Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

XR Spine Thoracic 4+ Views

Facility

$548.00

Service Code	HCPCS 72074
Hospital Charge Code	1170488
Hospital Revenue Code	320
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$531.56
Rate for Payer: AlohaCare Medicaid	$274.00
Rate for Payer: AlohaCare Medicare	$274.00
Rate for Payer: Cash Price	$356.20
Rate for Payer: Cash Price	$356.20
Rate for Payer: Devoted Health Medicare	$301.40
Rate for Payer: Hawaii Medical Service Association ABD	$30.26
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$274.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.95
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$465.80
Rate for Payer: Humana Medicare	$274.00
Rate for Payer: Kaiser Permanente Commercial	$493.20
Rate for Payer: Kaiser Permanente Medicaid	$279.48
Rate for Payer: Kaiser Permanente Medicare	$274.00
Rate for Payer: MDX Hawaii PPO	$531.56
Rate for Payer: Ohana Health Plan Medicaid	$274.00
Rate for Payer: Ohana Health Plan Medicare	$274.00
Rate for Payer: UnitedHealthcare Medicaid	$30.26
Rate for Payer: UnitedHealthcare Medicare	$274.00
Rate for Payer: University Health Alliance Commercial	$93.89

XR Spine Thoracic 4+ Views - Report

Professional

Both

$85.00

Service Code	HCPCS 72074 26
Hospital Charge Code	629995
Hospital Revenue Code	972
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$72.25
Rate for Payer: AlohaCare Medicaid	$29.77
Rate for Payer: AlohaCare Medicare	$11.63
Rate for Payer: Cash Price	$55.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Devoted Health Medicare	$12.79
Rate for Payer: Hawaii Medical Service Association Medicare	$11.63
Rate for Payer: Hawaii Western Management Group Commercial	$52.34
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$12.79
Rate for Payer: Kaiser Permanente Medicaid	$12.79
Rate for Payer: Kaiser Permanente Medicare	$12.79
Rate for Payer: Ohana Health Plan Medicaid	$29.77
Rate for Payer: Ohana Health Plan Medicare	$11.63
Rate for Payer: UnitedHealthcare Medicaid	$29.77
Rate for Payer: UnitedHealthcare Medicare	$11.63

XR Spine Thoracolumbar 2+ Views

Facility

$578.00

Service Code	HCPCS 72080
Hospital Charge Code	1170490
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
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	$21.96
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	$24.13
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	$21.96
Rate for Payer: UnitedHealthcare Medicare	$289.00
Rate for Payer: University Health Alliance Commercial	$72.83

XR Spine Thoracolumbar 2+ Views

Facility

$578.00

Service Code	HCPCS 72080
Hospital Charge Code	1170490
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 Spine Thoracolumbar 2+ Views - Report

Professional

Both

$76.00

Service Code	HCPCS 72080 26
Hospital Charge Code	629987
Hospital Revenue Code	972
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$64.60
Rate for Payer: AlohaCare Medicaid	$23.01
Rate for Payer: AlohaCare Medicare	$10.29
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$11.32
Rate for Payer: Hawaii Medical Service Association Medicare	$10.29
Rate for Payer: Hawaii Western Management Group Commercial	$41.42
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$11.32
Rate for Payer: Kaiser Permanente Medicaid	$11.32
Rate for Payer: Kaiser Permanente Medicare	$11.32
Rate for Payer: Ohana Health Plan Medicaid	$23.01
Rate for Payer: Ohana Health Plan Medicare	$10.29
Rate for Payer: UnitedHealthcare Medicaid	$23.01
Rate for Payer: UnitedHealthcare Medicare	$10.29

XR Sternoclavicular Joint(s)

Facility

$523.00

Service Code	HCPCS 71130
Hospital Charge Code	1170494
Hospital Revenue Code	320
Min. Negotiated Rate	$23.21
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	$23.21
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	$25.49
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	$23.21
Rate for Payer: UnitedHealthcare Medicare	$261.50
Rate for Payer: University Health Alliance Commercial	$76.85

XR Sternoclavicular Joint(s)

Facility

$523.00

Service Code	HCPCS 71130
Hospital Charge Code	1170494
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 Sternoclavicular Joint(s) - Report

Professional

Both

$76.00

Service Code	HCPCS 71130 26
Hospital Charge Code	629977
Hospital Revenue Code	972
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$64.60
Rate for Payer: AlohaCare Medicaid	$27.57
Rate for Payer: AlohaCare Medicare	$10.63
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$11.69
Rate for Payer: Hawaii Medical Service Association Medicare	$10.63
Rate for Payer: Hawaii Western Management Group Commercial	$42.95
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$11.69
Rate for Payer: Kaiser Permanente Medicaid	$11.69
Rate for Payer: Kaiser Permanente Medicare	$11.69
Rate for Payer: Ohana Health Plan Medicaid	$27.57
Rate for Payer: Ohana Health Plan Medicare	$10.63
Rate for Payer: UnitedHealthcare Medicaid	$27.57
Rate for Payer: UnitedHealthcare Medicare	$10.63

XR Sternum 2+ Views

Facility

$523.00

Service Code	HCPCS 71120
Hospital Charge Code	1170496
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 Sternum 2+ Views

Facility

$523.00

Service Code	HCPCS 71120
Hospital Charge Code	1170496
Hospital Revenue Code	320
Min. Negotiated Rate	$21.34
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	$21.34
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	$23.43
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	$21.34
Rate for Payer: UnitedHealthcare Medicare	$261.50
Rate for Payer: University Health Alliance Commercial	$69.73

XR Sternum 2+ Views - Report

Professional

Both

$76.00

Service Code	HCPCS 71120 26
Hospital Charge Code	629975
Hospital Revenue Code	972
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$64.60
Rate for Payer: AlohaCare Medicaid	$22.35
Rate for Payer: AlohaCare Medicare	$9.53
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$10.48
Rate for Payer: Hawaii Medical Service Association Medicare	$9.53
Rate for Payer: Hawaii Western Management Group Commercial	$39.48
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$10.48
Rate for Payer: Kaiser Permanente Medicaid	$10.48
Rate for Payer: Kaiser Permanente Medicare	$10.48
Rate for Payer: Ohana Health Plan Medicaid	$22.35
Rate for Payer: Ohana Health Plan Medicare	$9.53
Rate for Payer: UnitedHealthcare Medicaid	$22.35
Rate for Payer: UnitedHealthcare Medicare	$9.53

XR Swallowing Function w/ Speech

Facility

$709.00

Service Code	HCPCS 74230 TC
Hospital Charge Code	1170500
Hospital Revenue Code	320
Min. Negotiated Rate	$602.65
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$460.85
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Kaiser Permanente Commercial	$638.10
Rate for Payer: MDX Hawaii PPO	$687.73

XR Swallowing Function w/ Speech

Facility

$709.00

Service Code	HCPCS 74230 TC
Hospital Charge Code	1170500
Hospital Revenue Code	320
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$687.73
Rate for Payer: AlohaCare Medicaid	$354.50
Rate for Payer: AlohaCare Medicare	$354.50
Rate for Payer: Cash Price	$460.85
Rate for Payer: Cash Price	$460.85
Rate for Payer: Devoted Health Medicare	$389.95
Rate for Payer: Hawaii Medical Service Association ABD	$42.98
Rate for Payer: Hawaii Medical Service Association Medicare	$354.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.81
Rate for Payer: Hawaii Western Management Group Commercial	$673.55
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Humana Medicare	$354.50
Rate for Payer: Kaiser Permanente Commercial	$638.10
Rate for Payer: Kaiser Permanente Medicaid	$361.59
Rate for Payer: Kaiser Permanente Medicare	$354.50
Rate for Payer: MDX Hawaii PPO	$687.73
Rate for Payer: Ohana Health Plan Medicaid	$354.50
Rate for Payer: Ohana Health Plan Medicare	$354.50
Rate for Payer: UnitedHealthcare Medicaid	$42.98
Rate for Payer: UnitedHealthcare Medicare	$354.50
Rate for Payer: University Health Alliance Commercial	$126.97

XR Swallowing Function w/ Speech - Report

Professional

Both

$244.00

Service Code	HCPCS 74230 26
Hospital Charge Code	629965
Hospital Revenue Code	972
Min. Negotiated Rate	$25.16
Max. Negotiated Rate	$207.40
Rate for Payer: AlohaCare Medicaid	$83.78
Rate for Payer: AlohaCare Medicare	$25.16
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Devoted Health Medicare	$27.68
Rate for Payer: Hawaii Medical Service Association Medicare	$25.16
Rate for Payer: Hawaii Western Management Group Commercial	$86.47
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$27.68
Rate for Payer: Kaiser Permanente Medicaid	$27.68
Rate for Payer: Kaiser Permanente Medicare	$27.68
Rate for Payer: Ohana Health Plan Medicaid	$83.78
Rate for Payer: Ohana Health Plan Medicare	$25.16
Rate for Payer: UnitedHealthcare Medicaid	$83.78
Rate for Payer: UnitedHealthcare Medicare	$25.16

XR Tibia/Fibula Bilateral

Facility

$431.00

Service Code	HCPCS 73590 50
Hospital Charge Code	1170514
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 Tibia/Fibula Bilateral

Facility

$431.00

Service Code	HCPCS 73590 50
Hospital Charge Code	1170514
Hospital Revenue Code	320
Min. Negotiated Rate	$18.46
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	$18.46
Rate for Payer: Hawaii Medical Service Association Medicare	$215.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.38
Rate for Payer: Hawaii Western Management Group Commercial	$409.45
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	$18.46
Rate for Payer: UnitedHealthcare Medicare	$215.50
Rate for Payer: University Health Alliance Commercial	$56.98

XR Tibia/Fibula Bilateral - Report

Professional

Both

$66.00

Service Code	HCPCS 73590 26,50
Hospital Charge Code	629947
Hospital Revenue Code	972
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$56.10
Rate for Payer: AlohaCare Medicaid	$21.09
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Hawaii Western Management Group Commercial	$32.05
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Ohana Health Plan Medicaid	$21.09
Rate for Payer: UnitedHealthcare Medicaid	$21.09

XR Tibia/Fibula Left

Facility

$431.00

Service Code	HCPCS 73590 LT
Hospital Charge Code	1170516
Hospital Revenue Code	320
Min. Negotiated Rate	$18.46
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	$18.46
Rate for Payer: Hawaii Medical Service Association Medicare	$215.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.38
Rate for Payer: Hawaii Western Management Group Commercial	$409.45
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	$18.46
Rate for Payer: UnitedHealthcare Medicare	$215.50
Rate for Payer: University Health Alliance Commercial	$56.98

XR Tibia/Fibula Left

Facility

$431.00

Service Code	HCPCS 73590 LT
Hospital Charge Code	1170516
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 Tibia/Fibula Left - Report

Professional

Both

$66.00

Service Code	HCPCS 73590 26,LT
Hospital Charge Code	629943
Hospital Revenue Code	972
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$56.10
Rate for Payer: AlohaCare Medicaid	$21.09
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Hawaii Western Management Group Commercial	$32.05
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Ohana Health Plan Medicaid	$21.09
Rate for Payer: UnitedHealthcare Medicaid	$21.09

XR Tibia/Fibula Right

Facility

$431.00

Service Code	HCPCS 73590 RT
Hospital Charge Code	1170518
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 Tibia/Fibula Right

Facility

$431.00

Service Code	HCPCS 73590 RT
Hospital Charge Code	1170518
Hospital Revenue Code	320
Min. Negotiated Rate	$18.46
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	$18.46
Rate for Payer: Hawaii Medical Service Association Medicare	$215.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.38
Rate for Payer: Hawaii Western Management Group Commercial	$409.45
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	$18.46
Rate for Payer: UnitedHealthcare Medicare	$215.50
Rate for Payer: University Health Alliance Commercial	$56.98

XR Tibia/Fibula Right - Report

Professional

Both

$66.00

Service Code	HCPCS 73590 26,RT
Hospital Charge Code	629937
Hospital Revenue Code	972
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$56.10
Rate for Payer: AlohaCare Medicaid	$21.09
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Hawaii Western Management Group Commercial	$32.05
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Ohana Health Plan Medicaid	$21.09
Rate for Payer: UnitedHealthcare Medicaid	$21.09

XR TMJ Open and Closed Bilateral

Facility

$461.00

Service Code	HCPCS 70330
Hospital Charge Code	1170502
Hospital Revenue Code	320
Min. Negotiated Rate	$391.85
Max. Negotiated Rate	$447.17
Rate for Payer: Cash Price	$299.65
Rate for Payer: Health Management Network Commercial	$391.85
Rate for Payer: Kaiser Permanente Commercial	$414.90
Rate for Payer: MDX Hawaii PPO	$447.17

XR TMJ Open and Closed Bilateral

Facility

$461.00

Service Code	HCPCS 70330
Hospital Charge Code	1170502
Hospital Revenue Code	320
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$447.17
Rate for Payer: AlohaCare Medicaid	$230.50
Rate for Payer: AlohaCare Medicare	$230.50
Rate for Payer: Cash Price	$299.65
Rate for Payer: Cash Price	$299.65
Rate for Payer: Devoted Health Medicare	$253.55
Rate for Payer: Hawaii Medical Service Association ABD	$27.83
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$230.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.26
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$391.85
Rate for Payer: Humana Medicare	$230.50
Rate for Payer: Kaiser Permanente Commercial	$414.90
Rate for Payer: Kaiser Permanente Medicaid	$235.11
Rate for Payer: Kaiser Permanente Medicare	$230.50
Rate for Payer: MDX Hawaii PPO	$447.17
Rate for Payer: Ohana Health Plan Medicaid	$230.50
Rate for Payer: Ohana Health Plan Medicare	$230.50
Rate for Payer: UnitedHealthcare Medicaid	$27.83
Rate for Payer: UnitedHealthcare Medicare	$230.50
Rate for Payer: University Health Alliance Commercial	$94.79

Know your out-of-pocket cost for care.

All Charges