Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

PAIN & SPINE: COOLED RF KIT 17G/150MM/4MM

Facility

$2,250.00

Hospital Charge Code	10721827
Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,462.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

PAIN & SPINE: COOLED RF KIT 17G/150MM/4MM

Facility

$2,250.00

Hospital Charge Code	10721827
Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,125.00
Rate for Payer: Cash Price	$1,462.50
Rate for Payer: Devoted Health Medicare	$1,237.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,125.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,125.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,125.00
Rate for Payer: Ohana Health Plan Medicare	$1,125.00
Rate for Payer: UnitedHealthcare Medicare	$1,125.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

PAIN & SPINE: COOLED RF KIT 17G/50MM/4MM

Facility

$2,250.00

Hospital Charge Code	10500432
Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,462.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

PAIN & SPINE: COOLED RF KIT 17G/50MM/4MM

Facility

$2,250.00

Hospital Charge Code	10500432
Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,125.00
Rate for Payer: Cash Price	$1,462.50
Rate for Payer: Devoted Health Medicare	$1,237.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,125.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,125.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,125.00
Rate for Payer: Ohana Health Plan Medicare	$1,125.00
Rate for Payer: UnitedHealthcare Medicare	$1,125.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

PAIN & SPINE COOLIEF COOLED RADIOFREQUENCY KIT 50

Facility

$2,250.00

Hospital Charge Code	9036238
Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,462.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

PAIN & SPINE COOLIEF COOLED RADIOFREQUENCY KIT 50

Facility

$2,250.00

Hospital Charge Code	9036238
Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,125.00
Rate for Payer: Cash Price	$1,462.50
Rate for Payer: Devoted Health Medicare	$1,237.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,125.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,125.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,125.00
Rate for Payer: Ohana Health Plan Medicare	$1,125.00
Rate for Payer: UnitedHealthcare Medicare	$1,125.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

PAIN & SPINE: DBM PUTTY 1.0cc

Facility

$807.00

Service Code	HCPCS C9359
Hospital Charge Code	11452143
Hospital Revenue Code	278
Min. Negotiated Rate	$403.50
Max. Negotiated Rate	$782.79
Rate for Payer: AlohaCare Medicaid	$403.50
Rate for Payer: AlohaCare Medicare	$403.50
Rate for Payer: Cash Price	$524.55
Rate for Payer: Devoted Health Medicare	$443.85
Rate for Payer: Hawaii Medical Service Association Medicare	$403.50
Rate for Payer: Hawaii Western Management Group Commercial	$564.90
Rate for Payer: Health Management Network Commercial	$685.95
Rate for Payer: Humana Medicare	$403.50
Rate for Payer: Kaiser Permanente Commercial	$726.30
Rate for Payer: Kaiser Permanente Medicaid	$411.57
Rate for Payer: Kaiser Permanente Medicare	$403.50
Rate for Payer: MDX Hawaii PPO	$782.79
Rate for Payer: Ohana Health Plan Medicaid	$403.50
Rate for Payer: Ohana Health Plan Medicare	$403.50
Rate for Payer: UnitedHealthcare Medicare	$403.50
Rate for Payer: University Health Alliance Commercial	$451.92

PAIN & SPINE: DBM PUTTY 1.0cc

Facility

$807.00

Service Code	HCPCS C9359
Hospital Charge Code	11452143
Hospital Revenue Code	278
Min. Negotiated Rate	$451.92
Max. Negotiated Rate	$782.79
Rate for Payer: Cash Price	$524.55
Rate for Payer: Hawaii Western Management Group Commercial	$564.90
Rate for Payer: Health Management Network Commercial	$685.95
Rate for Payer: Kaiser Permanente Commercial	$726.30
Rate for Payer: MDX Hawaii PPO	$782.79
Rate for Payer: University Health Alliance Commercial	$451.92

PAIN & SPINE EXTENSION 3708120 1X8 20CM

Facility

$1,785.00

Service Code	HCPCS C1883
Hospital Charge Code	8806216
Hospital Revenue Code	278
Min. Negotiated Rate	$999.60
Max. Negotiated Rate	$1,731.45
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Kaiser Permanente Commercial	$1,606.50
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: University Health Alliance Commercial	$999.60

PAIN & SPINE EXTENSION 3708120 1X8 20CM

Facility

$1,785.00

Service Code	HCPCS C1883
Hospital Charge Code	8806216
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,731.45
Rate for Payer: AlohaCare Medicaid	$892.50
Rate for Payer: AlohaCare Medicare	$892.50
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Devoted Health Medicare	$981.75
Rate for Payer: Hawaii Medical Service Association Medicare	$892.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Humana Medicare	$892.50
Rate for Payer: Kaiser Permanente Commercial	$1,606.50
Rate for Payer: Kaiser Permanente Medicaid	$910.35
Rate for Payer: Kaiser Permanente Medicare	$892.50
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: Ohana Health Plan Medicaid	$892.50
Rate for Payer: Ohana Health Plan Medicare	$892.50
Rate for Payer: UnitedHealthcare Medicare	$892.50
Rate for Payer: University Health Alliance Commercial	$999.60

PAIN & SPINE EXTENSION 3708140 1X8 20CM

Facility

$1,785.00

Service Code	HCPCS C1883
Hospital Charge Code	8806217
Hospital Revenue Code	278
Min. Negotiated Rate	$999.60
Max. Negotiated Rate	$1,731.45
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Kaiser Permanente Commercial	$1,606.50
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: University Health Alliance Commercial	$999.60

PAIN & SPINE EXTENSION 3708140 1X8 20CM

Facility

$1,785.00

Service Code	HCPCS C1883
Hospital Charge Code	8806217
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,731.45
Rate for Payer: AlohaCare Medicaid	$892.50
Rate for Payer: AlohaCare Medicare	$892.50
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Devoted Health Medicare	$981.75
Rate for Payer: Hawaii Medical Service Association Medicare	$892.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Humana Medicare	$892.50
Rate for Payer: Kaiser Permanente Commercial	$1,606.50
Rate for Payer: Kaiser Permanente Medicaid	$910.35
Rate for Payer: Kaiser Permanente Medicare	$892.50
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: Ohana Health Plan Medicaid	$892.50
Rate for Payer: Ohana Health Plan Medicare	$892.50
Rate for Payer: UnitedHealthcare Medicare	$892.50
Rate for Payer: University Health Alliance Commercial	$999.60

PAIN & SPINE EXTENSION 3708160 1X8 60CM

Facility

$1,785.00

Service Code	HCPCS C1883
Hospital Charge Code	8806218
Hospital Revenue Code	278
Min. Negotiated Rate	$999.60
Max. Negotiated Rate	$1,731.45
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Kaiser Permanente Commercial	$1,606.50
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: University Health Alliance Commercial	$999.60

PAIN & SPINE EXTENSION 3708160 1X8 60CM

Facility

$1,785.00

Service Code	HCPCS C1883
Hospital Charge Code	8806218
Hospital Revenue Code	278
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,731.45
Rate for Payer: AlohaCare Medicaid	$892.50
Rate for Payer: AlohaCare Medicare	$892.50
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Devoted Health Medicare	$981.75
Rate for Payer: Hawaii Medical Service Association Medicare	$892.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Humana Medicare	$892.50
Rate for Payer: Kaiser Permanente Commercial	$1,606.50
Rate for Payer: Kaiser Permanente Medicaid	$910.35
Rate for Payer: Kaiser Permanente Medicare	$892.50
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: Ohana Health Plan Medicaid	$892.50
Rate for Payer: Ohana Health Plan Medicare	$892.50
Rate for Payer: UnitedHealthcare Medicare	$892.50
Rate for Payer: University Health Alliance Commercial	$999.60

PAIN & SPINE EXTENSION 3708220 8-2-4 OCTAPOLAR 20CM

Facility

$2,985.00

Service Code	HCPCS C1883
Hospital Charge Code	8806219
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,895.45
Rate for Payer: AlohaCare Medicaid	$1,492.50
Rate for Payer: AlohaCare Medicare	$1,492.50
Rate for Payer: Cash Price	$1,940.25
Rate for Payer: Devoted Health Medicare	$1,641.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,492.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Humana Medicare	$1,492.50
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: Kaiser Permanente Medicare	$1,492.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: Ohana Health Plan Medicaid	$1,492.50
Rate for Payer: Ohana Health Plan Medicare	$1,492.50
Rate for Payer: UnitedHealthcare Medicare	$1,492.50
Rate for Payer: University Health Alliance Commercial	$1,671.60

PAIN & SPINE EXTENSION 3708220 8-2-4 OCTAPOLAR 20CM

Facility

$2,985.00

Service Code	HCPCS C1883
Hospital Charge Code	8806219
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,940.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

PAIN & SPINE EXTENSION 3708240 8-2-4 OCTAPOLAR 40CM

Facility

$2,985.00

Service Code	HCPCS C1883
Hospital Charge Code	8806220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,940.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

PAIN & SPINE EXTENSION 3708240 8-2-4 OCTAPOLAR 40CM

Facility

$2,985.00

Service Code	HCPCS C1883
Hospital Charge Code	8806220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,895.45
Rate for Payer: AlohaCare Medicaid	$1,492.50
Rate for Payer: AlohaCare Medicare	$1,492.50
Rate for Payer: Cash Price	$1,940.25
Rate for Payer: Devoted Health Medicare	$1,641.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,492.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Humana Medicare	$1,492.50
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: Kaiser Permanente Medicare	$1,492.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: Ohana Health Plan Medicaid	$1,492.50
Rate for Payer: Ohana Health Plan Medicare	$1,492.50
Rate for Payer: UnitedHealthcare Medicare	$1,492.50
Rate for Payer: University Health Alliance Commercial	$1,671.60

PAIN & SPINE EXTENSION 3708260 8-2-4 OCTAPOLAR 60CM

Facility

$2,985.00

Service Code	HCPCS C1883
Hospital Charge Code	8806221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,895.45
Rate for Payer: AlohaCare Medicaid	$1,492.50
Rate for Payer: AlohaCare Medicare	$1,492.50
Rate for Payer: Cash Price	$1,940.25
Rate for Payer: Devoted Health Medicare	$1,641.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,492.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Humana Medicare	$1,492.50
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: Kaiser Permanente Medicare	$1,492.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: Ohana Health Plan Medicaid	$1,492.50
Rate for Payer: Ohana Health Plan Medicare	$1,492.50
Rate for Payer: UnitedHealthcare Medicare	$1,492.50
Rate for Payer: University Health Alliance Commercial	$1,671.60

PAIN & SPINE EXTENSION 3708260 8-2-4 OCTAPOLAR 60CM

Facility

$2,985.00

Service Code	HCPCS C1883
Hospital Charge Code	8806221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,940.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

PAIN & SPINE EXTENSION 3708320 4X8 LZ .110SP 20CM

Facility

$2,085.00

Service Code	HCPCS C1883
Hospital Charge Code	8806222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$1,042.50
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Devoted Health Medicare	$1,146.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,042.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$1,042.50
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$1,042.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$1,042.50
Rate for Payer: Ohana Health Plan Medicare	$1,042.50
Rate for Payer: UnitedHealthcare Medicare	$1,042.50
Rate for Payer: University Health Alliance Commercial	$1,167.60

PAIN & SPINE EXTENSION 3708320 4X8 LZ .110SP 20CM

Facility

$2,085.00

Service Code	HCPCS C1883
Hospital Charge Code	8806222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.60
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: University Health Alliance Commercial	$1,167.60

PAIN & SPINE EXTENSION 3708340 4X8 LZ .110SP 40CM

Facility

$2,085.00

Service Code	HCPCS C1883
Hospital Charge Code	8806223
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$1,042.50
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Devoted Health Medicare	$1,146.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,042.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$1,042.50
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$1,042.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$1,042.50
Rate for Payer: Ohana Health Plan Medicare	$1,042.50
Rate for Payer: UnitedHealthcare Medicare	$1,042.50
Rate for Payer: University Health Alliance Commercial	$1,167.60

PAIN & SPINE EXTENSION 3708340 4X8 LZ .110SP 40CM

Facility

$2,085.00

Service Code	HCPCS C1883
Hospital Charge Code	8806223
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.60
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: University Health Alliance Commercial	$1,167.60

PAIN & SPINE EXTENSION 3708360 4X8 LZ .110SP 60CM

Facility

$2,085.00

Service Code	HCPCS C1883
Hospital Charge Code	8806224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$1,042.50
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Devoted Health Medicare	$1,146.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,042.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$1,042.50
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$1,042.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$1,042.50
Rate for Payer: Ohana Health Plan Medicare	$1,042.50
Rate for Payer: UnitedHealthcare Medicare	$1,042.50
Rate for Payer: University Health Alliance Commercial	$1,167.60

Know your out-of-pocket cost for care.

All Charges