Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Cortisol Level FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8117893
Hospital Revenue Code	301
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84

Cortisol Level FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8117893
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$86.00
Rate for Payer: AlohaCare Medicare	$86.00
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$94.60
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$86.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$86.00
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$86.00
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$86.00
Rate for Payer: Ohana Health Plan Medicare	$86.00
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$86.00
Rate for Payer: University Health Alliance Commercial	$42.14

Cortisol, P.M.

Facility

$128.00

Service Code	HCPCS 82533
Hospital Charge Code	12514248
Hospital Revenue Code	301
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

Cortisol, P.M.

Facility

$128.00

Service Code	HCPCS 82533
Hospital Charge Code	12514248
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
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	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$64.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
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	$22.53
Rate for Payer: UnitedHealthcare Medicare	$64.00
Rate for Payer: University Health Alliance Commercial	$42.14

cosyntropin 0.25 mg vial [HHSC]

Facility

$435.35

Service Code	HCPCS J0834
Hospital Charge Code	2500209
Hospital Revenue Code	250
Min. Negotiated Rate	$370.05
Max. Negotiated Rate	$422.29
Rate for Payer: Cash Price	$282.98
Rate for Payer: Cash Price	$331.04
Rate for Payer: Health Management Network Commercial	$370.05
Rate for Payer: Health Management Network Commercial	$432.90
Rate for Payer: Kaiser Permanente Commercial	$391.81
Rate for Payer: Kaiser Permanente Commercial	$458.37
Rate for Payer: MDX Hawaii PPO	$494.02
Rate for Payer: MDX Hawaii PPO	$422.29

cosyntropin 0.25 mg vial [HHSC]

Facility

$435.35

Service Code	HCPCS J0834
Hospital Charge Code	2500209
Hospital Revenue Code	636
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$422.29
Rate for Payer: AlohaCare Medicaid	$217.68
Rate for Payer: AlohaCare Medicaid	$254.65
Rate for Payer: AlohaCare Medicare	$254.65
Rate for Payer: AlohaCare Medicare	$217.68
Rate for Payer: Cash Price	$331.04
Rate for Payer: Cash Price	$282.98
Rate for Payer: Cash Price	$282.98
Rate for Payer: Cash Price	$331.04
Rate for Payer: Devoted Health Medicare	$239.44
Rate for Payer: Devoted Health Medicare	$280.12
Rate for Payer: Hawaii Medical Service Association ABD	$28.02
Rate for Payer: Hawaii Medical Service Association ABD	$28.02
Rate for Payer: Hawaii Medical Service Association Medicare	$254.65
Rate for Payer: Hawaii Medical Service Association Medicare	$217.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.02
Rate for Payer: Hawaii Western Management Group Commercial	$413.58
Rate for Payer: Hawaii Western Management Group Commercial	$483.83
Rate for Payer: Health Management Network Commercial	$432.90
Rate for Payer: Health Management Network Commercial	$370.05
Rate for Payer: Humana Medicare	$217.68
Rate for Payer: Humana Medicare	$254.65
Rate for Payer: Kaiser Permanente Commercial	$391.81
Rate for Payer: Kaiser Permanente Commercial	$458.37
Rate for Payer: Kaiser Permanente Medicaid	$259.74
Rate for Payer: Kaiser Permanente Medicaid	$222.03
Rate for Payer: Kaiser Permanente Medicare	$217.68
Rate for Payer: Kaiser Permanente Medicare	$254.65
Rate for Payer: MDX Hawaii PPO	$422.29
Rate for Payer: MDX Hawaii PPO	$494.02
Rate for Payer: Ohana Health Plan Medicaid	$254.65
Rate for Payer: Ohana Health Plan Medicaid	$217.68
Rate for Payer: Ohana Health Plan Medicare	$217.68
Rate for Payer: Ohana Health Plan Medicare	$254.65
Rate for Payer: UnitedHealthcare Medicaid	$305.58
Rate for Payer: UnitedHealthcare Medicaid	$261.21
Rate for Payer: UnitedHealthcare Medicare	$217.68
Rate for Payer: UnitedHealthcare Medicare	$254.65
Rate for Payer: University Health Alliance Commercial	$317.33
Rate for Payer: University Health Alliance Commercial	$371.23

COVID19 AG IA POC

Facility

$239.00

Service Code	HCPCS 87426 QW
Hospital Charge Code	9401769
Hospital Revenue Code	301
Min. Negotiated Rate	$203.15
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$155.35
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: MDX Hawaii PPO	$231.83

COVID19 AG IA POC

Facility

$239.00

Service Code	HCPCS 87426 QW
Hospital Charge Code	9401769
Hospital Revenue Code	301
Min. Negotiated Rate	$35.33
Max. Negotiated Rate	$231.83
Rate for Payer: AlohaCare Medicaid	$119.50
Rate for Payer: AlohaCare Medicare	$119.50
Rate for Payer: Cash Price	$155.35
Rate for Payer: Cash Price	$155.35
Rate for Payer: Devoted Health Medicare	$131.45
Rate for Payer: Hawaii Medical Service Association ABD	$45.00
Rate for Payer: Hawaii Medical Service Association Commercial	$44.16
Rate for Payer: Hawaii Medical Service Association Medicare	$119.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$35.33
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Humana Medicare	$119.50
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: Kaiser Permanente Medicaid	$121.89
Rate for Payer: Kaiser Permanente Medicare	$119.50
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: Ohana Health Plan Medicaid	$119.50
Rate for Payer: Ohana Health Plan Medicare	$119.50
Rate for Payer: UnitedHealthcare Medicaid	$35.33
Rate for Payer: UnitedHealthcare Medicare	$119.50
Rate for Payer: University Health Alliance Commercial	$174.21

Covid 19 AG IA POC RE

Facility

$42.00

Service Code	HCPCS 87811 QW
Hospital Charge Code	10298744
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$51.73
Rate for Payer: AlohaCare Medicaid	$21.00
Rate for Payer: AlohaCare Medicare	$21.00
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Devoted Health Medicare	$23.10
Rate for Payer: Hawaii Medical Service Association ABD	$41.38
Rate for Payer: Hawaii Medical Service Association Commercial	$51.73
Rate for Payer: Hawaii Medical Service Association Medicare	$21.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$41.38
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Humana Medicare	$21.00
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$21.42
Rate for Payer: Kaiser Permanente Medicare	$21.00
Rate for Payer: MDX Hawaii PPO	$40.74
Rate for Payer: Ohana Health Plan Medicaid	$21.00
Rate for Payer: Ohana Health Plan Medicare	$21.00
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: UnitedHealthcare Medicare	$21.00
Rate for Payer: University Health Alliance Commercial	$30.61

Covid 19 AG IA POC RE

Facility

$42.00

Service Code	HCPCS 87811 QW
Hospital Charge Code	10298744
Hospital Revenue Code	306
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$27.30
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: MDX Hawaii PPO	$40.74

COVID-19 Vaccine IM Administration (Janssen) Single Dose_HOSP

Facility

$101.00

Service Code	HCPCS 0031A
Hospital Charge Code	9386123
Hospital Revenue Code	771
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$65.65
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: MDX Hawaii PPO	$97.97

COVID-19 Vaccine IM Administration (Janssen) Single Dose_HOSP

Facility

$101.00

Service Code	HCPCS 0031A
Hospital Charge Code	9386123
Hospital Revenue Code	771
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$50.50
Rate for Payer: AlohaCare Medicare	$50.50
Rate for Payer: Cash Price	$65.65
Rate for Payer: Devoted Health Medicare	$55.55
Rate for Payer: Hawaii Medical Service Association Medicare	$50.50
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$50.50
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$50.50
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$50.50
Rate for Payer: Ohana Health Plan Medicare	$50.50
Rate for Payer: UnitedHealthcare Medicare	$50.50
Rate for Payer: University Health Alliance Commercial	$73.62

COVID-19 Vaccine IM Administration (MODERNA) First Dose

Facility

$142.00

Service Code	HCPCS 0011A
Hospital Charge Code	9328301
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$103.50

COVID-19 Vaccine IM Administration (MODERNA) First Dose

Facility

$142.00

Service Code	HCPCS 0011A
Hospital Charge Code	9328301
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

COVID-19 Vaccine IM Administration (MODERNA) Second Dose

Facility

$142.00

Service Code	HCPCS 0012A
Hospital Charge Code	9328302
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

COVID-19 Vaccine IM Administration (MODERNA) Second Dose

Facility

$142.00

Service Code	HCPCS 0012A
Hospital Charge Code	9328302
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$103.50

COVID-19 Vaccine IM Administration (MODERNA) Third Dose

Facility

$142.00

Service Code	HCPCS 0013A
Hospital Charge Code	9629662
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

COVID-19 Vaccine IM Administration (MODERNA) Third Dose

Facility

$142.00

Service Code	HCPCS 0013A
Hospital Charge Code	9629662
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$103.50

COVID-19 Vaccine IM Administration (PFIZER) First Dose

Facility

$142.00

Service Code	HCPCS 0001A
Hospital Charge Code	9328303
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

COVID-19 Vaccine IM Administration (PFIZER) First Dose

Facility

$142.00

Service Code	HCPCS 0001A
Hospital Charge Code	9328303
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$103.50

COVID-19 Vaccine IM Administration (PFIZER) Second Dose

Facility

$142.00

Service Code	HCPCS 0002A
Hospital Charge Code	9328304
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

COVID-19 Vaccine IM Administration (PFIZER) Second Dose

Facility

$142.00

Service Code	HCPCS 0002A
Hospital Charge Code	9328304
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$103.50

COVID-19 Vaccine IM Administration (PFIZER) Third Dose

Facility

$142.00

Service Code	HCPCS 0003A
Hospital Charge Code	9629660
Hospital Revenue Code	771
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$103.50

COVID-19 Vaccine IM Administration (PFIZER) Third Dose

Facility

$142.00

Service Code	HCPCS 0003A
Hospital Charge Code	9629660
Hospital Revenue Code	771
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Covid, Flu AB by PCR (Cepheid) FSI

Facility

$561.00

Service Code	HCPCS 87636 QW
Hospital Charge Code	12862434
Hospital Revenue Code	306
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$544.17
Rate for Payer: AlohaCare Medicaid	$280.50
Rate for Payer: AlohaCare Medicare	$280.50
Rate for Payer: Cash Price	$364.65
Rate for Payer: Cash Price	$364.65
Rate for Payer: Devoted Health Medicare	$308.55
Rate for Payer: Hawaii Medical Service Association ABD	$142.63
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$280.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$142.63
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$476.85
Rate for Payer: Humana Medicare	$280.50
Rate for Payer: Kaiser Permanente Commercial	$504.90
Rate for Payer: Kaiser Permanente Medicaid	$286.11
Rate for Payer: Kaiser Permanente Medicare	$280.50
Rate for Payer: MDX Hawaii PPO	$544.17
Rate for Payer: Ohana Health Plan Medicaid	$280.50
Rate for Payer: Ohana Health Plan Medicare	$280.50
Rate for Payer: UnitedHealthcare Medicaid	$142.63
Rate for Payer: UnitedHealthcare Medicare	$280.50
Rate for Payer: University Health Alliance Commercial	$408.91

Know your out-of-pocket cost for care.

All Charges