Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

XR Lower Extremity Infant (0-1yr) Right - Report

Professional

Both

$86.00

Service Code	HCPCS 73592 26,RT
Hospital Charge Code	630342
Hospital Revenue Code	972
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$73.10
Rate for Payer: AlohaCare Medicaid	$21.09
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Hawaii Western Management Group Commercial	$30.36
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Ohana Health Plan Medicaid	$21.09
Rate for Payer: UnitedHealthcare Medicaid	$21.09

XR Mandible Complete 4+ Views

Facility

$635.00

Service Code	HCPCS 70110
Hospital Charge Code	1170301
Hospital Revenue Code	320
Min. Negotiated Rate	$539.75
Max. Negotiated Rate	$615.95
Rate for Payer: Cash Price	$412.75
Rate for Payer: Health Management Network Commercial	$539.75
Rate for Payer: Kaiser Permanente Commercial	$571.50
Rate for Payer: MDX Hawaii PPO	$615.95

XR Mandible Complete 4+ Views

Facility

$635.00

Service Code	HCPCS 70110
Hospital Charge Code	1170301
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$615.95
Rate for Payer: AlohaCare Medicaid	$317.50
Rate for Payer: AlohaCare Medicare	$317.50
Rate for Payer: Cash Price	$412.75
Rate for Payer: Cash Price	$412.75
Rate for Payer: Devoted Health Medicare	$349.25
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	$317.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$539.75
Rate for Payer: Humana Medicare	$317.50
Rate for Payer: Kaiser Permanente Commercial	$571.50
Rate for Payer: Kaiser Permanente Medicaid	$323.85
Rate for Payer: Kaiser Permanente Medicare	$317.50
Rate for Payer: MDX Hawaii PPO	$615.95
Rate for Payer: Ohana Health Plan Medicaid	$317.50
Rate for Payer: Ohana Health Plan Medicare	$317.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$317.50
Rate for Payer: University Health Alliance Commercial	$78.16

XR Mandible Complete 4+ Views - Report

Professional

Both

$90.00

Service Code	HCPCS 70110 26
Hospital Charge Code	630340
Hospital Revenue Code	972
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$76.50
Rate for Payer: AlohaCare Medicaid	$29.08
Rate for Payer: AlohaCare Medicare	$12.01
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$13.21
Rate for Payer: Hawaii Medical Service Association Medicare	$12.01
Rate for Payer: Hawaii Western Management Group Commercial	$41.25
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$13.21
Rate for Payer: Kaiser Permanente Medicaid	$13.21
Rate for Payer: Kaiser Permanente Medicare	$13.21
Rate for Payer: Ohana Health Plan Medicaid	$29.08
Rate for Payer: Ohana Health Plan Medicare	$12.01
Rate for Payer: UnitedHealthcare Medicaid	$29.08
Rate for Payer: UnitedHealthcare Medicare	$12.01

XR Mandible Less Than 4 Views

Facility

$521.00

Service Code	HCPCS 70100
Hospital Charge Code	1170303
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$260.50
Rate for Payer: Cash Price	$338.65
Rate for Payer: Cash Price	$338.65
Rate for Payer: Devoted Health Medicare	$286.55
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$260.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.57
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$260.50
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$260.50
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$260.50
Rate for Payer: Ohana Health Plan Medicare	$260.50
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$260.50
Rate for Payer: University Health Alliance Commercial	$61.70

XR Mandible Less Than 4 Views

Facility

$521.00

Service Code	HCPCS 70100
Hospital Charge Code	1170303
Hospital Revenue Code	320
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$338.65
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

XR Mandible Less Than 4 Views - Report

Professional

Both

$68.00

Service Code	HCPCS 70100 26
Hospital Charge Code	630338
Hospital Revenue Code	972
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$57.80
Rate for Payer: AlohaCare Medicaid	$26.08
Rate for Payer: AlohaCare Medicare	$9.24
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$10.16
Rate for Payer: Hawaii Medical Service Association Medicare	$9.24
Rate for Payer: Hawaii Western Management Group Commercial	$33.12
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$10.16
Rate for Payer: Kaiser Permanente Medicaid	$10.16
Rate for Payer: Kaiser Permanente Medicare	$10.16
Rate for Payer: Ohana Health Plan Medicaid	$26.08
Rate for Payer: Ohana Health Plan Medicare	$9.24
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: UnitedHealthcare Medicare	$9.24

XR Mastoids < 3 Views Left

Facility

$319.00

Service Code	HCPCS 70120 LT
Hospital Charge Code	8111116
Hospital Revenue Code	320
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43

XR Mastoids < 3 Views Left

Facility

$319.00

Service Code	HCPCS 70120 LT
Hospital Charge Code	8111116
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$309.43
Rate for Payer: AlohaCare Medicaid	$159.50
Rate for Payer: AlohaCare Medicare	$159.50
Rate for Payer: Cash Price	$207.35
Rate for Payer: Cash Price	$207.35
Rate for Payer: Devoted Health Medicare	$175.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Medicare	$159.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.45
Rate for Payer: Hawaii Western Management Group Commercial	$303.05
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Humana Medicare	$159.50
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: Kaiser Permanente Medicaid	$162.69
Rate for Payer: Kaiser Permanente Medicare	$159.50
Rate for Payer: MDX Hawaii PPO	$309.43
Rate for Payer: Ohana Health Plan Medicaid	$159.50
Rate for Payer: Ohana Health Plan Medicare	$159.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$159.50
Rate for Payer: University Health Alliance Commercial	$69.12

XR Mastoids < 3 Views Left - Report

Professional

Both

$145.00

Service Code	HCPCS 70120 26,LT
Hospital Charge Code	8111117
Hospital Revenue Code	972
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$25.62
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Hawaii Western Management Group Commercial	$37.46
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Ohana Health Plan Medicaid	$25.62
Rate for Payer: UnitedHealthcare Medicaid	$25.62

XR Mastoids < 3 Views Right

Facility

$319.00

Service Code	HCPCS 70120 RT
Hospital Charge Code	8111118
Hospital Revenue Code	320
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43

XR Mastoids < 3 Views Right

Facility

$319.00

Service Code	HCPCS 70120 RT
Hospital Charge Code	8111118
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$309.43
Rate for Payer: AlohaCare Medicaid	$159.50
Rate for Payer: AlohaCare Medicare	$159.50
Rate for Payer: Cash Price	$207.35
Rate for Payer: Cash Price	$207.35
Rate for Payer: Devoted Health Medicare	$175.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Medicare	$159.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.45
Rate for Payer: Hawaii Western Management Group Commercial	$303.05
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Humana Medicare	$159.50
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: Kaiser Permanente Medicaid	$162.69
Rate for Payer: Kaiser Permanente Medicare	$159.50
Rate for Payer: MDX Hawaii PPO	$309.43
Rate for Payer: Ohana Health Plan Medicaid	$159.50
Rate for Payer: Ohana Health Plan Medicare	$159.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$159.50
Rate for Payer: University Health Alliance Commercial	$69.12

XR Mastoids < 3 Views Right - Report

Professional

Both

$145.00

Service Code	HCPCS 70120 26,RT
Hospital Charge Code	8111119
Hospital Revenue Code	972
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$25.62
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Hawaii Western Management Group Commercial	$37.46
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Ohana Health Plan Medicaid	$25.62
Rate for Payer: UnitedHealthcare Medicaid	$25.62

XR Mastoids Complete

Facility

$319.00

Service Code	HCPCS 70120 50
Hospital Charge Code	1170315
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$309.43
Rate for Payer: AlohaCare Medicaid	$159.50
Rate for Payer: AlohaCare Medicare	$159.50
Rate for Payer: Cash Price	$207.35
Rate for Payer: Cash Price	$207.35
Rate for Payer: Devoted Health Medicare	$175.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Medicare	$159.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.45
Rate for Payer: Hawaii Western Management Group Commercial	$303.05
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Humana Medicare	$159.50
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: Kaiser Permanente Medicaid	$162.69
Rate for Payer: Kaiser Permanente Medicare	$159.50
Rate for Payer: MDX Hawaii PPO	$309.43
Rate for Payer: Ohana Health Plan Medicaid	$159.50
Rate for Payer: Ohana Health Plan Medicare	$159.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$159.50
Rate for Payer: University Health Alliance Commercial	$69.12

XR Mastoids Complete

Facility

$319.00

Service Code	HCPCS 70120 50
Hospital Charge Code	1170315
Hospital Revenue Code	320
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43

XR Mastoids Complete - Report

Professional

Both

$105.00

Service Code	HCPCS 70120 26,50
Hospital Charge Code	630324
Hospital Revenue Code	972
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$89.25
Rate for Payer: AlohaCare Medicaid	$25.62
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Hawaii Western Management Group Commercial	$37.46
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Ohana Health Plan Medicaid	$25.62
Rate for Payer: UnitedHealthcare Medicaid	$25.62

XR Myelogram 2 or More Regions w/ Inject

Facility

$1,585.00

Service Code	HCPCS 72270
Hospital Charge Code	5182399
Hospital Revenue Code	320
Min. Negotiated Rate	$1,347.25
Max. Negotiated Rate	$1,537.45
Rate for Payer: Cash Price	$1,030.25
Rate for Payer: Health Management Network Commercial	$1,347.25
Rate for Payer: Kaiser Permanente Commercial	$1,426.50
Rate for Payer: MDX Hawaii PPO	$1,537.45

XR Myelogram 2 or More Regions w/ Inject

Facility

$1,585.00

Service Code	HCPCS 72270
Hospital Charge Code	5182399
Hospital Revenue Code	320
Min. Negotiated Rate	$201.02
Max. Negotiated Rate	$1,537.45
Rate for Payer: AlohaCare Medicaid	$792.50
Rate for Payer: AlohaCare Medicare	$792.50
Rate for Payer: Cash Price	$1,030.25
Rate for Payer: Cash Price	$1,030.25
Rate for Payer: Devoted Health Medicare	$871.75
Rate for Payer: Hawaii Medical Service Association ABD	$201.02
Rate for Payer: Hawaii Medical Service Association Commercial	$1,001.12
Rate for Payer: Hawaii Medical Service Association Medicare	$792.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$218.30
Rate for Payer: Hawaii Western Management Group Commercial	$800.90
Rate for Payer: Health Management Network Commercial	$1,347.25
Rate for Payer: Humana Medicare	$792.50
Rate for Payer: Kaiser Permanente Commercial	$1,426.50
Rate for Payer: Kaiser Permanente Medicaid	$808.35
Rate for Payer: Kaiser Permanente Medicare	$792.50
Rate for Payer: MDX Hawaii PPO	$1,537.45
Rate for Payer: Ohana Health Plan Medicaid	$792.50
Rate for Payer: Ohana Health Plan Medicare	$792.50
Rate for Payer: UnitedHealthcare Medicaid	$201.02
Rate for Payer: UnitedHealthcare Medicare	$792.50
Rate for Payer: University Health Alliance Commercial	$524.68

XR Myelogram 2 or More Regions w/ Inject - Report

Professional

Both

$1,091.00

Service Code	HCPCS 72270 26
Hospital Charge Code	5182401
Hospital Revenue Code	972
Min. Negotiated Rate	$61.10
Max. Negotiated Rate	$927.35
Rate for Payer: AlohaCare Medicaid	$100.09
Rate for Payer: AlohaCare Medicare	$61.10
Rate for Payer: Cash Price	$709.15
Rate for Payer: Cash Price	$709.15
Rate for Payer: Devoted Health Medicare	$67.21
Rate for Payer: Hawaii Medical Service Association Medicare	$61.10
Rate for Payer: Hawaii Western Management Group Commercial	$340.81
Rate for Payer: Health Management Network Commercial	$927.35
Rate for Payer: Kaiser Permanente Commercial	$67.21
Rate for Payer: Kaiser Permanente Medicaid	$67.21
Rate for Payer: Kaiser Permanente Medicare	$67.21
Rate for Payer: Ohana Health Plan Medicaid	$100.09
Rate for Payer: Ohana Health Plan Medicare	$61.10
Rate for Payer: UnitedHealthcare Medicaid	$100.09
Rate for Payer: UnitedHealthcare Medicare	$61.10

XR Myelogram Cervical Spine

Facility

$1,585.00

Service Code	HCPCS 72240
Hospital Charge Code	1170319
Hospital Revenue Code	320
Min. Negotiated Rate	$156.47
Max. Negotiated Rate	$1,537.45
Rate for Payer: AlohaCare Medicaid	$792.50
Rate for Payer: AlohaCare Medicare	$792.50
Rate for Payer: Cash Price	$1,030.25
Rate for Payer: Cash Price	$1,030.25
Rate for Payer: Devoted Health Medicare	$871.75
Rate for Payer: Hawaii Medical Service Association ABD	$156.47
Rate for Payer: Hawaii Medical Service Association Commercial	$1,001.12
Rate for Payer: Hawaii Medical Service Association Medicare	$792.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.48
Rate for Payer: Hawaii Western Management Group Commercial	$800.90
Rate for Payer: Health Management Network Commercial	$1,347.25
Rate for Payer: Humana Medicare	$792.50
Rate for Payer: Kaiser Permanente Commercial	$1,426.50
Rate for Payer: Kaiser Permanente Medicaid	$808.35
Rate for Payer: Kaiser Permanente Medicare	$792.50
Rate for Payer: MDX Hawaii PPO	$1,537.45
Rate for Payer: Ohana Health Plan Medicaid	$792.50
Rate for Payer: Ohana Health Plan Medicare	$792.50
Rate for Payer: UnitedHealthcare Medicaid	$156.47
Rate for Payer: UnitedHealthcare Medicare	$792.50
Rate for Payer: University Health Alliance Commercial	$375.70

XR Myelogram Cervical Spine

Facility

$1,585.00

Service Code	HCPCS 72240
Hospital Charge Code	1170319
Hospital Revenue Code	320
Min. Negotiated Rate	$1,347.25
Max. Negotiated Rate	$1,537.45
Rate for Payer: Cash Price	$1,030.25
Rate for Payer: Health Management Network Commercial	$1,347.25
Rate for Payer: Kaiser Permanente Commercial	$1,426.50
Rate for Payer: MDX Hawaii PPO	$1,537.45

XR Myelogram Cervical Spine - Report

Professional

Both

$1,091.00

Service Code	HCPCS 72240 26
Hospital Charge Code	629691
Hospital Revenue Code	972
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$927.35
Rate for Payer: AlohaCare Medicaid	$73.58
Rate for Payer: AlohaCare Medicare	$43.80
Rate for Payer: Cash Price	$709.15
Rate for Payer: Cash Price	$709.15
Rate for Payer: Devoted Health Medicare	$48.18
Rate for Payer: Hawaii Medical Service Association Medicare	$43.80
Rate for Payer: Hawaii Western Management Group Commercial	$258.70
Rate for Payer: Health Management Network Commercial	$927.35
Rate for Payer: Kaiser Permanente Commercial	$48.18
Rate for Payer: Kaiser Permanente Medicaid	$48.18
Rate for Payer: Kaiser Permanente Medicare	$48.18
Rate for Payer: Ohana Health Plan Medicaid	$73.58
Rate for Payer: Ohana Health Plan Medicare	$43.80
Rate for Payer: UnitedHealthcare Medicaid	$73.58
Rate for Payer: UnitedHealthcare Medicare	$43.80

XR Myelogram Injection

Facility

$504.00

Service Code	HCPCS 62284
Hospital Charge Code	2425581
Hospital Revenue Code	361
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$488.88
Rate for Payer: Cash Price	$327.60
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: Kaiser Permanente Commercial	$453.60
Rate for Payer: MDX Hawaii PPO	$488.88

XR Myelogram Injection

Facility

$504.00

Service Code	HCPCS 62284
Hospital Charge Code	2425581
Hospital Revenue Code	361
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$252.00
Rate for Payer: AlohaCare Medicare	$252.00
Rate for Payer: Cash Price	$327.60
Rate for Payer: Cash Price	$327.60
Rate for Payer: Cash Price	$327.60
Rate for Payer: Devoted Health Medicare	$277.20
Rate for Payer: Hawaii Medical Service Association Medicare	$252.00
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: Humana Medicare	$252.00
Rate for Payer: Kaiser Permanente Commercial	$453.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$252.00
Rate for Payer: MDX Hawaii PPO	$488.88
Rate for Payer: Ohana Health Plan Medicaid	$252.00
Rate for Payer: Ohana Health Plan Medicare	$252.00
Rate for Payer: UnitedHealthcare Medicaid	$78.52
Rate for Payer: UnitedHealthcare Medicare	$252.00
Rate for Payer: University Health Alliance Commercial	$367.37

XR Myelogram Injection - Report

Professional

Both

$194.00

Service Code	HCPCS 62284
Hospital Charge Code	2425583
Hospital Revenue Code	972
Min. Negotiated Rate	$71.80
Max. Negotiated Rate	$164.90
Rate for Payer: AlohaCare Medicaid	$83.12
Rate for Payer: AlohaCare Medicare	$71.80
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Devoted Health Medicare	$78.98
Rate for Payer: Hawaii Medical Service Association ABD	$83.12
Rate for Payer: Hawaii Medical Service Association Commercial	$142.05
Rate for Payer: Hawaii Medical Service Association Medicare	$71.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83.12
Rate for Payer: Hawaii Western Management Group Commercial	$159.64
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$78.98
Rate for Payer: Kaiser Permanente Medicaid	$78.98
Rate for Payer: Kaiser Permanente Medicare	$78.98
Rate for Payer: Ohana Health Plan Medicaid	$83.12
Rate for Payer: Ohana Health Plan Medicare	$71.80
Rate for Payer: UnitedHealthcare Medicaid	$83.12
Rate for Payer: UnitedHealthcare Medicare	$71.80
Rate for Payer: University Health Alliance Commercial	$111.87

Know your out-of-pocket cost for care.

All Charges