Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

PAIN & SPINE LEAD 977D160 TRIAL 3MM SUBCOMPACT 1X8

Facility

$2,700.00

Service Code	HCPCS C1778
Hospital Charge Code	8806202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: AlohaCare Medicaid	$1,350.00
Rate for Payer: AlohaCare Medicare	$1,350.00
Rate for Payer: Cash Price	$1,755.00
Rate for Payer: Devoted Health Medicare	$1,485.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,890.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Humana Medicare	$1,350.00
Rate for Payer: Kaiser Permanente Commercial	$2,430.00
Rate for Payer: Kaiser Permanente Medicaid	$1,377.00
Rate for Payer: Kaiser Permanente Medicare	$1,350.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: Ohana Health Plan Medicaid	$1,350.00
Rate for Payer: Ohana Health Plan Medicare	$1,350.00
Rate for Payer: UnitedHealthcare Medicare	$1,350.00
Rate for Payer: University Health Alliance Commercial	$1,512.00

PAIN & SPINE LEAD 977D160 TRIAL 3MM SUBCOMPACT 1X8

Facility

$2,700.00

Service Code	HCPCS C1778
Hospital Charge Code	8806202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,512.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: Cash Price	$1,755.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,890.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Commercial	$2,430.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: University Health Alliance Commercial	$1,512.00

PAIN & SPINE LEAD 977D260 TRIAL 5MM COMPACT 1X8

Facility

$2,970.00

Service Code	HCPCS C1778
Hospital Charge Code	8806203
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,880.90
Rate for Payer: AlohaCare Medicaid	$1,485.00
Rate for Payer: AlohaCare Medicare	$1,485.00
Rate for Payer: Cash Price	$1,930.50
Rate for Payer: Devoted Health Medicare	$1,633.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,485.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Humana Medicare	$1,485.00
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: Kaiser Permanente Medicaid	$1,514.70
Rate for Payer: Kaiser Permanente Medicare	$1,485.00
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: Ohana Health Plan Medicaid	$1,485.00
Rate for Payer: Ohana Health Plan Medicare	$1,485.00
Rate for Payer: UnitedHealthcare Medicare	$1,485.00
Rate for Payer: University Health Alliance Commercial	$1,663.20

PAIN & SPINE LEAD 977D260 TRIAL 5MM COMPACT 1X8

Facility

$2,970.00

Service Code	HCPCS C1778
Hospital Charge Code	8806203
Hospital Revenue Code	278
Min. Negotiated Rate	$1,663.20
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,930.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: University Health Alliance Commercial	$1,663.20

PAIN & SPINE: LEAD KIT 60CM

Facility

$5,106.00

Service Code	HCPCS C1778
Hospital Charge Code	8743137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,859.36
Max. Negotiated Rate	$4,952.82
Rate for Payer: Cash Price	$3,318.90
Rate for Payer: Hawaii Western Management Group Commercial	$3,574.20
Rate for Payer: Health Management Network Commercial	$4,340.10
Rate for Payer: Kaiser Permanente Commercial	$4,595.40
Rate for Payer: MDX Hawaii PPO	$4,952.82
Rate for Payer: University Health Alliance Commercial	$2,859.36

PAIN & SPINE: LEAD KIT 60CM

Facility

$5,106.00

Service Code	HCPCS C1778
Hospital Charge Code	8743137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,553.00
Max. Negotiated Rate	$4,952.82
Rate for Payer: AlohaCare Medicaid	$2,553.00
Rate for Payer: AlohaCare Medicare	$2,553.00
Rate for Payer: Cash Price	$3,318.90
Rate for Payer: Devoted Health Medicare	$2,808.30
Rate for Payer: Hawaii Medical Service Association Medicare	$2,553.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,574.20
Rate for Payer: Health Management Network Commercial	$4,340.10
Rate for Payer: Humana Medicare	$2,553.00
Rate for Payer: Kaiser Permanente Commercial	$4,595.40
Rate for Payer: Kaiser Permanente Medicaid	$2,604.06
Rate for Payer: Kaiser Permanente Medicare	$2,553.00
Rate for Payer: MDX Hawaii PPO	$4,952.82
Rate for Payer: Ohana Health Plan Medicaid	$2,553.00
Rate for Payer: Ohana Health Plan Medicare	$2,553.00
Rate for Payer: UnitedHealthcare Medicare	$2,553.00
Rate for Payer: University Health Alliance Commercial	$2,859.36

PAIN & SPINE: MEDTRONIC 10GA OSTEOCOOL BONE ACCESS KIT

Facility

$1,611.00

Hospital Charge Code	9334136
Hospital Revenue Code	272
Min. Negotiated Rate	$1,369.35
Max. Negotiated Rate	$1,562.67
Rate for Payer: Cash Price	$1,047.15
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: MDX Hawaii PPO	$1,562.67

PAIN & SPINE: MEDTRONIC 10GA OSTEOCOOL BONE ACCESS KIT

Facility

$1,611.00

Hospital Charge Code	9334136
Hospital Revenue Code	272
Min. Negotiated Rate	$805.50
Max. Negotiated Rate	$1,562.67
Rate for Payer: AlohaCare Medicaid	$805.50
Rate for Payer: AlohaCare Medicare	$805.50
Rate for Payer: Cash Price	$1,047.15
Rate for Payer: Devoted Health Medicare	$886.05
Rate for Payer: Hawaii Medical Service Association Medicare	$805.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,530.45
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Humana Medicare	$805.50
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: Kaiser Permanente Medicaid	$821.61
Rate for Payer: Kaiser Permanente Medicare	$805.50
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: Ohana Health Plan Medicaid	$805.50
Rate for Payer: Ohana Health Plan Medicare	$805.50
Rate for Payer: UnitedHealthcare Medicare	$805.50
Rate for Payer: University Health Alliance Commercial	$1,174.26

PAIN & SPINE: MEDTRONIC ACCESSORY KIT

Facility

$220.00

Hospital Charge Code	9533210
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

PAIN & SPINE: MEDTRONIC ACCESSORY KIT

Facility

$220.00

Hospital Charge Code	9533210
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

PAIN & SPINE: MEDTRONIC ACCESSORY KIT (TRIAL)

Facility

$220.00

Hospital Charge Code	9390094
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

PAIN & SPINE: MEDTRONIC ACCESSORY KIT (TRIAL)

Facility

$220.00

Hospital Charge Code	9390094
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

PAIN & SPINE: MEDTRONIC CONTROLLER

Facility

$3,714.00

Hospital Charge Code	8743135
Hospital Revenue Code	272
Min. Negotiated Rate	$1,857.00
Max. Negotiated Rate	$3,602.58
Rate for Payer: AlohaCare Medicaid	$1,857.00
Rate for Payer: AlohaCare Medicare	$1,857.00
Rate for Payer: Cash Price	$2,414.10
Rate for Payer: Devoted Health Medicare	$2,042.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,857.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,528.30
Rate for Payer: Health Management Network Commercial	$3,156.90
Rate for Payer: Humana Medicare	$1,857.00
Rate for Payer: Kaiser Permanente Commercial	$3,342.60
Rate for Payer: Kaiser Permanente Medicaid	$1,894.14
Rate for Payer: Kaiser Permanente Medicare	$1,857.00
Rate for Payer: MDX Hawaii PPO	$3,602.58
Rate for Payer: Ohana Health Plan Medicaid	$1,857.00
Rate for Payer: Ohana Health Plan Medicare	$1,857.00
Rate for Payer: UnitedHealthcare Medicare	$1,857.00
Rate for Payer: University Health Alliance Commercial	$2,707.13

PAIN & SPINE: MEDTRONIC CONTROLLER

Facility

$3,714.00

Hospital Charge Code	8743135
Hospital Revenue Code	272
Min. Negotiated Rate	$3,156.90
Max. Negotiated Rate	$3,602.58
Rate for Payer: Cash Price	$2,414.10
Rate for Payer: Health Management Network Commercial	$3,156.90
Rate for Payer: Kaiser Permanente Commercial	$3,342.60
Rate for Payer: MDX Hawaii PPO	$3,602.58

PAIN & SPINE: MEDTRONIC IMPLANTABLE NEUROSTIMULATOR

Facility

$20,193.00

Service Code	HCPCS C1767
Hospital Charge Code	8743138
Hospital Revenue Code	278
Min. Negotiated Rate	$11,308.08
Max. Negotiated Rate	$19,587.21
Rate for Payer: Cash Price	$13,125.45
Rate for Payer: Hawaii Western Management Group Commercial	$14,135.10
Rate for Payer: Health Management Network Commercial	$17,164.05
Rate for Payer: Kaiser Permanente Commercial	$18,173.70
Rate for Payer: MDX Hawaii PPO	$19,587.21
Rate for Payer: University Health Alliance Commercial	$11,308.08

PAIN & SPINE: MEDTRONIC IMPLANTABLE NEUROSTIMULATOR

Facility

$20,193.00

Service Code	HCPCS C1767
Hospital Charge Code	8743138
Hospital Revenue Code	278
Min. Negotiated Rate	$10,096.50
Max. Negotiated Rate	$19,587.21
Rate for Payer: AlohaCare Medicaid	$10,096.50
Rate for Payer: AlohaCare Medicare	$10,096.50
Rate for Payer: Cash Price	$13,125.45
Rate for Payer: Devoted Health Medicare	$11,106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$10,096.50
Rate for Payer: Hawaii Western Management Group Commercial	$14,135.10
Rate for Payer: Health Management Network Commercial	$17,164.05
Rate for Payer: Humana Medicare	$10,096.50
Rate for Payer: Kaiser Permanente Commercial	$18,173.70
Rate for Payer: Kaiser Permanente Medicaid	$10,298.43
Rate for Payer: Kaiser Permanente Medicare	$10,096.50
Rate for Payer: MDX Hawaii PPO	$19,587.21
Rate for Payer: Ohana Health Plan Medicaid	$10,096.50
Rate for Payer: Ohana Health Plan Medicare	$10,096.50
Rate for Payer: UnitedHealthcare Medicare	$10,096.50
Rate for Payer: University Health Alliance Commercial	$11,308.08

PAIN & SPINE: MEDTRONIC KYPHOPLASTY 15MM FIRST FRACTURE KIT

Facility

$11,514.00

Hospital Charge Code	9390095
Hospital Revenue Code	278
Min. Negotiated Rate	$6,447.84
Max. Negotiated Rate	$11,168.58
Rate for Payer: Cash Price	$7,484.10
Rate for Payer: Hawaii Western Management Group Commercial	$8,059.80
Rate for Payer: Health Management Network Commercial	$9,786.90
Rate for Payer: Kaiser Permanente Commercial	$10,362.60
Rate for Payer: MDX Hawaii PPO	$11,168.58
Rate for Payer: University Health Alliance Commercial	$6,447.84

PAIN & SPINE: MEDTRONIC KYPHOPLASTY 15MM FIRST FRACTURE KIT

Facility

$11,514.00

Hospital Charge Code	9390095
Hospital Revenue Code	278
Min. Negotiated Rate	$5,757.00
Max. Negotiated Rate	$11,168.58
Rate for Payer: AlohaCare Medicaid	$5,757.00
Rate for Payer: AlohaCare Medicare	$5,757.00
Rate for Payer: Cash Price	$7,484.10
Rate for Payer: Devoted Health Medicare	$6,332.70
Rate for Payer: Hawaii Medical Service Association Medicare	$5,757.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,059.80
Rate for Payer: Health Management Network Commercial	$9,786.90
Rate for Payer: Humana Medicare	$5,757.00
Rate for Payer: Kaiser Permanente Commercial	$10,362.60
Rate for Payer: Kaiser Permanente Medicaid	$5,872.14
Rate for Payer: Kaiser Permanente Medicare	$5,757.00
Rate for Payer: MDX Hawaii PPO	$11,168.58
Rate for Payer: Ohana Health Plan Medicaid	$5,757.00
Rate for Payer: Ohana Health Plan Medicare	$5,757.00
Rate for Payer: UnitedHealthcare Medicare	$5,757.00
Rate for Payer: University Health Alliance Commercial	$6,447.84

PAIN & SPINE: MEDTRONIC OSTEOCOOL ABLATION KIT DUAL PROBES SZ TIP 10MM 160MM 10G

Facility

$10,414.00

Hospital Charge Code	9561552
Hospital Revenue Code	272
Min. Negotiated Rate	$5,207.00
Max. Negotiated Rate	$10,101.58
Rate for Payer: AlohaCare Medicaid	$5,207.00
Rate for Payer: AlohaCare Medicare	$5,207.00
Rate for Payer: Cash Price	$6,769.10
Rate for Payer: Devoted Health Medicare	$5,727.70
Rate for Payer: Hawaii Medical Service Association Medicare	$5,207.00
Rate for Payer: Hawaii Western Management Group Commercial	$9,893.30
Rate for Payer: Health Management Network Commercial	$8,851.90
Rate for Payer: Humana Medicare	$5,207.00
Rate for Payer: Kaiser Permanente Commercial	$9,372.60
Rate for Payer: Kaiser Permanente Medicaid	$5,311.14
Rate for Payer: Kaiser Permanente Medicare	$5,207.00
Rate for Payer: MDX Hawaii PPO	$10,101.58
Rate for Payer: Ohana Health Plan Medicaid	$5,207.00
Rate for Payer: Ohana Health Plan Medicare	$5,207.00
Rate for Payer: UnitedHealthcare Medicare	$5,207.00
Rate for Payer: University Health Alliance Commercial	$7,590.76

PAIN & SPINE: MEDTRONIC OSTEOCOOL ABLATION KIT DUAL PROBES SZ TIP 10MM 160MM 10G

Facility

$10,414.00

Hospital Charge Code	9561552
Hospital Revenue Code	272
Min. Negotiated Rate	$8,851.90
Max. Negotiated Rate	$10,101.58
Rate for Payer: Cash Price	$6,769.10
Rate for Payer: Health Management Network Commercial	$8,851.90
Rate for Payer: Kaiser Permanente Commercial	$9,372.60
Rate for Payer: MDX Hawaii PPO	$10,101.58

PAIN & SPINE: MEDTRONIC RECHARGER

Facility

$2,774.00

Service Code	HCPCS L8681
Hospital Charge Code	8743136
Hospital Revenue Code	278
Min. Negotiated Rate	$92.36
Max. Negotiated Rate	$2,690.78
Rate for Payer: AlohaCare Medicaid	$1,387.00
Rate for Payer: AlohaCare Medicare	$1,387.00
Rate for Payer: Cash Price	$1,803.10
Rate for Payer: Cash Price	$1,803.10
Rate for Payer: Devoted Health Medicare	$1,525.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,387.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,941.80
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Humana Medicare	$1,387.00
Rate for Payer: Kaiser Permanente Commercial	$2,496.60
Rate for Payer: Kaiser Permanente Medicaid	$1,414.74
Rate for Payer: Kaiser Permanente Medicare	$1,387.00
Rate for Payer: MDX Hawaii PPO	$2,690.78
Rate for Payer: Ohana Health Plan Medicaid	$1,387.00
Rate for Payer: Ohana Health Plan Medicare	$1,387.00
Rate for Payer: UnitedHealthcare Medicaid	$92.36
Rate for Payer: UnitedHealthcare Medicare	$1,387.00
Rate for Payer: University Health Alliance Commercial	$1,553.44

PAIN & SPINE: MEDTRONIC RECHARGER

Facility

$2,774.00

Service Code	HCPCS L8681
Hospital Charge Code	8743136
Hospital Revenue Code	278
Min. Negotiated Rate	$1,553.44
Max. Negotiated Rate	$2,690.78
Rate for Payer: Cash Price	$1,803.10
Rate for Payer: Hawaii Western Management Group Commercial	$1,941.80
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Kaiser Permanente Commercial	$2,496.60
Rate for Payer: MDX Hawaii PPO	$2,690.78
Rate for Payer: University Health Alliance Commercial	$1,553.44

PAIN & SPINE: MEDTRONIC SPINAL BONE CEMENT AND KYPHON MIXER PACK

Facility

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	8855862
Hospital Revenue Code	278
Min. Negotiated Rate	$688.00
Max. Negotiated Rate	$1,334.72
Rate for Payer: AlohaCare Medicaid	$688.00
Rate for Payer: AlohaCare Medicare	$688.00
Rate for Payer: Cash Price	$894.40
Rate for Payer: Devoted Health Medicare	$756.80
Rate for Payer: Hawaii Medical Service Association Medicare	$688.00
Rate for Payer: Hawaii Western Management Group Commercial	$963.20
Rate for Payer: Health Management Network Commercial	$1,169.60
Rate for Payer: Humana Medicare	$688.00
Rate for Payer: Kaiser Permanente Commercial	$1,238.40
Rate for Payer: Kaiser Permanente Medicaid	$701.76
Rate for Payer: Kaiser Permanente Medicare	$688.00
Rate for Payer: MDX Hawaii PPO	$1,334.72
Rate for Payer: Ohana Health Plan Medicaid	$688.00
Rate for Payer: Ohana Health Plan Medicare	$688.00
Rate for Payer: UnitedHealthcare Medicare	$688.00
Rate for Payer: University Health Alliance Commercial	$770.56

PAIN & SPINE: MEDTRONIC SPINAL BONE CEMENT AND KYPHON MIXER PACK

Facility

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	8855862
Hospital Revenue Code	278
Min. Negotiated Rate	$770.56
Max. Negotiated Rate	$1,334.72
Rate for Payer: Cash Price	$894.40
Rate for Payer: Hawaii Western Management Group Commercial	$963.20
Rate for Payer: Health Management Network Commercial	$1,169.60
Rate for Payer: Kaiser Permanente Commercial	$1,238.40
Rate for Payer: MDX Hawaii PPO	$1,334.72
Rate for Payer: University Health Alliance Commercial	$770.56

PAIN & SPINE: MEDTRONIC SPINAL KYPHOPLASTY 10MM TRAY FIRST FRACTURE

Facility

$10,810.00

Service Code	HCPCS C1713
Hospital Charge Code	8848268
Hospital Revenue Code	278
Min. Negotiated Rate	$5,405.00
Max. Negotiated Rate	$10,485.70
Rate for Payer: AlohaCare Medicaid	$5,405.00
Rate for Payer: AlohaCare Medicare	$5,405.00
Rate for Payer: Cash Price	$7,026.50
Rate for Payer: Devoted Health Medicare	$5,945.50
Rate for Payer: Hawaii Medical Service Association Medicare	$5,405.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,567.00
Rate for Payer: Health Management Network Commercial	$9,188.50
Rate for Payer: Humana Medicare	$5,405.00
Rate for Payer: Kaiser Permanente Commercial	$9,729.00
Rate for Payer: Kaiser Permanente Medicaid	$5,513.10
Rate for Payer: Kaiser Permanente Medicare	$5,405.00
Rate for Payer: MDX Hawaii PPO	$10,485.70
Rate for Payer: Ohana Health Plan Medicaid	$5,405.00
Rate for Payer: Ohana Health Plan Medicare	$5,405.00
Rate for Payer: UnitedHealthcare Medicare	$5,405.00
Rate for Payer: University Health Alliance Commercial	$6,053.60

Know your out-of-pocket cost for care.

All Charges