Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

SPINE & PAIN: BOSTON SCIENTIFIC NOVI PATIENT TRIAL KIT

Facility

$432.00

Hospital Charge Code	8882399
Hospital Revenue Code	272
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$419.04
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$216.00
Rate for Payer: Cash Price	$280.80
Rate for Payer: Devoted Health Medicare	$237.60
Rate for Payer: Hawaii Medical Service Association Medicare	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$216.00
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$220.32
Rate for Payer: Kaiser Permanente Medicare	$216.00
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$216.00
Rate for Payer: Ohana Health Plan Medicare	$216.00
Rate for Payer: UnitedHealthcare Medicare	$216.00
Rate for Payer: University Health Alliance Commercial	$314.88

SPINE & PAIN: BOSTON SCIENTIFIC NOVI PATIENT TRIAL KIT

Facility

$432.00

Hospital Charge Code	8882399
Hospital Revenue Code	272
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

SPINE & PAIN: BOSTON SCIENTIFIC PADDLE BANK FOR COVEREDGE 32 SURGICAL LEAD

Facility

$300.00

Hospital Charge Code	9458964
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

SPINE & PAIN: BOSTON SCIENTIFIC PADDLE BANK FOR COVEREDGE 32 SURGICAL LEAD

Facility

$300.00

Hospital Charge Code	9458964
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$150.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$165.00
Rate for Payer: Hawaii Medical Service Association Medicare	$150.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$150.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$150.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$150.00
Rate for Payer: Ohana Health Plan Medicare	$150.00
Rate for Payer: UnitedHealthcare Medicare	$150.00
Rate for Payer: University Health Alliance Commercial	$218.67

SPINE & PAIN: BOSTON SCIENTIFIC PADDLE BANK FOR COVEREDGE X 32 SURGICAL LEAD

Facility

$300.00

Hospital Charge Code	9458965
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$150.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$165.00
Rate for Payer: Hawaii Medical Service Association Medicare	$150.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$150.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$150.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$150.00
Rate for Payer: Ohana Health Plan Medicare	$150.00
Rate for Payer: UnitedHealthcare Medicare	$150.00
Rate for Payer: University Health Alliance Commercial	$218.67

SPINE & PAIN: BOSTON SCIENTIFIC PADDLE BANK FOR COVEREDGE X 32 SURGICAL LEAD

Facility

$300.00

Hospital Charge Code	9458965
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

SPINE & PAIN: BOSTON SCIENTIFIC PASSING ELEVATOR

Facility

$300.00

Hospital Charge Code	9458963
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Hawaii Western Management Group Commercial	$210.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: University Health Alliance Commercial	$168.00

SPINE & PAIN: BOSTON SCIENTIFIC PASSING ELEVATOR

Facility

$300.00

Hospital Charge Code	9458963
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$150.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$165.00
Rate for Payer: Hawaii Medical Service Association Medicare	$150.00
Rate for Payer: Hawaii Western Management Group Commercial	$210.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$150.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$150.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$150.00
Rate for Payer: Ohana Health Plan Medicare	$150.00
Rate for Payer: UnitedHealthcare Medicare	$150.00
Rate for Payer: University Health Alliance Commercial	$168.00

SPINE & PAIN: BOSTON SCIENTIFIC PATIENT TRIAL KIT - SPECTRA, NOVI, AND MONTAGE MRI SAFE

Facility

$432.00

Hospital Charge Code	8882400
Hospital Revenue Code	272
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$419.04
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$216.00
Rate for Payer: Cash Price	$280.80
Rate for Payer: Devoted Health Medicare	$237.60
Rate for Payer: Hawaii Medical Service Association Medicare	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$216.00
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$220.32
Rate for Payer: Kaiser Permanente Medicare	$216.00
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$216.00
Rate for Payer: Ohana Health Plan Medicare	$216.00
Rate for Payer: UnitedHealthcare Medicare	$216.00
Rate for Payer: University Health Alliance Commercial	$314.88

SPINE & PAIN: BOSTON SCIENTIFIC PATIENT TRIAL KIT - SPECTRA, NOVI, AND MONTAGE MRI SAFE

Facility

$432.00

Hospital Charge Code	8882400
Hospital Revenue Code	272
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

SPINE & PAIN: BOSTON SCIENTIFIC PHASE III LEAD EXTENSION 25 CM

Facility

$2,120.00

Service Code	HCPCS C1883
Hospital Charge Code	9456774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,056.40
Rate for Payer: AlohaCare Medicaid	$1,060.00
Rate for Payer: AlohaCare Medicare	$1,060.00
Rate for Payer: Cash Price	$1,378.00
Rate for Payer: Devoted Health Medicare	$1,166.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,060.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Humana Medicare	$1,060.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: Kaiser Permanente Medicaid	$1,081.20
Rate for Payer: Kaiser Permanente Medicare	$1,060.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: Ohana Health Plan Medicaid	$1,060.00
Rate for Payer: Ohana Health Plan Medicare	$1,060.00
Rate for Payer: UnitedHealthcare Medicare	$1,060.00
Rate for Payer: University Health Alliance Commercial	$1,187.20

SPINE & PAIN: BOSTON SCIENTIFIC PHASE III LEAD EXTENSION 25 CM

Facility

$2,120.00

Service Code	HCPCS C1883
Hospital Charge Code	9456774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: Cash Price	$1,378.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: University Health Alliance Commercial	$1,187.20

SPINE & PAIN: BOSTON SCIENTIFIC PHASE III LEAD EXTENSION 35 CM

Facility

$2,120.00

Service Code	HCPCS C1883
Hospital Charge Code	9458552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,056.40
Rate for Payer: AlohaCare Medicaid	$1,060.00
Rate for Payer: AlohaCare Medicare	$1,060.00
Rate for Payer: Cash Price	$1,378.00
Rate for Payer: Devoted Health Medicare	$1,166.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,060.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Humana Medicare	$1,060.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: Kaiser Permanente Medicaid	$1,081.20
Rate for Payer: Kaiser Permanente Medicare	$1,060.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: Ohana Health Plan Medicaid	$1,060.00
Rate for Payer: Ohana Health Plan Medicare	$1,060.00
Rate for Payer: UnitedHealthcare Medicare	$1,060.00
Rate for Payer: University Health Alliance Commercial	$1,187.20

SPINE & PAIN: BOSTON SCIENTIFIC PHASE III LEAD EXTENSION 35 CM

Facility

$2,120.00

Service Code	HCPCS C1883
Hospital Charge Code	9458552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: Cash Price	$1,378.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: University Health Alliance Commercial	$1,187.20

SPINE & PAIN: BOSTON SCIENTIFIC PHASE III LEAD EXTENSION 55 CM

Facility

$2,120.00

Service Code	HCPCS C1883
Hospital Charge Code	9458553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,056.40
Rate for Payer: AlohaCare Medicaid	$1,060.00
Rate for Payer: AlohaCare Medicare	$1,060.00
Rate for Payer: Cash Price	$1,378.00
Rate for Payer: Devoted Health Medicare	$1,166.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,060.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Humana Medicare	$1,060.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: Kaiser Permanente Medicaid	$1,081.20
Rate for Payer: Kaiser Permanente Medicare	$1,060.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: Ohana Health Plan Medicaid	$1,060.00
Rate for Payer: Ohana Health Plan Medicare	$1,060.00
Rate for Payer: UnitedHealthcare Medicare	$1,060.00
Rate for Payer: University Health Alliance Commercial	$1,187.20

SPINE & PAIN: BOSTON SCIENTIFIC PHASE III LEAD EXTENSION 55 CM

Facility

$2,120.00

Service Code	HCPCS C1883
Hospital Charge Code	9458553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: Cash Price	$1,378.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: University Health Alliance Commercial	$1,187.20

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION ADAPTER - 55CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882683
Hospital Revenue Code	272
Min. Negotiated Rate	$1,090.00
Max. Negotiated Rate	$2,114.60
Rate for Payer: AlohaCare Medicaid	$1,090.00
Rate for Payer: AlohaCare Medicare	$1,090.00
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Devoted Health Medicare	$1,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,090.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,071.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Humana Medicare	$1,090.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: Kaiser Permanente Medicaid	$1,111.80
Rate for Payer: Kaiser Permanente Medicare	$1,090.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: Ohana Health Plan Medicaid	$1,090.00
Rate for Payer: Ohana Health Plan Medicare	$1,090.00
Rate for Payer: UnitedHealthcare Medicare	$1,090.00
Rate for Payer: University Health Alliance Commercial	$1,589.00

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION ADAPTER - 55CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882683
Hospital Revenue Code	272
Min. Negotiated Rate	$1,853.00
Max. Negotiated Rate	$2,114.60
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: MDX Hawaii PPO	$2,114.60

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION CONNECTOR MI - 35CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882386
Hospital Revenue Code	278
Min. Negotiated Rate	$1,220.80
Max. Negotiated Rate	$2,114.60
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: University Health Alliance Commercial	$1,220.80

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION CONNECTOR MI - 35CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882386
Hospital Revenue Code	278
Min. Negotiated Rate	$1,090.00
Max. Negotiated Rate	$2,114.60
Rate for Payer: AlohaCare Medicaid	$1,090.00
Rate for Payer: AlohaCare Medicare	$1,090.00
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Devoted Health Medicare	$1,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,090.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Humana Medicare	$1,090.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: Kaiser Permanente Medicaid	$1,111.80
Rate for Payer: Kaiser Permanente Medicare	$1,090.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: Ohana Health Plan Medicaid	$1,090.00
Rate for Payer: Ohana Health Plan Medicare	$1,090.00
Rate for Payer: UnitedHealthcare Medicare	$1,090.00
Rate for Payer: University Health Alliance Commercial	$1,220.80

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION CONNECTOR MI - 55CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882387
Hospital Revenue Code	278
Min. Negotiated Rate	$1,220.80
Max. Negotiated Rate	$2,114.60
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: University Health Alliance Commercial	$1,220.80

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION CONNECTOR MI - 55CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882387
Hospital Revenue Code	278
Min. Negotiated Rate	$1,090.00
Max. Negotiated Rate	$2,114.60
Rate for Payer: AlohaCare Medicaid	$1,090.00
Rate for Payer: AlohaCare Medicare	$1,090.00
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Devoted Health Medicare	$1,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,090.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Humana Medicare	$1,090.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: Kaiser Permanente Medicaid	$1,111.80
Rate for Payer: Kaiser Permanente Medicare	$1,090.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: Ohana Health Plan Medicaid	$1,090.00
Rate for Payer: Ohana Health Plan Medicare	$1,090.00
Rate for Payer: UnitedHealthcare Medicare	$1,090.00
Rate for Payer: University Health Alliance Commercial	$1,220.80

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION CONNECTOR MI - 70CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882388
Hospital Revenue Code	278
Min. Negotiated Rate	$1,220.80
Max. Negotiated Rate	$2,114.60
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: University Health Alliance Commercial	$1,220.80

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION CONNECTOR MI - 70CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882388
Hospital Revenue Code	278
Min. Negotiated Rate	$1,090.00
Max. Negotiated Rate	$2,114.60
Rate for Payer: AlohaCare Medicaid	$1,090.00
Rate for Payer: AlohaCare Medicare	$1,090.00
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Devoted Health Medicare	$1,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,090.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Humana Medicare	$1,090.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: Kaiser Permanente Medicaid	$1,111.80
Rate for Payer: Kaiser Permanente Medicare	$1,090.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: Ohana Health Plan Medicaid	$1,090.00
Rate for Payer: Ohana Health Plan Medicare	$1,090.00
Rate for Payer: UnitedHealthcare Medicare	$1,090.00
Rate for Payer: University Health Alliance Commercial	$1,220.80

SPINE & PAIN: BOSTON SCIENTIFIC PRECISION M8 ADAPTER - 15CM

Facility

$2,180.00

Service Code	HCPCS C1883
Hospital Charge Code	8882389
Hospital Revenue Code	278
Min. Negotiated Rate	$1,090.00
Max. Negotiated Rate	$2,114.60
Rate for Payer: AlohaCare Medicaid	$1,090.00
Rate for Payer: AlohaCare Medicare	$1,090.00
Rate for Payer: Cash Price	$1,417.00
Rate for Payer: Devoted Health Medicare	$1,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,090.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,526.00
Rate for Payer: Health Management Network Commercial	$1,853.00
Rate for Payer: Humana Medicare	$1,090.00
Rate for Payer: Kaiser Permanente Commercial	$1,962.00
Rate for Payer: Kaiser Permanente Medicaid	$1,111.80
Rate for Payer: Kaiser Permanente Medicare	$1,090.00
Rate for Payer: MDX Hawaii PPO	$2,114.60
Rate for Payer: Ohana Health Plan Medicaid	$1,090.00
Rate for Payer: Ohana Health Plan Medicare	$1,090.00
Rate for Payer: UnitedHealthcare Medicare	$1,090.00
Rate for Payer: University Health Alliance Commercial	$1,220.80

Know your out-of-pocket cost for care.

All Charges