Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG GLUCOSE 2HR PP ONLY

Facility

$59.00

Service Code	HCPCS 82950
Hospital Charge Code	H3010662
Hospital Revenue Code	301
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: MDX Hawaii PPO	$57.23

HCHG GLUCOSE 2HR PP ONLY

Facility

$59.00

Service Code	HCPCS 82950
Hospital Charge Code	H3010662
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$4.75
Rate for Payer: AlohaCare Medicare	$4.75
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Devoted Health Medicare	$5.22
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$4.75
Rate for Payer: Kaiser Permanente Commercial	$37.17
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$4.75
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$5.22
Rate for Payer: Ohana Health Plan Medicare	$4.75
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$4.75
Rate for Payer: University Health Alliance Commercial	$12.28

HCHG GLUCOSE-BODY FLD

Facility

$67.00

Service Code	HCPCS 82945
Hospital Charge Code	H3010676
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$3.93
Rate for Payer: AlohaCare Medicare	$3.93
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Devoted Health Medicare	$4.32
Rate for Payer: Hawaii Medical Service Association ABD	$5.42
Rate for Payer: Hawaii Medical Service Association Commercial	$4.91
Rate for Payer: Hawaii Medical Service Association Medicare	$3.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.69
Rate for Payer: Hawaii Western Management Group Commercial	$3.93
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$3.93
Rate for Payer: Kaiser Permanente Commercial	$42.21
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$3.93
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$4.32
Rate for Payer: Ohana Health Plan Medicare	$3.93
Rate for Payer: UnitedHealthcare Medicaid	$5.42
Rate for Payer: UnitedHealthcare Medicare	$3.93
Rate for Payer: University Health Alliance Commercial	$10.14

HCHG GLUCOSE-BODY FLD

Facility

$67.00

Service Code	HCPCS 82945
Hospital Charge Code	H3010676
Hospital Revenue Code	301
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$43.55
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: MDX Hawaii PPO	$64.99

HCHG GLUCOSE CSF

Facility

$67.00

Service Code	HCPCS 82945
Hospital Charge Code	H3010664
Hospital Revenue Code	301
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$43.55
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: MDX Hawaii PPO	$64.99

HCHG GLUCOSE CSF

Facility

$67.00

Service Code	HCPCS 82945
Hospital Charge Code	H3010664
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$3.93
Rate for Payer: AlohaCare Medicare	$3.93
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Devoted Health Medicare	$4.32
Rate for Payer: Hawaii Medical Service Association ABD	$5.42
Rate for Payer: Hawaii Medical Service Association Commercial	$4.91
Rate for Payer: Hawaii Medical Service Association Medicare	$3.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.69
Rate for Payer: Hawaii Western Management Group Commercial	$3.93
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$3.93
Rate for Payer: Kaiser Permanente Commercial	$42.21
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$3.93
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$4.32
Rate for Payer: Ohana Health Plan Medicare	$3.93
Rate for Payer: UnitedHealthcare Medicaid	$5.42
Rate for Payer: UnitedHealthcare Medicare	$3.93
Rate for Payer: University Health Alliance Commercial	$10.14

HCHG GLUCOSE PRECISION G

Facility

$43.00

Service Code	HCPCS 82962
Hospital Charge Code	H3010668
Hospital Revenue Code	301
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$27.95
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

HCHG GLUCOSE PRECISION G

Facility

$43.00

Service Code	HCPCS 82962
Hospital Charge Code	H3010668
Hospital Revenue Code	301
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$3.28
Rate for Payer: AlohaCare Medicare	$3.28
Rate for Payer: Cash Price	$27.95
Rate for Payer: Cash Price	$27.95
Rate for Payer: Devoted Health Medicare	$3.61
Rate for Payer: Hawaii Medical Service Association ABD	$2.50
Rate for Payer: Hawaii Medical Service Association Commercial	$4.10
Rate for Payer: Hawaii Medical Service Association Medicare	$3.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$3.28
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$3.28
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$3.61
Rate for Payer: Ohana Health Plan Medicare	$3.28
Rate for Payer: UnitedHealthcare Medicaid	$2.50
Rate for Payer: UnitedHealthcare Medicare	$3.28
Rate for Payer: University Health Alliance Commercial	$4.68

HCHG GLUCOSE QUANTITATIVE BLOOD

Facility

$55.00

Service Code	HCPCS 82947
Hospital Charge Code	H3010656
Hospital Revenue Code	301
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$3.93
Rate for Payer: AlohaCare Medicare	$3.93
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$4.32
Rate for Payer: Hawaii Medical Service Association ABD	$5.42
Rate for Payer: Hawaii Medical Service Association Commercial	$4.91
Rate for Payer: Hawaii Medical Service Association Medicare	$3.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.69
Rate for Payer: Hawaii Western Management Group Commercial	$3.93
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$3.93
Rate for Payer: Kaiser Permanente Commercial	$34.65
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$3.93
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$4.32
Rate for Payer: Ohana Health Plan Medicare	$3.93
Rate for Payer: UnitedHealthcare Medicaid	$5.42
Rate for Payer: UnitedHealthcare Medicare	$3.93
Rate for Payer: University Health Alliance Commercial	$10.14

HCHG GLUCOSE QUANTITATIVE BLOOD

Facility

$55.00

Service Code	HCPCS 82947
Hospital Charge Code	H3010656
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$35.75
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: MDX Hawaii PPO	$53.35

HCHG GLUCOSE TOL 3 HR PREG

Facility

$90.00

Service Code	HCPCS 82951
Hospital Charge Code	H3010670
Hospital Revenue Code	301
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$87.30

HCHG GLUCOSE TOL 3 HR PREG

Facility

$90.00

Service Code	HCPCS 82951
Hospital Charge Code	H3010670
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$12.87
Rate for Payer: AlohaCare Medicare	$12.87
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$14.16
Rate for Payer: Hawaii Medical Service Association ABD	$17.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16.09
Rate for Payer: Hawaii Medical Service Association Medicare	$12.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.69
Rate for Payer: Hawaii Western Management Group Commercial	$12.87
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$12.87
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$12.87
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$14.16
Rate for Payer: Ohana Health Plan Medicare	$12.87
Rate for Payer: UnitedHealthcare Medicaid	$17.80
Rate for Payer: UnitedHealthcare Medicare	$12.87
Rate for Payer: University Health Alliance Commercial	$33.28

HCHG GLUTAMIC ACID DECARBOXYLASE AB - 90

Facility

$169.00

Service Code	HCPCS 86341
Hospital Charge Code	H3001099
Hospital Revenue Code	300
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$23.57
Rate for Payer: AlohaCare Medicare	$23.57
Rate for Payer: Cash Price	$109.85
Rate for Payer: Cash Price	$109.85
Rate for Payer: Devoted Health Medicare	$25.93
Rate for Payer: Hawaii Medical Service Association ABD	$25.15
Rate for Payer: Hawaii Medical Service Association Commercial	$29.46
Rate for Payer: Hawaii Medical Service Association Medicare	$23.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.41
Rate for Payer: Hawaii Western Management Group Commercial	$23.57
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$23.57
Rate for Payer: Kaiser Permanente Commercial	$106.47
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$23.57
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$25.93
Rate for Payer: Ohana Health Plan Medicare	$23.57
Rate for Payer: UnitedHealthcare Medicaid	$25.15
Rate for Payer: UnitedHealthcare Medicare	$23.57
Rate for Payer: University Health Alliance Commercial	$47.05

HCHG GLUTAMIC ACID DECARBOXYLASE AB - 90

Facility

$169.00

Service Code	HCPCS 86341
Hospital Charge Code	H3001099
Hospital Revenue Code	300
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$109.85
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: MDX Hawaii PPO	$163.93

HCHG GM1 AB 90

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3020518
Hospital Revenue Code	301
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

HCHG GM1 AB 90

Facility

$160.00

Service Code	HCPCS 83520
Hospital Charge Code	H3020518
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$33.47

HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM

Facility

$128.00

Service Code	HCPCS 84703
Hospital Charge Code	H3011367
Hospital Revenue Code	301
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: MDX Hawaii PPO	$124.16

HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM

Facility

$128.00

Service Code	HCPCS 84703
Hospital Charge Code	H3011367
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$7.52
Rate for Payer: AlohaCare Medicare	$7.52
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Devoted Health Medicare	$8.27
Rate for Payer: Hawaii Medical Service Association ABD	$10.38
Rate for Payer: Hawaii Medical Service Association Commercial	$9.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.90
Rate for Payer: Hawaii Western Management Group Commercial	$7.52
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$7.52
Rate for Payer: Kaiser Permanente Commercial	$80.64
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$7.52
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$8.27
Rate for Payer: Ohana Health Plan Medicare	$7.52
Rate for Payer: UnitedHealthcare Medicaid	$10.38
Rate for Payer: UnitedHealthcare Medicare	$7.52
Rate for Payer: University Health Alliance Commercial	$19.41

HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM & REFLEX TO QUANT

Facility

$128.00

Service Code	HCPCS 84703
Hospital Charge Code	H3011368
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$7.52
Rate for Payer: AlohaCare Medicare	$7.52
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Devoted Health Medicare	$8.27
Rate for Payer: Hawaii Medical Service Association ABD	$10.38
Rate for Payer: Hawaii Medical Service Association Commercial	$9.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.90
Rate for Payer: Hawaii Western Management Group Commercial	$7.52
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$7.52
Rate for Payer: Kaiser Permanente Commercial	$80.64
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$7.52
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$8.27
Rate for Payer: Ohana Health Plan Medicare	$7.52
Rate for Payer: UnitedHealthcare Medicaid	$10.38
Rate for Payer: UnitedHealthcare Medicare	$7.52
Rate for Payer: University Health Alliance Commercial	$19.41

HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM & REFLEX TO QUANT

Facility

$128.00

Service Code	HCPCS 84703
Hospital Charge Code	H3011368
Hospital Revenue Code	301
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: MDX Hawaii PPO	$124.16

HCHG GONADOTROPIN, CHORIONIC (HCG); QUANT, SERUM

Facility

$204.00

Service Code	HCPCS 84702
Hospital Charge Code	H3010700
Hospital Revenue Code	301
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$15.05
Rate for Payer: AlohaCare Medicare	$15.05
Rate for Payer: Cash Price	$132.60
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$18.81
Rate for Payer: Hawaii Medical Service Association Medicare	$15.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$15.05
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$15.05
Rate for Payer: Kaiser Permanente Commercial	$128.52
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$15.05
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$16.55
Rate for Payer: Ohana Health Plan Medicare	$15.05
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$15.05
Rate for Payer: University Health Alliance Commercial	$38.91

HCHG GONADOTROPIN, CHORIONIC (HCG); QUANT, SERUM

Facility

$204.00

Service Code	HCPCS 84702
Hospital Charge Code	H3010700
Hospital Revenue Code	301
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: MDX Hawaii PPO	$197.88

HCHG GRAM STAIN SMEAR

Facility

$65.00

Service Code	HCPCS 87205
Hospital Charge Code	H3060200
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$40.95
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG GRAM STAIN SMEAR

Facility

$65.00

Service Code	HCPCS 87205
Hospital Charge Code	H3060200
Hospital Revenue Code	306
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: MDX Hawaii PPO	$63.05

HCHG GROWTH HORMONE 90

Facility

$206.00

Service Code	HCPCS 83003
Hospital Charge Code	H3010686
Hospital Revenue Code	301
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$199.82
Rate for Payer: AlohaCare Medicaid	$16.67
Rate for Payer: AlohaCare Medicare	$16.67
Rate for Payer: Cash Price	$133.90
Rate for Payer: Cash Price	$133.90
Rate for Payer: Devoted Health Medicare	$18.34
Rate for Payer: Hawaii Medical Service Association ABD	$23.04
Rate for Payer: Hawaii Medical Service Association Commercial	$20.84
Rate for Payer: Hawaii Medical Service Association Medicare	$16.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.19
Rate for Payer: Hawaii Western Management Group Commercial	$16.67
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Humana Medicare	$16.67
Rate for Payer: Kaiser Permanente Commercial	$129.78
Rate for Payer: Kaiser Permanente Medicaid	$105.06
Rate for Payer: Kaiser Permanente Medicare	$16.67
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: Ohana Health Plan Medicaid	$18.34
Rate for Payer: Ohana Health Plan Medicare	$16.67
Rate for Payer: UnitedHealthcare Medicaid	$23.04
Rate for Payer: UnitedHealthcare Medicare	$16.67
Rate for Payer: University Health Alliance Commercial	$43.09

Know your out-of-pocket cost for care.

All Charges