Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

XR Elbow Complete 3+ Views Left

Facility

$525.00

Service Code	HCPCS 73080 LT
Hospital Charge Code	1170127
Hospital Revenue Code	320
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$341.25
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

XR Elbow Complete 3+ Views Left

Facility

$525.00

Service Code	HCPCS 73080 LT
Hospital Charge Code	1170127
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$262.50
Rate for Payer: Cash Price	$341.25
Rate for Payer: Cash Price	$341.25
Rate for Payer: Devoted Health Medicare	$288.75
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Medicare	$262.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$262.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$262.50
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$262.50
Rate for Payer: Ohana Health Plan Medicare	$262.50
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$262.50
Rate for Payer: University Health Alliance Commercial	$68.41

XR Elbow Complete 3+ Views Left - Report

Professional

Both

$121.00

Service Code	HCPCS 73080 26,LT
Hospital Charge Code	630684
Hospital Revenue Code	972
Min. Negotiated Rate	$21.98
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$21.98
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$34.64
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$21.98
Rate for Payer: UnitedHealthcare Medicaid	$21.98

XR Elbow Complete 3+ Views Right

Facility

$525.00

Service Code	HCPCS 73080 RT
Hospital Charge Code	1170129
Hospital Revenue Code	320
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$341.25
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

XR Elbow Complete 3+ Views Right

Facility

$525.00

Service Code	HCPCS 73080 RT
Hospital Charge Code	1170129
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$262.50
Rate for Payer: Cash Price	$341.25
Rate for Payer: Cash Price	$341.25
Rate for Payer: Devoted Health Medicare	$288.75
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Medicare	$262.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$262.50
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$262.50
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$262.50
Rate for Payer: Ohana Health Plan Medicare	$262.50
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$262.50
Rate for Payer: University Health Alliance Commercial	$68.41

XR Elbow Complete 3+ Views Right - Report

Professional

Both

$121.00

Service Code	HCPCS 73080 26,RT
Hospital Charge Code	630680
Hospital Revenue Code	972
Min. Negotiated Rate	$21.98
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$21.98
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Hawaii Western Management Group Commercial	$34.64
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Ohana Health Plan Medicaid	$21.98
Rate for Payer: UnitedHealthcare Medicaid	$21.98

XR Esophagoscopy Remove Foreign Body

Facility

$658.00

Service Code	HCPCS 74235
Hospital Charge Code	2425452
Hospital Revenue Code	320
Min. Negotiated Rate	$559.30
Max. Negotiated Rate	$638.26
Rate for Payer: Cash Price	$427.70
Rate for Payer: Health Management Network Commercial	$559.30
Rate for Payer: Kaiser Permanente Commercial	$592.20
Rate for Payer: MDX Hawaii PPO	$638.26

XR Esophagoscopy Remove Foreign Body

Facility

$658.00

Service Code	HCPCS 74235
Hospital Charge Code	2425452
Hospital Revenue Code	320
Min. Negotiated Rate	$93.99
Max. Negotiated Rate	$638.26
Rate for Payer: AlohaCare Medicaid	$329.00
Rate for Payer: AlohaCare Medicare	$329.00
Rate for Payer: Cash Price	$427.70
Rate for Payer: Cash Price	$427.70
Rate for Payer: Devoted Health Medicare	$361.90
Rate for Payer: Hawaii Medical Service Association ABD	$132.88
Rate for Payer: Hawaii Medical Service Association Medicare	$329.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$93.99
Rate for Payer: Hawaii Western Management Group Commercial	$625.10
Rate for Payer: Health Management Network Commercial	$559.30
Rate for Payer: Humana Medicare	$329.00
Rate for Payer: Kaiser Permanente Commercial	$592.20
Rate for Payer: Kaiser Permanente Medicaid	$335.58
Rate for Payer: Kaiser Permanente Medicare	$329.00
Rate for Payer: MDX Hawaii PPO	$638.26
Rate for Payer: Ohana Health Plan Medicaid	$329.00
Rate for Payer: Ohana Health Plan Medicare	$329.00
Rate for Payer: UnitedHealthcare Medicaid	$132.88
Rate for Payer: UnitedHealthcare Medicare	$329.00
Rate for Payer: University Health Alliance Commercial	$479.62

XR Esophagoscopy Remove Foreign Body - Report

Professional

Both

$184.00

Service Code	HCPCS 74235 26
Hospital Charge Code	2425454
Hospital Revenue Code	972
Min. Negotiated Rate	$55.67
Max. Negotiated Rate	$179.96
Rate for Payer: AlohaCare Medicaid	$132.88
Rate for Payer: AlohaCare Medicare	$55.67
Rate for Payer: Cash Price	$119.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Devoted Health Medicare	$61.24
Rate for Payer: Hawaii Medical Service Association Medicare	$55.67
Rate for Payer: Hawaii Western Management Group Commercial	$179.96
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$61.24
Rate for Payer: Kaiser Permanente Medicaid	$61.24
Rate for Payer: Kaiser Permanente Medicare	$61.24
Rate for Payer: Ohana Health Plan Medicaid	$132.88
Rate for Payer: Ohana Health Plan Medicare	$55.67
Rate for Payer: UnitedHealthcare Medicaid	$132.88
Rate for Payer: UnitedHealthcare Medicare	$55.67

XR Esophagus

Facility

$454.00

Service Code	HCPCS 74220
Hospital Charge Code	1170137
Hospital Revenue Code	320
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$440.38
Rate for Payer: AlohaCare Medicaid	$227.00
Rate for Payer: AlohaCare Medicare	$227.00
Rate for Payer: Cash Price	$295.10
Rate for Payer: Cash Price	$295.10
Rate for Payer: Devoted Health Medicare	$249.70
Rate for Payer: Hawaii Medical Service Association ABD	$39.30
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$227.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.37
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Humana Medicare	$227.00
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: Kaiser Permanente Medicaid	$231.54
Rate for Payer: Kaiser Permanente Medicare	$227.00
Rate for Payer: MDX Hawaii PPO	$440.38
Rate for Payer: Ohana Health Plan Medicaid	$227.00
Rate for Payer: Ohana Health Plan Medicare	$227.00
Rate for Payer: UnitedHealthcare Medicaid	$39.30
Rate for Payer: UnitedHealthcare Medicare	$227.00
Rate for Payer: University Health Alliance Commercial	$167.61

XR Esophagus

Facility

$454.00

Service Code	HCPCS 74220
Hospital Charge Code	1170137
Hospital Revenue Code	320
Min. Negotiated Rate	$385.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$295.10
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: MDX Hawaii PPO	$440.38

XR Esophagus - Report

Professional

Both

$244.00

Service Code	HCPCS 74220 26
Hospital Charge Code	630672
Hospital Revenue Code	972
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$207.40
Rate for Payer: AlohaCare Medicaid	$64.75
Rate for Payer: AlohaCare Medicare	$28.26
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Devoted Health Medicare	$31.09
Rate for Payer: Hawaii Medical Service Association Medicare	$28.26
Rate for Payer: Hawaii Western Management Group Commercial	$77.11
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$31.09
Rate for Payer: Kaiser Permanente Medicaid	$31.09
Rate for Payer: Kaiser Permanente Medicare	$31.09
Rate for Payer: Ohana Health Plan Medicaid	$64.75
Rate for Payer: Ohana Health Plan Medicare	$28.26
Rate for Payer: UnitedHealthcare Medicaid	$64.75
Rate for Payer: UnitedHealthcare Medicare	$28.26

XR Facet Injection Lumb/Sacr Lv1 Bilat

Facility

$2,288.00

Service Code	HCPCS 64493 50
Hospital Charge Code	8207978
Hospital Revenue Code	361
Min. Negotiated Rate	$1,944.80
Max. Negotiated Rate	$2,219.36
Rate for Payer: Cash Price	$1,487.20
Rate for Payer: Health Management Network Commercial	$1,944.80
Rate for Payer: Kaiser Permanente Commercial	$2,059.20
Rate for Payer: MDX Hawaii PPO	$2,219.36

XR Facet Injection Lumb/Sacr Lv1 Bilat

Facility

$2,288.00

Service Code	HCPCS 64493 50
Hospital Charge Code	8207978
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,144.00
Rate for Payer: AlohaCare Medicare	$1,144.00
Rate for Payer: Cash Price	$1,487.20
Rate for Payer: Cash Price	$1,487.20
Rate for Payer: Devoted Health Medicare	$1,258.40
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	$1,144.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,944.80
Rate for Payer: Humana Medicare	$1,144.00
Rate for Payer: Kaiser Permanente Commercial	$2,059.20
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,144.00
Rate for Payer: MDX Hawaii PPO	$2,219.36
Rate for Payer: Ohana Health Plan Medicaid	$1,144.00
Rate for Payer: Ohana Health Plan Medicare	$1,144.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,144.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

XR Facet Injection Lumb/Sacr Lv2 Bilat

Facility

$813.00

Service Code	HCPCS 64494 50
Hospital Charge Code	8207981
Hospital Revenue Code	361
Min. Negotiated Rate	$25.51
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$406.50
Rate for Payer: AlohaCare Medicare	$406.50
Rate for Payer: Cash Price	$528.45
Rate for Payer: Cash Price	$528.45
Rate for Payer: Cash Price	$528.45
Rate for Payer: Devoted Health Medicare	$447.15
Rate for Payer: Hawaii Medical Service Association Medicare	$406.50
Rate for Payer: Health Management Network Commercial	$691.05
Rate for Payer: Humana Medicare	$406.50
Rate for Payer: Kaiser Permanente Commercial	$731.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$406.50
Rate for Payer: MDX Hawaii PPO	$788.61
Rate for Payer: Ohana Health Plan Medicaid	$406.50
Rate for Payer: Ohana Health Plan Medicare	$406.50
Rate for Payer: UnitedHealthcare Medicaid	$25.51
Rate for Payer: UnitedHealthcare Medicare	$406.50
Rate for Payer: University Health Alliance Commercial	$592.60

XR Facet Injection Lumb/Sacr Lv2 Bilat

Facility

$813.00

Service Code	HCPCS 64494 50
Hospital Charge Code	8207981
Hospital Revenue Code	361
Min. Negotiated Rate	$691.05
Max. Negotiated Rate	$788.61
Rate for Payer: Cash Price	$528.45
Rate for Payer: Health Management Network Commercial	$691.05
Rate for Payer: Kaiser Permanente Commercial	$731.70
Rate for Payer: MDX Hawaii PPO	$788.61

XR Facet Injection Lumb/Sacr Lv3+ Bilat

Facility

$813.00

Service Code	HCPCS 64495 50
Hospital Charge Code	8207984
Hospital Revenue Code	361
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$406.50
Rate for Payer: AlohaCare Medicare	$406.50
Rate for Payer: Cash Price	$528.45
Rate for Payer: Cash Price	$528.45
Rate for Payer: Cash Price	$528.45
Rate for Payer: Devoted Health Medicare	$447.15
Rate for Payer: Hawaii Medical Service Association Medicare	$406.50
Rate for Payer: Health Management Network Commercial	$691.05
Rate for Payer: Humana Medicare	$406.50
Rate for Payer: Kaiser Permanente Commercial	$731.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$406.50
Rate for Payer: MDX Hawaii PPO	$788.61
Rate for Payer: Ohana Health Plan Medicaid	$406.50
Rate for Payer: Ohana Health Plan Medicare	$406.50
Rate for Payer: UnitedHealthcare Medicaid	$26.10
Rate for Payer: UnitedHealthcare Medicare	$406.50
Rate for Payer: University Health Alliance Commercial	$592.60

XR Facet Injection Lumb/Sacr Lv3+ Bilat

Facility

$813.00

Service Code	HCPCS 64495 50
Hospital Charge Code	8207984
Hospital Revenue Code	361
Min. Negotiated Rate	$691.05
Max. Negotiated Rate	$788.61
Rate for Payer: Cash Price	$528.45
Rate for Payer: Health Management Network Commercial	$691.05
Rate for Payer: Kaiser Permanente Commercial	$731.70
Rate for Payer: MDX Hawaii PPO	$788.61

XR Facial Bones < 3 Views

Facility

$578.00

Service Code	HCPCS 70140
Hospital Charge Code	1170139
Hospital Revenue Code	320
Min. Negotiated Rate	$491.30
Max. Negotiated Rate	$560.66
Rate for Payer: Cash Price	$375.70
Rate for Payer: Health Management Network Commercial	$491.30
Rate for Payer: Kaiser Permanente Commercial	$520.20
Rate for Payer: MDX Hawaii PPO	$560.66

XR Facial Bones < 3 Views

Facility

$578.00

Service Code	HCPCS 70140
Hospital Charge Code	1170139
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$560.66
Rate for Payer: AlohaCare Medicaid	$289.00
Rate for Payer: AlohaCare Medicare	$289.00
Rate for Payer: Cash Price	$375.70
Rate for Payer: Cash Price	$375.70
Rate for Payer: Devoted Health Medicare	$317.90
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$289.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$491.30
Rate for Payer: Humana Medicare	$289.00
Rate for Payer: Kaiser Permanente Commercial	$520.20
Rate for Payer: Kaiser Permanente Medicaid	$294.78
Rate for Payer: Kaiser Permanente Medicare	$289.00
Rate for Payer: MDX Hawaii PPO	$560.66
Rate for Payer: Ohana Health Plan Medicaid	$289.00
Rate for Payer: Ohana Health Plan Medicare	$289.00
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$289.00
Rate for Payer: University Health Alliance Commercial	$64.21

XR Facial Bones 3+ Views

Facility

$690.00

Service Code	HCPCS 70150
Hospital Charge Code	1170141
Hospital Revenue Code	320
Min. Negotiated Rate	$586.50
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30

XR Facial Bones 3+ Views

Facility

$690.00

Service Code	HCPCS 70150
Hospital Charge Code	1170141
Hospital Revenue Code	320
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association ABD	$25.96
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.19
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicaid	$25.96
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$87.39

XR Facial Bones < 3 Views - Report

Professional

Both

$121.00

Service Code	HCPCS 70140 26
Hospital Charge Code	630668
Hospital Revenue Code	972
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$21.23
Rate for Payer: AlohaCare Medicare	$9.96
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$10.96
Rate for Payer: Hawaii Medical Service Association Medicare	$9.96
Rate for Payer: Hawaii Western Management Group Commercial	$37.80
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$10.96
Rate for Payer: Kaiser Permanente Medicaid	$10.96
Rate for Payer: Kaiser Permanente Medicare	$10.96
Rate for Payer: Ohana Health Plan Medicaid	$21.23
Rate for Payer: Ohana Health Plan Medicare	$9.96
Rate for Payer: UnitedHealthcare Medicaid	$21.23
Rate for Payer: UnitedHealthcare Medicare	$9.96

XR Facial Bones 3+ Views - Report

Professional

Both

$145.00

Service Code	HCPCS 70150 26
Hospital Charge Code	630664
Hospital Revenue Code	972
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$31.58
Rate for Payer: AlohaCare Medicare	$12.72
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$13.99
Rate for Payer: Hawaii Medical Service Association Medicare	$12.72
Rate for Payer: Hawaii Western Management Group Commercial	$49.10
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$13.99
Rate for Payer: Kaiser Permanente Medicaid	$13.99
Rate for Payer: Kaiser Permanente Medicare	$13.99
Rate for Payer: Ohana Health Plan Medicaid	$31.58
Rate for Payer: Ohana Health Plan Medicare	$12.72
Rate for Payer: UnitedHealthcare Medicaid	$31.58
Rate for Payer: UnitedHealthcare Medicare	$12.72

XR Femur 1 View Left

Facility

$398.00

Service Code	HCPCS 73551 LT
Hospital Charge Code	7520564
Hospital Revenue Code	320
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$386.06
Rate for Payer: AlohaCare Medicaid	$199.00
Rate for Payer: AlohaCare Medicare	$199.00
Rate for Payer: Cash Price	$258.70
Rate for Payer: Cash Price	$258.70
Rate for Payer: Devoted Health Medicare	$218.90
Rate for Payer: Hawaii Medical Service Association ABD	$13.37
Rate for Payer: Hawaii Medical Service Association Medicare	$199.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.27
Rate for Payer: Hawaii Western Management Group Commercial	$378.10
Rate for Payer: Health Management Network Commercial	$338.30
Rate for Payer: Humana Medicare	$199.00
Rate for Payer: Kaiser Permanente Commercial	$358.20
Rate for Payer: Kaiser Permanente Medicaid	$202.98
Rate for Payer: Kaiser Permanente Medicare	$199.00
Rate for Payer: MDX Hawaii PPO	$386.06
Rate for Payer: Ohana Health Plan Medicaid	$199.00
Rate for Payer: Ohana Health Plan Medicare	$199.00
Rate for Payer: UnitedHealthcare Medicaid	$19.48
Rate for Payer: UnitedHealthcare Medicare	$199.00
Rate for Payer: University Health Alliance Commercial	$57.63

Know your out-of-pocket cost for care.

All Charges