Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

77063 MG Mammo Screening Right w/ Tomo. Tech

Facility

$75.00

Service Code	HCPCS 77063 52,RT
Hospital Charge Code	12133856
Hospital Revenue Code	403
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$113.48
Rate for Payer: AlohaCare Medicaid	$37.50
Rate for Payer: AlohaCare Medicare	$37.50
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Devoted Health Medicare	$41.25
Rate for Payer: Hawaii Medical Service Association ABD	$17.35
Rate for Payer: Hawaii Medical Service Association Medicare	$37.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.69
Rate for Payer: Hawaii Western Management Group Commercial	$71.25
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Humana Medicare	$37.50
Rate for Payer: Kaiser Permanente Commercial	$67.50
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: Kaiser Permanente Medicare	$37.50
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: Ohana Health Plan Medicaid	$37.50
Rate for Payer: Ohana Health Plan Medicare	$37.50
Rate for Payer: UnitedHealthcare Medicaid	$33.66
Rate for Payer: UnitedHealthcare Medicare	$37.50
Rate for Payer: University Health Alliance Commercial	$113.48

77063 MG Mammo Screening Right w/ Tomo. Tech

Facility

$75.00

Service Code	HCPCS 77063 52,RT
Hospital Charge Code	12133856
Hospital Revenue Code	403
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Kaiser Permanente Commercial	$67.50
Rate for Payer: MDX Hawaii PPO	$72.75

77063 MG Screening Tomo Bilateral

Facility

$93.00

Service Code	HCPCS 77063
Hospital Charge Code	9886507
Hospital Revenue Code	320
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$113.48
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$51.15
Rate for Payer: Hawaii Medical Service Association ABD	$17.35
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.69
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicaid	$33.66
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$113.48

77063 MG Screening Tomo Bilateral

Professional

Both

$48.00

Service Code	HCPCS 77063
Hospital Charge Code	9886507
Hospital Revenue Code	972
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$61.04
Rate for Payer: AlohaCare Medicaid	$33.66
Rate for Payer: AlohaCare Medicare	$54.85
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$60.34
Rate for Payer: Hawaii Medical Service Association Medicare	$54.85
Rate for Payer: Hawaii Western Management Group Commercial	$61.04
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$60.34
Rate for Payer: Kaiser Permanente Medicaid	$60.34
Rate for Payer: Kaiser Permanente Medicare	$60.34
Rate for Payer: Ohana Health Plan Medicaid	$33.66
Rate for Payer: Ohana Health Plan Medicare	$54.85
Rate for Payer: UnitedHealthcare Medicaid	$33.66
Rate for Payer: UnitedHealthcare Medicare	$54.85

77063 MG Screening Tomo Bilateral

Facility

$93.00

Service Code	HCPCS 77063
Hospital Charge Code	9886507
Hospital Revenue Code	320
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

77063 MG Screening Tomo Unilateral

Facility

$93.00

Service Code	HCPCS 77063
Hospital Charge Code	9886509
Hospital Revenue Code	320
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

77063 MG Screening Tomo Unilateral

Professional

Both

$48.00

Service Code	HCPCS 77063
Hospital Charge Code	9886509
Hospital Revenue Code	972
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$61.04
Rate for Payer: AlohaCare Medicaid	$33.66
Rate for Payer: AlohaCare Medicare	$54.85
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$60.34
Rate for Payer: Hawaii Medical Service Association Medicare	$54.85
Rate for Payer: Hawaii Western Management Group Commercial	$61.04
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$60.34
Rate for Payer: Kaiser Permanente Medicaid	$60.34
Rate for Payer: Kaiser Permanente Medicare	$60.34
Rate for Payer: Ohana Health Plan Medicaid	$33.66
Rate for Payer: Ohana Health Plan Medicare	$54.85
Rate for Payer: UnitedHealthcare Medicaid	$33.66
Rate for Payer: UnitedHealthcare Medicare	$54.85

77063 MG Screening Tomo Unilateral

Facility

$93.00

Service Code	HCPCS 77063
Hospital Charge Code	9886509
Hospital Revenue Code	320
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$113.48
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$51.15
Rate for Payer: Hawaii Medical Service Association ABD	$17.35
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.69
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicaid	$33.66
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$113.48

78803 Rp Loclzj Tum Spect 1 Area

Professional

Both

$756.00

Service Code	HCPCS 78803
Hospital Charge Code	8882004
Hospital Revenue Code	972
Min. Negotiated Rate	$234.70
Max. Negotiated Rate	$642.60
Rate for Payer: AlohaCare Medicaid	$234.70
Rate for Payer: AlohaCare Medicare	$374.95
Rate for Payer: Cash Price	$491.40
Rate for Payer: Cash Price	$491.40
Rate for Payer: Devoted Health Medicare	$412.44
Rate for Payer: Hawaii Medical Service Association Medicare	$374.95
Rate for Payer: Hawaii Western Management Group Commercial	$347.90
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Kaiser Permanente Commercial	$412.44
Rate for Payer: Kaiser Permanente Medicaid	$412.44
Rate for Payer: Kaiser Permanente Medicare	$412.44
Rate for Payer: Ohana Health Plan Medicaid	$234.70
Rate for Payer: Ohana Health Plan Medicare	$374.95
Rate for Payer: UnitedHealthcare Medicaid	$234.70
Rate for Payer: UnitedHealthcare Medicare	$374.95

80158 Cyclospirine FSI

Facility

$202.00

Service Code	HCPCS 80158
Hospital Charge Code	8857578
Hospital Revenue Code	301
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$131.30
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: MDX Hawaii PPO	$195.94

80158 Cyclospirine FSI

Facility

$202.00

Service Code	HCPCS 80158
Hospital Charge Code	8857578
Hospital Revenue Code	301
Min. Negotiated Rate	$18.05
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$101.00
Rate for Payer: AlohaCare Medicare	$101.00
Rate for Payer: Cash Price	$131.30
Rate for Payer: Cash Price	$131.30
Rate for Payer: Devoted Health Medicare	$111.10
Rate for Payer: Hawaii Medical Service Association ABD	$24.95
Rate for Payer: Hawaii Medical Service Association Commercial	$22.56
Rate for Payer: Hawaii Medical Service Association Medicare	$101.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.20
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$101.00
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$101.00
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$101.00
Rate for Payer: Ohana Health Plan Medicare	$101.00
Rate for Payer: UnitedHealthcare Medicaid	$24.95
Rate for Payer: UnitedHealthcare Medicare	$101.00
Rate for Payer: University Health Alliance Commercial	$46.68

80326- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80326
Hospital Charge Code	9700537
Hospital Revenue Code	301
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$21.48
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.55
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

80326- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80326
Hospital Charge Code	9700537
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80345- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80345
Hospital Charge Code	9700542
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80345- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80345
Hospital Charge Code	9700542
Hospital Revenue Code	301
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$15.80
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.59
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

80347- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80347
Hospital Charge Code	9700552
Hospital Revenue Code	301
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$25.56
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.84
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

80347- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80347
Hospital Charge Code	9700552
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80349- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80349
Hospital Charge Code	9700517
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80349- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80349
Hospital Charge Code	9700517
Hospital Revenue Code	301
Min. Negotiated Rate	$18.31
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$18.31
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

80353- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80353
Hospital Charge Code	9700522
Hospital Revenue Code	301
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$21.67
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.76
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

80353- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80353
Hospital Charge Code	9700522
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80358- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80358
Hospital Charge Code	9700547
Hospital Revenue Code	301
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$21.67
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.76
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

80358- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80358
Hospital Charge Code	9700547
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80364- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80364
Hospital Charge Code	9700527
Hospital Revenue Code	301
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

80364- Meconium Drug Screen with Reflex FSI

Facility

$554.00

Service Code	HCPCS 80364
Hospital Charge Code	9700527
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$537.38
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$277.00
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Devoted Health Medicare	$304.70
Rate for Payer: Hawaii Medical Service Association ABD	$26.89
Rate for Payer: Hawaii Medical Service Association Medicare	$277.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.23
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$277.00
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: Kaiser Permanente Medicare	$277.00
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$277.00
Rate for Payer: Ohana Health Plan Medicare	$277.00
Rate for Payer: UnitedHealthcare Medicare	$277.00
Rate for Payer: University Health Alliance Commercial	$403.81

Know your out-of-pocket cost for care.

All Charges