: Kaiser Permanente Medicaid	$1,369.86
Rate for Payer: Kaiser Permanente Medicare	$1,128.12
Rate for Payer: MDX Hawaii PPO	$2,605.42
Rate for Payer: Ohana Health Plan Medicaid	$1,128.12
Rate for Payer: Ohana Health Plan Medicare	$1,128.12
Rate for Payer: UnitedHealthcare Medicaid	$316.18
Rate for Payer: UnitedHealthcare Medicare	$1,128.12
Rate for Payer: University Health Alliance Commercial	$851.02

CT Angiography Abdomen/Pelvis

Facility

$2,686.00

Service Code	HCPCS 74174
Hospital Charge Code	424741740
Hospital Revenue Code	352
Min. Negotiated Rate	$2,283.10
Max. Negotiated Rate	$2,605.42
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: MDX Hawaii PPO	$2,605.42

CT Angiography Chest/Abdomen/Pelvis

Facility

$1,302.00

Service Code	HCPCS 71275
Hospital Charge Code	424712751
Hospital Revenue Code	352
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CT Angiography Chest/Abdomen/Pelvis

Facility

$1,302.00

Service Code	HCPCS 71275
Hospital Charge Code	424712751
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$320.86
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$320.86
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$860.75

Know your out-of-pocket cost for care.

All Charges