Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

epoetin alfa 10,000 units/mL Inj Sol [KMC]

Facility

$1,282.80

Service Code	HCPCS J0885
Hospital Revenue Code	636
Min. Negotiated Rate	$1,090.38
Max. Negotiated Rate	$1,244.32
Rate for Payer: Cash Price	$833.82
Rate for Payer: Health Management Network Commercial	$1,090.38
Rate for Payer: Kaiser Permanente Commercial	$1,154.52
Rate for Payer: MDX Hawaii PPO	$1,244.32

epoetin alfa 10,000 units/mL Inj Sol [KMC]

Facility

$1,282.80

Service Code	HCPCS J0885
Hospital Revenue Code	636
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$1,244.32
Rate for Payer: AlohaCare Medicaid	$641.40
Rate for Payer: AlohaCare Medicare	$538.78
Rate for Payer: Cash Price	$833.82
Rate for Payer: Cash Price	$833.82
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,180.18
Rate for Payer: Devoted Health Medicare	$538.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.68
Rate for Payer: Hawaii Medical Service Association Commercial	$9.14
Rate for Payer: Hawaii Medical Service Association Medicare	$538.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,218.66
Rate for Payer: Health Management Network Commercial	$1,090.38
Rate for Payer: Humana Medicare	$538.78
Rate for Payer: Kaiser Permanente Commercial	$1,154.52
Rate for Payer: Kaiser Permanente Medicaid	$654.23
Rate for Payer: Kaiser Permanente Medicare	$538.78
Rate for Payer: MDX Hawaii PPO	$1,244.32
Rate for Payer: Ohana Health Plan Medicaid	$538.78
Rate for Payer: Ohana Health Plan Medicare	$538.78
Rate for Payer: UnitedHealthcare Medicaid	$769.68
Rate for Payer: UnitedHealthcare Medicare	$538.78
Rate for Payer: University Health Alliance Commercial	$935.03

epoetin alfa 4000 units/mL Inj Sol [KMC]

Facility

$513.12

Service Code	HCPCS JO885
Hospital Revenue Code	636
Min. Negotiated Rate	$436.15
Max. Negotiated Rate	$497.73
Rate for Payer: Cash Price	$333.53
Rate for Payer: Health Management Network Commercial	$436.15
Rate for Payer: Kaiser Permanente Commercial	$461.81
Rate for Payer: MDX Hawaii PPO	$497.73

epoetin alfa 4000 units/mL Inj Sol [KMC]

Facility

$513.12

Service Code	HCPCS JO885
Hospital Revenue Code	636
Min. Negotiated Rate	$215.51
Max. Negotiated Rate	$497.73
Rate for Payer: AlohaCare Medicaid	$256.56
Rate for Payer: AlohaCare Medicare	$215.51
Rate for Payer: Cash Price	$333.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$472.07
Rate for Payer: Devoted Health Medicare	$215.51
Rate for Payer: Hawaii Medical Service Association Medicare	$215.51
Rate for Payer: Hawaii Western Management Group Commercial	$487.46
Rate for Payer: Health Management Network Commercial	$436.15
Rate for Payer: Humana Medicare	$215.51
Rate for Payer: Kaiser Permanente Commercial	$461.81
Rate for Payer: Kaiser Permanente Medicaid	$261.69
Rate for Payer: Kaiser Permanente Medicare	$215.51
Rate for Payer: MDX Hawaii PPO	$497.73
Rate for Payer: Ohana Health Plan Medicaid	$215.51
Rate for Payer: Ohana Health Plan Medicare	$215.51
Rate for Payer: UnitedHealthcare Medicaid	$307.87
Rate for Payer: UnitedHealthcare Medicare	$215.51
Rate for Payer: University Health Alliance Commercial	$374.01

epoetin alfa epbx 2000 units/mL Soln [KMC]

Facility

$105.89

Service Code	HCPCS Q5106
Hospital Revenue Code	637
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$102.71
Rate for Payer: AlohaCare Medicaid	$52.95
Rate for Payer: AlohaCare Medicare	$44.47
Rate for Payer: Cash Price	$68.83
Rate for Payer: Cash Price	$68.83
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$97.42
Rate for Payer: Devoted Health Medicare	$44.47
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.57
Rate for Payer: Hawaii Medical Service Association Commercial	$9.85
Rate for Payer: Hawaii Medical Service Association Medicare	$44.47
Rate for Payer: Hawaii Western Management Group Commercial	$100.60
Rate for Payer: Health Management Network Commercial	$90.01
Rate for Payer: Humana Medicare	$44.47
Rate for Payer: Kaiser Permanente Commercial	$95.30
Rate for Payer: Kaiser Permanente Medicaid	$54.00
Rate for Payer: Kaiser Permanente Medicare	$44.47
Rate for Payer: MDX Hawaii PPO	$102.71
Rate for Payer: Ohana Health Plan Medicaid	$44.47
Rate for Payer: Ohana Health Plan Medicare	$44.47
Rate for Payer: UnitedHealthcare Medicaid	$5.68
Rate for Payer: UnitedHealthcare Medicare	$44.47
Rate for Payer: University Health Alliance Commercial	$77.18

epoetin alfa epbx 2000 units/mL Soln [KMC]

Facility

$105.89

Service Code	HCPCS Q5106
Hospital Revenue Code	637
Min. Negotiated Rate	$90.01
Max. Negotiated Rate	$102.71
Rate for Payer: Cash Price	$68.83
Rate for Payer: Health Management Network Commercial	$90.01
Rate for Payer: Kaiser Permanente Commercial	$95.30
Rate for Payer: MDX Hawaii PPO	$102.71

ER 7.6-12.5CM REP INTER S Charge

Facility

$1,017.00

Service Code	HCPCS 12034
Hospital Charge Code	440120340
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$508.50
Rate for Payer: AlohaCare Medicare	$427.14
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$935.64
Rate for Payer: Devoted Health Medicare	$427.14
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	$427.14
Rate for Payer: Hawaii Western Management Group Commercial	$966.15
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Humana Medicare	$427.14
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$427.14
Rate for Payer: MDX Hawaii PPO	$986.49
Rate for Payer: Ohana Health Plan Medicaid	$427.14
Rate for Payer: Ohana Health Plan Medicare	$427.14
Rate for Payer: UnitedHealthcare Medicare	$427.14
Rate for Payer: University Health Alliance Commercial	$5,160.40

ER 7.6-12.5CM REP INTER S Charge

Facility

$1,017.00

Service Code	HCPCS 12034
Hospital Charge Code	440120340
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$986.49
Rate for Payer: Cash Price	$661.05
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: MDX Hawaii PPO	$986.49

ER ACCUCHECK Charge

Facility

$37.00

Service Code	HCPCS 82962
Hospital Charge Code	317829620
Hospital Revenue Code	301
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

ER ACCUCHECK Charge

Facility

$37.00

Service Code	HCPCS 82962
Hospital Charge Code	317829620
Hospital Revenue Code	301
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$15.54
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.04
Rate for Payer: Devoted Health Medicare	$15.54
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.50
Rate for Payer: Hawaii Medical Service Association Commercial	$4.10
Rate for Payer: Hawaii Medical Service Association Medicare	$15.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$15.54
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$15.54
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$15.54
Rate for Payer: Ohana Health Plan Medicare	$15.54
Rate for Payer: UnitedHealthcare Medicaid	$2.50
Rate for Payer: UnitedHealthcare Medicare	$15.54
Rate for Payer: University Health Alliance Commercial	$4.68

ER CL TRMT NASAL FX W/O M Charge

Facility

$432.00

Service Code	HCPCS 21310
Hospital Charge Code	440213100
Hospital Revenue Code	450
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$181.44
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$397.44
Rate for Payer: Devoted Health Medicare	$181.44
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	$181.44
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$181.44
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$181.44
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$181.44
Rate for Payer: Ohana Health Plan Medicare	$181.44
Rate for Payer: UnitedHealthcare Medicare	$181.44
Rate for Payer: University Health Alliance Commercial	$314.88

ER CL TRMT NASAL FX W/O M Charge

Facility

$432.00

Service Code	HCPCS 21310
Hospital Charge Code	440213100
Hospital Revenue Code	450
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

erenumab 70 mg/mL Soln [KMC]

Facility

$3,247.00

Service Code	NDC 55513084101
Hospital Revenue Code	250
Min. Negotiated Rate	$2,759.95
Max. Negotiated Rate	$3,149.59
Rate for Payer: Cash Price	$2,110.55
Rate for Payer: Health Management Network Commercial	$2,759.95
Rate for Payer: Kaiser Permanente Commercial	$2,922.30
Rate for Payer: MDX Hawaii PPO	$3,149.59

erenumab 70 mg/mL Soln [KMC]

Facility

$3,247.00

Service Code	NDC 55513084101
Hospital Revenue Code	250
Min. Negotiated Rate	$1,363.74
Max. Negotiated Rate	$3,149.59
Rate for Payer: AlohaCare Medicaid	$1,623.50
Rate for Payer: AlohaCare Medicare	$1,363.74
Rate for Payer: Cash Price	$2,110.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,987.24
Rate for Payer: Devoted Health Medicare	$1,363.74
Rate for Payer: Hawaii Medical Service Association Medicare	$1,363.74
Rate for Payer: Hawaii Western Management Group Commercial	$3,084.65
Rate for Payer: Health Management Network Commercial	$2,759.95
Rate for Payer: Humana Medicare	$1,363.74
Rate for Payer: Kaiser Permanente Commercial	$2,922.30
Rate for Payer: Kaiser Permanente Medicaid	$1,655.97
Rate for Payer: Kaiser Permanente Medicare	$1,363.74
Rate for Payer: MDX Hawaii PPO	$3,149.59
Rate for Payer: Ohana Health Plan Medicaid	$1,363.74
Rate for Payer: Ohana Health Plan Medicare	$1,363.74
Rate for Payer: UnitedHealthcare Medicaid	$1,948.20
Rate for Payer: UnitedHealthcare Medicare	$1,363.74
Rate for Payer: University Health Alliance Commercial	$2,366.74

ER FX PHALANX NOT GT TOE Charge

Facility

$887.00

Service Code	HCPCS 28515
Hospital Charge Code	440285150
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

ER FX PHALANX NOT GT TOE Charge

Facility

$887.00

Service Code	HCPCS 28515
Hospital Charge Code	440285150
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

ergocalciferol 50,000 intl units Cap [KMC]

Facility

$3.00

Service Code	NDC 69452015120
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

ergocalciferol 50,000 intl units Cap [KMC]

Facility

$3.00

Service Code	NDC 69452015120
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

ER NOSE CTRL HEM POST

Facility

$432.00

Service Code	HCPCS 30905
Hospital Charge Code	440309050
Hospital Revenue Code	450
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

ER NOSE CTRL HEM POST

Facility

$432.00

Service Code	HCPCS 30905
Hospital Charge Code	440309050
Hospital Revenue Code	450
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$181.44
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$397.44
Rate for Payer: Devoted Health Medicare	$181.44
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	$181.44
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$181.44
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$181.44
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$181.44
Rate for Payer: Ohana Health Plan Medicare	$181.44
Rate for Payer: UnitedHealthcare Medicare	$181.44
Rate for Payer: University Health Alliance Commercial	$314.88

ER NOSE CTRL POST SUBSEQ Charge

Facility

$432.00

Service Code	HCPCS 30906
Hospital Charge Code	440309060
Hospital Revenue Code	450
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

ER NOSE CTRL POST SUBSEQ Charge

Facility

$432.00

Service Code	HCPCS 30906
Hospital Charge Code	440309060
Hospital Revenue Code	450
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$181.44
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$397.44
Rate for Payer: Devoted Health Medicare	$181.44
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	$181.44
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$181.44
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$181.44
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$181.44
Rate for Payer: Ohana Health Plan Medicare	$181.44
Rate for Payer: UnitedHealthcare Medicare	$181.44
Rate for Payer: University Health Alliance Commercial	$314.88

ER Pro Application of finger splint; dynamic

Facility

$286.00

Service Code	HCPCS 29131
Hospital Charge Code	440291310
Hospital Revenue Code	450
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$277.42
Rate for Payer: Cash Price	$185.90
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: MDX Hawaii PPO	$277.42

ER Pro Application of finger splint; dynamic

Facility

$286.00

Service Code	HCPCS 29131
Hospital Charge Code	440291310
Hospital Revenue Code	450
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$143.00
Rate for Payer: AlohaCare Medicare	$120.12
Rate for Payer: Cash Price	$185.90
Rate for Payer: Cash Price	$185.90
Rate for Payer: Cash Price	$185.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$263.12
Rate for Payer: Devoted Health Medicare	$120.12
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	$120.12
Rate for Payer: Hawaii Western Management Group Commercial	$271.70
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Humana Medicare	$120.12
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$120.12
Rate for Payer: MDX Hawaii PPO	$277.42
Rate for Payer: Ohana Health Plan Medicaid	$120.12
Rate for Payer: Ohana Health Plan Medicare	$120.12
Rate for Payer: UnitedHealthcare Medicare	$120.12
Rate for Payer: University Health Alliance Commercial	$208.47

ER STRAPPING WRIST/ELBOW Charge

Facility

$286.00

Service Code	HCPCS 29260
Hospital Charge Code	440292600
Hospital Revenue Code	450
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$143.00
Rate for Payer: AlohaCare Medicare	$120.12
Rate for Payer: Cash Price	$185.90
Rate for Payer: Cash Price	$185.90
Rate for Payer: Cash Price	$185.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$263.12
Rate for Payer: Devoted Health Medicare	$120.12
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	$120.12
Rate for Payer: Hawaii Western Management Group Commercial	$271.70
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Humana Medicare	$120.12
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$120.12
Rate for Payer: MDX Hawaii PPO	$277.42
Rate for Payer: Ohana Health Plan Medicaid	$120.12
Rate for Payer: Ohana Health Plan Medicare	$120.12
Rate for Payer: UnitedHealthcare Medicare	$120.12
Rate for Payer: University Health Alliance Commercial	$208.47

Know your out-of-pocket cost for care.

All Charges