Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

XR Abdomen 2 Views

Facility

$385.00

Service Code	HCPCS 74019
Hospital Charge Code	8111094
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$373.45
Rate for Payer: AlohaCare Medicaid	$192.50
Rate for Payer: AlohaCare Medicare	$192.50
Rate for Payer: Cash Price	$250.25
Rate for Payer: Cash Price	$250.25
Rate for Payer: Devoted Health Medicare	$211.75
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$192.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.30
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Humana Medicare	$192.50
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: Kaiser Permanente Medicaid	$196.35
Rate for Payer: Kaiser Permanente Medicare	$192.50
Rate for Payer: MDX Hawaii PPO	$373.45
Rate for Payer: Ohana Health Plan Medicaid	$192.50
Rate for Payer: Ohana Health Plan Medicare	$192.50
Rate for Payer: UnitedHealthcare Medicaid	$24.32
Rate for Payer: UnitedHealthcare Medicare	$192.50
Rate for Payer: University Health Alliance Commercial	$68.82

XR Abdomen 2 Views

Facility

$385.00

Service Code	HCPCS 74019
Hospital Charge Code	8111094
Hospital Revenue Code	320
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$373.45
Rate for Payer: Cash Price	$250.25
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: MDX Hawaii PPO	$373.45

XR Abdomen 2 Views - Report

Professional

Both

$145.00

Service Code	HCPCS 74019 26
Hospital Charge Code	8111096
Hospital Revenue Code	972
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$123.25
Rate for Payer: Ohana Health Plan Medicare	$10.96
Rate for Payer: AlohaCare Medicaid	$24.32
Rate for Payer: AlohaCare Medicare	$10.96
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$12.06
Rate for Payer: Hawaii Medical Service Association Medicare	$10.96
Rate for Payer: Hawaii Western Management Group Commercial	$42.35
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$12.06
Rate for Payer: Kaiser Permanente Medicaid	$12.06
Rate for Payer: Kaiser Permanente Medicare	$12.06
Rate for Payer: Ohana Health Plan Medicaid	$24.32
Rate for Payer: UnitedHealthcare Medicaid	$24.32
Rate for Payer: UnitedHealthcare Medicare	$10.96

XR Abdomen 3plus Views

Facility

$431.00

Service Code	HCPCS 74021
Hospital Charge Code	8111097
Hospital Revenue Code	320
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Kaiser Permanente Commercial	$387.90
Rate for Payer: MDX Hawaii PPO	$418.07

XR Abdomen 3plus Views

Facility

$431.00

Service Code	HCPCS 74021
Hospital Charge Code	8111097
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$215.50
Rate for Payer: AlohaCare Medicare	$215.50
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Devoted Health Medicare	$237.05
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$215.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.07
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Humana Medicare	$215.50
Rate for Payer: Kaiser Permanente Commercial	$387.90
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$215.50
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: Ohana Health Plan Medicaid	$215.50
Rate for Payer: Ohana Health Plan Medicare	$215.50
Rate for Payer: UnitedHealthcare Medicaid	$28.57
Rate for Payer: UnitedHealthcare Medicare	$215.50
Rate for Payer: University Health Alliance Commercial	$80.29

XR Abdomen 3+ Views - Report

Professional

Both

$145.00

Service Code	HCPCS 74021 26
Hospital Charge Code	8111099
Hospital Revenue Code	972
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$28.57
Rate for Payer: AlohaCare Medicare	$12.68
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$13.95
Rate for Payer: Hawaii Medical Service Association Medicare	$12.68
Rate for Payer: Hawaii Western Management Group Commercial	$49.40
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$13.95
Rate for Payer: Kaiser Permanente Medicaid	$13.95
Rate for Payer: Kaiser Permanente Medicare	$13.95
Rate for Payer: Ohana Health Plan Medicaid	$28.57
Rate for Payer: Ohana Health Plan Medicare	$12.68
Rate for Payer: UnitedHealthcare Medicaid	$28.57
Rate for Payer: UnitedHealthcare Medicare	$12.68

XR Abdomen Complete w Decub and/or Erect

Facility

$580.00

Service Code	HCPCS 74019
Hospital Charge Code	1169930
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$562.60
Rate for Payer: AlohaCare Medicaid	$290.00
Rate for Payer: AlohaCare Medicare	$290.00
Rate for Payer: Cash Price	$377.00
Rate for Payer: Cash Price	$377.00
Rate for Payer: Devoted Health Medicare	$319.00
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$290.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.30
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$493.00
Rate for Payer: Humana Medicare	$290.00
Rate for Payer: Kaiser Permanente Commercial	$522.00
Rate for Payer: Kaiser Permanente Medicaid	$295.80
Rate for Payer: Kaiser Permanente Medicare	$290.00
Rate for Payer: MDX Hawaii PPO	$562.60
Rate for Payer: Ohana Health Plan Medicaid	$290.00
Rate for Payer: Ohana Health Plan Medicare	$290.00
Rate for Payer: UnitedHealthcare Medicaid	$24.32
Rate for Payer: UnitedHealthcare Medicare	$290.00
Rate for Payer: University Health Alliance Commercial	$68.82

XR Abdomen Complete w Decub and/or Erect

Facility

$580.00

Service Code	HCPCS 74019
Hospital Charge Code	1169930
Hospital Revenue Code	320
Min. Negotiated Rate	$493.00
Max. Negotiated Rate	$562.60
Rate for Payer: Cash Price	$377.00
Rate for Payer: Health Management Network Commercial	$493.00
Rate for Payer: Kaiser Permanente Commercial	$522.00
Rate for Payer: MDX Hawaii PPO	$562.60

XR Abdomen Complete w Decub and/or Erect - Report

Professional

Both

$76.00

Service Code	HCPCS 74019 26
Hospital Charge Code	625619
Hospital Revenue Code	972
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$64.60
Rate for Payer: AlohaCare Medicaid	$24.32
Rate for Payer: AlohaCare Medicare	$10.96
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$12.06
Rate for Payer: Hawaii Medical Service Association Medicare	$10.96
Rate for Payer: Hawaii Western Management Group Commercial	$42.35
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$12.06
Rate for Payer: Kaiser Permanente Medicaid	$12.06
Rate for Payer: Kaiser Permanente Medicare	$12.06
Rate for Payer: Ohana Health Plan Medicaid	$24.32
Rate for Payer: Ohana Health Plan Medicare	$10.96
Rate for Payer: UnitedHealthcare Medicaid	$24.32
Rate for Payer: UnitedHealthcare Medicare	$10.96

XR Abdomen Series + Chest 1 View

Facility

$708.00

Service Code	HCPCS 74022
Hospital Charge Code	1169932
Hospital Revenue Code	320
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
Rate for Payer: Hawaii Medical Service Association ABD	$24.39
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.81
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$24.39
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$95.72

XR Abdomen Series + Chest 1 View

Facility

$708.00

Service Code	HCPCS 74022
Hospital Charge Code	1169932
Hospital Revenue Code	320
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

XR Abdomen Series + Chest 1 View - Report

Professional

Both

$106.00

Service Code	HCPCS 74022 26
Hospital Charge Code	625631
Hospital Revenue Code	972
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$90.10
Rate for Payer: AlohaCare Medicaid	$33.12
Rate for Payer: AlohaCare Medicare	$15.30
Rate for Payer: Cash Price	$68.90
Rate for Payer: Cash Price	$68.90
Rate for Payer: Devoted Health Medicare	$16.83
Rate for Payer: Hawaii Medical Service Association Medicare	$15.30
Rate for Payer: Hawaii Western Management Group Commercial	$49.96
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$16.83
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$16.83
Rate for Payer: Ohana Health Plan Medicaid	$33.12
Rate for Payer: Ohana Health Plan Medicare	$15.30
Rate for Payer: UnitedHealthcare Medicaid	$33.12
Rate for Payer: UnitedHealthcare Medicare	$15.30

XR AC Joints Bilateral

Facility

$523.00

Service Code	HCPCS 73050
Hospital Charge Code	1169922
Hospital Revenue Code	320
Min. Negotiated Rate	$444.55
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$339.95
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: MDX Hawaii PPO	$507.31

XR AC Joints Bilateral

Facility

$523.00

Service Code	HCPCS 73050
Hospital Charge Code	1169922
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$507.31
Rate for Payer: AlohaCare Medicaid	$261.50
Rate for Payer: AlohaCare Medicare	$261.50
Rate for Payer: Cash Price	$339.95
Rate for Payer: Cash Price	$339.95
Rate for Payer: Devoted Health Medicare	$287.65
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$261.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Humana Medicare	$261.50
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: Kaiser Permanente Medicare	$261.50
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: Ohana Health Plan Medicaid	$261.50
Rate for Payer: Ohana Health Plan Medicare	$261.50
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$261.50
Rate for Payer: University Health Alliance Commercial	$73.74

XR AC Joints Bilateral - Report

Professional

Both

$82.00

Service Code	HCPCS 73050 26
Hospital Charge Code	625649
Hospital Revenue Code	972
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$69.70
Rate for Payer: AlohaCare Medicaid	$19.19
Rate for Payer: AlohaCare Medicare	$9.62
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Devoted Health Medicare	$10.58
Rate for Payer: Hawaii Medical Service Association Medicare	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$40.32
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$10.58
Rate for Payer: Kaiser Permanente Medicaid	$10.58
Rate for Payer: Kaiser Permanente Medicare	$10.58
Rate for Payer: Ohana Health Plan Medicaid	$19.19
Rate for Payer: Ohana Health Plan Medicare	$9.62
Rate for Payer: UnitedHealthcare Medicaid	$19.19
Rate for Payer: UnitedHealthcare Medicare	$9.62

XR Ankle 2 Views Bilateral

Facility

$416.00

Service Code	HCPCS 73600 50
Hospital Charge Code	1169934
Hospital Revenue Code	320
Min. Negotiated Rate	$353.60
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: MDX Hawaii PPO	$403.52

XR Ankle 2 Views Bilateral

Facility

$416.00

Service Code	HCPCS 73600 50
Hospital Charge Code	1169934
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$403.52
Rate for Payer: AlohaCare Medicaid	$208.00
Rate for Payer: AlohaCare Medicare	$208.00
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Devoted Health Medicare	$228.80
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Medicare	$208.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$395.20
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Humana Medicare	$208.00
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: Kaiser Permanente Medicaid	$212.16
Rate for Payer: Kaiser Permanente Medicare	$208.00
Rate for Payer: MDX Hawaii PPO	$403.52
Rate for Payer: Ohana Health Plan Medicaid	$208.00
Rate for Payer: Ohana Health Plan Medicare	$208.00
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$208.00
Rate for Payer: University Health Alliance Commercial	$55.46

XR Ankle 2 Views Bilateral - Report

Professional

Both

$60.00

Service Code	HCPCS 73600 26,50
Hospital Charge Code	625717
Hospital Revenue Code	972
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicaid	$21.55
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$30.36
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Ohana Health Plan Medicaid	$21.55
Rate for Payer: UnitedHealthcare Medicaid	$21.55

XR Ankle 2 Views Left

Facility

$416.00

Service Code	HCPCS 73600 LT
Hospital Charge Code	1169936
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$403.52
Rate for Payer: AlohaCare Medicaid	$208.00
Rate for Payer: AlohaCare Medicare	$208.00
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Devoted Health Medicare	$228.80
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Medicare	$208.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$395.20
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Humana Medicare	$208.00
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: Kaiser Permanente Medicaid	$212.16
Rate for Payer: Kaiser Permanente Medicare	$208.00
Rate for Payer: MDX Hawaii PPO	$403.52
Rate for Payer: Ohana Health Plan Medicaid	$208.00
Rate for Payer: Ohana Health Plan Medicare	$208.00
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$208.00
Rate for Payer: University Health Alliance Commercial	$55.46

XR Ankle 2 Views Left

Facility

$416.00

Service Code	HCPCS 73600 LT
Hospital Charge Code	1169936
Hospital Revenue Code	320
Min. Negotiated Rate	$353.60
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: MDX Hawaii PPO	$403.52

XR Ankle 2 Views Left - Report

Professional

Both

$60.00

Service Code	HCPCS 73600 26,LT
Hospital Charge Code	625719
Hospital Revenue Code	972
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicaid	$21.55
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$30.36
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Ohana Health Plan Medicaid	$21.55
Rate for Payer: UnitedHealthcare Medicaid	$21.55

XR Ankle 2 Views Right

Facility

$416.00

Service Code	HCPCS 73600 RT
Hospital Charge Code	1169938
Hospital Revenue Code	320
Min. Negotiated Rate	$353.60
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: MDX Hawaii PPO	$403.52

XR Ankle 2 Views Right

Facility

$416.00

Service Code	HCPCS 73600 RT
Hospital Charge Code	1169938
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$403.52
Rate for Payer: AlohaCare Medicaid	$208.00
Rate for Payer: AlohaCare Medicare	$208.00
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Devoted Health Medicare	$228.80
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Medicare	$208.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$395.20
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Humana Medicare	$208.00
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: Kaiser Permanente Medicaid	$212.16
Rate for Payer: Kaiser Permanente Medicare	$208.00
Rate for Payer: MDX Hawaii PPO	$403.52
Rate for Payer: Ohana Health Plan Medicaid	$208.00
Rate for Payer: Ohana Health Plan Medicare	$208.00
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$208.00
Rate for Payer: University Health Alliance Commercial	$55.46

XR Ankle 2 Views Right - Report

Professional

Both

$60.00

Service Code	HCPCS 73600 26,RT
Hospital Charge Code	625721
Hospital Revenue Code	972
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicaid	$21.55
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$30.36
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Ohana Health Plan Medicaid	$21.55
Rate for Payer: UnitedHealthcare Medicaid	$21.55

XR Ankle Complete 3+ Views Bilateral

Facility

$481.00

Service Code	HCPCS 73610 50
Hospital Charge Code	1169940
Hospital Revenue Code	320
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$466.57
Rate for Payer: AlohaCare Medicaid	$240.50
Rate for Payer: AlohaCare Medicare	$240.50
Rate for Payer: Cash Price	$312.65
Rate for Payer: Cash Price	$312.65
Rate for Payer: Devoted Health Medicare	$264.55
Rate for Payer: Hawaii Medical Service Association ABD	$17.34
Rate for Payer: Hawaii Medical Service Association Medicare	$240.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.95
Rate for Payer: Hawaii Western Management Group Commercial	$456.95
Rate for Payer: Health Management Network Commercial	$408.85
Rate for Payer: Humana Medicare	$240.50
Rate for Payer: Kaiser Permanente Commercial	$432.90
Rate for Payer: Kaiser Permanente Medicaid	$245.31
Rate for Payer: Kaiser Permanente Medicare	$240.50
Rate for Payer: MDX Hawaii PPO	$466.57
Rate for Payer: Ohana Health Plan Medicaid	$240.50
Rate for Payer: Ohana Health Plan Medicare	$240.50
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$240.50
Rate for Payer: University Health Alliance Commercial	$62.59

Know your out-of-pocket cost for care.

All Charges