Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG APPLICATON ON-BODY INJECTOR

Facility

$279.00

Service Code	HCPCS 96377
Hospital Charge Code	H9400147
Hospital Revenue Code	940
Min. Negotiated Rate	$237.15
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$181.35
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: MDX Hawaii PPO	$270.63

HCHG APPLICATON ON-BODY INJECTOR

Facility

$279.00

Service Code	HCPCS 96377
Hospital Charge Code	H9400147
Hospital Revenue Code	940
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$270.63
Rate for Payer: AlohaCare Medicaid	$55.32
Rate for Payer: AlohaCare Medicare	$55.32
Rate for Payer: Cash Price	$181.35
Rate for Payer: Cash Price	$181.35
Rate for Payer: Devoted Health Medicare	$60.85
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$55.32
Rate for Payer: Hawaii Western Management Group Commercial	$265.05
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Humana Medicare	$55.32
Rate for Payer: Kaiser Permanente Commercial	$175.77
Rate for Payer: Kaiser Permanente Medicaid	$142.29
Rate for Payer: Kaiser Permanente Medicare	$55.32
Rate for Payer: MDX Hawaii PPO	$270.63
Rate for Payer: Ohana Health Plan Medicaid	$60.85
Rate for Payer: Ohana Health Plan Medicare	$55.32
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicare	$55.32
Rate for Payer: University Health Alliance Commercial	$203.36

HCHG APPLIC SHORT ARM CAST

Facility

$1,096.00

Service Code	HCPCS 29075
Hospital Charge Code	H4500124
Hospital Revenue Code	450
Min. Negotiated Rate	$931.60
Max. Negotiated Rate	$1,063.12
Rate for Payer: Cash Price	$712.40
Rate for Payer: Health Management Network Commercial	$931.60
Rate for Payer: MDX Hawaii PPO	$1,063.12

HCHG APPLIC SHORT ARM CAST

Facility

$1,096.00

Service Code	HCPCS 29075
Hospital Charge Code	H4500124
Hospital Revenue Code	450
Min. Negotiated Rate	$330.41
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$330.41
Rate for Payer: AlohaCare Medicare	$330.41
Rate for Payer: Cash Price	$712.40
Rate for Payer: Cash Price	$712.40
Rate for Payer: Cash Price	$712.40
Rate for Payer: Cash Price	$712.40
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$330.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.20
Rate for Payer: Health Management Network Commercial	$931.60
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$690.48
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,063.12
Rate for Payer: Ohana Health Plan Medicaid	$363.45
Rate for Payer: Ohana Health Plan Medicare	$330.41
Rate for Payer: UnitedHealthcare Medicare	$330.41
Rate for Payer: University Health Alliance Commercial	$798.87

HCHG APPLIC SHORT LEG CAST

Facility

$1,374.00

Service Code	HCPCS 29405
Hospital Charge Code	H4500126
Hospital Revenue Code	450
Min. Negotiated Rate	$330.41
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$330.41
Rate for Payer: AlohaCare Medicare	$330.41
Rate for Payer: Cash Price	$893.10
Rate for Payer: Cash Price	$893.10
Rate for Payer: Cash Price	$893.10
Rate for Payer: Cash Price	$893.10
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$330.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,305.30
Rate for Payer: Health Management Network Commercial	$1,167.90
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$865.62
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,332.78
Rate for Payer: Ohana Health Plan Medicaid	$363.45
Rate for Payer: Ohana Health Plan Medicare	$330.41
Rate for Payer: UnitedHealthcare Medicare	$330.41
Rate for Payer: University Health Alliance Commercial	$1,001.51

HCHG APPLIC SHORT LEG CAST

Facility

$1,374.00

Service Code	HCPCS 29405
Hospital Charge Code	H4500126
Hospital Revenue Code	450
Min. Negotiated Rate	$1,167.90
Max. Negotiated Rate	$1,332.78
Rate for Payer: Cash Price	$893.10
Rate for Payer: Health Management Network Commercial	$1,167.90
Rate for Payer: MDX Hawaii PPO	$1,332.78

HCHG APPLIC SPLINT FINGER STATIC

Facility

$816.00

Service Code	HCPCS 29130
Hospital Charge Code	H4500684
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG APPLIC SPLINT FINGER STATIC

Facility

$816.00

Service Code	HCPCS 29130
Hospital Charge Code	H4500684
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG APPLIC SPLINT LONG ARM

Facility

$1,001.00

Service Code	HCPCS 29105
Hospital Charge Code	H4500686
Hospital Revenue Code	450
Min. Negotiated Rate	$191.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$191.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$950.95
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$630.63
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$729.63

HCHG APPLIC SPLINT LONG ARM

Facility

$1,001.00

Service Code	HCPCS 29105
Hospital Charge Code	H4500686
Hospital Revenue Code	450
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: MDX Hawaii PPO	$970.97

HCHG APPLIC SPLINT LONG LEG

Facility

$1,001.00

Service Code	HCPCS 29505
Hospital Charge Code	H4500688
Hospital Revenue Code	450
Min. Negotiated Rate	$191.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$191.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$950.95
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$630.63
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$729.63

HCHG APPLIC SPLINT LONG LEG

Facility

$1,001.00

Service Code	HCPCS 29505
Hospital Charge Code	H4500688
Hospital Revenue Code	450
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: MDX Hawaii PPO	$970.97

HCHG APPLIC SPLINT SHORT ARM

Facility

$816.00

Service Code	HCPCS 29125
Hospital Charge Code	H4500690
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: MDX Hawaii PPO	$791.52

HCHG APPLIC SPLINT SHORT ARM

Facility

$816.00

Service Code	HCPCS 29125
Hospital Charge Code	H4500690
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$514.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$594.78

HCHG APPLIC SPLINT SHORT LEG

Facility

$1,001.00

Service Code	HCPCS 29515
Hospital Charge Code	H4500692
Hospital Revenue Code	450
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: MDX Hawaii PPO	$970.97

HCHG APPLIC SPLINT SHORT LEG

Facility

$1,001.00

Service Code	HCPCS 29515
Hospital Charge Code	H4500692
Hospital Revenue Code	450
Min. Negotiated Rate	$191.97
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Cash Price	$650.65
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$191.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$950.95
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$630.63
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$729.63

HCHG APPLY FOREARM SPLINT

Facility

$836.00

Service Code	HCPCS 29126
Hospital Charge Code	H4500963
Hospital Revenue Code	450
Min. Negotiated Rate	$710.60
Max. Negotiated Rate	$810.92
Rate for Payer: Cash Price	$543.40
Rate for Payer: Health Management Network Commercial	$710.60
Rate for Payer: MDX Hawaii PPO	$810.92

HCHG APPLY FOREARM SPLINT

Facility

$836.00

Service Code	HCPCS 29126
Hospital Charge Code	H4500963
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$543.40
Rate for Payer: Cash Price	$543.40
Rate for Payer: Cash Price	$543.40
Rate for Payer: Cash Price	$543.40
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$794.20
Rate for Payer: Health Management Network Commercial	$710.60
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$526.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$810.92
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$609.36

HCHG APT TEST

Facility

$70.00

Service Code	HCPCS 83033
Hospital Charge Code	H3010244
Hospital Revenue Code	301
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$8.00
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Devoted Health Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association ABD	$8.24
Rate for Payer: Hawaii Medical Service Association Commercial	$10.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.65
Rate for Payer: Hawaii Western Management Group Commercial	$8.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$8.00
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$8.80
Rate for Payer: Ohana Health Plan Medicare	$8.00
Rate for Payer: UnitedHealthcare Medicaid	$8.24
Rate for Payer: UnitedHealthcare Medicare	$8.00
Rate for Payer: University Health Alliance Commercial	$15.41

HCHG APT TEST

Facility

$70.00

Service Code	HCPCS 83033
Hospital Charge Code	H3010244
Hospital Revenue Code	301
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$45.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: MDX Hawaii PPO	$67.90

HCHG ARGININE VASOPRESSIN

Facility

$418.00

Service Code	HCPCS 84588
Hospital Charge Code	H3010246
Hospital Revenue Code	301
Min. Negotiated Rate	$355.30
Max. Negotiated Rate	$405.46
Rate for Payer: Cash Price	$271.70
Rate for Payer: Health Management Network Commercial	$355.30
Rate for Payer: MDX Hawaii PPO	$405.46

HCHG ARGININE VASOPRESSIN

Facility

$418.00

Service Code	HCPCS 84588
Hospital Charge Code	H3010246
Hospital Revenue Code	301
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$405.46
Rate for Payer: AlohaCare Medicaid	$33.94
Rate for Payer: AlohaCare Medicare	$33.94
Rate for Payer: Cash Price	$271.70
Rate for Payer: Cash Price	$271.70
Rate for Payer: Devoted Health Medicare	$37.33
Rate for Payer: Hawaii Medical Service Association ABD	$46.91
Rate for Payer: Hawaii Medical Service Association Commercial	$42.42
Rate for Payer: Hawaii Medical Service Association Medicare	$33.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.26
Rate for Payer: Hawaii Western Management Group Commercial	$33.94
Rate for Payer: Health Management Network Commercial	$355.30
Rate for Payer: Humana Medicare	$33.94
Rate for Payer: Kaiser Permanente Commercial	$263.34
Rate for Payer: Kaiser Permanente Medicaid	$213.18
Rate for Payer: Kaiser Permanente Medicare	$33.94
Rate for Payer: MDX Hawaii PPO	$405.46
Rate for Payer: Ohana Health Plan Medicaid	$37.33
Rate for Payer: Ohana Health Plan Medicare	$33.94
Rate for Payer: UnitedHealthcare Medicaid	$46.91
Rate for Payer: UnitedHealthcare Medicare	$33.94
Rate for Payer: University Health Alliance Commercial	$87.75

HCHG ARSENIC URINE 90

Facility

$232.00

Service Code	HCPCS 82175
Hospital Charge Code	H3010252
Hospital Revenue Code	301
Min. Negotiated Rate	$197.20
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$150.80
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: MDX Hawaii PPO	$225.04

HCHG ARSENIC URINE 90

Facility

$232.00

Service Code	HCPCS 82175
Hospital Charge Code	H3010252
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$225.04
Rate for Payer: AlohaCare Medicaid	$18.97
Rate for Payer: AlohaCare Medicare	$18.97
Rate for Payer: Cash Price	$150.80
Rate for Payer: Cash Price	$150.80
Rate for Payer: Devoted Health Medicare	$20.87
Rate for Payer: Hawaii Medical Service Association ABD	$26.22
Rate for Payer: Hawaii Medical Service Association Commercial	$23.71
Rate for Payer: Hawaii Medical Service Association Medicare	$18.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.53
Rate for Payer: Hawaii Western Management Group Commercial	$18.97
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Humana Medicare	$18.97
Rate for Payer: Kaiser Permanente Commercial	$146.16
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: Kaiser Permanente Medicare	$18.97
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: Ohana Health Plan Medicaid	$20.87
Rate for Payer: Ohana Health Plan Medicare	$18.97
Rate for Payer: UnitedHealthcare Medicaid	$26.22
Rate for Payer: UnitedHealthcare Medicare	$18.97
Rate for Payer: University Health Alliance Commercial	$49.04

HCHG ART DPLX IMAG PERIP F/U-LOW EXTREM

Facility

$708.00

Service Code	HCPCS 93926
Hospital Charge Code	H9210102
Hospital Revenue Code	921
Min. Negotiated Rate	$103.46
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$103.46
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$123.54
Rate for Payer: Hawaii Western Management Group Commercial	$672.60
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$446.04
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$103.46
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$516.06

Know your out-of-pocket cost for care.

All Charges