Kohala Hospital

All Charges

Charge

Type

Setting

Price

CEFAZOLIN 1 G (50 MG/ML) RECON.SOLN FOR NON-INJ USE

Facility

$7.56

Service Code	NDC 00143992490
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$7.33
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Kaiser Permanente Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.33

CEFAZOLIN 1 GRAM INJ RECON.SOLN.

Facility

$7.56

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$7.48
Rate for Payer: AlohaCare Medicaid	$3.78
Rate for Payer: AlohaCare Medicare	$6.80
Rate for Payer: Cash Price	$4.91
Rate for Payer: Cash Price	$4.91
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Medicare	$6.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$7.18
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Humana Medicare	$6.80
Rate for Payer: Kaiser Permanente Commercial	$6.80
Rate for Payer: Kaiser Permanente Medicaid	$3.86
Rate for Payer: Kaiser Permanente Medicare	$6.80
Rate for Payer: MDX Hawaii PPO	$7.33
Rate for Payer: Ohana Health Plan Medicaid	$6.80
Rate for Payer: Ohana Health Plan Medicare	$6.80
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: UnitedHealthcare Medicare	$6.80
Rate for Payer: University Health Alliance Commercial	$5.51

CEFAZOLIN 1 GRAM INJ RECON.SOLN.

Facility

$7.56

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$7.33
Rate for Payer: Cash Price	$4.91
Rate for Payer: Health Management Network Commercial	$6.43
Rate for Payer: Kaiser Permanente Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.33

CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV PREOP USE IVPB

Facility

$72.32

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$71.60
Rate for Payer: AlohaCare Medicaid	$36.16
Rate for Payer: AlohaCare Medicare	$65.09
Rate for Payer: Cash Price	$47.01
Rate for Payer: Cash Price	$47.01
Rate for Payer: Devoted Health Medicare	$71.60
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Medicare	$65.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$68.70
Rate for Payer: Health Management Network Commercial	$61.47
Rate for Payer: Humana Medicare	$65.09
Rate for Payer: Kaiser Permanente Commercial	$65.09
Rate for Payer: Kaiser Permanente Medicaid	$36.88
Rate for Payer: Kaiser Permanente Medicare	$65.09
Rate for Payer: MDX Hawaii PPO	$70.15
Rate for Payer: Ohana Health Plan Medicaid	$65.09
Rate for Payer: Ohana Health Plan Medicare	$65.09
Rate for Payer: UnitedHealthcare Medicaid	$43.39
Rate for Payer: UnitedHealthcare Medicare	$65.09
Rate for Payer: University Health Alliance Commercial	$52.71

CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV PREOP USE IVPB

Facility

$72.32

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$61.47
Max. Negotiated Rate	$70.15
Rate for Payer: Cash Price	$47.01
Rate for Payer: Health Management Network Commercial	$61.47
Rate for Payer: Kaiser Permanente Commercial	$65.09
Rate for Payer: MDX Hawaii PPO	$70.15

CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV IVPB

Facility

$79.11

Service Code	HCPCS J0690
Hospital Revenue Code	250
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$76.74
Rate for Payer: Cash Price	$51.42
Rate for Payer: Health Management Network Commercial	$67.24
Rate for Payer: Kaiser Permanente Commercial	$71.20
Rate for Payer: MDX Hawaii PPO	$76.74

CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV IVPB

Facility

$79.11

Service Code	HCPCS J0690
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$78.32
Rate for Payer: AlohaCare Medicaid	$39.55
Rate for Payer: AlohaCare Medicare	$71.20
Rate for Payer: Cash Price	$51.42
Rate for Payer: Cash Price	$51.42
Rate for Payer: Devoted Health Medicare	$78.32
Rate for Payer: Hawaii Medical Service Association ABD	$1.37
Rate for Payer: Hawaii Medical Service Association Medicare	$71.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$75.15
Rate for Payer: Health Management Network Commercial	$67.24
Rate for Payer: Humana Medicare	$71.20
Rate for Payer: Kaiser Permanente Commercial	$71.20
Rate for Payer: Kaiser Permanente Medicaid	$40.35
Rate for Payer: Kaiser Permanente Medicare	$71.20
Rate for Payer: MDX Hawaii PPO	$76.74
Rate for Payer: Ohana Health Plan Medicaid	$71.20
Rate for Payer: Ohana Health Plan Medicare	$71.20
Rate for Payer: UnitedHealthcare Medicaid	$47.47
Rate for Payer: UnitedHealthcare Medicare	$71.20
Rate for Payer: University Health Alliance Commercial	$57.66

CEFDINIR 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$275.86

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$137.93
Max. Negotiated Rate	$273.10
Rate for Payer: AlohaCare Medicaid	$137.93
Rate for Payer: AlohaCare Medicare	$248.27
Rate for Payer: Cash Price	$179.31
Rate for Payer: Devoted Health Medicare	$273.10
Rate for Payer: Hawaii Medical Service Association Medicare	$248.27
Rate for Payer: Hawaii Western Management Group Commercial	$262.07
Rate for Payer: Health Management Network Commercial	$234.48
Rate for Payer: Humana Medicare	$248.27
Rate for Payer: Kaiser Permanente Commercial	$248.27
Rate for Payer: Kaiser Permanente Medicaid	$140.69
Rate for Payer: Kaiser Permanente Medicare	$248.27
Rate for Payer: MDX Hawaii PPO	$267.58
Rate for Payer: Ohana Health Plan Medicaid	$248.27
Rate for Payer: Ohana Health Plan Medicare	$248.27
Rate for Payer: UnitedHealthcare Medicare	$248.27
Rate for Payer: University Health Alliance Commercial	$201.07

CEFDINIR 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$275.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$234.48
Max. Negotiated Rate	$267.58
Rate for Payer: Cash Price	$179.31
Rate for Payer: Health Management Network Commercial	$234.48
Rate for Payer: Kaiser Permanente Commercial	$248.27
Rate for Payer: MDX Hawaii PPO	$267.58

CEFDINIR 300 MG PO CAP

Facility

$28.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$27.38
Rate for Payer: Cash Price	$18.35
Rate for Payer: Health Management Network Commercial	$24.00
Rate for Payer: Kaiser Permanente Commercial	$25.41
Rate for Payer: MDX Hawaii PPO	$27.38

CEFDINIR 300 MG PO CAP

Facility

$28.23

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$14.12
Max. Negotiated Rate	$27.95
Rate for Payer: AlohaCare Medicaid	$14.12
Rate for Payer: AlohaCare Medicare	$25.41
Rate for Payer: Cash Price	$18.35
Rate for Payer: Devoted Health Medicare	$27.95
Rate for Payer: Hawaii Medical Service Association Medicare	$25.41
Rate for Payer: Hawaii Western Management Group Commercial	$26.82
Rate for Payer: Health Management Network Commercial	$24.00
Rate for Payer: Humana Medicare	$25.41
Rate for Payer: Kaiser Permanente Commercial	$25.41
Rate for Payer: Kaiser Permanente Medicaid	$14.40
Rate for Payer: Kaiser Permanente Medicare	$25.41
Rate for Payer: MDX Hawaii PPO	$27.38
Rate for Payer: Ohana Health Plan Medicaid	$25.41
Rate for Payer: Ohana Health Plan Medicare	$25.41
Rate for Payer: UnitedHealthcare Medicare	$25.41
Rate for Payer: University Health Alliance Commercial	$20.58

CEFEPIME 1 GRAM INJ RECON.SOLN.

Facility

$102.19

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$86.86
Max. Negotiated Rate	$99.12
Rate for Payer: Cash Price	$66.42
Rate for Payer: Health Management Network Commercial	$86.86
Rate for Payer: Kaiser Permanente Commercial	$91.97
Rate for Payer: MDX Hawaii PPO	$99.12

CEFEPIME 1 GRAM INJ RECON.SOLN.

Facility

$102.19

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$101.17
Rate for Payer: AlohaCare Medicaid	$51.09
Rate for Payer: AlohaCare Medicare	$91.97
Rate for Payer: Cash Price	$66.42
Rate for Payer: Cash Price	$66.42
Rate for Payer: Devoted Health Medicare	$101.17
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$91.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$97.08
Rate for Payer: Health Management Network Commercial	$86.86
Rate for Payer: Humana Medicare	$91.97
Rate for Payer: Kaiser Permanente Commercial	$91.97
Rate for Payer: Kaiser Permanente Medicaid	$52.12
Rate for Payer: Kaiser Permanente Medicare	$91.97
Rate for Payer: MDX Hawaii PPO	$99.12
Rate for Payer: Ohana Health Plan Medicaid	$91.97
Rate for Payer: Ohana Health Plan Medicare	$91.97
Rate for Payer: UnitedHealthcare Medicaid	$61.31
Rate for Payer: UnitedHealthcare Medicare	$91.97
Rate for Payer: University Health Alliance Commercial	$74.49

CEFEPIME 2 GRAM INJ RECON.SOLN.

Facility

$58.21

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$57.63
Rate for Payer: AlohaCare Medicaid	$29.11
Rate for Payer: AlohaCare Medicaid	$92.54
Rate for Payer: AlohaCare Medicare	$166.57
Rate for Payer: AlohaCare Medicare	$52.39
Rate for Payer: Cash Price	$120.30
Rate for Payer: Cash Price	$120.30
Rate for Payer: Cash Price	$37.84
Rate for Payer: Cash Price	$37.84
Rate for Payer: Devoted Health Medicare	$183.23
Rate for Payer: Devoted Health Medicare	$57.63
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$166.57
Rate for Payer: Hawaii Medical Service Association Medicare	$52.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$175.83
Rate for Payer: Hawaii Western Management Group Commercial	$55.30
Rate for Payer: Health Management Network Commercial	$157.32
Rate for Payer: Health Management Network Commercial	$49.48
Rate for Payer: Humana Medicare	$166.57
Rate for Payer: Humana Medicare	$52.39
Rate for Payer: Kaiser Permanente Commercial	$52.39
Rate for Payer: Kaiser Permanente Commercial	$166.57
Rate for Payer: Kaiser Permanente Medicaid	$94.39
Rate for Payer: Kaiser Permanente Medicaid	$29.69
Rate for Payer: Kaiser Permanente Medicare	$166.57
Rate for Payer: Kaiser Permanente Medicare	$52.39
Rate for Payer: MDX Hawaii PPO	$179.53
Rate for Payer: MDX Hawaii PPO	$56.46
Rate for Payer: Ohana Health Plan Medicaid	$52.39
Rate for Payer: Ohana Health Plan Medicaid	$166.57
Rate for Payer: Ohana Health Plan Medicare	$166.57
Rate for Payer: Ohana Health Plan Medicare	$52.39
Rate for Payer: UnitedHealthcare Medicaid	$111.05
Rate for Payer: UnitedHealthcare Medicaid	$34.93
Rate for Payer: UnitedHealthcare Medicare	$52.39
Rate for Payer: UnitedHealthcare Medicare	$166.57
Rate for Payer: University Health Alliance Commercial	$134.90
Rate for Payer: University Health Alliance Commercial	$42.43

CEFEPIME 2 GRAM INJ RECON.SOLN.

Facility

$185.08

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$157.32
Max. Negotiated Rate	$179.53
Rate for Payer: Cash Price	$120.30
Rate for Payer: Cash Price	$37.84
Rate for Payer: Health Management Network Commercial	$49.48
Rate for Payer: Health Management Network Commercial	$157.32
Rate for Payer: Kaiser Permanente Commercial	$166.57
Rate for Payer: Kaiser Permanente Commercial	$52.39
Rate for Payer: MDX Hawaii PPO	$179.53
Rate for Payer: MDX Hawaii PPO	$56.46

CEFEPIME IN DEXTROSE 5 % 1 GRAM/50 ML IV IVPB

Facility

$99.48

Service Code	HCPCS J0703
Hospital Revenue Code	636
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$98.49
Rate for Payer: AlohaCare Medicaid	$49.74
Rate for Payer: AlohaCare Medicare	$89.53
Rate for Payer: Cash Price	$64.66
Rate for Payer: Cash Price	$64.66
Rate for Payer: Devoted Health Medicare	$98.49
Rate for Payer: Hawaii Medical Service Association ABD	$5.07
Rate for Payer: Hawaii Medical Service Association Medicare	$89.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.07
Rate for Payer: Hawaii Western Management Group Commercial	$94.51
Rate for Payer: Health Management Network Commercial	$84.56
Rate for Payer: Humana Medicare	$89.53
Rate for Payer: Kaiser Permanente Commercial	$89.53
Rate for Payer: Kaiser Permanente Medicaid	$50.73
Rate for Payer: Kaiser Permanente Medicare	$89.53
Rate for Payer: MDX Hawaii PPO	$96.50
Rate for Payer: Ohana Health Plan Medicaid	$89.53
Rate for Payer: Ohana Health Plan Medicare	$89.53
Rate for Payer: UnitedHealthcare Medicaid	$59.69
Rate for Payer: UnitedHealthcare Medicare	$89.53
Rate for Payer: University Health Alliance Commercial	$72.51

CEFEPIME IN DEXTROSE 5 % 1 GRAM/50 ML IV IVPB

Facility

$99.48

Service Code	HCPCS J0703
Hospital Revenue Code	250
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$96.50
Rate for Payer: Cash Price	$64.66
Rate for Payer: Health Management Network Commercial	$84.56
Rate for Payer: Kaiser Permanente Commercial	$89.53
Rate for Payer: MDX Hawaii PPO	$96.50

CEFEPIME IN DEXTROSE 5 % 2 GRAM/50 ML IV IVPB

Facility

$141.58

Service Code	HCPCS J0703
Hospital Revenue Code	636
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$140.16
Rate for Payer: AlohaCare Medicaid	$70.79
Rate for Payer: AlohaCare Medicare	$127.42
Rate for Payer: Cash Price	$92.03
Rate for Payer: Cash Price	$92.03
Rate for Payer: Devoted Health Medicare	$140.16
Rate for Payer: Hawaii Medical Service Association ABD	$5.07
Rate for Payer: Hawaii Medical Service Association Medicare	$127.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.07
Rate for Payer: Hawaii Western Management Group Commercial	$134.50
Rate for Payer: Health Management Network Commercial	$120.34
Rate for Payer: Humana Medicare	$127.42
Rate for Payer: Kaiser Permanente Commercial	$127.42
Rate for Payer: Kaiser Permanente Medicaid	$72.21
Rate for Payer: Kaiser Permanente Medicare	$127.42
Rate for Payer: MDX Hawaii PPO	$137.33
Rate for Payer: Ohana Health Plan Medicaid	$127.42
Rate for Payer: Ohana Health Plan Medicare	$127.42
Rate for Payer: UnitedHealthcare Medicaid	$84.95
Rate for Payer: UnitedHealthcare Medicare	$127.42
Rate for Payer: University Health Alliance Commercial	$103.20

CEFEPIME IN DEXTROSE 5 % 2 GRAM/50 ML IV IVPB

Facility

$141.58

Service Code	HCPCS J0703
Hospital Revenue Code	250
Min. Negotiated Rate	$120.34
Max. Negotiated Rate	$137.33
Rate for Payer: Cash Price	$92.03
Rate for Payer: Health Management Network Commercial	$120.34
Rate for Payer: Kaiser Permanente Commercial	$127.42
Rate for Payer: MDX Hawaii PPO	$137.33

CEFTAZIDIME 1 GRAM INJ RECON.SOLN.

Facility

$29.81

Service Code	HCPCS J0713
Hospital Revenue Code	250
Min. Negotiated Rate	$25.34
Max. Negotiated Rate	$28.92
Rate for Payer: Cash Price	$19.38
Rate for Payer: Health Management Network Commercial	$25.34
Rate for Payer: Kaiser Permanente Commercial	$26.83
Rate for Payer: MDX Hawaii PPO	$28.92

CEFTAZIDIME 1 GRAM INJ RECON.SOLN.

Facility

$29.81

Service Code	HCPCS J0713
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$29.51
Rate for Payer: AlohaCare Medicaid	$14.90
Rate for Payer: AlohaCare Medicare	$26.83
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cash Price	$19.38
Rate for Payer: Devoted Health Medicare	$29.51
Rate for Payer: Hawaii Medical Service Association ABD	$2.09
Rate for Payer: Hawaii Medical Service Association Medicare	$26.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$28.32
Rate for Payer: Health Management Network Commercial	$25.34
Rate for Payer: Humana Medicare	$26.83
Rate for Payer: Kaiser Permanente Commercial	$26.83
Rate for Payer: Kaiser Permanente Medicaid	$15.20
Rate for Payer: Kaiser Permanente Medicare	$26.83
Rate for Payer: MDX Hawaii PPO	$28.92
Rate for Payer: Ohana Health Plan Medicaid	$26.83
Rate for Payer: Ohana Health Plan Medicare	$26.83
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$26.83
Rate for Payer: University Health Alliance Commercial	$21.73

CEFTAZIDIME 2 GRAM INJ RECON.SOLN.

Facility

$67.68

Service Code	HCPCS J0713
Hospital Revenue Code	250
Min. Negotiated Rate	$57.53
Max. Negotiated Rate	$65.65
Rate for Payer: Cash Price	$43.99
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Kaiser Permanente Commercial	$60.91
Rate for Payer: MDX Hawaii PPO	$65.65

CEFTAZIDIME 2 GRAM INJ RECON.SOLN.

Facility

$67.68

Service Code	HCPCS J0713
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$67.00
Rate for Payer: AlohaCare Medicaid	$33.84
Rate for Payer: AlohaCare Medicare	$60.91
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$43.99
Rate for Payer: Devoted Health Medicare	$67.00
Rate for Payer: Hawaii Medical Service Association ABD	$2.09
Rate for Payer: Hawaii Medical Service Association Medicare	$60.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$64.30
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Humana Medicare	$60.91
Rate for Payer: Kaiser Permanente Commercial	$60.91
Rate for Payer: Kaiser Permanente Medicaid	$34.52
Rate for Payer: Kaiser Permanente Medicare	$60.91
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: Ohana Health Plan Medicaid	$60.91
Rate for Payer: Ohana Health Plan Medicare	$60.91
Rate for Payer: UnitedHealthcare Medicaid	$40.61
Rate for Payer: UnitedHealthcare Medicare	$60.91
Rate for Payer: University Health Alliance Commercial	$49.33

CEFTAZIDIME-AVIBACTAM 2.5 G IV RECON.SOLN.

Facility

$1,102.30

Service Code	HCPCS J0714
Hospital Revenue Code	250
Min. Negotiated Rate	$936.96
Max. Negotiated Rate	$1,069.23
Rate for Payer: Cash Price	$716.50
Rate for Payer: Health Management Network Commercial	$936.96
Rate for Payer: Kaiser Permanente Commercial	$992.07
Rate for Payer: MDX Hawaii PPO	$1,069.23

CEFTAZIDIME-AVIBACTAM 2.5 G IV RECON.SOLN.

Facility

$1,102.30

Service Code	HCPCS J0714
Hospital Revenue Code	636
Min. Negotiated Rate	$104.95
Max. Negotiated Rate	$1,091.28
Rate for Payer: AlohaCare Medicaid	$551.15
Rate for Payer: AlohaCare Medicare	$992.07
Rate for Payer: Cash Price	$716.50
Rate for Payer: Cash Price	$716.50
Rate for Payer: Devoted Health Medicare	$1,091.28
Rate for Payer: Hawaii Medical Service Association ABD	$104.95
Rate for Payer: Hawaii Medical Service Association Commercial	$130.94
Rate for Payer: Hawaii Medical Service Association Medicare	$992.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$104.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.18
Rate for Payer: Health Management Network Commercial	$936.96
Rate for Payer: Humana Medicare	$992.07
Rate for Payer: Kaiser Permanente Commercial	$992.07
Rate for Payer: Kaiser Permanente Medicaid	$562.17
Rate for Payer: Kaiser Permanente Medicare	$992.07
Rate for Payer: MDX Hawaii PPO	$1,069.23
Rate for Payer: Ohana Health Plan Medicaid	$992.07
Rate for Payer: Ohana Health Plan Medicare	$992.07
Rate for Payer: UnitedHealthcare Medicaid	$661.38
Rate for Payer: UnitedHealthcare Medicare	$992.07
Rate for Payer: University Health Alliance Commercial	$803.47

Know your out-of-pocket cost for care.

All Charges