Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG HIV-1/2 AG/AB WITH REFLEX - 90

Facility

$173.00

Service Code	HCPCS 87390
Hospital Charge Code	H3021052
Hospital Revenue Code	302
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

HCHG HIV-1/2 AG/AB WITH REFLEX - 90

Facility

$103.00

Service Code	HCPCS 86702
Hospital Charge Code	H3021051
Hospital Revenue Code	302
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$101.97
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: AlohaCare Medicare	$92.70
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Devoted Health Medicare	$101.97
Rate for Payer: Hawaii Medical Service Association ABD	$18.69
Rate for Payer: Hawaii Medical Service Association Commercial	$16.90
Rate for Payer: Hawaii Medical Service Association Medicare	$92.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.62
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$92.70
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$92.70
Rate for Payer: Ohana Health Plan Medicare	$92.70
Rate for Payer: UnitedHealthcare Medicaid	$18.69
Rate for Payer: UnitedHealthcare Medicare	$92.70
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG HIV-1/2 AG/AB WITH REFLEX - 90

Facility

$103.00

Service Code	HCPCS 86702
Hospital Charge Code	H3021051
Hospital Revenue Code	302
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

HCHG HIV-1/2 AG/AB WITH REFLEX - 90

Facility

$68.00

Service Code	HCPCS 86701
Hospital Charge Code	H3021050
Hospital Revenue Code	302
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

HCHG HIV-1 RNA QUANT BY PCR 90

Facility

$518.00

Service Code	HCPCS 87536
Hospital Charge Code	H3060234
Hospital Revenue Code	306
Min. Negotiated Rate	$85.10
Max. Negotiated Rate	$512.82
Rate for Payer: AlohaCare Medicaid	$259.00
Rate for Payer: AlohaCare Medicare	$466.20
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Devoted Health Medicare	$512.82
Rate for Payer: Hawaii Medical Service Association ABD	$117.59
Rate for Payer: Hawaii Medical Service Association Commercial	$106.38
Rate for Payer: Hawaii Medical Service Association Medicare	$466.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$123.47
Rate for Payer: Hawaii Western Management Group Commercial	$85.10
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$466.20
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$466.20
Rate for Payer: Ohana Health Plan Medicare	$466.20
Rate for Payer: UnitedHealthcare Medicaid	$117.59
Rate for Payer: UnitedHealthcare Medicare	$466.20
Rate for Payer: University Health Alliance Commercial	$219.95

HCHG HIV-1 RNA QUANT BY PCR 90

Facility

$518.00

Service Code	HCPCS 87536
Hospital Charge Code	H3060234
Hospital Revenue Code	306
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$336.70
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46

HCHG HLA-B27

Facility

$184.00

Service Code	HCPCS 86812
Hospital Charge Code	H3020582
Hospital Revenue Code	302
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$182.16
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$165.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Devoted Health Medicare	$182.16
Rate for Payer: Hawaii Medical Service Association ABD	$35.66
Rate for Payer: Hawaii Medical Service Association Commercial	$32.26
Rate for Payer: Hawaii Medical Service Association Medicare	$165.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.44
Rate for Payer: Hawaii Western Management Group Commercial	$25.81
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$165.60
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$165.60
Rate for Payer: Ohana Health Plan Medicare	$165.60
Rate for Payer: UnitedHealthcare Medicaid	$35.66
Rate for Payer: UnitedHealthcare Medicare	$165.60
Rate for Payer: University Health Alliance Commercial	$66.71

HCHG HLA-B27

Facility

$184.00

Service Code	HCPCS 86812
Hospital Charge Code	H3020582
Hospital Revenue Code	302
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

HCHG HOMOCYSTEINE TOT

Facility

$133.00

Service Code	HCPCS 83090
Hospital Charge Code	H3010730
Hospital Revenue Code	301
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

HCHG HOMOCYSTEINE TOT

Facility

$133.00

Service Code	HCPCS 83090
Hospital Charge Code	H3010730
Hospital Revenue Code	301
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$131.67
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$119.70
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$131.67
Rate for Payer: Hawaii Medical Service Association ABD	$23.31
Rate for Payer: Hawaii Medical Service Association Commercial	$22.40
Rate for Payer: Hawaii Medical Service Association Medicare	$119.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.48
Rate for Payer: Hawaii Western Management Group Commercial	$17.92
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$119.70
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$119.70
Rate for Payer: Ohana Health Plan Medicare	$119.70
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: UnitedHealthcare Medicare	$119.70
Rate for Payer: University Health Alliance Commercial	$43.60

HCHG HOMOGENIZATION TISSUE F/CULTURE - 90

Facility

$41.00

Service Code	HCPCS 87176
Hospital Charge Code	H3011638
Hospital Revenue Code	300
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$40.59
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$36.90
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$40.59
Rate for Payer: Hawaii Medical Service Association ABD	$4.93
Rate for Payer: Hawaii Medical Service Association Commercial	$7.35
Rate for Payer: Hawaii Medical Service Association Medicare	$36.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.12
Rate for Payer: Hawaii Western Management Group Commercial	$5.88
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$36.90
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$36.90
Rate for Payer: Ohana Health Plan Medicare	$36.90
Rate for Payer: UnitedHealthcare Medicaid	$4.93
Rate for Payer: UnitedHealthcare Medicare	$36.90
Rate for Payer: University Health Alliance Commercial	$15.21

HCHG HOMOGENIZATION TISSUE F/CULTURE - 90

Facility

$41.00

Service Code	HCPCS 87176
Hospital Charge Code	H3011638
Hospital Revenue Code	300
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77

HCHG H PYLORI AB

Facility

$287.00

Service Code	HCPCS 86677
Hospital Charge Code	K3020010
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$284.13
Rate for Payer: AlohaCare Medicaid	$143.50
Rate for Payer: AlohaCare Medicare	$258.30
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Devoted Health Medicare	$284.13
Rate for Payer: Hawaii Medical Service Association ABD	$20.05
Rate for Payer: Hawaii Medical Service Association Commercial	$21.06
Rate for Payer: Hawaii Medical Service Association Medicare	$258.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.05
Rate for Payer: Hawaii Western Management Group Commercial	$16.85
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Humana Medicare	$258.30
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: Kaiser Permanente Medicaid	$146.37
Rate for Payer: Kaiser Permanente Medicare	$258.30
Rate for Payer: MDX Hawaii PPO	$278.39
Rate for Payer: Ohana Health Plan Medicaid	$258.30
Rate for Payer: Ohana Health Plan Medicare	$258.30
Rate for Payer: UnitedHealthcare Medicaid	$20.05
Rate for Payer: UnitedHealthcare Medicare	$258.30
Rate for Payer: University Health Alliance Commercial	$37.52

HCHG H PYLORI AB

Facility

$287.00

Service Code	HCPCS 86677
Hospital Charge Code	K3020010
Hospital Revenue Code	302
Min. Negotiated Rate	$243.95
Max. Negotiated Rate	$278.39
Rate for Payer: Cash Price	$186.55
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: MDX Hawaii PPO	$278.39

HCHG H PYLORI AG EIA STOOL

Facility

$179.00

Service Code	HCPCS 87338
Hospital Charge Code	H3060204
Hospital Revenue Code	306
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$177.21
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$161.10
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Devoted Health Medicare	$177.21
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$17.98
Rate for Payer: Hawaii Medical Service Association Medicare	$161.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.70
Rate for Payer: Hawaii Western Management Group Commercial	$14.38
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$161.10
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$161.10
Rate for Payer: Ohana Health Plan Medicare	$161.10
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$161.10
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG H PYLORI AG EIA STOOL

Facility

$179.00

Service Code	HCPCS 87338
Hospital Charge Code	H3060204
Hospital Revenue Code	306
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

HCHG H PYLORI BREATH DRUG ADMIN

Facility

$117.00

Service Code	HCPCS 83014
Hospital Charge Code	H3010688
Hospital Revenue Code	301
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$115.83
Rate for Payer: AlohaCare Medicaid	$58.50
Rate for Payer: AlohaCare Medicare	$105.30
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cash Price	$76.05
Rate for Payer: Devoted Health Medicare	$115.83
Rate for Payer: Hawaii Medical Service Association ABD	$10.86
Rate for Payer: Hawaii Medical Service Association Commercial	$9.82
Rate for Payer: Hawaii Medical Service Association Medicare	$105.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$7.86
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Humana Medicare	$105.30
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: Kaiser Permanente Medicaid	$59.67
Rate for Payer: Kaiser Permanente Medicare	$105.30
Rate for Payer: MDX Hawaii PPO	$113.49
Rate for Payer: Ohana Health Plan Medicaid	$105.30
Rate for Payer: Ohana Health Plan Medicare	$105.30
Rate for Payer: UnitedHealthcare Medicaid	$10.86
Rate for Payer: UnitedHealthcare Medicare	$105.30
Rate for Payer: University Health Alliance Commercial	$20.31

HCHG H PYLORI BREATH DRUG ADMIN

Facility

$117.00

Service Code	HCPCS 83014
Hospital Charge Code	H3010688
Hospital Revenue Code	301
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$76.05
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: MDX Hawaii PPO	$113.49

HCHG H PYLORI BREATH TEST

Facility

$827.00

Service Code	HCPCS 83013
Hospital Charge Code	H3010690
Hospital Revenue Code	301
Min. Negotiated Rate	$67.36
Max. Negotiated Rate	$818.73
Rate for Payer: AlohaCare Medicaid	$413.50
Rate for Payer: AlohaCare Medicare	$744.30
Rate for Payer: Cash Price	$537.55
Rate for Payer: Cash Price	$537.55
Rate for Payer: Devoted Health Medicare	$818.73
Rate for Payer: Hawaii Medical Service Association ABD	$93.09
Rate for Payer: Hawaii Medical Service Association Commercial	$84.20
Rate for Payer: Hawaii Medical Service Association Medicare	$744.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$97.74
Rate for Payer: Hawaii Western Management Group Commercial	$67.36
Rate for Payer: Health Management Network Commercial	$702.95
Rate for Payer: Humana Medicare	$744.30
Rate for Payer: Kaiser Permanente Commercial	$744.30
Rate for Payer: Kaiser Permanente Medicaid	$421.77
Rate for Payer: Kaiser Permanente Medicare	$744.30
Rate for Payer: MDX Hawaii PPO	$802.19
Rate for Payer: Ohana Health Plan Medicaid	$744.30
Rate for Payer: Ohana Health Plan Medicare	$744.30
Rate for Payer: UnitedHealthcare Medicaid	$93.09
Rate for Payer: UnitedHealthcare Medicare	$744.30
Rate for Payer: University Health Alliance Commercial	$174.10

HCHG H PYLORI BREATH TEST

Facility

$827.00

Service Code	HCPCS 83013
Hospital Charge Code	H3010690
Hospital Revenue Code	301
Min. Negotiated Rate	$702.95
Max. Negotiated Rate	$802.19
Rate for Payer: Cash Price	$537.55
Rate for Payer: Health Management Network Commercial	$702.95
Rate for Payer: Kaiser Permanente Commercial	$744.30
Rate for Payer: MDX Hawaii PPO	$802.19

HCHG HSV, AMP PROBE

Facility

$518.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060645
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$512.82
Rate for Payer: AlohaCare Medicaid	$259.00
Rate for Payer: AlohaCare Medicare	$466.20
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Devoted Health Medicare	$512.82
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$466.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$466.20
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$466.20
Rate for Payer: Ohana Health Plan Medicare	$466.20
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$466.20
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG HSV, AMP PROBE

Facility

$518.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060645
Hospital Revenue Code	306
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$336.70
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46

HCHG HSV DNA AMP PROBE - 90

Facility

$518.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060798
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$512.82
Rate for Payer: AlohaCare Medicaid	$259.00
Rate for Payer: AlohaCare Medicare	$466.20
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Devoted Health Medicare	$512.82
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$466.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$466.20
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$466.20
Rate for Payer: Ohana Health Plan Medicare	$466.20
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$466.20
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG HSV DNA AMP PROBE - 90

Facility

$518.00

Service Code	HCPCS 87529
Hospital Charge Code	H3060798
Hospital Revenue Code	306
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$336.70
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46

HCHG HUMERUS, MIN 2 VIEWS

Facility

$564.00

Service Code	HCPCS 73060
Hospital Charge Code	H3200456
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$558.36
Rate for Payer: AlohaCare Medicaid	$282.00
Rate for Payer: AlohaCare Medicare	$507.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Devoted Health Medicare	$558.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$507.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Humana Medicare	$507.60
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: Kaiser Permanente Medicaid	$287.64
Rate for Payer: Kaiser Permanente Medicare	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08
Rate for Payer: Ohana Health Plan Medicaid	$507.60
Rate for Payer: Ohana Health Plan Medicare	$507.60
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$507.60
Rate for Payer: University Health Alliance Commercial	$61.20

Know your out-of-pocket cost for care.

All Charges