Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Rapid Flu Rfx CoV-2 FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8860988
Hospital Revenue Code	300
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.01

Rapid Flu Rfx CoV-2 FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8860988
Hospital Revenue Code	300
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Rapid Flu Rfx PCR Rfx CoV-2 FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8860989
Hospital Revenue Code	300
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.01

Rapid Flu Rfx PCR Rfx CoV-2 FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8860989
Hospital Revenue Code	300
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Rapid Influenza A/B NAAT FSI

Facility

$947.00

Service Code	HCPCS 87502
Hospital Charge Code	9905084
Hospital Revenue Code	306
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$918.59
Rate for Payer: AlohaCare Medicaid	$473.50
Rate for Payer: AlohaCare Medicare	$473.50
Rate for Payer: Cash Price	$615.55
Rate for Payer: Cash Price	$615.55
Rate for Payer: Devoted Health Medicare	$520.85
Rate for Payer: Hawaii Medical Service Association ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Medicare	$473.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$117.54
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Humana Medicare	$473.50
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: Kaiser Permanente Medicaid	$482.97
Rate for Payer: Kaiser Permanente Medicare	$473.50
Rate for Payer: MDX Hawaii PPO	$918.59
Rate for Payer: Ohana Health Plan Medicaid	$473.50
Rate for Payer: Ohana Health Plan Medicare	$473.50
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: UnitedHealthcare Medicare	$473.50
Rate for Payer: University Health Alliance Commercial	$221.54

Rapid Influenza A/B NAAT FSI

Facility

$947.00

Service Code	HCPCS 87502
Hospital Charge Code	9905084
Hospital Revenue Code	306
Min. Negotiated Rate	$804.95
Max. Negotiated Rate	$918.59
Rate for Payer: Cash Price	$615.55
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: MDX Hawaii PPO	$918.59

Rapid Molecular MRSA Screen (Nasal)

Facility

$210.00

Service Code	HCPCS 87641
Hospital Charge Code	12514759
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$203.70
Rate for Payer: AlohaCare Medicaid	$105.00
Rate for Payer: AlohaCare Medicare	$105.00
Rate for Payer: Cash Price	$136.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Devoted Health Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association ABD	$49.04
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$105.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.49
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Humana Medicare	$105.00
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: Kaiser Permanente Medicaid	$107.10
Rate for Payer: Kaiser Permanente Medicare	$105.00
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: Ohana Health Plan Medicaid	$105.00
Rate for Payer: Ohana Health Plan Medicare	$105.00
Rate for Payer: UnitedHealthcare Medicaid	$49.04
Rate for Payer: UnitedHealthcare Medicare	$105.00
Rate for Payer: University Health Alliance Commercial	$90.72

Rapid Molecular MRSA Screen (Nasal)

Facility

$210.00

Service Code	HCPCS 87641
Hospital Charge Code	12514759
Hospital Revenue Code	306
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$136.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: MDX Hawaii PPO	$203.70

Rapid Plasma Reagin with Reflex to Titer

Facility

$89.00

Service Code	HCPCS 86592
Hospital Charge Code	9189930
Hospital Revenue Code	300
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$44.50
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Devoted Health Medicare	$48.95
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$44.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$44.50
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$44.50
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$44.50
Rate for Payer: Ohana Health Plan Medicare	$44.50
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$44.50
Rate for Payer: University Health Alliance Commercial	$11.03

Rapid Plasma Reagin with Reflex to Titer

Facility

$89.00

Service Code	HCPCS 86592
Hospital Charge Code	9189930
Hospital Revenue Code	300
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

RAPID RHINO 4.5 CM

Facility

$235.00

Hospital Charge Code	9230672
Hospital Revenue Code	272
Min. Negotiated Rate	$117.50
Max. Negotiated Rate	$227.95
Rate for Payer: AlohaCare Medicaid	$117.50
Rate for Payer: AlohaCare Medicare	$117.50
Rate for Payer: Cash Price	$152.75
Rate for Payer: Devoted Health Medicare	$129.25
Rate for Payer: Hawaii Medical Service Association Medicare	$117.50
Rate for Payer: Hawaii Western Management Group Commercial	$223.25
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Humana Medicare	$117.50
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: Kaiser Permanente Medicaid	$119.85
Rate for Payer: Kaiser Permanente Medicare	$117.50
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: Ohana Health Plan Medicaid	$117.50
Rate for Payer: Ohana Health Plan Medicare	$117.50
Rate for Payer: UnitedHealthcare Medicare	$117.50
Rate for Payer: University Health Alliance Commercial	$171.29

RAPID RHINO 4.5 CM

Facility

$235.00

Hospital Charge Code	9230672
Hospital Revenue Code	272
Min. Negotiated Rate	$199.75
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$152.75
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: MDX Hawaii PPO	$227.95

RAPID RHINO 5.5 CM

Facility

$208.00

Hospital Charge Code	9230674
Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$104.00
Rate for Payer: Cash Price	$135.20
Rate for Payer: Devoted Health Medicare	$114.40
Rate for Payer: Hawaii Medical Service Association Medicare	$104.00
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$104.00
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$104.00
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$104.00
Rate for Payer: Ohana Health Plan Medicare	$104.00
Rate for Payer: UnitedHealthcare Medicare	$104.00
Rate for Payer: University Health Alliance Commercial	$151.61

RAPID RHINO 5.5 CM

Facility

$208.00

Hospital Charge Code	9230674
Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

RAPID RHINO 7.5 CM

Facility

$242.00

Hospital Charge Code	9230673
Hospital Revenue Code	272
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$234.74
Rate for Payer: AlohaCare Medicaid	$121.00
Rate for Payer: AlohaCare Medicare	$121.00
Rate for Payer: Cash Price	$157.30
Rate for Payer: Devoted Health Medicare	$133.10
Rate for Payer: Hawaii Medical Service Association Medicare	$121.00
Rate for Payer: Hawaii Western Management Group Commercial	$229.90
Rate for Payer: Health Management Network Commercial	$205.70
Rate for Payer: Humana Medicare	$121.00
Rate for Payer: Kaiser Permanente Commercial	$217.80
Rate for Payer: Kaiser Permanente Medicaid	$123.42
Rate for Payer: Kaiser Permanente Medicare	$121.00
Rate for Payer: MDX Hawaii PPO	$234.74
Rate for Payer: Ohana Health Plan Medicaid	$121.00
Rate for Payer: Ohana Health Plan Medicare	$121.00
Rate for Payer: UnitedHealthcare Medicare	$121.00
Rate for Payer: University Health Alliance Commercial	$176.39

RAPID RHINO 7.5 CM

Facility

$242.00

Hospital Charge Code	9230673
Hospital Revenue Code	272
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$234.74
Rate for Payer: Cash Price	$157.30
Rate for Payer: Health Management Network Commercial	$205.70
Rate for Payer: Kaiser Permanente Commercial	$217.80
Rate for Payer: MDX Hawaii PPO	$234.74

Rapid sequence intubation

Facility

$1,446.00

Service Code	HCPCS 31500
Hospital Charge Code	2636297
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$723.00
Rate for Payer: Cash Price	$939.90
Rate for Payer: Cash Price	$939.90
Rate for Payer: Cash Price	$939.90
Rate for Payer: Devoted Health Medicare	$795.30
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	$723.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,373.70
Rate for Payer: Health Management Network Commercial	$1,229.10
Rate for Payer: Humana Medicare	$723.00
Rate for Payer: Kaiser Permanente Commercial	$1,301.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$723.00
Rate for Payer: MDX Hawaii PPO	$1,402.62
Rate for Payer: Ohana Health Plan Medicaid	$723.00
Rate for Payer: Ohana Health Plan Medicare	$723.00
Rate for Payer: UnitedHealthcare Medicare	$723.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

Rapid sequence intubation

Facility

$1,446.00

Service Code	HCPCS 31500
Hospital Charge Code	2636297
Hospital Revenue Code	450
Min. Negotiated Rate	$1,229.10
Max. Negotiated Rate	$1,402.62
Rate for Payer: Cash Price	$939.90
Rate for Payer: Health Management Network Commercial	$1,229.10
Rate for Payer: Kaiser Permanente Commercial	$1,301.40
Rate for Payer: MDX Hawaii PPO	$1,402.62

Rapid Strep

Facility

$134.00

Service Code	HCPCS 87880 QW
Hospital Charge Code	2836317
Hospital Revenue Code	306
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

Rapid Strep

Facility

$134.00

Service Code	HCPCS 87880 QW
Hospital Charge Code	2836317
Hospital Revenue Code	306
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$67.00
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$73.70
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.66
Rate for Payer: Hawaii Medical Service Association Medicare	$67.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.53
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$67.00
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$67.00
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$67.00
Rate for Payer: Ohana Health Plan Medicare	$67.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$67.00
Rate for Payer: University Health Alliance Commercial	$31.01

Rapid Strep POCT

Facility

$134.00

Service Code	HCPCS 87880
Hospital Charge Code	9841868
Hospital Revenue Code	306
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$67.00
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$73.70
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.66
Rate for Payer: Hawaii Medical Service Association Medicare	$67.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.53
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$67.00
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$67.00
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$67.00
Rate for Payer: Ohana Health Plan Medicare	$67.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$67.00
Rate for Payer: University Health Alliance Commercial	$31.01

Rapid Strep POCT

Facility

$134.00

Service Code	HCPCS 87880
Hospital Charge Code	9841868
Hospital Revenue Code	306
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

RBC 1 Unit FSI

Facility

$339.00

Service Code	HCPCS 86920
Hospital Charge Code	11652600
Hospital Revenue Code	305
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$328.83
Rate for Payer: AlohaCare Medicaid	$169.50
Rate for Payer: AlohaCare Medicare	$169.50
Rate for Payer: Cash Price	$220.35
Rate for Payer: Cash Price	$220.35
Rate for Payer: Devoted Health Medicare	$186.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$169.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Humana Medicare	$169.50
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: Kaiser Permanente Medicaid	$172.89
Rate for Payer: Kaiser Permanente Medicare	$169.50
Rate for Payer: MDX Hawaii PPO	$328.83
Rate for Payer: Ohana Health Plan Medicaid	$169.50
Rate for Payer: Ohana Health Plan Medicare	$169.50
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$169.50
Rate for Payer: University Health Alliance Commercial	$42.35

RBC 1 Unit FSI

Facility

$339.00

Service Code	HCPCS 86920
Hospital Charge Code	11652600
Hospital Revenue Code	305
Min. Negotiated Rate	$288.15
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$220.35
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: MDX Hawaii PPO	$328.83

RBC 2 Units FSI

Facility

$339.00

Service Code	HCPCS 86920
Hospital Charge Code	11641969
Hospital Revenue Code	305
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$328.83
Rate for Payer: AlohaCare Medicaid	$169.50
Rate for Payer: AlohaCare Medicare	$169.50
Rate for Payer: Cash Price	$220.35
Rate for Payer: Cash Price	$220.35
Rate for Payer: Devoted Health Medicare	$186.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$169.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Humana Medicare	$169.50
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: Kaiser Permanente Medicaid	$172.89
Rate for Payer: Kaiser Permanente Medicare	$169.50
Rate for Payer: MDX Hawaii PPO	$328.83
Rate for Payer: Ohana Health Plan Medicaid	$169.50
Rate for Payer: Ohana Health Plan Medicare	$169.50
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$169.50
Rate for Payer: University Health Alliance Commercial	$42.35

Know your out-of-pocket cost for care.

All Charges