Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

ES TROCH NAIL, LT, 11MM X 36CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984014
Hospital Revenue Code	278
Min. Negotiated Rate	$3,404.80
Max. Negotiated Rate	$5,897.60
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 36CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984014
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 39CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984019
Hospital Revenue Code	278
Min. Negotiated Rate	$3,404.80
Max. Negotiated Rate	$5,897.60
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 39CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984019
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 42CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984020
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 42CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984020
Hospital Revenue Code	278
Min. Negotiated Rate	$3,404.80
Max. Negotiated Rate	$5,897.60
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 45CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984021
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 11MM X 45CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12984021
Hospital Revenue Code	278
Min. Negotiated Rate	$3,404.80
Max. Negotiated Rate	$5,897.60
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, LT, 12.5MM X 30CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12984022
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 30CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12984022
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 33CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12984023
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 33CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12984023
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 36CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987589
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 36CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987589
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 39CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987590
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 39CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987590
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 42CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987591
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 42CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987591
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987648
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, LT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	12987648
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

ES TROCH NAIL, RT, 10MM X 33CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12987643
Hospital Revenue Code	278
Min. Negotiated Rate	$3,404.80
Max. Negotiated Rate	$5,897.60
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, RT, 10MM X 33CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12987643
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, RT, 10MM X 36CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12987649
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, RT, 10MM X 36CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12987649
Hospital Revenue Code	278
Min. Negotiated Rate	$3,404.80
Max. Negotiated Rate	$5,897.60
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: University Health Alliance Commercial	$3,404.80

ES TROCH NAIL, RT, 10MM X 39CM X 130

Facility

$6,080.00

Service Code	HCPCS C1713
Hospital Charge Code	12987650
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.00
Max. Negotiated Rate	$5,897.60
Rate for Payer: AlohaCare Medicaid	$3,040.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$3,952.00
Rate for Payer: Devoted Health Medicare	$3,344.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,256.00
Rate for Payer: Health Management Network Commercial	$5,168.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$5,472.00
Rate for Payer: Kaiser Permanente Medicaid	$3,100.80
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$5,897.60
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$3,404.80

Know your out-of-pocket cost for care.

All Charges