Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

TROCH NAIL, LT, 12.5MM X 30CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001600
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 30CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001600
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 33CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001597
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 33CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001597
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 36CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000948
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 36CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000948
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 39CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000949
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 39CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000949
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 42CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000950
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 42CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000950
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, LT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	13000951
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

TROCH NAIL, LT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	13000951
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

TROCH NAIL, RT, 12.5MM X 30CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000952
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 30CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000952
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 33CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001001
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 33CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001001
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 36CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000998
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 36CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13000998
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 39CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001002
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 39CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001002
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 42CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001003
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 42CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001003
Hospital Revenue Code	278
Min. Negotiated Rate	$2,830.00
Max. Negotiated Rate	$5,490.20
Rate for Payer: AlohaCare Medicaid	$2,830.00
Rate for Payer: AlohaCare Medicare	$2,830.00
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Devoted Health Medicare	$3,113.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Humana Medicare	$2,830.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: Kaiser Permanente Medicaid	$2,886.60
Rate for Payer: Kaiser Permanente Medicare	$2,830.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: Ohana Health Plan Medicaid	$2,830.00
Rate for Payer: Ohana Health Plan Medicare	$2,830.00
Rate for Payer: UnitedHealthcare Medicare	$2,830.00
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	13001006
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

TROCH NAIL, RT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	13001006
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

tropicamide 1% ophth drop 15mL [HHSC]

Facility

$167.08

Service Code	NDC 70069012101
Hospital Charge Code	2500841
Hospital Revenue Code	250
Min. Negotiated Rate	$83.54
Max. Negotiated Rate	$162.07
Rate for Payer: AlohaCare Medicaid	$83.54
Rate for Payer: AlohaCare Medicare	$83.54
Rate for Payer: Cash Price	$108.60
Rate for Payer: Devoted Health Medicare	$91.89
Rate for Payer: Hawaii Medical Service Association Medicare	$83.54
Rate for Payer: Hawaii Western Management Group Commercial	$158.73
Rate for Payer: Health Management Network Commercial	$142.02
Rate for Payer: Humana Medicare	$83.54
Rate for Payer: Kaiser Permanente Commercial	$150.37
Rate for Payer: Kaiser Permanente Medicaid	$85.21
Rate for Payer: Kaiser Permanente Medicare	$83.54
Rate for Payer: MDX Hawaii PPO	$162.07
Rate for Payer: Ohana Health Plan Medicaid	$83.54
Rate for Payer: Ohana Health Plan Medicare	$83.54
Rate for Payer: UnitedHealthcare Medicaid	$100.25
Rate for Payer: UnitedHealthcare Medicare	$83.54
Rate for Payer: University Health Alliance Commercial	$121.78

Know your out-of-pocket cost for care.

All Charges