Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Culture DLS, Aerobic

Facility

$145.00

Service Code	HCPCS 87077
Hospital Charge Code	422870775
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$60.90
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$133.40
Rate for Payer: Devoted Health Medicare	$60.90
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$60.90
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$60.90
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$60.90
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$60.90
Rate for Payer: Ohana Health Plan Medicare	$60.90
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$60.90
Rate for Payer: University Health Alliance Commercial	$20.89

Culture DLS, Aerobic

Facility

$145.00

Service Code	HCPCS 87077
Hospital Charge Code	422870775
Hospital Revenue Code	306
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

Culture DLS, Urine

Facility

$41.00

Service Code	HCPCS 87088
Hospital Charge Code	422870885
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$17.22
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.72
Rate for Payer: Devoted Health Medicare	$17.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$17.22
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$17.22
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$17.22
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$17.22
Rate for Payer: Ohana Health Plan Medicare	$17.22
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$17.22
Rate for Payer: University Health Alliance Commercial	$19.74

Culture DLS, Urine

Facility

$41.00

Service Code	HCPCS 87088
Hospital Charge Code	422870885
Hospital Revenue Code	306
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77

CURRENT TOBACCO NON-USER CAD CAP COPD PV DM

Professional

Both

$0.01

Service Code	HCPCS 1036F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

CURRENT TOBACCO SMOKER

Professional

Both

$0.01

Service Code	HCPCS 1034F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

cyanocobalamin 1000 mcg/mL Soln[KMC]

Facility

$17.80

Service Code	HCPCS J3420
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$17.27
Rate for Payer: AlohaCare Medicaid	$8.90
Rate for Payer: AlohaCare Medicare	$7.48
Rate for Payer: Cash Price	$11.57
Rate for Payer: Cash Price	$11.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.38
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.95
Rate for Payer: Hawaii Medical Service Association Medicare	$7.48
Rate for Payer: Hawaii Western Management Group Commercial	$16.91
Rate for Payer: Health Management Network Commercial	$15.13
Rate for Payer: Humana Medicare	$7.48
Rate for Payer: Kaiser Permanente Commercial	$16.02
Rate for Payer: Kaiser Permanente Medicaid	$9.08
Rate for Payer: Kaiser Permanente Medicare	$7.48
Rate for Payer: MDX Hawaii PPO	$17.27
Rate for Payer: Ohana Health Plan Medicaid	$7.48
Rate for Payer: Ohana Health Plan Medicare	$7.48
Rate for Payer: UnitedHealthcare Medicaid	$10.68
Rate for Payer: UnitedHealthcare Medicare	$7.48
Rate for Payer: University Health Alliance Commercial	$12.97

cyanocobalamin 1000 mcg/mL Soln[KMC]

Facility

$17.80

Service Code	HCPCS J3420
Hospital Revenue Code	636
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$17.27
Rate for Payer: Cash Price	$11.57
Rate for Payer: Health Management Network Commercial	$15.13
Rate for Payer: Kaiser Permanente Commercial	$16.02
Rate for Payer: MDX Hawaii PPO	$17.27

cyanocobalamin 1000 mcg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
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

cyanocobalamin 1000 mcg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
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

cyclobenzaprine 5 mg Tab [KMC]

Facility

$6.56

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.36
Rate for Payer: AlohaCare Medicaid	$3.28
Rate for Payer: AlohaCare Medicare	$2.76
Rate for Payer: Cash Price	$4.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.04
Rate for Payer: Devoted Health Medicare	$2.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2.76
Rate for Payer: Hawaii Western Management Group Commercial	$6.23
Rate for Payer: Health Management Network Commercial	$5.58
Rate for Payer: Humana Medicare	$2.76
Rate for Payer: Kaiser Permanente Commercial	$5.90
Rate for Payer: Kaiser Permanente Medicaid	$3.35
Rate for Payer: Kaiser Permanente Medicare	$2.76
Rate for Payer: MDX Hawaii PPO	$6.36
Rate for Payer: Ohana Health Plan Medicaid	$2.76
Rate for Payer: Ohana Health Plan Medicare	$2.76
Rate for Payer: UnitedHealthcare Medicare	$2.76
Rate for Payer: University Health Alliance Commercial	$4.78

cyclobenzaprine 5 mg Tab [KMC]

Facility

$6.56

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$6.36
Rate for Payer: Cash Price	$4.26
Rate for Payer: Health Management Network Commercial	$5.58
Rate for Payer: Kaiser Permanente Commercial	$5.90
Rate for Payer: MDX Hawaii PPO	$6.36

cyclopentolate Ophth 1% Sol [KMC]

Facility

$32.66

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$27.76
Max. Negotiated Rate	$31.68
Rate for Payer: Cash Price	$21.23
Rate for Payer: Health Management Network Commercial	$27.76
Rate for Payer: Kaiser Permanente Commercial	$29.39
Rate for Payer: MDX Hawaii PPO	$31.68

cyclopentolate Ophth 1% Sol [KMC]

Facility

$32.66

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$31.68
Rate for Payer: AlohaCare Medicaid	$16.33
Rate for Payer: AlohaCare Medicare	$13.72
Rate for Payer: Cash Price	$21.23
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$30.05
Rate for Payer: Devoted Health Medicare	$13.72
Rate for Payer: Hawaii Medical Service Association Medicare	$13.72
Rate for Payer: Hawaii Western Management Group Commercial	$31.03
Rate for Payer: Health Management Network Commercial	$27.76
Rate for Payer: Humana Medicare	$13.72
Rate for Payer: Kaiser Permanente Commercial	$29.39
Rate for Payer: Kaiser Permanente Medicaid	$16.66
Rate for Payer: Kaiser Permanente Medicare	$13.72
Rate for Payer: MDX Hawaii PPO	$31.68
Rate for Payer: Ohana Health Plan Medicaid	$13.72
Rate for Payer: Ohana Health Plan Medicare	$13.72
Rate for Payer: UnitedHealthcare Medicare	$13.72
Rate for Payer: University Health Alliance Commercial	$23.81

Cyclospora by Modified Acid Fast DLS

Facility

$282.00

Service Code	HCPCS 80158
Hospital Charge Code	422801585
Hospital Revenue Code	306
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$253.80
Rate for Payer: MDX Hawaii PPO	$273.54

Cyclospora by Modified Acid Fast DLS

Facility

$282.00

Service Code	HCPCS 80158
Hospital Charge Code	422801585
Hospital Revenue Code	306
Min. Negotiated Rate	$18.05
Max. Negotiated Rate	$273.54
Rate for Payer: AlohaCare Medicaid	$141.00
Rate for Payer: AlohaCare Medicare	$118.44
Rate for Payer: Cash Price	$183.30
Rate for Payer: Cash Price	$183.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$259.44
Rate for Payer: Devoted Health Medicare	$118.44
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$24.95
Rate for Payer: Hawaii Medical Service Association Commercial	$22.56
Rate for Payer: Hawaii Medical Service Association Medicare	$118.44
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Humana Medicare	$118.44
Rate for Payer: Kaiser Permanente Commercial	$253.80
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: Kaiser Permanente Medicare	$118.44
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: Ohana Health Plan Medicaid	$118.44
Rate for Payer: Ohana Health Plan Medicare	$118.44
Rate for Payer: UnitedHealthcare Medicaid	$24.95
Rate for Payer: UnitedHealthcare Medicare	$118.44
Rate for Payer: University Health Alliance Commercial	$46.68

cycloSPORINE modified 100 mg Cap [KMC]

Facility

$21.99

Service Code	HCPCS J7502
Hospital Revenue Code	636
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$21.33
Rate for Payer: Cash Price	$14.29
Rate for Payer: Health Management Network Commercial	$18.69
Rate for Payer: Kaiser Permanente Commercial	$19.79
Rate for Payer: MDX Hawaii PPO	$21.33

cycloSPORINE modified 100 mg Cap [KMC]

Facility

$21.99

Service Code	HCPCS J7502
Hospital Revenue Code	636
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$21.33
Rate for Payer: AlohaCare Medicaid	$10.99
Rate for Payer: AlohaCare Medicare	$9.24
Rate for Payer: Cash Price	$14.29
Rate for Payer: Cash Price	$14.29
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$20.23
Rate for Payer: Devoted Health Medicare	$9.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.07
Rate for Payer: Hawaii Medical Service Association Medicare	$9.24
Rate for Payer: Hawaii Western Management Group Commercial	$20.89
Rate for Payer: Health Management Network Commercial	$18.69
Rate for Payer: Humana Medicare	$9.24
Rate for Payer: Kaiser Permanente Commercial	$19.79
Rate for Payer: Kaiser Permanente Medicaid	$11.21
Rate for Payer: Kaiser Permanente Medicare	$9.24
Rate for Payer: MDX Hawaii PPO	$21.33
Rate for Payer: Ohana Health Plan Medicaid	$9.24
Rate for Payer: Ohana Health Plan Medicare	$9.24
Rate for Payer: UnitedHealthcare Medicaid	$13.19
Rate for Payer: UnitedHealthcare Medicare	$9.24
Rate for Payer: University Health Alliance Commercial	$16.03

cycloSPORINE modified 25 mg/ 0.25 mL Liq [KMC]

Facility

$23.64

Service Code	HCPCS J7502
Hospital Revenue Code	636
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$22.93
Rate for Payer: AlohaCare Medicaid	$11.82
Rate for Payer: AlohaCare Medicare	$9.93
Rate for Payer: Cash Price	$15.37
Rate for Payer: Cash Price	$15.37
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21.75
Rate for Payer: Devoted Health Medicare	$9.93
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.07
Rate for Payer: Hawaii Medical Service Association Medicare	$9.93
Rate for Payer: Hawaii Western Management Group Commercial	$22.46
Rate for Payer: Health Management Network Commercial	$20.09
Rate for Payer: Humana Medicare	$9.93
Rate for Payer: Kaiser Permanente Commercial	$21.28
Rate for Payer: Kaiser Permanente Medicaid	$12.06
Rate for Payer: Kaiser Permanente Medicare	$9.93
Rate for Payer: MDX Hawaii PPO	$22.93
Rate for Payer: Ohana Health Plan Medicaid	$9.93
Rate for Payer: Ohana Health Plan Medicare	$9.93
Rate for Payer: UnitedHealthcare Medicaid	$14.18
Rate for Payer: UnitedHealthcare Medicare	$9.93
Rate for Payer: University Health Alliance Commercial	$17.23

cycloSPORINE modified 25 mg/ 0.25 mL Liq [KMC]

Facility

$23.64

Service Code	HCPCS J7502
Hospital Revenue Code	636
Min. Negotiated Rate	$20.09
Max. Negotiated Rate	$22.93
Rate for Payer: Cash Price	$15.37
Rate for Payer: Health Management Network Commercial	$20.09
Rate for Payer: Kaiser Permanente Commercial	$21.28
Rate for Payer: MDX Hawaii PPO	$22.93

cycloSPORINE modified 25 mg Cap [KMC]

Facility

$5.50

Service Code	HCPCS J7515
Hospital Revenue Code	636
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$5.33
Rate for Payer: Cash Price	$3.58
Rate for Payer: Health Management Network Commercial	$4.67
Rate for Payer: Kaiser Permanente Commercial	$4.95
Rate for Payer: MDX Hawaii PPO	$5.33

cycloSPORINE modified 25 mg Cap [KMC]

Facility

$5.50

Service Code	HCPCS J7515
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$5.33
Rate for Payer: AlohaCare Medicaid	$2.75
Rate for Payer: AlohaCare Medicare	$2.31
Rate for Payer: Cash Price	$3.58
Rate for Payer: Cash Price	$3.58
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.06
Rate for Payer: Devoted Health Medicare	$2.31
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.77
Rate for Payer: Hawaii Medical Service Association Medicare	$2.31
Rate for Payer: Hawaii Western Management Group Commercial	$5.22
Rate for Payer: Health Management Network Commercial	$4.67
Rate for Payer: Humana Medicare	$2.31
Rate for Payer: Kaiser Permanente Commercial	$4.95
Rate for Payer: Kaiser Permanente Medicaid	$2.81
Rate for Payer: Kaiser Permanente Medicare	$2.31
Rate for Payer: MDX Hawaii PPO	$5.33
Rate for Payer: Ohana Health Plan Medicaid	$2.31
Rate for Payer: Ohana Health Plan Medicare	$2.31
Rate for Payer: UnitedHealthcare Medicaid	$3.30
Rate for Payer: UnitedHealthcare Medicare	$2.31
Rate for Payer: University Health Alliance Commercial	$4.01

cycloSPORINE modified 50 mg Cap [KMC]

Facility

$10.95

Service Code	HCPCS J7515
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$10.62
Rate for Payer: AlohaCare Medicaid	$5.47
Rate for Payer: AlohaCare Medicare	$4.60
Rate for Payer: Cash Price	$7.12
Rate for Payer: Cash Price	$7.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.07
Rate for Payer: Devoted Health Medicare	$4.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.77
Rate for Payer: Hawaii Medical Service Association Medicare	$4.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.40
Rate for Payer: Health Management Network Commercial	$9.31
Rate for Payer: Humana Medicare	$4.60
Rate for Payer: Kaiser Permanente Commercial	$9.86
Rate for Payer: Kaiser Permanente Medicaid	$5.58
Rate for Payer: Kaiser Permanente Medicare	$4.60
Rate for Payer: MDX Hawaii PPO	$10.62
Rate for Payer: Ohana Health Plan Medicaid	$4.60
Rate for Payer: Ohana Health Plan Medicare	$4.60
Rate for Payer: UnitedHealthcare Medicaid	$6.57
Rate for Payer: UnitedHealthcare Medicare	$4.60
Rate for Payer: University Health Alliance Commercial	$7.98

cycloSPORINE modified 50 mg Cap [KMC]

Facility

$10.95

Service Code	HCPCS J7515
Hospital Revenue Code	636
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$10.62
Rate for Payer: Cash Price	$7.12
Rate for Payer: Health Management Network Commercial	$9.31
Rate for Payer: Kaiser Permanente Commercial	$9.86
Rate for Payer: MDX Hawaii PPO	$10.62

cycloSPORINE ophthalmic 0.05% Emu UD [KMC]

Facility

$49.07

Service Code	NDC 60505620201
Hospital Revenue Code	250
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$47.60
Rate for Payer: AlohaCare Medicaid	$24.54
Rate for Payer: AlohaCare Medicare	$20.61
Rate for Payer: Cash Price	$31.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$45.14
Rate for Payer: Devoted Health Medicare	$20.61
Rate for Payer: Hawaii Medical Service Association Medicare	$20.61
Rate for Payer: Hawaii Western Management Group Commercial	$46.62
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: Humana Medicare	$20.61
Rate for Payer: Kaiser Permanente Commercial	$44.16
Rate for Payer: Kaiser Permanente Medicaid	$25.03
Rate for Payer: Kaiser Permanente Medicare	$20.61
Rate for Payer: MDX Hawaii PPO	$47.60
Rate for Payer: Ohana Health Plan Medicaid	$20.61
Rate for Payer: Ohana Health Plan Medicare	$20.61
Rate for Payer: UnitedHealthcare Medicaid	$29.44
Rate for Payer: UnitedHealthcare Medicare	$20.61
Rate for Payer: University Health Alliance Commercial	$35.77

Know your out-of-pocket cost for care.

All Charges