Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

BLANKET, COOLING

Facility

$63.00

Hospital Charge Code	8274470
Hospital Revenue Code	271
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$31.50
Rate for Payer: Cash Price	$40.95
Rate for Payer: Devoted Health Medicare	$34.65
Rate for Payer: Hawaii Medical Service Association Medicare	$31.50
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$31.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$31.50
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$31.50
Rate for Payer: Ohana Health Plan Medicare	$31.50
Rate for Payer: UnitedHealthcare Medicare	$31.50
Rate for Payer: University Health Alliance Commercial	$45.92

Bld Typ Donor Bld Ea Ag

Facility

$708.00

Service Code	HCPCS 86902
Hospital Charge Code	8502938
Hospital Revenue Code	300
Min. Negotiated Rate	$5.38
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	$5.38
Rate for Payer: Hawaii Medical Service Association Commercial	$7.94
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$6.35
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	$5.38
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$9.95

Bld Typ Donor Bld Ea Ag

Facility

$708.00

Service Code	HCPCS 86902
Hospital Charge Code	8502938
Hospital Revenue Code	300
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

BLEEDING CONTROL† - 00916

Professional

Both

$191.00

Hospital Charge Code	8970812
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

Blood Culture 2 FSI

Facility

$128.00

Service Code	HCPCS 87040
Hospital Charge Code	8117862
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$64.00
Rate for Payer: AlohaCare Medicare	$64.00
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Devoted Health Medicare	$70.40
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$64.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$64.00
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$64.00
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$64.00
Rate for Payer: Ohana Health Plan Medicare	$64.00
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$64.00
Rate for Payer: University Health Alliance Commercial	$26.68

Blood Culture 2 FSI

Facility

$128.00

Service Code	HCPCS 87040
Hospital Charge Code	8117862
Hospital Revenue Code	306
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: MDX Hawaii PPO	$124.16

Blood Culture FSI

Facility

$128.00

Service Code	HCPCS 87040
Hospital Charge Code	8117863
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$64.00
Rate for Payer: AlohaCare Medicare	$64.00
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Devoted Health Medicare	$70.40
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$64.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$64.00
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$64.00
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$64.00
Rate for Payer: Ohana Health Plan Medicare	$64.00
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$64.00
Rate for Payer: University Health Alliance Commercial	$26.68

Blood Culture FSI

Facility

$128.00

Service Code	HCPCS 87040
Hospital Charge Code	8117863
Hospital Revenue Code	306
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: MDX Hawaii PPO	$124.16

Blood Draw from Arterial Line

Facility

$255.00

Service Code	HCPCS 37799
Hospital Charge Code	11112761
Hospital Revenue Code	300
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$801.11
Rate for Payer: AlohaCare Medicaid	$127.50
Rate for Payer: AlohaCare Medicare	$127.50
Rate for Payer: Cash Price	$165.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Devoted Health Medicare	$140.25
Rate for Payer: Hawaii Medical Service Association Commercial	$801.11
Rate for Payer: Hawaii Medical Service Association Medicare	$127.50
Rate for Payer: Hawaii Western Management Group Commercial	$242.25
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Humana Medicare	$127.50
Rate for Payer: Kaiser Permanente Commercial	$229.50
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: Kaiser Permanente Medicare	$127.50
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: Ohana Health Plan Medicaid	$127.50
Rate for Payer: Ohana Health Plan Medicare	$127.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$127.50
Rate for Payer: University Health Alliance Commercial	$185.87

Blood Draw from Arterial Line

Facility

$255.00

Service Code	HCPCS 37799
Hospital Charge Code	11112761
Hospital Revenue Code	300
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Kaiser Permanente Commercial	$229.50
Rate for Payer: MDX Hawaii PPO	$247.35

Blood Draw from Central Line

Facility

$330.00

Service Code	HCPCS 36592
Hospital Charge Code	11106988
Hospital Revenue Code	300
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$320.10
Rate for Payer: Cash Price	$214.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Kaiser Permanente Commercial	$297.00
Rate for Payer: MDX Hawaii PPO	$320.10

Blood Draw from Central Line

Facility

$330.00

Service Code	HCPCS 36592
Hospital Charge Code	11106988
Hospital Revenue Code	300
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$320.10
Rate for Payer: AlohaCare Medicaid	$165.00
Rate for Payer: AlohaCare Medicare	$165.00
Rate for Payer: Cash Price	$214.50
Rate for Payer: Cash Price	$214.50
Rate for Payer: Devoted Health Medicare	$181.50
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$165.00
Rate for Payer: Hawaii Western Management Group Commercial	$313.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Humana Medicare	$165.00
Rate for Payer: Kaiser Permanente Commercial	$297.00
Rate for Payer: Kaiser Permanente Medicaid	$168.30
Rate for Payer: Kaiser Permanente Medicare	$165.00
Rate for Payer: MDX Hawaii PPO	$320.10
Rate for Payer: Ohana Health Plan Medicaid	$165.00
Rate for Payer: Ohana Health Plan Medicare	$165.00
Rate for Payer: UnitedHealthcare Medicaid	$15.71
Rate for Payer: UnitedHealthcare Medicare	$165.00
Rate for Payer: University Health Alliance Commercial	$240.54

Blood Draw From CENTRAL LINE or PICC Charge

Facility

$487.00

Service Code	HCPCS 36591
Hospital Charge Code	8386872
Hospital Revenue Code	300
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$472.39
Rate for Payer: AlohaCare Medicaid	$243.50
Rate for Payer: AlohaCare Medicare	$243.50
Rate for Payer: Cash Price	$316.55
Rate for Payer: Cash Price	$316.55
Rate for Payer: Devoted Health Medicare	$267.85
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$243.50
Rate for Payer: Hawaii Western Management Group Commercial	$462.65
Rate for Payer: Health Management Network Commercial	$413.95
Rate for Payer: Humana Medicare	$243.50
Rate for Payer: Kaiser Permanente Commercial	$438.30
Rate for Payer: Kaiser Permanente Medicaid	$248.37
Rate for Payer: Kaiser Permanente Medicare	$243.50
Rate for Payer: MDX Hawaii PPO	$472.39
Rate for Payer: Ohana Health Plan Medicaid	$243.50
Rate for Payer: Ohana Health Plan Medicare	$243.50
Rate for Payer: UnitedHealthcare Medicaid	$12.68
Rate for Payer: UnitedHealthcare Medicare	$243.50
Rate for Payer: University Health Alliance Commercial	$354.97

Blood Draw From CENTRAL LINE or PICC Charge

Facility

$487.00

Service Code	HCPCS 36591
Hospital Charge Code	8386872
Hospital Revenue Code	300
Min. Negotiated Rate	$413.95
Max. Negotiated Rate	$472.39
Rate for Payer: Cash Price	$316.55
Rate for Payer: Health Management Network Commercial	$413.95
Rate for Payer: Kaiser Permanente Commercial	$438.30
Rate for Payer: MDX Hawaii PPO	$472.39

Blood Draw or Accessing Implantable Port

Facility

$330.00

Service Code	HCPCS 36592
Hospital Charge Code	11112762
Hospital Revenue Code	300
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$320.10
Rate for Payer: AlohaCare Medicaid	$165.00
Rate for Payer: AlohaCare Medicare	$165.00
Rate for Payer: Cash Price	$214.50
Rate for Payer: Cash Price	$214.50
Rate for Payer: Devoted Health Medicare	$181.50
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$165.00
Rate for Payer: Hawaii Western Management Group Commercial	$313.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Humana Medicare	$165.00
Rate for Payer: Kaiser Permanente Commercial	$297.00
Rate for Payer: Kaiser Permanente Medicaid	$168.30
Rate for Payer: Kaiser Permanente Medicare	$165.00
Rate for Payer: MDX Hawaii PPO	$320.10
Rate for Payer: Ohana Health Plan Medicaid	$165.00
Rate for Payer: Ohana Health Plan Medicare	$165.00
Rate for Payer: UnitedHealthcare Medicaid	$15.71
Rate for Payer: UnitedHealthcare Medicare	$165.00
Rate for Payer: University Health Alliance Commercial	$240.54

Blood Draw or Accessing Implantable Port

Facility

$330.00

Service Code	HCPCS 36592
Hospital Charge Code	11112762
Hospital Revenue Code	300
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$320.10
Rate for Payer: Cash Price	$214.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Kaiser Permanente Commercial	$297.00
Rate for Payer: MDX Hawaii PPO	$320.10

Blood Gas Arterial Cord FSI

Facility

$341.00

Service Code	HCPCS 82805
Hospital Charge Code	8395713
Hospital Revenue Code	301
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$221.65
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: MDX Hawaii PPO	$330.77

Blood Gas Arterial Cord FSI

Facility

$341.00

Service Code	HCPCS 82805
Hospital Charge Code	8395713
Hospital Revenue Code	301
Min. Negotiated Rate	$39.21
Max. Negotiated Rate	$330.77
Rate for Payer: AlohaCare Medicaid	$170.50
Rate for Payer: AlohaCare Medicare	$170.50
Rate for Payer: Cash Price	$221.65
Rate for Payer: Cash Price	$221.65
Rate for Payer: Devoted Health Medicare	$187.55
Rate for Payer: Hawaii Medical Service Association ABD	$39.21
Rate for Payer: Hawaii Medical Service Association Commercial	$98.46
Rate for Payer: Hawaii Medical Service Association Medicare	$170.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.17
Rate for Payer: Hawaii Western Management Group Commercial	$78.77
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Humana Medicare	$170.50
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: Kaiser Permanente Medicaid	$173.91
Rate for Payer: Kaiser Permanente Medicare	$170.50
Rate for Payer: MDX Hawaii PPO	$330.77
Rate for Payer: Ohana Health Plan Medicaid	$170.50
Rate for Payer: Ohana Health Plan Medicare	$170.50
Rate for Payer: UnitedHealthcare Medicaid	$39.21
Rate for Payer: UnitedHealthcare Medicare	$170.50
Rate for Payer: University Health Alliance Commercial	$73.35

Blood Gas Arterial FSI

Facility

$341.00

Service Code	HCPCS 82805
Hospital Charge Code	8128108
Hospital Revenue Code	301
Min. Negotiated Rate	$39.21
Max. Negotiated Rate	$330.77
Rate for Payer: AlohaCare Medicaid	$170.50
Rate for Payer: AlohaCare Medicare	$170.50
Rate for Payer: Cash Price	$221.65
Rate for Payer: Cash Price	$221.65
Rate for Payer: Devoted Health Medicare	$187.55
Rate for Payer: Hawaii Medical Service Association ABD	$39.21
Rate for Payer: Hawaii Medical Service Association Commercial	$98.46
Rate for Payer: Hawaii Medical Service Association Medicare	$170.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.17
Rate for Payer: Hawaii Western Management Group Commercial	$78.77
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Humana Medicare	$170.50
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: Kaiser Permanente Medicaid	$173.91
Rate for Payer: Kaiser Permanente Medicare	$170.50
Rate for Payer: MDX Hawaii PPO	$330.77
Rate for Payer: Ohana Health Plan Medicaid	$170.50
Rate for Payer: Ohana Health Plan Medicare	$170.50
Rate for Payer: UnitedHealthcare Medicaid	$39.21
Rate for Payer: UnitedHealthcare Medicare	$170.50
Rate for Payer: University Health Alliance Commercial	$73.35

Blood Gas Arterial FSI

Facility

$341.00

Service Code	HCPCS 82805
Hospital Charge Code	8128108
Hospital Revenue Code	301
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$221.65
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: MDX Hawaii PPO	$330.77

Blood Gas Capillary FSI

Facility

$341.00

Service Code	HCPCS 82805
Hospital Charge Code	8395712
Hospital Revenue Code	301
Min. Negotiated Rate	$39.21
Max. Negotiated Rate	$330.77
Rate for Payer: AlohaCare Medicaid	$170.50
Rate for Payer: AlohaCare Medicare	$170.50
Rate for Payer: Cash Price	$221.65
Rate for Payer: Cash Price	$221.65
Rate for Payer: Devoted Health Medicare	$187.55
Rate for Payer: Hawaii Medical Service Association ABD	$39.21
Rate for Payer: Hawaii Medical Service Association Commercial	$98.46
Rate for Payer: Hawaii Medical Service Association Medicare	$170.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.17
Rate for Payer: Hawaii Western Management Group Commercial	$78.77
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Humana Medicare	$170.50
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: Kaiser Permanente Medicaid	$173.91
Rate for Payer: Kaiser Permanente Medicare	$170.50
Rate for Payer: MDX Hawaii PPO	$330.77
Rate for Payer: Ohana Health Plan Medicaid	$170.50
Rate for Payer: Ohana Health Plan Medicare	$170.50
Rate for Payer: UnitedHealthcare Medicaid	$39.21
Rate for Payer: UnitedHealthcare Medicare	$170.50
Rate for Payer: University Health Alliance Commercial	$73.35

Blood Gas Capillary FSI

Facility

$341.00

Service Code	HCPCS 82805
Hospital Charge Code	8395712
Hospital Revenue Code	301
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$221.65
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: MDX Hawaii PPO	$330.77

BLOOD GAS DRAW CHARGE

Facility

$259.00

Service Code	HCPCS 82803
Hospital Charge Code	8243035
Hospital Revenue Code	301
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$168.35
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

BLOOD GAS DRAW CHARGE

Facility

$259.00

Service Code	HCPCS 82803
Hospital Charge Code	8243035
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$129.50
Rate for Payer: Cash Price	$168.35
Rate for Payer: Cash Price	$168.35
Rate for Payer: Devoted Health Medicare	$142.45
Rate for Payer: Hawaii Medical Service Association ABD	$26.74
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$129.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.08
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$129.50
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$129.50
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$129.50
Rate for Payer: Ohana Health Plan Medicare	$129.50
Rate for Payer: UnitedHealthcare Medicaid	$26.74
Rate for Payer: UnitedHealthcare Medicare	$129.50
Rate for Payer: University Health Alliance Commercial	$50.02

Blood Gases Arterial POCT

Facility

$264.00

Service Code	HCPCS 82803
Hospital Charge Code	9364577
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$256.08
Rate for Payer: AlohaCare Medicaid	$132.00
Rate for Payer: AlohaCare Medicare	$132.00
Rate for Payer: Cash Price	$171.60
Rate for Payer: Cash Price	$171.60
Rate for Payer: Devoted Health Medicare	$145.20
Rate for Payer: Hawaii Medical Service Association ABD	$26.74
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$132.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.08
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Humana Medicare	$132.00
Rate for Payer: Kaiser Permanente Commercial	$237.60
Rate for Payer: Kaiser Permanente Medicaid	$134.64
Rate for Payer: Kaiser Permanente Medicare	$132.00
Rate for Payer: MDX Hawaii PPO	$256.08
Rate for Payer: Ohana Health Plan Medicaid	$132.00
Rate for Payer: Ohana Health Plan Medicare	$132.00
Rate for Payer: UnitedHealthcare Medicaid	$26.74
Rate for Payer: UnitedHealthcare Medicare	$132.00
Rate for Payer: University Health Alliance Commercial	$50.02

Know your out-of-pocket cost for care.

All Charges