Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG HERPES SIMPLEX TYPE 2 AB, IGG

Facility

$238.00

Service Code	HCPCS 86696
Hospital Charge Code	H3020920
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$19.35
Rate for Payer: AlohaCare Medicare	$19.35
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$21.29
Rate for Payer: Hawaii Medical Service Association ABD	$27.05
Rate for Payer: Hawaii Medical Service Association Commercial	$24.19
Rate for Payer: Hawaii Medical Service Association Medicare	$19.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.40
Rate for Payer: Hawaii Western Management Group Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$19.35
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$19.35
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$21.29
Rate for Payer: Ohana Health Plan Medicare	$19.35
Rate for Payer: UnitedHealthcare Medicaid	$27.05
Rate for Payer: UnitedHealthcare Medicare	$19.35
Rate for Payer: University Health Alliance Commercial	$50.04

HCHG HERPES VIRUS -6 AMP PROBE - 90

Facility

$329.00

Service Code	HCPCS 87532
Hospital Charge Code	H3060723
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$319.13
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$213.85
Rate for Payer: Cash Price	$213.85
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$279.65
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$207.27
Rate for Payer: Kaiser Permanente Medicaid	$167.79
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$319.13
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG HERPES VIRUS -6 AMP PROBE - 90

Facility

$329.00

Service Code	HCPCS 87532
Hospital Charge Code	H3060723
Hospital Revenue Code	306
Min. Negotiated Rate	$279.65
Max. Negotiated Rate	$319.13
Rate for Payer: Cash Price	$213.85
Rate for Payer: Health Management Network Commercial	$279.65
Rate for Payer: MDX Hawaii PPO	$319.13

HCHG HERPES VIRUS 6 PANEL 90

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020564
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG HERPES VIRUS 6 PANEL 90

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020564
Hospital Revenue Code	302
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG HERPES VIRUS 6 PANEL 90

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020562
Hospital Revenue Code	302
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG HERPES VIRUS 6 PANEL 90

Facility

$211.00

Service Code	HCPCS 86790
Hospital Charge Code	H3020562
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$12.88
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$14.17
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$12.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$12.88
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$12.88
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$14.17
Rate for Payer: Ohana Health Plan Medicare	$12.88
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$12.88
Rate for Payer: University Health Alliance Commercial	$33.30

HCHG HEXAGONAL PHOSPHOLIPID NEUTRAL - 90

Facility

$179.00

Service Code	HCPCS 85598
Hospital Charge Code	H3050288
Hospital Revenue Code	305
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$17.98
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Devoted Health Medicare	$19.78
Rate for Payer: Hawaii Medical Service Association ABD	$25.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22.48
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.08
Rate for Payer: Hawaii Western Management Group Commercial	$17.98
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$112.77
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$19.78
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicaid	$25.30
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$130.47

HCHG HEXAGONAL PHOSPHOLIPID NEUTRAL - 90

Facility

$179.00

Service Code	HCPCS 85598
Hospital Charge Code	H3050288
Hospital Revenue Code	305
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: MDX Hawaii PPO	$173.63

HCHG HFOV VENT MGMT SUBSEQUENT DAY

Facility

$1,383.00

Service Code	HCPCS 94003
Hospital Charge Code	H4100282
Hospital Revenue Code	410
Min. Negotiated Rate	$1,175.55
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$898.95
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: MDX Hawaii PPO	$1,341.51

HCHG HFOV VENT MGMT SUBSEQUENT DAY

Facility

$1,383.00

Service Code	HCPCS 94003
Hospital Charge Code	H4100282
Hospital Revenue Code	410
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$1,341.51
Rate for Payer: AlohaCare Medicaid	$729.82
Rate for Payer: AlohaCare Medicare	$729.82
Rate for Payer: Cash Price	$898.95
Rate for Payer: Cash Price	$898.95
Rate for Payer: Devoted Health Medicare	$802.80
Rate for Payer: Hawaii Medical Service Association Commercial	$912.27
Rate for Payer: Hawaii Medical Service Association Medicare	$729.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,313.85
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Humana Medicare	$729.82
Rate for Payer: Kaiser Permanente Commercial	$871.29
Rate for Payer: Kaiser Permanente Medicaid	$705.33
Rate for Payer: Kaiser Permanente Medicare	$729.82
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: Ohana Health Plan Medicaid	$802.80
Rate for Payer: Ohana Health Plan Medicare	$729.82
Rate for Payer: UnitedHealthcare Medicaid	$43.79
Rate for Payer: UnitedHealthcare Medicare	$729.82
Rate for Payer: University Health Alliance Commercial	$1,008.07

HCHG HHV-6 DNA AMP PROBE - 90

Facility

$329.00

Service Code	HCPCS 87532
Hospital Charge Code	H3060796
Hospital Revenue Code	306
Min. Negotiated Rate	$279.65
Max. Negotiated Rate	$319.13
Rate for Payer: Cash Price	$213.85
Rate for Payer: Health Management Network Commercial	$279.65
Rate for Payer: MDX Hawaii PPO	$319.13

HCHG HHV-6 DNA AMP PROBE - 90

Facility

$329.00

Service Code	HCPCS 87532
Hospital Charge Code	H3060796
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$319.13
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$213.85
Rate for Payer: Cash Price	$213.85
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$279.65
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$207.27
Rate for Payer: Kaiser Permanente Medicaid	$167.79
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$319.13
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG HI-FLOW SYSTEM INITIAL DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100302
Hospital Revenue Code	410
Min. Negotiated Rate	$799.85
Max. Negotiated Rate	$912.77
Rate for Payer: Cash Price	$611.65
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: MDX Hawaii PPO	$912.77

HCHG HI-FLOW SYSTEM INITIAL DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100302
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$912.77
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$611.65
Rate for Payer: Cash Price	$611.65
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Hawaii Western Management Group Commercial	$893.95
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$592.83
Rate for Payer: Kaiser Permanente Medicaid	$479.91
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$912.77
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$685.89

HCHG HI-FLOW SYSTEM SUBSEQ DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100303
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$912.77
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Cash Price	$611.65
Rate for Payer: Cash Price	$611.65
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Hawaii Western Management Group Commercial	$893.95
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Commercial	$592.83
Rate for Payer: Kaiser Permanente Medicaid	$479.91
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: MDX Hawaii PPO	$912.77
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$258.69
Rate for Payer: University Health Alliance Commercial	$685.89

HCHG HI-FLOW SYSTEM SUBSEQ DAY

Facility

$941.00

Service Code	HCPCS 94660
Hospital Charge Code	H4100303
Hospital Revenue Code	410
Min. Negotiated Rate	$799.85
Max. Negotiated Rate	$912.77
Rate for Payer: Cash Price	$611.65
Rate for Payer: Health Management Network Commercial	$799.85
Rate for Payer: MDX Hawaii PPO	$912.77

HCHG HIP ARTHROGRAM

Facility

$1,661.00

Service Code	HCPCS 73525
Hospital Charge Code	H3200448
Hospital Revenue Code	322
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$1,611.17
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,079.65
Rate for Payer: Cash Price	$1,079.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$69.25
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,411.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,046.43
Rate for Payer: Kaiser Permanente Medicaid	$847.11
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,611.17
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$69.25
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$206.57

HCHG HIP ARTHROGRAM

Facility

$1,661.00

Service Code	HCPCS 73525
Hospital Charge Code	H3200448
Hospital Revenue Code	322
Min. Negotiated Rate	$1,411.85
Max. Negotiated Rate	$1,611.17
Rate for Payer: Cash Price	$1,079.65
Rate for Payer: Health Management Network Commercial	$1,411.85
Rate for Payer: MDX Hawaii PPO	$1,611.17

HCHG HIPS BILAT W/ OR W/O PELVIS 2 VIEWS

Facility

$708.00

Service Code	HCPCS 73521
Hospital Charge Code	H3200989
Hospital Revenue Code	320
Min. Negotiated Rate	$19.61
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	$19.61
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	$26.81
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
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	$27.57
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$82.40

HCHG HIPS BILAT W/ OR W/O PELVIS 2 VIEWS

Facility

$708.00

Service Code	HCPCS 73521
Hospital Charge Code	H3200989
Hospital Revenue Code	320
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: MDX Hawaii PPO	$686.76

HCHG HIPS BILAT W/ OR W/O PELVIS 3-4 VIEWS

Facility

$664.00

Service Code	HCPCS 73522
Hospital Charge Code	H3200990
Hospital Revenue Code	320
Min. Negotiated Rate	$564.40
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$431.60
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: MDX Hawaii PPO	$644.08

HCHG HIPS BILAT W/ OR W/O PELVIS 3-4 VIEWS

Facility

$664.00

Service Code	HCPCS 73522
Hospital Charge Code	H3200990
Hospital Revenue Code	320
Min. Negotiated Rate	$23.36
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$431.60
Rate for Payer: Cash Price	$431.60
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$23.36
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	$31.91
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$418.32
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$36.08
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$101.31

HCHG HIPS BILAT W/ OR W/O PELVIS MIN 5 VIEWS

Facility

$810.00

Service Code	HCPCS 73523
Hospital Charge Code	H3200991
Hospital Revenue Code	320
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: MDX Hawaii PPO	$785.70

HCHG HIPS BILAT W/ OR W/O PELVIS MIN 5 VIEWS

Facility

$810.00

Service Code	HCPCS 73523
Hospital Charge Code	H3200991
Hospital Revenue Code	320
Min. Negotiated Rate	$28.11
Max. Negotiated Rate	$785.70
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$28.11
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	$38.40
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: Kaiser Permanente Medicaid	$413.10
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$41.41
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$118.03

Know your out-of-pocket cost for care.

All Charges