Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

vancomycin 125 mg capsule [HHSC]

Facility

$149.17

Service Code	NDC 68180016613
Hospital Charge Code	2500847
Hospital Revenue Code	250
Min. Negotiated Rate	$126.79
Max. Negotiated Rate	$144.69
Rate for Payer: Cash Price	$96.96
Rate for Payer: Health Management Network Commercial	$126.79
Rate for Payer: Kaiser Permanente Commercial	$134.25
Rate for Payer: MDX Hawaii PPO	$144.69

vancomycin 125 mg capsule [HHSC]

Facility

$149.17

Service Code	NDC 68180016613
Hospital Charge Code	2500847
Hospital Revenue Code	250
Min. Negotiated Rate	$74.58
Max. Negotiated Rate	$144.69
Rate for Payer: AlohaCare Medicaid	$74.58
Rate for Payer: AlohaCare Medicare	$74.58
Rate for Payer: Cash Price	$96.96
Rate for Payer: Devoted Health Medicare	$82.04
Rate for Payer: Hawaii Medical Service Association Medicare	$74.58
Rate for Payer: Hawaii Western Management Group Commercial	$141.71
Rate for Payer: Health Management Network Commercial	$126.79
Rate for Payer: Humana Medicare	$74.58
Rate for Payer: Kaiser Permanente Commercial	$134.25
Rate for Payer: Kaiser Permanente Medicaid	$76.08
Rate for Payer: Kaiser Permanente Medicare	$74.58
Rate for Payer: MDX Hawaii PPO	$144.69
Rate for Payer: Ohana Health Plan Medicaid	$74.58
Rate for Payer: Ohana Health Plan Medicare	$74.58
Rate for Payer: UnitedHealthcare Medicaid	$89.50
Rate for Payer: UnitedHealthcare Medicare	$74.58
Rate for Payer: University Health Alliance Commercial	$108.73

vancomycin 125 mg capsule [HHSC]

Facility

$149.01

Service Code	NDC 00121086720
Hospital Charge Code	2500847
Hospital Revenue Code	250
Min. Negotiated Rate	$126.66
Max. Negotiated Rate	$144.54
Rate for Payer: Cash Price	$96.86
Rate for Payer: Health Management Network Commercial	$126.66
Rate for Payer: Kaiser Permanente Commercial	$134.11
Rate for Payer: MDX Hawaii PPO	$144.54

vancomycin 1500mg/300mL-SWFI premix [HHSC]

Facility

$133.52

Service Code	HCPCS J3375
Hospital Charge Code	2501012
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$129.51
Rate for Payer: AlohaCare Medicaid	$66.76
Rate for Payer: AlohaCare Medicare	$66.76
Rate for Payer: Cash Price	$86.79
Rate for Payer: Cash Price	$86.79
Rate for Payer: Devoted Health Medicare	$73.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$66.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$126.84
Rate for Payer: Health Management Network Commercial	$113.49
Rate for Payer: Humana Medicare	$66.76
Rate for Payer: Kaiser Permanente Commercial	$120.17
Rate for Payer: Kaiser Permanente Medicaid	$68.10
Rate for Payer: Kaiser Permanente Medicare	$66.76
Rate for Payer: MDX Hawaii PPO	$129.51
Rate for Payer: Ohana Health Plan Medicaid	$66.76
Rate for Payer: Ohana Health Plan Medicare	$66.76
Rate for Payer: UnitedHealthcare Medicaid	$80.11
Rate for Payer: UnitedHealthcare Medicare	$66.76
Rate for Payer: University Health Alliance Commercial	$97.32

vancomycin 1500mg/300mL-SWFI premix [HHSC]

Facility

$133.52

Service Code	HCPCS J3375
Hospital Charge Code	2501012
Hospital Revenue Code	250
Min. Negotiated Rate	$113.49
Max. Negotiated Rate	$129.51
Rate for Payer: Cash Price	$86.79
Rate for Payer: Health Management Network Commercial	$113.49
Rate for Payer: Kaiser Permanente Commercial	$120.17
Rate for Payer: MDX Hawaii PPO	$129.51

vancomycin 1750mg/350mL-SWFI premix [HHSC]

Facility

$148.56

Service Code	HCPCS J3375
Hospital Charge Code	2501153
Hospital Revenue Code	250
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$144.10
Rate for Payer: Cash Price	$96.56
Rate for Payer: Health Management Network Commercial	$126.28
Rate for Payer: Kaiser Permanente Commercial	$133.70
Rate for Payer: MDX Hawaii PPO	$144.10

vancomycin 1750mg/350mL-SWFI premix [HHSC]

Facility

$148.56

Service Code	HCPCS J3375
Hospital Charge Code	2501153
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$144.10
Rate for Payer: AlohaCare Medicaid	$74.28
Rate for Payer: AlohaCare Medicare	$74.28
Rate for Payer: Cash Price	$96.56
Rate for Payer: Cash Price	$96.56
Rate for Payer: Devoted Health Medicare	$81.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$74.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$141.13
Rate for Payer: Health Management Network Commercial	$126.28
Rate for Payer: Humana Medicare	$74.28
Rate for Payer: Kaiser Permanente Commercial	$133.70
Rate for Payer: Kaiser Permanente Medicaid	$75.77
Rate for Payer: Kaiser Permanente Medicare	$74.28
Rate for Payer: MDX Hawaii PPO	$144.10
Rate for Payer: Ohana Health Plan Medicaid	$74.28
Rate for Payer: Ohana Health Plan Medicare	$74.28
Rate for Payer: UnitedHealthcare Medicaid	$89.14
Rate for Payer: UnitedHealthcare Medicare	$74.28
Rate for Payer: University Health Alliance Commercial	$108.29

vancomycin 2000mg/400mL-SWFI premix [HHSC]

Facility

$158.60

Service Code	HCPCS J3375
Hospital Charge Code	2501029
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$153.84
Rate for Payer: AlohaCare Medicaid	$79.30
Rate for Payer: AlohaCare Medicare	$79.30
Rate for Payer: Cash Price	$103.09
Rate for Payer: Cash Price	$103.09
Rate for Payer: Devoted Health Medicare	$87.23
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$79.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$150.67
Rate for Payer: Health Management Network Commercial	$134.81
Rate for Payer: Humana Medicare	$79.30
Rate for Payer: Kaiser Permanente Commercial	$142.74
Rate for Payer: Kaiser Permanente Medicaid	$80.89
Rate for Payer: Kaiser Permanente Medicare	$79.30
Rate for Payer: MDX Hawaii PPO	$153.84
Rate for Payer: Ohana Health Plan Medicaid	$79.30
Rate for Payer: Ohana Health Plan Medicare	$79.30
Rate for Payer: UnitedHealthcare Medicaid	$95.16
Rate for Payer: UnitedHealthcare Medicare	$79.30
Rate for Payer: University Health Alliance Commercial	$115.60

vancomycin 2000mg/400mL-SWFI premix [HHSC]

Facility

$158.60

Service Code	HCPCS J3375
Hospital Charge Code	2501029
Hospital Revenue Code	250
Min. Negotiated Rate	$134.81
Max. Negotiated Rate	$153.84
Rate for Payer: Cash Price	$103.09
Rate for Payer: Health Management Network Commercial	$134.81
Rate for Payer: Kaiser Permanente Commercial	$142.74
Rate for Payer: MDX Hawaii PPO	$153.84

vancomycin 500 mg vial [HHSC]

Facility

$19.68

Service Code	HCPCS J3373
Hospital Charge Code	2500848
Hospital Revenue Code	250
Min. Negotiated Rate	$16.73
Max. Negotiated Rate	$19.09
Rate for Payer: Cash Price	$12.79
Rate for Payer: Cash Price	$36.84
Rate for Payer: Health Management Network Commercial	$16.73
Rate for Payer: Health Management Network Commercial	$48.17
Rate for Payer: Kaiser Permanente Commercial	$17.71
Rate for Payer: Kaiser Permanente Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$54.97
Rate for Payer: MDX Hawaii PPO	$19.09

vancomycin 500 mg vial [HHSC]

Facility

$19.68

Service Code	HCPCS J3373
Hospital Charge Code	2500848
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$19.09
Rate for Payer: AlohaCare Medicaid	$9.84
Rate for Payer: AlohaCare Medicaid	$28.34
Rate for Payer: AlohaCare Medicare	$28.34
Rate for Payer: AlohaCare Medicare	$9.84
Rate for Payer: Cash Price	$12.79
Rate for Payer: Cash Price	$12.79
Rate for Payer: Cash Price	$36.84
Rate for Payer: Cash Price	$36.84
Rate for Payer: Devoted Health Medicare	$10.82
Rate for Payer: Devoted Health Medicare	$31.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Medicare	$28.34
Rate for Payer: Hawaii Medical Service Association Medicare	$9.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$53.84
Rate for Payer: Health Management Network Commercial	$48.17
Rate for Payer: Health Management Network Commercial	$16.73
Rate for Payer: Humana Medicare	$28.34
Rate for Payer: Humana Medicare	$9.84
Rate for Payer: Kaiser Permanente Commercial	$17.71
Rate for Payer: Kaiser Permanente Commercial	$51.00
Rate for Payer: Kaiser Permanente Medicaid	$28.90
Rate for Payer: Kaiser Permanente Medicaid	$10.04
Rate for Payer: Kaiser Permanente Medicare	$9.84
Rate for Payer: Kaiser Permanente Medicare	$28.34
Rate for Payer: MDX Hawaii PPO	$19.09
Rate for Payer: MDX Hawaii PPO	$54.97
Rate for Payer: Ohana Health Plan Medicaid	$28.34
Rate for Payer: Ohana Health Plan Medicaid	$9.84
Rate for Payer: Ohana Health Plan Medicare	$9.84
Rate for Payer: Ohana Health Plan Medicare	$28.34
Rate for Payer: UnitedHealthcare Medicaid	$34.00
Rate for Payer: UnitedHealthcare Medicaid	$11.81
Rate for Payer: UnitedHealthcare Medicare	$9.84
Rate for Payer: UnitedHealthcare Medicare	$28.34
Rate for Payer: University Health Alliance Commercial	$14.34
Rate for Payer: University Health Alliance Commercial	$41.31

vancomycin 750mg/150mL-SWFI premix [HHSC]

Facility

$78.34

Service Code	HCPCS J3375
Hospital Charge Code	2501131
Hospital Revenue Code	250
Min. Negotiated Rate	$66.59
Max. Negotiated Rate	$75.99
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: MDX Hawaii PPO	$75.99

vancomycin 750mg/150mL-SWFI premix [HHSC]

Facility

$78.34

Service Code	HCPCS J3375
Hospital Charge Code	2501131
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$75.99
Rate for Payer: AlohaCare Medicaid	$39.17
Rate for Payer: AlohaCare Medicare	$39.17
Rate for Payer: Cash Price	$50.92
Rate for Payer: Cash Price	$50.92
Rate for Payer: Devoted Health Medicare	$43.09
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$39.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$74.42
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Humana Medicare	$39.17
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: Kaiser Permanente Medicaid	$39.95
Rate for Payer: Kaiser Permanente Medicare	$39.17
Rate for Payer: MDX Hawaii PPO	$75.99
Rate for Payer: Ohana Health Plan Medicaid	$39.17
Rate for Payer: Ohana Health Plan Medicare	$39.17
Rate for Payer: UnitedHealthcare Medicaid	$47.00
Rate for Payer: UnitedHealthcare Medicare	$39.17
Rate for Payer: University Health Alliance Commercial	$57.10

Vancomycin (No Time)

Facility

$169.00

Service Code	HCPCS 80202
Hospital Charge Code	12516218
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$84.50
Rate for Payer: AlohaCare Medicare	$84.50
Rate for Payer: Cash Price	$109.85
Rate for Payer: Cash Price	$109.85
Rate for Payer: Devoted Health Medicare	$92.95
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$84.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$84.50
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$84.50
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$84.50
Rate for Payer: Ohana Health Plan Medicare	$84.50
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$84.50
Rate for Payer: University Health Alliance Commercial	$35.02

Vancomycin (No Time)

Facility

$169.00

Service Code	HCPCS 80202
Hospital Charge Code	12516218
Hospital Revenue Code	301
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$109.85
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93

Vancomycin Random FSI

Facility

$155.00

Service Code	HCPCS 80202
Hospital Charge Code	8228937
Hospital Revenue Code	301
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

Vancomycin Random FSI

Facility

$155.00

Service Code	HCPCS 80202
Hospital Charge Code	8228937
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$77.50
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$85.25
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$77.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$77.50
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$77.50
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$77.50
Rate for Payer: Ohana Health Plan Medicare	$77.50
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$77.50
Rate for Payer: University Health Alliance Commercial	$35.02

Vancomycin Trough FSI

Facility

$155.00

Service Code	HCPCS 80202
Hospital Charge Code	8128160
Hospital Revenue Code	301
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

Vancomycin Trough FSI

Facility

$155.00

Service Code	HCPCS 80202
Hospital Charge Code	8128160
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$77.50
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$85.25
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$77.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$77.50
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$77.50
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$77.50
Rate for Payer: Ohana Health Plan Medicare	$77.50
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$77.50
Rate for Payer: University Health Alliance Commercial	$35.02

VAPOTHERM CIRCUIT HIGH FLOW DISPOSABLE PATIENT CIRCUIT

Facility

$399.00

Hospital Charge Code	8938950
Hospital Revenue Code	272
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$387.03
Rate for Payer: AlohaCare Medicaid	$199.50
Rate for Payer: AlohaCare Medicare	$199.50
Rate for Payer: Cash Price	$259.35
Rate for Payer: Devoted Health Medicare	$219.45
Rate for Payer: Hawaii Medical Service Association Medicare	$199.50
Rate for Payer: Hawaii Western Management Group Commercial	$379.05
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Humana Medicare	$199.50
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$203.49
Rate for Payer: Kaiser Permanente Medicare	$199.50
Rate for Payer: MDX Hawaii PPO	$387.03
Rate for Payer: Ohana Health Plan Medicaid	$199.50
Rate for Payer: Ohana Health Plan Medicare	$199.50
Rate for Payer: UnitedHealthcare Medicare	$199.50
Rate for Payer: University Health Alliance Commercial	$290.83

VAPOTHERM CIRCUIT HIGH FLOW DISPOSABLE PATIENT CIRCUIT

Facility

$399.00

Hospital Charge Code	8938950
Hospital Revenue Code	272
Min. Negotiated Rate	$339.15
Max. Negotiated Rate	$387.03
Rate for Payer: Cash Price	$259.35
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: MDX Hawaii PPO	$387.03

VAPOTHERM CIRCUIT LOW FLOW DISPOSABLE PATIENT CIRCUIT

Facility

$399.00

Hospital Charge Code	8938951
Hospital Revenue Code	272
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$387.03
Rate for Payer: AlohaCare Medicaid	$199.50
Rate for Payer: AlohaCare Medicare	$199.50
Rate for Payer: Cash Price	$259.35
Rate for Payer: Devoted Health Medicare	$219.45
Rate for Payer: Hawaii Medical Service Association Medicare	$199.50
Rate for Payer: Hawaii Western Management Group Commercial	$379.05
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Humana Medicare	$199.50
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$203.49
Rate for Payer: Kaiser Permanente Medicare	$199.50
Rate for Payer: MDX Hawaii PPO	$387.03
Rate for Payer: Ohana Health Plan Medicaid	$199.50
Rate for Payer: Ohana Health Plan Medicare	$199.50
Rate for Payer: UnitedHealthcare Medicare	$199.50
Rate for Payer: University Health Alliance Commercial	$290.83

VAPOTHERM CIRCUIT LOW FLOW DISPOSABLE PATIENT CIRCUIT

Facility

$399.00

Hospital Charge Code	8938951
Hospital Revenue Code	272
Min. Negotiated Rate	$339.15
Max. Negotiated Rate	$387.03
Rate for Payer: Cash Price	$259.35
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: MDX Hawaii PPO	$387.03

Varicella zoster, IgG FSI

Facility

$147.00

Service Code	HCPCS 86787
Hospital Charge Code	8118079
Hospital Revenue Code	302
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

Varicella zoster, IgG FSI

Facility

$147.00

Service Code	HCPCS 86787
Hospital Charge Code	8118079
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$33.30

Know your out-of-pocket cost for care.

All Charges