Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ACCOM SEMI ACUTE

Facility

$2,750.00

Hospital Charge Code	K0000003
Hospital Revenue Code	121
Min. Negotiated Rate	$2,337.50
Max. Negotiated Rate	$7,250.00
Rate for Payer: Cash Price	$1,787.50
Rate for Payer: Cash Price	$1,787.50
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,337.50
Rate for Payer: MDX Hawaii PPO	$2,667.50
Rate for Payer: University Health Alliance Commercial	$5,923.00

HCHG ACCOM SEMI OB

Facility

$3,000.00

Hospital Charge Code	K0000008
Hospital Revenue Code	122
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$7,250.00
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$5,923.00

HCHG ACCOM WAITLIST PRIV ICF

Facility

$2,365.00

Hospital Charge Code	K0000001
Hospital Revenue Code	111
Min. Negotiated Rate	$486.76
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$486.76
Rate for Payer: Cash Price	$1,537.25
Rate for Payer: Cash Price	$1,537.25
Rate for Payer: Hawaii Medical Service Association ABD	$486.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$486.76
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,010.25
Rate for Payer: Kaiser Permanente Medicaid	$486.76
Rate for Payer: MDX Hawaii PPO	$2,294.05
Rate for Payer: Ohana Health Plan Medicaid	$486.76
Rate for Payer: UnitedHealthcare Medicaid	$486.76
Rate for Payer: University Health Alliance Commercial	$2,320.00

HCHG ACCOM WAITLIST PRIV SNF

Facility

$2,500.00

Hospital Charge Code	K0000002
Hospital Revenue Code	111
Min. Negotiated Rate	$486.76
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$486.76
Rate for Payer: Cash Price	$1,625.00
Rate for Payer: Cash Price	$1,625.00
Rate for Payer: Hawaii Medical Service Association ABD	$486.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$486.76
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,125.00
Rate for Payer: Kaiser Permanente Medicaid	$486.76
Rate for Payer: MDX Hawaii PPO	$2,425.00
Rate for Payer: Ohana Health Plan Medicaid	$486.76
Rate for Payer: UnitedHealthcare Medicaid	$486.76
Rate for Payer: University Health Alliance Commercial	$2,320.00

HCHG ACCOM WAITLIST SEMI ICF

Facility

$2,365.00

Hospital Charge Code	K0000006
Hospital Revenue Code	121
Min. Negotiated Rate	$486.76
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$486.76
Rate for Payer: Cash Price	$1,537.25
Rate for Payer: Cash Price	$1,537.25
Rate for Payer: Hawaii Medical Service Association ABD	$486.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$486.76
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,010.25
Rate for Payer: Kaiser Permanente Medicaid	$486.76
Rate for Payer: MDX Hawaii PPO	$2,294.05
Rate for Payer: Ohana Health Plan Medicaid	$486.76
Rate for Payer: UnitedHealthcare Medicaid	$486.76
Rate for Payer: University Health Alliance Commercial	$2,320.00

HCHG ACCOM WAITLIST SEMI SNF

Facility

$2,500.00

Hospital Charge Code	K0000007
Hospital Revenue Code	121
Min. Negotiated Rate	$486.76
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$486.76
Rate for Payer: Cash Price	$1,625.00
Rate for Payer: Cash Price	$1,625.00
Rate for Payer: Hawaii Medical Service Association ABD	$486.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$486.76
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,125.00
Rate for Payer: Kaiser Permanente Medicaid	$486.76
Rate for Payer: MDX Hawaii PPO	$2,425.00
Rate for Payer: Ohana Health Plan Medicaid	$486.76
Rate for Payer: UnitedHealthcare Medicaid	$486.76
Rate for Payer: University Health Alliance Commercial	$2,320.00

HCHG ACETAMINOPHEN (TYLENOL)

Facility

$138.00

Service Code	HCPCS 80143
Hospital Charge Code	H3011724
Hospital Revenue Code	301
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$18.64
Rate for Payer: AlohaCare Medicare	$18.64
Rate for Payer: Cash Price	$89.70
Rate for Payer: Cash Price	$89.70
Rate for Payer: Devoted Health Medicare	$20.50
Rate for Payer: Hawaii Medical Service Association ABD	$18.92
Rate for Payer: Hawaii Medical Service Association Commercial	$23.30
Rate for Payer: Hawaii Medical Service Association Medicare	$18.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$18.64
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$18.64
Rate for Payer: Kaiser Permanente Commercial	$86.94
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$18.64
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$18.64
Rate for Payer: UnitedHealthcare Medicaid	$11.18
Rate for Payer: UnitedHealthcare Medicare	$18.64
Rate for Payer: University Health Alliance Commercial	$100.59

HCHG ACETAMINOPHEN (TYLENOL)

Facility

$138.00

Service Code	HCPCS 80143
Hospital Charge Code	H3011724
Hospital Revenue Code	301
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$89.70
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: MDX Hawaii PPO	$133.86

HCHG ACETAMINOPHEN TYLENOL

Facility

$393.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010018
Hospital Revenue Code	301
Min. Negotiated Rate	$334.05
Max. Negotiated Rate	$381.21
Rate for Payer: Cash Price	$255.45
Rate for Payer: Health Management Network Commercial	$334.05
Rate for Payer: MDX Hawaii PPO	$381.21

HCHG ACETAMINOPHEN TYLENOL

Facility

$393.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010018
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$381.21
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$255.45
Rate for Payer: Cash Price	$255.45
Rate for Payer: Devoted Health Medicare	$68.35
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$62.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$334.05
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$247.59
Rate for Payer: Kaiser Permanente Medicaid	$200.43
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$381.21
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG ACETYLCHOLINE RECEP AB MOD

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3000120
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association ABD	$18.67
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.60
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$114.66
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$18.67
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG ACETYLCHOLINE RECEP AB MOD

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3000120
Hospital Revenue Code	301
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: MDX Hawaii PPO	$176.54

HCHG ACETYLCHOLINE RECEPTOR AB 90

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3010120
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association ABD	$18.67
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.60
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$114.66
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$18.67
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG ACETYLCHOLINE RECEPTOR AB 90

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3010120
Hospital Revenue Code	301
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: MDX Hawaii PPO	$176.54

HCHG ACETYLCHOLINE REC MOD AB SO

Facility

$156.00

Service Code	HCPCS 83516
Hospital Charge Code	K3010035
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$11.53
Rate for Payer: AlohaCare Medicare	$11.53
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$12.68
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$11.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$11.53
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$11.53
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$12.68
Rate for Payer: Ohana Health Plan Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$11.53
Rate for Payer: University Health Alliance Commercial	$29.82

HCHG ACETYLCHOLINE REC MOD AB SO

Facility

$156.00

Service Code	HCPCS 83516
Hospital Charge Code	K3010035
Hospital Revenue Code	301
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HCHG ACID FAST BACILLI ID BY MALDI

Facility

$134.00

Service Code	HCPCS 87118
Hospital Charge Code	H3060712
Hospital Revenue Code	306
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$14.61
Rate for Payer: AlohaCare Medicare	$14.61
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$16.07
Rate for Payer: Hawaii Medical Service Association ABD	$15.13
Rate for Payer: Hawaii Medical Service Association Commercial	$18.26
Rate for Payer: Hawaii Medical Service Association Medicare	$14.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.89
Rate for Payer: Hawaii Western Management Group Commercial	$14.61
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$14.61
Rate for Payer: Kaiser Permanente Commercial	$84.42
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$14.61
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$16.07
Rate for Payer: Ohana Health Plan Medicare	$14.61
Rate for Payer: UnitedHealthcare Medicaid	$15.13
Rate for Payer: UnitedHealthcare Medicare	$14.61
Rate for Payer: University Health Alliance Commercial	$28.29

HCHG ACID FAST BACILLI ID BY MALDI

Facility

$134.00

Service Code	HCPCS 87118
Hospital Charge Code	H3060712
Hospital Revenue Code	306
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: MDX Hawaii PPO	$129.98

HCHG ACROMIOCLAV JOINTS W WO WT DISTRACTION

Facility

$545.00

Service Code	HCPCS 73050
Hospital Charge Code	H3200130
Hospital Revenue Code	320
Min. Negotiated Rate	$463.25
Max. Negotiated Rate	$528.65
Rate for Payer: Cash Price	$354.25
Rate for Payer: Health Management Network Commercial	$463.25
Rate for Payer: MDX Hawaii PPO	$528.65

HCHG ACROMIOCLAV JOINTS W WO WT DISTRACTION

Facility

$545.00

Service Code	HCPCS 73050
Hospital Charge Code	H3200130
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$528.65
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$354.25
Rate for Payer: Cash Price	$354.25
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$463.25
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$343.35
Rate for Payer: Kaiser Permanente Medicaid	$277.95
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$528.65
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$73.74

HCHG ACTH LEVEL RIA 90

Facility

$475.00

Service Code	HCPCS 82024
Hospital Charge Code	H3010130
Hospital Revenue Code	301
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$460.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: MDX Hawaii PPO	$460.75

HCHG ACTH LEVEL RIA 90

Facility

$475.00

Service Code	HCPCS 82024
Hospital Charge Code	H3010130
Hospital Revenue Code	301
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$460.75
Rate for Payer: AlohaCare Medicaid	$38.62
Rate for Payer: AlohaCare Medicare	$38.62
Rate for Payer: Cash Price	$308.75
Rate for Payer: Cash Price	$308.75
Rate for Payer: Devoted Health Medicare	$42.48
Rate for Payer: Hawaii Medical Service Association ABD	$53.38
Rate for Payer: Hawaii Medical Service Association Commercial	$48.27
Rate for Payer: Hawaii Medical Service Association Medicare	$38.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.05
Rate for Payer: Hawaii Western Management Group Commercial	$38.62
Rate for Payer: Health Management Network Commercial	$403.75
Rate for Payer: Humana Medicare	$38.62
Rate for Payer: Kaiser Permanente Commercial	$299.25
Rate for Payer: Kaiser Permanente Medicaid	$242.25
Rate for Payer: Kaiser Permanente Medicare	$38.62
Rate for Payer: MDX Hawaii PPO	$460.75
Rate for Payer: Ohana Health Plan Medicaid	$42.48
Rate for Payer: Ohana Health Plan Medicare	$38.62
Rate for Payer: UnitedHealthcare Medicaid	$53.38
Rate for Payer: UnitedHealthcare Medicare	$38.62
Rate for Payer: University Health Alliance Commercial	$99.84

HCHG ACTIN (SMOOTH MUSCLE) AB

Facility

$149.00

Service Code	HCPCS 86015
Hospital Charge Code	H3021041
Hospital Revenue Code	302
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

HCHG ACTIN (SMOOTH MUSCLE) AB

Facility

$149.00

Service Code	HCPCS 86015
Hospital Charge Code	H3021041
Hospital Revenue Code	302
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$12.05
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$12.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$12.05
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$12.05
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$6.92
Rate for Payer: UnitedHealthcare Medicare	$12.05
Rate for Payer: University Health Alliance Commercial	$108.61

HCHG ACUTE HEPATITIS PANEL

Facility

$804.00

Service Code	HCPCS 80074
Hospital Charge Code	H3010132
Hospital Revenue Code	301
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$779.88
Rate for Payer: AlohaCare Medicaid	$47.63
Rate for Payer: AlohaCare Medicare	$47.63
Rate for Payer: Cash Price	$522.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Devoted Health Medicare	$52.39
Rate for Payer: Hawaii Medical Service Association ABD	$65.82
Rate for Payer: Hawaii Medical Service Association Commercial	$59.54
Rate for Payer: Hawaii Medical Service Association Medicare	$47.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$69.11
Rate for Payer: Hawaii Western Management Group Commercial	$47.63
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Humana Medicare	$47.63
Rate for Payer: Kaiser Permanente Commercial	$506.52
Rate for Payer: Kaiser Permanente Medicaid	$410.04
Rate for Payer: Kaiser Permanente Medicare	$47.63
Rate for Payer: MDX Hawaii PPO	$779.88
Rate for Payer: Ohana Health Plan Medicaid	$52.39
Rate for Payer: Ohana Health Plan Medicare	$47.63
Rate for Payer: UnitedHealthcare Medicaid	$65.82
Rate for Payer: UnitedHealthcare Medicare	$47.63
Rate for Payer: University Health Alliance Commercial	$123.10

Know your out-of-pocket cost for care.

All Charges