Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

30020-Drainage Nasal Septum Abscess/Hematoma

Facility

$2,772.00

Service Code	HCPCS 30020
Hospital Charge Code	8080069
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,688.84
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,386.00
Rate for Payer: Cash Price	$1,801.80
Rate for Payer: Cash Price	$1,801.80
Rate for Payer: Cash Price	$1,801.80
Rate for Payer: Devoted Health Medicare	$1,524.60
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,386.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$2,356.20
Rate for Payer: Humana Medicare	$1,386.00
Rate for Payer: Kaiser Permanente Commercial	$2,494.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,386.00
Rate for Payer: MDX Hawaii PPO	$2,688.84
Rate for Payer: Ohana Health Plan Medicaid	$1,386.00
Rate for Payer: Ohana Health Plan Medicare	$1,386.00
Rate for Payer: UnitedHealthcare Medicare	$1,386.00
Rate for Payer: University Health Alliance Commercial	$2,020.51

30020-Drainage Nasal Septum Abscess/Hematoma

Facility

$2,772.00

Service Code	HCPCS 30020
Hospital Charge Code	8080069
Hospital Revenue Code	450
Min. Negotiated Rate	$2,356.20
Max. Negotiated Rate	$2,688.84
Rate for Payer: Cash Price	$1,801.80
Rate for Payer: Health Management Network Commercial	$2,356.20
Rate for Payer: Kaiser Permanente Commercial	$2,494.80
Rate for Payer: MDX Hawaii PPO	$2,688.84

30300-Intranasal

Facility

$401.00

Service Code	HCPCS 30300
Hospital Charge Code	8080145
Hospital Revenue Code	450
Min. Negotiated Rate	$200.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$200.50
Rate for Payer: Cash Price	$260.65
Rate for Payer: Cash Price	$260.65
Rate for Payer: Cash Price	$260.65
Rate for Payer: Devoted Health Medicare	$220.55
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$200.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.95
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: Humana Medicare	$200.50
Rate for Payer: Kaiser Permanente Commercial	$360.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$200.50
Rate for Payer: MDX Hawaii PPO	$388.97
Rate for Payer: Ohana Health Plan Medicaid	$200.50
Rate for Payer: Ohana Health Plan Medicare	$200.50
Rate for Payer: UnitedHealthcare Medicare	$200.50
Rate for Payer: University Health Alliance Commercial	$292.29

30300-Intranasal

Facility

$401.00

Service Code	HCPCS 30300
Hospital Charge Code	8080145
Hospital Revenue Code	450
Min. Negotiated Rate	$340.85
Max. Negotiated Rate	$388.97
Rate for Payer: Cash Price	$260.65
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: Kaiser Permanente Commercial	$360.90
Rate for Payer: MDX Hawaii PPO	$388.97

30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE

Facility

$451.00

Service Code	HCPCS 30300
Hospital Charge Code	8051015
Hospital Revenue Code	450
Min. Negotiated Rate	$383.35
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$293.15
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: MDX Hawaii PPO	$437.47

30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE

Facility

$451.00

Service Code	HCPCS 30300
Hospital Charge Code	8051015
Hospital Revenue Code	450
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$225.50
Rate for Payer: Cash Price	$293.15
Rate for Payer: Cash Price	$293.15
Rate for Payer: Cash Price	$293.15
Rate for Payer: Devoted Health Medicare	$248.05
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$225.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$428.45
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Humana Medicare	$225.50
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$225.50
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: Ohana Health Plan Medicaid	$225.50
Rate for Payer: Ohana Health Plan Medicare	$225.50
Rate for Payer: UnitedHealthcare Medicare	$225.50
Rate for Payer: University Health Alliance Commercial	$328.73

30901-Anterior Simple

Facility

$580.00

Service Code	HCPCS 30901
Hospital Charge Code	8080160
Hospital Revenue Code	450
Min. Negotiated Rate	$493.00
Max. Negotiated Rate	$562.60
Rate for Payer: Cash Price	$377.00
Rate for Payer: Health Management Network Commercial	$493.00
Rate for Payer: Kaiser Permanente Commercial	$522.00
Rate for Payer: MDX Hawaii PPO	$562.60

30901-Anterior Simple

Facility

$580.00

Service Code	HCPCS 30901
Hospital Charge Code	8080160
Hospital Revenue Code	450
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: MDX Hawaii PPO	$562.60
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$290.00
Rate for Payer: Cash Price	$377.00
Rate for Payer: Cash Price	$377.00
Rate for Payer: Cash Price	$377.00
Rate for Payer: Devoted Health Medicare	$319.00
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$290.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$551.00
Rate for Payer: Health Management Network Commercial	$493.00
Rate for Payer: Humana Medicare	$290.00
Rate for Payer: Kaiser Permanente Commercial	$522.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$290.00
Rate for Payer: Ohana Health Plan Medicaid	$290.00
Rate for Payer: Ohana Health Plan Medicare	$290.00
Rate for Payer: UnitedHealthcare Medicare	$290.00
Rate for Payer: University Health Alliance Commercial	$422.76

30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P

Facility

$629.00

Service Code	HCPCS 30901
Hospital Charge Code	8051016
Hospital Revenue Code	450
Min. Negotiated Rate	$534.65
Max. Negotiated Rate	$610.13
Rate for Payer: Cash Price	$408.85
Rate for Payer: Health Management Network Commercial	$534.65
Rate for Payer: Kaiser Permanente Commercial	$566.10
Rate for Payer: MDX Hawaii PPO	$610.13

30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P

Facility

$629.00

Service Code	HCPCS 30901
Hospital Charge Code	8051016
Hospital Revenue Code	450
Min. Negotiated Rate	$314.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$314.50
Rate for Payer: Cash Price	$408.85
Rate for Payer: Cash Price	$408.85
Rate for Payer: Cash Price	$408.85
Rate for Payer: Devoted Health Medicare	$345.95
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$314.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$597.55
Rate for Payer: Health Management Network Commercial	$534.65
Rate for Payer: Humana Medicare	$314.50
Rate for Payer: Kaiser Permanente Commercial	$566.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$314.50
Rate for Payer: MDX Hawaii PPO	$610.13
Rate for Payer: Ohana Health Plan Medicaid	$314.50
Rate for Payer: Ohana Health Plan Medicare	$314.50
Rate for Payer: UnitedHealthcare Medicare	$314.50
Rate for Payer: University Health Alliance Commercial	$458.48

30903-Anterior Complex

Facility

$665.00

Service Code	HCPCS 30903
Hospital Charge Code	8080161
Hospital Revenue Code	450
Min. Negotiated Rate	$332.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$332.50
Rate for Payer: Cash Price	$432.25
Rate for Payer: Cash Price	$432.25
Rate for Payer: Cash Price	$432.25
Rate for Payer: Devoted Health Medicare	$365.75
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$332.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$631.75
Rate for Payer: Health Management Network Commercial	$565.25
Rate for Payer: Humana Medicare	$332.50
Rate for Payer: Kaiser Permanente Commercial	$598.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$332.50
Rate for Payer: MDX Hawaii PPO	$645.05
Rate for Payer: Ohana Health Plan Medicaid	$332.50
Rate for Payer: Ohana Health Plan Medicare	$332.50
Rate for Payer: UnitedHealthcare Medicare	$332.50
Rate for Payer: University Health Alliance Commercial	$484.72

30903-Anterior Complex

Facility

$665.00

Service Code	HCPCS 30903
Hospital Charge Code	8080161
Hospital Revenue Code	450
Min. Negotiated Rate	$565.25
Max. Negotiated Rate	$645.05
Rate for Payer: Cash Price	$432.25
Rate for Payer: Health Management Network Commercial	$565.25
Rate for Payer: Kaiser Permanente Commercial	$598.50
Rate for Payer: MDX Hawaii PPO	$645.05

30905-Posterior Initial

Facility

$690.00

Service Code	HCPCS 30905
Hospital Charge Code	8080162
Hospital Revenue Code	450
Min. Negotiated Rate	$586.50
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30

30905-Posterior Initial

Facility

$690.00

Service Code	HCPCS 30905
Hospital Charge Code	8080162
Hospital Revenue Code	450
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Cash Price	$448.50
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$655.50
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$502.94

30906-Posterior Subsequent

Facility

$1,316.00

Service Code	HCPCS 30906
Hospital Charge Code	8080163
Hospital Revenue Code	450
Min. Negotiated Rate	$1,118.60
Max. Negotiated Rate	$1,276.52
Rate for Payer: Cash Price	$855.40
Rate for Payer: Health Management Network Commercial	$1,118.60
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: MDX Hawaii PPO	$1,276.52

30906-Posterior Subsequent

Facility

$1,316.00

Service Code	HCPCS 30906
Hospital Charge Code	8080163
Hospital Revenue Code	450
Min. Negotiated Rate	$525.09
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$658.00
Rate for Payer: Cash Price	$855.40
Rate for Payer: Cash Price	$855.40
Rate for Payer: Cash Price	$855.40
Rate for Payer: Devoted Health Medicare	$723.80
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$658.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,250.20
Rate for Payer: Health Management Network Commercial	$1,118.60
Rate for Payer: Humana Medicare	$658.00
Rate for Payer: Kaiser Permanente Commercial	$1,184.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$658.00
Rate for Payer: MDX Hawaii PPO	$1,276.52
Rate for Payer: Ohana Health Plan Medicaid	$658.00
Rate for Payer: Ohana Health Plan Medicare	$658.00
Rate for Payer: UnitedHealthcare Medicare	$658.00
Rate for Payer: University Health Alliance Commercial	$959.23

3-0 POLYSORB CV-25

Facility

$16.00

Hospital Charge Code	8274567
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$8.00
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association Medicare	$8.00
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$8.00
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$8.00
Rate for Payer: Ohana Health Plan Medicare	$8.00
Rate for Payer: UnitedHealthcare Medicare	$8.00
Rate for Payer: University Health Alliance Commercial	$11.66

3-0 POLYSORB CV-25

Facility

$16.00

Hospital Charge Code	8274567
Hospital Revenue Code	272
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

3.0 X 14MM VAL KREULOCK SCREW, TI

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Charge Code	12944328
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$705.25
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$607.60

3.0 X 14MM VAL KREULOCK SCREW, TI

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Charge Code	12944328
Hospital Revenue Code	278
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$542.50
Rate for Payer: Cash Price	$705.25
Rate for Payer: Devoted Health Medicare	$596.75
Rate for Payer: Hawaii Medical Service Association Medicare	$542.50
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$542.50
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$542.50
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$542.50
Rate for Payer: Ohana Health Plan Medicare	$542.50
Rate for Payer: UnitedHealthcare Medicare	$542.50
Rate for Payer: University Health Alliance Commercial	$607.60

3.0 X 18MM VAL KREULOCK SCREW, TI

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Charge Code	12953414
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$705.25
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$607.60

3.0 X 18MM VAL KREULOCK SCREW, TI

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Charge Code	12953414
Hospital Revenue Code	278
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$542.50
Rate for Payer: Cash Price	$705.25
Rate for Payer: Devoted Health Medicare	$596.75
Rate for Payer: Hawaii Medical Service Association Medicare	$542.50
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$542.50
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$542.50
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$542.50
Rate for Payer: Ohana Health Plan Medicare	$542.50
Rate for Payer: UnitedHealthcare Medicare	$542.50
Rate for Payer: University Health Alliance Commercial	$607.60

31500-Endotracheal Intubation

Facility

$1,440.00

Service Code	HCPCS 31500
Hospital Charge Code	8080170
Hospital Revenue Code	761
Min. Negotiated Rate	$1,224.00
Max. Negotiated Rate	$1,396.80
Rate for Payer: Cash Price	$936.00
Rate for Payer: Health Management Network Commercial	$1,224.00
Rate for Payer: Kaiser Permanente Commercial	$1,296.00
Rate for Payer: MDX Hawaii PPO	$1,396.80

31500-Endotracheal Intubation

Facility

$1,440.00

Service Code	HCPCS 31500
Hospital Charge Code	8080170
Hospital Revenue Code	761
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$720.00
Rate for Payer: AlohaCare Medicare	$720.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Devoted Health Medicare	$792.00
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$720.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.00
Rate for Payer: Health Management Network Commercial	$1,224.00
Rate for Payer: Humana Medicare	$720.00
Rate for Payer: Kaiser Permanente Commercial	$1,296.00
Rate for Payer: Kaiser Permanente Medicaid	$734.40
Rate for Payer: Kaiser Permanente Medicare	$720.00
Rate for Payer: MDX Hawaii PPO	$1,396.80
Rate for Payer: Ohana Health Plan Medicaid	$720.00
Rate for Payer: Ohana Health Plan Medicare	$720.00
Rate for Payer: UnitedHealthcare Medicaid	$93.64
Rate for Payer: UnitedHealthcare Medicare	$720.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee

Facility

$1,650.00

Service Code	HCPCS 31500
Hospital Charge Code	8211215
Hospital Revenue Code	761
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$825.00
Rate for Payer: Cash Price	$1,072.50
Rate for Payer: Cash Price	$1,072.50
Rate for Payer: Cash Price	$1,072.50
Rate for Payer: Devoted Health Medicare	$907.50
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$825.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.50
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$825.00
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$825.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$825.00
Rate for Payer: Ohana Health Plan Medicare	$825.00
Rate for Payer: UnitedHealthcare Medicaid	$93.64
Rate for Payer: UnitedHealthcare Medicare	$825.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

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