Kohala Hospital

All Charges

Charge

Type

Setting

Price

METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN

Facility

$22.21

Service Code	HCPCS J2765
Hospital Revenue Code	250
Min. Negotiated Rate	$18.88
Max. Negotiated Rate	$21.54
Rate for Payer: Cash Price	$14.44
Rate for Payer: Health Management Network Commercial	$18.88
Rate for Payer: Kaiser Permanente Commercial	$19.99
Rate for Payer: MDX Hawaii PPO	$21.54

METOCLOPRAMIDE HCL 5 MG PO TABLET

Facility

$4.99

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.94
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$4.49
Rate for Payer: Cash Price	$3.24
Rate for Payer: Devoted Health Medicare	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.49
Rate for Payer: Hawaii Western Management Group Commercial	$4.74
Rate for Payer: Health Management Network Commercial	$4.24
Rate for Payer: Humana Medicare	$4.49
Rate for Payer: Kaiser Permanente Commercial	$4.49
Rate for Payer: Kaiser Permanente Medicaid	$2.54
Rate for Payer: Kaiser Permanente Medicare	$4.49
Rate for Payer: MDX Hawaii PPO	$4.84
Rate for Payer: Ohana Health Plan Medicaid	$4.49
Rate for Payer: Ohana Health Plan Medicare	$4.49
Rate for Payer: UnitedHealthcare Medicare	$4.49
Rate for Payer: University Health Alliance Commercial	$3.64

METOCLOPRAMIDE HCL 5 MG PO TABLET

Facility

$4.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$4.84
Rate for Payer: Cash Price	$3.24
Rate for Payer: Health Management Network Commercial	$4.24
Rate for Payer: Kaiser Permanente Commercial	$4.49
Rate for Payer: MDX Hawaii PPO	$4.84

METOLAZONE 5 MG PO TABLET

Facility

$13.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$12.62
Rate for Payer: Cash Price	$8.46
Rate for Payer: Health Management Network Commercial	$11.06
Rate for Payer: Kaiser Permanente Commercial	$11.71
Rate for Payer: MDX Hawaii PPO	$12.62

METOLAZONE 5 MG PO TABLET

Facility

$13.01

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$12.88
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$11.71
Rate for Payer: Cash Price	$8.46
Rate for Payer: Devoted Health Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Medicare	$11.71
Rate for Payer: Hawaii Western Management Group Commercial	$12.36
Rate for Payer: Health Management Network Commercial	$11.06
Rate for Payer: Humana Medicare	$11.71
Rate for Payer: Kaiser Permanente Commercial	$11.71
Rate for Payer: Kaiser Permanente Medicaid	$6.64
Rate for Payer: Kaiser Permanente Medicare	$11.71
Rate for Payer: MDX Hawaii PPO	$12.62
Rate for Payer: Ohana Health Plan Medicaid	$11.71
Rate for Payer: Ohana Health Plan Medicare	$11.71
Rate for Payer: UnitedHealthcare Medicare	$11.71
Rate for Payer: University Health Alliance Commercial	$9.48

METOPROLOL SUCCINATE 25 MG PO TAB SR 24H

Facility

$4.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.75
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Management Network Commercial	$3.60
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Kaiser Permanente Commercial	$3.81
Rate for Payer: Kaiser Permanente Commercial	$5.54
Rate for Payer: MDX Hawaii PPO	$5.98
Rate for Payer: MDX Hawaii PPO	$4.10

METOPROLOL SUCCINATE 25 MG PO TAB SR 24H

Facility

$6.16

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$6.10
Rate for Payer: AlohaCare Medicaid	$3.08
Rate for Payer: AlohaCare Medicaid	$2.12
Rate for Payer: AlohaCare Medicare	$3.81
Rate for Payer: AlohaCare Medicare	$5.54
Rate for Payer: Cash Price	$2.75
Rate for Payer: Cash Price	$4.00
Rate for Payer: Devoted Health Medicare	$6.10
Rate for Payer: Devoted Health Medicare	$4.19
Rate for Payer: Hawaii Medical Service Association Medicare	$3.81
Rate for Payer: Hawaii Medical Service Association Medicare	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$4.02
Rate for Payer: Hawaii Western Management Group Commercial	$5.85
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Health Management Network Commercial	$3.60
Rate for Payer: Humana Medicare	$5.54
Rate for Payer: Humana Medicare	$3.81
Rate for Payer: Kaiser Permanente Commercial	$3.81
Rate for Payer: Kaiser Permanente Commercial	$5.54
Rate for Payer: Kaiser Permanente Medicaid	$3.14
Rate for Payer: Kaiser Permanente Medicaid	$2.16
Rate for Payer: Kaiser Permanente Medicare	$3.81
Rate for Payer: Kaiser Permanente Medicare	$5.54
Rate for Payer: MDX Hawaii PPO	$4.10
Rate for Payer: MDX Hawaii PPO	$5.98
Rate for Payer: Ohana Health Plan Medicaid	$3.81
Rate for Payer: Ohana Health Plan Medicaid	$5.54
Rate for Payer: Ohana Health Plan Medicare	$3.81
Rate for Payer: Ohana Health Plan Medicare	$5.54
Rate for Payer: UnitedHealthcare Medicare	$5.54
Rate for Payer: UnitedHealthcare Medicare	$3.81
Rate for Payer: University Health Alliance Commercial	$4.49
Rate for Payer: University Health Alliance Commercial	$3.08

METOPROLOL SUCCINATE 50 MG PO TAB SR 24H

Facility

$6.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Kaiser Permanente Commercial	$5.54
Rate for Payer: MDX Hawaii PPO	$5.98

METOPROLOL SUCCINATE 50 MG PO TAB SR 24H

Facility

$6.16

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$6.10
Rate for Payer: AlohaCare Medicaid	$3.08
Rate for Payer: AlohaCare Medicare	$5.54
Rate for Payer: Cash Price	$4.00
Rate for Payer: Devoted Health Medicare	$6.10
Rate for Payer: Hawaii Medical Service Association Medicare	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$5.85
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Humana Medicare	$5.54
Rate for Payer: Kaiser Permanente Commercial	$5.54
Rate for Payer: Kaiser Permanente Medicaid	$3.14
Rate for Payer: Kaiser Permanente Medicare	$5.54
Rate for Payer: MDX Hawaii PPO	$5.98
Rate for Payer: Ohana Health Plan Medicaid	$5.54
Rate for Payer: Ohana Health Plan Medicare	$5.54
Rate for Payer: UnitedHealthcare Medicare	$5.54
Rate for Payer: University Health Alliance Commercial	$4.49

METOPROLOL TARTRATE 25 MG PO TABLET

Facility

$1.35

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.34
Rate for Payer: AlohaCare Medicaid	$0.68
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: AlohaCare Medicare	$1.22
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$0.88
Rate for Payer: Devoted Health Medicare	$1.34
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1.22
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$1.28
Rate for Payer: Health Management Network Commercial	$1.15
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.22
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.22
Rate for Payer: Kaiser Permanente Medicaid	$0.69
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: Kaiser Permanente Medicare	$1.22
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$1.31
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicaid	$1.22
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.22
Rate for Payer: UnitedHealthcare Medicare	$1.22
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.98
Rate for Payer: University Health Alliance Commercial	$0.87

METOPROLOL TARTRATE 25 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$0.88
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.15
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.22
Rate for Payer: MDX Hawaii PPO	$1.31
Rate for Payer: MDX Hawaii PPO	$1.16

METOPROLOL TARTRATE 50 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

METOPROLOL TARTRATE 50 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87

METOPROLOL TARTRATE 5 MG/5 ML IV SOLN

Facility

$7.15

Service Code	HCPCS J0616
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$7.08
Rate for Payer: AlohaCare Medicaid	$3.58
Rate for Payer: AlohaCare Medicare	$6.43
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cash Price	$4.65
Rate for Payer: Devoted Health Medicare	$7.08
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$6.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$6.79
Rate for Payer: Health Management Network Commercial	$6.08
Rate for Payer: Humana Medicare	$6.43
Rate for Payer: Kaiser Permanente Commercial	$6.43
Rate for Payer: Kaiser Permanente Medicaid	$3.65
Rate for Payer: Kaiser Permanente Medicare	$6.43
Rate for Payer: MDX Hawaii PPO	$6.94
Rate for Payer: Ohana Health Plan Medicaid	$6.43
Rate for Payer: Ohana Health Plan Medicare	$6.43
Rate for Payer: UnitedHealthcare Medicaid	$4.29
Rate for Payer: UnitedHealthcare Medicare	$6.43
Rate for Payer: University Health Alliance Commercial	$5.21

METOPROLOL TARTRATE 5 MG/5 ML IV SOLN

Facility

$7.15

Service Code	HCPCS J0616
Hospital Revenue Code	250
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$6.94
Rate for Payer: Cash Price	$4.65
Rate for Payer: Health Management Network Commercial	$6.08
Rate for Payer: Kaiser Permanente Commercial	$6.43
Rate for Payer: MDX Hawaii PPO	$6.94

METRONIDAZOLE 250 MG PO TABLET

Facility

$2.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.33
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: Kaiser Permanente Commercial	$2.16
Rate for Payer: MDX Hawaii PPO	$2.33

METRONIDAZOLE 250 MG PO TABLET

Facility

$2.40

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.38
Rate for Payer: AlohaCare Medicaid	$1.20
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: Cash Price	$1.56
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Hawaii Western Management Group Commercial	$2.28
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: Humana Medicare	$2.16
Rate for Payer: Kaiser Permanente Commercial	$2.16
Rate for Payer: Kaiser Permanente Medicaid	$1.22
Rate for Payer: Kaiser Permanente Medicare	$2.16
Rate for Payer: MDX Hawaii PPO	$2.33
Rate for Payer: Ohana Health Plan Medicaid	$2.16
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicare	$2.16
Rate for Payer: University Health Alliance Commercial	$1.75

METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV IVPB

Facility

$11.60

Service Code	HCPCS J1836
Hospital Revenue Code	250
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$11.25
Rate for Payer: Cash Price	$7.54
Rate for Payer: Health Management Network Commercial	$9.86
Rate for Payer: Kaiser Permanente Commercial	$10.44
Rate for Payer: MDX Hawaii PPO	$11.25

METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV IVPB

Facility

$11.60

Service Code	HCPCS J1836
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$11.48
Rate for Payer: AlohaCare Medicaid	$5.80
Rate for Payer: AlohaCare Medicare	$10.44
Rate for Payer: Cash Price	$7.54
Rate for Payer: Cash Price	$7.54
Rate for Payer: Devoted Health Medicare	$11.48
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Medicare	$10.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$11.02
Rate for Payer: Health Management Network Commercial	$9.86
Rate for Payer: Humana Medicare	$10.44
Rate for Payer: Kaiser Permanente Commercial	$10.44
Rate for Payer: Kaiser Permanente Medicaid	$5.92
Rate for Payer: Kaiser Permanente Medicare	$10.44
Rate for Payer: MDX Hawaii PPO	$11.25
Rate for Payer: Ohana Health Plan Medicaid	$10.44
Rate for Payer: Ohana Health Plan Medicare	$10.44
Rate for Payer: UnitedHealthcare Medicaid	$6.96
Rate for Payer: UnitedHealthcare Medicare	$10.44
Rate for Payer: University Health Alliance Commercial	$8.46

MICONAZOLE NITRATE 2 % TOP CR

Facility

$72.68

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$71.95
Rate for Payer: AlohaCare Medicaid	$36.34
Rate for Payer: AlohaCare Medicare	$65.41
Rate for Payer: Cash Price	$47.24
Rate for Payer: Devoted Health Medicare	$71.95
Rate for Payer: Hawaii Medical Service Association Medicare	$65.41
Rate for Payer: Hawaii Western Management Group Commercial	$69.05
Rate for Payer: Health Management Network Commercial	$61.78
Rate for Payer: Humana Medicare	$65.41
Rate for Payer: Kaiser Permanente Commercial	$65.41
Rate for Payer: Kaiser Permanente Medicaid	$37.07
Rate for Payer: Kaiser Permanente Medicare	$65.41
Rate for Payer: MDX Hawaii PPO	$70.50
Rate for Payer: Ohana Health Plan Medicaid	$65.41
Rate for Payer: Ohana Health Plan Medicare	$65.41
Rate for Payer: UnitedHealthcare Medicare	$65.41
Rate for Payer: University Health Alliance Commercial	$52.98

MICONAZOLE NITRATE 2 % TOP CR

Facility

$72.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$61.78
Max. Negotiated Rate	$70.50
Rate for Payer: Cash Price	$47.24
Rate for Payer: Health Management Network Commercial	$61.78
Rate for Payer: Kaiser Permanente Commercial	$65.41
Rate for Payer: MDX Hawaii PPO	$70.50

MICROFIBRIL. COLLAGEN HEMOSTAT 2 X 6.25 X 7 CM-CM-MM TOP SPONGE

Facility

$204.30

Service Code	NDC 53276105002
Hospital Revenue Code	250
Min. Negotiated Rate	$173.66
Max. Negotiated Rate	$198.17
Rate for Payer: Cash Price	$132.80
Rate for Payer: Health Management Network Commercial	$173.66
Rate for Payer: Kaiser Permanente Commercial	$183.87
Rate for Payer: MDX Hawaii PPO	$198.17

MICROFIBRIL. COLLAGEN HEMOSTAT 2 X 6.25 X 7 CM-CM-MM TOP SPONGE

Facility

$204.30

Service Code	NDC 53276105002
Hospital Revenue Code	250
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$202.26
Rate for Payer: AlohaCare Medicaid	$102.15
Rate for Payer: AlohaCare Medicare	$183.87
Rate for Payer: Cash Price	$132.80
Rate for Payer: Devoted Health Medicare	$202.26
Rate for Payer: Hawaii Medical Service Association Medicare	$183.87
Rate for Payer: Hawaii Western Management Group Commercial	$194.09
Rate for Payer: Health Management Network Commercial	$173.66
Rate for Payer: Humana Medicare	$183.87
Rate for Payer: Kaiser Permanente Commercial	$183.87
Rate for Payer: Kaiser Permanente Medicaid	$104.19
Rate for Payer: Kaiser Permanente Medicare	$183.87
Rate for Payer: MDX Hawaii PPO	$198.17
Rate for Payer: Ohana Health Plan Medicaid	$183.87
Rate for Payer: Ohana Health Plan Medicare	$183.87
Rate for Payer: UnitedHealthcare Medicaid	$122.58
Rate for Payer: UnitedHealthcare Medicare	$183.87
Rate for Payer: University Health Alliance Commercial	$148.91

MIDAZOLAM 1 MG/ML 2 ML INJ SOLN

Facility

$3.05

Service Code	HCPCS J2250
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.96
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: Health Management Network Commercial	$3.05
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: Kaiser Permanente Commercial	$3.23
Rate for Payer: MDX Hawaii PPO	$3.48
Rate for Payer: MDX Hawaii PPO	$2.96

MIDAZOLAM 1 MG/ML 2 ML INJ SOLN

Facility

$3.05

Service Code	HCPCS J2250
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.02
Rate for Payer: AlohaCare Medicaid	$1.52
Rate for Payer: AlohaCare Medicaid	$1.79
Rate for Payer: AlohaCare Medicare	$3.23
Rate for Payer: AlohaCare Medicare	$2.75
Rate for Payer: Cash Price	$2.33
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cash Price	$2.33
Rate for Payer: Devoted Health Medicare	$3.02
Rate for Payer: Devoted Health Medicare	$3.55
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$3.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$2.90
Rate for Payer: Hawaii Western Management Group Commercial	$3.41
Rate for Payer: Health Management Network Commercial	$3.05
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: Humana Medicare	$2.75
Rate for Payer: Humana Medicare	$3.23
Rate for Payer: Kaiser Permanente Commercial	$2.75
Rate for Payer: Kaiser Permanente Commercial	$3.23
Rate for Payer: Kaiser Permanente Medicaid	$1.83
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: Kaiser Permanente Medicare	$2.75
Rate for Payer: Kaiser Permanente Medicare	$3.23
Rate for Payer: MDX Hawaii PPO	$2.96
Rate for Payer: MDX Hawaii PPO	$3.48
Rate for Payer: Ohana Health Plan Medicaid	$3.23
Rate for Payer: Ohana Health Plan Medicaid	$2.75
Rate for Payer: Ohana Health Plan Medicare	$2.75
Rate for Payer: Ohana Health Plan Medicare	$3.23
Rate for Payer: UnitedHealthcare Medicaid	$2.15
Rate for Payer: UnitedHealthcare Medicaid	$1.83
Rate for Payer: UnitedHealthcare Medicare	$2.75
Rate for Payer: UnitedHealthcare Medicare	$3.23
Rate for Payer: University Health Alliance Commercial	$2.22
Rate for Payer: University Health Alliance Commercial	$2.62

Know your out-of-pocket cost for care.

All Charges