Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bill Only AP 88332 Surg Frozen Sect Addl

Facility

$195.00

Service Code	HCPCS 88332 TC
Hospital Charge Code	8196802
Hospital Revenue Code	310
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$97.50
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Devoted Health Medicare	$107.25
Rate for Payer: Hawaii Medical Service Association ABD	$6.29
Rate for Payer: Hawaii Medical Service Association Medicare	$97.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.19
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$97.50
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$97.50
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$97.50
Rate for Payer: Ohana Health Plan Medicare	$97.50
Rate for Payer: UnitedHealthcare Medicaid	$6.29
Rate for Payer: UnitedHealthcare Medicare	$97.50
Rate for Payer: University Health Alliance Commercial	$21.05

Bill Only AP 88332 Surg Frozen Sect Addl

Facility

$195.00

Service Code	HCPCS 88332 TC
Hospital Charge Code	8196802
Hospital Revenue Code	310
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$126.75
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15

Bill Only AP 88333 Cyto Exam Site

Facility

$1,723.00

Service Code	HCPCS 88333 TC
Hospital Charge Code	8196799
Hospital Revenue Code	310
Min. Negotiated Rate	$1,464.55
Max. Negotiated Rate	$1,671.31
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Health Management Network Commercial	$1,464.55
Rate for Payer: Kaiser Permanente Commercial	$1,550.70
Rate for Payer: MDX Hawaii PPO	$1,671.31

Bill Only AP 88333 Cyto Exam Site

Facility

$1,723.00

Service Code	HCPCS 88333 TC
Hospital Charge Code	8196799
Hospital Revenue Code	310
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$1,671.31
Rate for Payer: AlohaCare Medicaid	$861.50
Rate for Payer: AlohaCare Medicare	$861.50
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Devoted Health Medicare	$947.65
Rate for Payer: Hawaii Medical Service Association ABD	$16.28
Rate for Payer: Hawaii Medical Service Association Medicare	$861.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,636.85
Rate for Payer: Health Management Network Commercial	$1,464.55
Rate for Payer: Humana Medicare	$861.50
Rate for Payer: Kaiser Permanente Commercial	$1,550.70
Rate for Payer: Kaiser Permanente Medicaid	$878.73
Rate for Payer: Kaiser Permanente Medicare	$861.50
Rate for Payer: MDX Hawaii PPO	$1,671.31
Rate for Payer: Ohana Health Plan Medicaid	$861.50
Rate for Payer: Ohana Health Plan Medicare	$861.50
Rate for Payer: UnitedHealthcare Medicaid	$16.28
Rate for Payer: UnitedHealthcare Medicare	$861.50
Rate for Payer: University Health Alliance Commercial	$62.12

Bill Only AP 88334 Cyto Exam Addl Site

Facility

$157.00

Service Code	HCPCS 88334 TC
Hospital Charge Code	8196800
Hospital Revenue Code	310
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$78.50
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Devoted Health Medicare	$86.35
Rate for Payer: Hawaii Medical Service Association ABD	$9.97
Rate for Payer: Hawaii Medical Service Association Medicare	$78.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.44
Rate for Payer: Hawaii Western Management Group Commercial	$149.15
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$78.50
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$78.50
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$78.50
Rate for Payer: Ohana Health Plan Medicare	$78.50
Rate for Payer: UnitedHealthcare Medicaid	$9.97
Rate for Payer: UnitedHealthcare Medicare	$78.50
Rate for Payer: University Health Alliance Commercial	$37.07

Bill Only AP 88334 Cyto Exam Addl Site

Facility

$157.00

Service Code	HCPCS 88334 TC
Hospital Charge Code	8196800
Hospital Revenue Code	310
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$102.05
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

Bill Only AP 88342 IHC EA Ab

Facility

$434.00

Service Code	HCPCS 88342 TC
Hospital Charge Code	8196804
Hospital Revenue Code	310
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$282.10
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: MDX Hawaii PPO	$420.98

Bill Only AP 88342 IHC EA Ab

Facility

$434.00

Service Code	HCPCS 88342 TC
Hospital Charge Code	8196804
Hospital Revenue Code	310
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$420.98
Rate for Payer: AlohaCare Medicaid	$217.00
Rate for Payer: AlohaCare Medicare	$217.00
Rate for Payer: Cash Price	$282.10
Rate for Payer: Cash Price	$282.10
Rate for Payer: Devoted Health Medicare	$238.70
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
Rate for Payer: Hawaii Medical Service Association Medicare	$217.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Humana Medicare	$217.00
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: Kaiser Permanente Medicare	$217.00
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: Ohana Health Plan Medicaid	$217.00
Rate for Payer: Ohana Health Plan Medicare	$217.00
Rate for Payer: UnitedHealthcare Medicaid	$28.15
Rate for Payer: UnitedHealthcare Medicare	$217.00
Rate for Payer: University Health Alliance Commercial	$115.59

Bill Only AP 88358 Morph Analysis Tumor

Facility

$746.00

Service Code	HCPCS 88358 TC
Hospital Charge Code	8196796
Hospital Revenue Code	310
Min. Negotiated Rate	$634.10
Max. Negotiated Rate	$723.62
Rate for Payer: Cash Price	$484.90
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: MDX Hawaii PPO	$723.62

Bill Only AP 88358 Morph Analysis Tumor

Facility

$746.00

Service Code	HCPCS 88358 TC
Hospital Charge Code	8196796
Hospital Revenue Code	310
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$723.62
Rate for Payer: AlohaCare Medicaid	$373.00
Rate for Payer: AlohaCare Medicare	$373.00
Rate for Payer: Cash Price	$484.90
Rate for Payer: Cash Price	$484.90
Rate for Payer: Devoted Health Medicare	$410.30
Rate for Payer: Hawaii Medical Service Association ABD	$12.39
Rate for Payer: Hawaii Medical Service Association Medicare	$373.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.60
Rate for Payer: Hawaii Western Management Group Commercial	$708.70
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Humana Medicare	$373.00
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: Kaiser Permanente Medicaid	$380.46
Rate for Payer: Kaiser Permanente Medicare	$373.00
Rate for Payer: MDX Hawaii PPO	$723.62
Rate for Payer: Ohana Health Plan Medicaid	$373.00
Rate for Payer: Ohana Health Plan Medicare	$373.00
Rate for Payer: UnitedHealthcare Medicaid	$12.39
Rate for Payer: UnitedHealthcare Medicare	$373.00
Rate for Payer: University Health Alliance Commercial	$58.87

Bill Only AP 88361 Tumor Comp Analysis

Facility

$931.00

Service Code	HCPCS 88361 TC
Hospital Charge Code	8080876
Hospital Revenue Code	310
Min. Negotiated Rate	$791.35
Max. Negotiated Rate	$903.07
Rate for Payer: Cash Price	$605.15
Rate for Payer: Health Management Network Commercial	$791.35
Rate for Payer: Kaiser Permanente Commercial	$837.90
Rate for Payer: MDX Hawaii PPO	$903.07

Bill Only AP 88361 Tumor Comp Analysis

Facility

$931.00

Service Code	HCPCS 88361 TC
Hospital Charge Code	8080876
Hospital Revenue Code	310
Min. Negotiated Rate	$67.41
Max. Negotiated Rate	$903.07
Rate for Payer: AlohaCare Medicaid	$465.50
Rate for Payer: AlohaCare Medicare	$465.50
Rate for Payer: Cash Price	$605.15
Rate for Payer: Cash Price	$605.15
Rate for Payer: Devoted Health Medicare	$512.05
Rate for Payer: Hawaii Medical Service Association ABD	$67.41
Rate for Payer: Hawaii Medical Service Association Medicare	$465.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83.58
Rate for Payer: Hawaii Western Management Group Commercial	$884.45
Rate for Payer: Health Management Network Commercial	$791.35
Rate for Payer: Humana Medicare	$465.50
Rate for Payer: Kaiser Permanente Commercial	$837.90
Rate for Payer: Kaiser Permanente Medicaid	$474.81
Rate for Payer: Kaiser Permanente Medicare	$465.50
Rate for Payer: MDX Hawaii PPO	$903.07
Rate for Payer: Ohana Health Plan Medicaid	$465.50
Rate for Payer: Ohana Health Plan Medicare	$465.50
Rate for Payer: UnitedHealthcare Medicaid	$67.41
Rate for Payer: UnitedHealthcare Medicare	$465.50
Rate for Payer: University Health Alliance Commercial	$206.28

Bill Only AP 88365 Insitu Hybrid Tech

Facility

$672.00

Service Code	HCPCS 88365 TC
Hospital Charge Code	8080867
Hospital Revenue Code	310
Min. Negotiated Rate	$52.74
Max. Negotiated Rate	$651.84
Rate for Payer: AlohaCare Medicaid	$336.00
Rate for Payer: AlohaCare Medicare	$336.00
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Devoted Health Medicare	$369.60
Rate for Payer: Hawaii Medical Service Association ABD	$82.14
Rate for Payer: Hawaii Medical Service Association Medicare	$336.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52.74
Rate for Payer: Hawaii Western Management Group Commercial	$638.40
Rate for Payer: Health Management Network Commercial	$571.20
Rate for Payer: Humana Medicare	$336.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$342.72
Rate for Payer: Kaiser Permanente Medicare	$336.00
Rate for Payer: MDX Hawaii PPO	$651.84
Rate for Payer: Ohana Health Plan Medicaid	$336.00
Rate for Payer: Ohana Health Plan Medicare	$336.00
Rate for Payer: UnitedHealthcare Medicaid	$82.14
Rate for Payer: UnitedHealthcare Medicare	$336.00
Rate for Payer: University Health Alliance Commercial	$187.68

Bill Only AP 88365 Insitu Hybrid Tech

Facility

$672.00

Service Code	HCPCS 88365 TC
Hospital Charge Code	8080867
Hospital Revenue Code	310
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$651.84
Rate for Payer: Cash Price	$436.80
Rate for Payer: Health Management Network Commercial	$571.20
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: MDX Hawaii PPO	$651.84

Bill Only AP 88368 ANA In Situ Hybrid EA

Facility

$708.00

Service Code	HCPCS 88368 TC
Hospital Charge Code	8196805
Hospital Revenue Code	310
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

Bill Only AP 88368 ANA In Situ Hybrid EA

Facility

$708.00

Service Code	HCPCS 88368 TC
Hospital Charge Code	8196805
Hospital Revenue Code	310
Min. Negotiated Rate	$89.78
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
Rate for Payer: Hawaii Medical Service Association ABD	$89.78
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$92.45
Rate for Payer: Hawaii Western Management Group Commercial	$672.60
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$89.78
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$264.24

Bill Only ASPAG (Asper Galactomannan Ag) FSI

Facility

$139.00

Service Code	HCPCS 87305
Hospital Charge Code	8453173
Hospital Revenue Code	306
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Bill Only ASPAG (Asper Galactomannan Ag) FSI

Facility

$139.00

Service Code	HCPCS 87305
Hospital Charge Code	8453173
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.01

Bill Only Bill For Full Crossmatch

Facility

$289.00

Service Code	HCPCS 86922
Hospital Charge Code	8301491
Hospital Revenue Code	300
Min. Negotiated Rate	$245.65
Max. Negotiated Rate	$280.33
Rate for Payer: Cash Price	$187.85
Rate for Payer: Health Management Network Commercial	$245.65
Rate for Payer: Kaiser Permanente Commercial	$260.10
Rate for Payer: MDX Hawaii PPO	$280.33

Bill Only Bill For Full Crossmatch

Facility

$289.00

Service Code	HCPCS 86922
Hospital Charge Code	8301491
Hospital Revenue Code	300
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$280.33
Rate for Payer: AlohaCare Medicaid	$144.50
Rate for Payer: AlohaCare Medicare	$144.50
Rate for Payer: Cash Price	$187.85
Rate for Payer: Cash Price	$187.85
Rate for Payer: Devoted Health Medicare	$158.95
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$144.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$245.65
Rate for Payer: Humana Medicare	$144.50
Rate for Payer: Kaiser Permanente Commercial	$260.10
Rate for Payer: Kaiser Permanente Medicaid	$147.39
Rate for Payer: Kaiser Permanente Medicare	$144.50
Rate for Payer: MDX Hawaii PPO	$280.33
Rate for Payer: Ohana Health Plan Medicaid	$144.50
Rate for Payer: Ohana Health Plan Medicare	$144.50
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$144.50
Rate for Payer: University Health Alliance Commercial	$210.65

Bill Only Blood Glucose for 2 Hr GTT

Facility

$94.00

Hospital Charge Code	12925325
Hospital Revenue Code	301
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$61.10
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

Bill Only Blood Glucose for 2 Hr GTT

Facility

$94.00

Hospital Charge Code	12925325
Hospital Revenue Code	301
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$47.00
Rate for Payer: Cash Price	$61.10
Rate for Payer: Devoted Health Medicare	$51.70
Rate for Payer: Hawaii Medical Service Association Medicare	$47.00
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$47.00
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$47.00
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$47.00
Rate for Payer: Ohana Health Plan Medicare	$47.00
Rate for Payer: UnitedHealthcare Medicare	$47.00
Rate for Payer: University Health Alliance Commercial	$68.52

Bill Only Capillary Draw Charge

Facility

$12.00

Service Code	HCPCS 36416
Hospital Charge Code	8301484
Hospital Revenue Code	300
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

Bill Only Capillary Draw Charge

Facility

$12.00

Service Code	HCPCS 36416
Hospital Charge Code	8301484
Hospital Revenue Code	300
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$6.00
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$6.60
Rate for Payer: Hawaii Medical Service Association Medicare	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$6.00
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$6.00
Rate for Payer: Ohana Health Plan Medicare	$6.00
Rate for Payer: UnitedHealthcare Medicare	$6.00
Rate for Payer: University Health Alliance Commercial	$8.75

Bill Only Chloride, 24 Hr Urine

Facility

$51.00

Service Code	HCPCS 82436
Hospital Charge Code	12925321
Hospital Revenue Code	301
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$25.50
Rate for Payer: Cash Price	$33.15
Rate for Payer: Cash Price	$33.15
Rate for Payer: Devoted Health Medicare	$28.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.95
Rate for Payer: Hawaii Medical Service Association Commercial	$7.19
Rate for Payer: Hawaii Medical Service Association Medicare	$25.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.30
Rate for Payer: Hawaii Western Management Group Commercial	$5.75
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$25.50
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$25.50
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$25.50
Rate for Payer: Ohana Health Plan Medicare	$25.50
Rate for Payer: UnitedHealthcare Medicaid	$6.95
Rate for Payer: UnitedHealthcare Medicare	$25.50
Rate for Payer: University Health Alliance Commercial	$12.99

Know your out-of-pocket cost for care.

All Charges