Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SKELETAL SURVEY PEDS

Facility

$589.00

Service Code	HCPCS 77076
Hospital Charge Code	H3200756
Hospital Revenue Code	320
Min. Negotiated Rate	$29.05
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$382.85
Rate for Payer: Cash Price	$382.85
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$29.98
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	$29.05
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$371.07
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$29.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$155.46

HCHG SKELETAL SURVEY PEDS

Facility

$589.00

Service Code	HCPCS 77076
Hospital Charge Code	H3200756
Hospital Revenue Code	320
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$382.85
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: MDX Hawaii PPO	$571.33

HCHG SKULL 1-3 VIEWS

Facility

$570.00

Service Code	HCPCS 70250
Hospital Charge Code	H3200758
Hospital Revenue Code	320
Min. Negotiated Rate	$484.50
Max. Negotiated Rate	$552.90
Rate for Payer: Cash Price	$370.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: MDX Hawaii PPO	$552.90

HCHG SKULL 1-3 VIEWS

Facility

$570.00

Service Code	HCPCS 70250
Hospital Charge Code	H3200758
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$552.90
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
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	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$290.70
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$552.90
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$72.65

HCHG SKULL 1-3 VIEWS PORT

Facility

$570.00

Service Code	HCPCS 70250
Hospital Charge Code	H3200760
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$552.90
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
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	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$290.70
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$552.90
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$72.65

HCHG SKULL 1-3 VIEWS PORT

Facility

$570.00

Service Code	HCPCS 70250
Hospital Charge Code	H3200760
Hospital Revenue Code	320
Min. Negotiated Rate	$484.50
Max. Negotiated Rate	$552.90
Rate for Payer: Cash Price	$370.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: MDX Hawaii PPO	$552.90

HCHG SKULL 4-5 VIEWS

Facility

$708.00

Service Code	HCPCS 70260
Hospital Charge Code	H3200762
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 SKULL 4-5 VIEWS

Facility

$708.00

Service Code	HCPCS 70260
Hospital Charge Code	H3200762
Hospital Revenue Code	320
Min. Negotiated Rate	$29.64
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	$29.64
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	$32.30
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	$29.64
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$100.57

HCHG SKULL - WATERS ONLY < 3 VIEWS

Facility

$364.00

Service Code	HCPCS 70210
Hospital Charge Code	H3200915
Hospital Revenue Code	320
Min. Negotiated Rate	$309.40
Max. Negotiated Rate	$353.08
Rate for Payer: Cash Price	$236.60
Rate for Payer: Health Management Network Commercial	$309.40
Rate for Payer: MDX Hawaii PPO	$353.08

HCHG SKULL - WATERS ONLY < 3 VIEWS

Facility

$364.00

Service Code	HCPCS 70210
Hospital Charge Code	H3200915
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$353.08
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$236.60
Rate for Payer: Cash Price	$236.60
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$20.40
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	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$309.40
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$229.32
Rate for Payer: Kaiser Permanente Medicaid	$185.64
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$353.08
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$62.81

HCHG SLEEP STUDY - UNATTENDED

Facility

$1,031.00

Service Code	HCPCS 95806
Hospital Charge Code	H7400166
Hospital Revenue Code	740
Min. Negotiated Rate	$114.38
Max. Negotiated Rate	$1,000.07
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$670.15
Rate for Payer: Cash Price	$670.15
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$114.38
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$121.44
Rate for Payer: Hawaii Western Management Group Commercial	$979.45
Rate for Payer: Health Management Network Commercial	$876.35
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$649.53
Rate for Payer: Kaiser Permanente Medicaid	$525.81
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,000.07
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$114.38
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$751.50

HCHG SLEEP STUDY - UNATTENDED

Facility

$1,031.00

Service Code	HCPCS 95806
Hospital Charge Code	H7400166
Hospital Revenue Code	740
Min. Negotiated Rate	$876.35
Max. Negotiated Rate	$1,000.07
Rate for Payer: Cash Price	$670.15
Rate for Payer: Health Management Network Commercial	$876.35
Rate for Payer: MDX Hawaii PPO	$1,000.07

HCHG SMALL BOWEL/GASTRO

Facility

$1,116.00

Service Code	HCPCS 74250
Hospital Charge Code	H3200772
Hospital Revenue Code	320
Min. Negotiated Rate	$948.60
Max. Negotiated Rate	$1,082.52
Rate for Payer: Cash Price	$725.40
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: MDX Hawaii PPO	$1,082.52

HCHG SMALL BOWEL/GASTRO

Facility

$1,116.00

Service Code	HCPCS 74250
Hospital Charge Code	H3200772
Hospital Revenue Code	320
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$1,082.52
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$725.40
Rate for Payer: Cash Price	$725.40
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$42.98
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.81
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$703.08
Rate for Payer: Kaiser Permanente Medicaid	$569.16
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,082.52
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$42.98
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$191.35

HCHG SMALL BOWEL SERIES

Facility

$1,116.00

Service Code	HCPCS 74250
Hospital Charge Code	H3200768
Hospital Revenue Code	320
Min. Negotiated Rate	$948.60
Max. Negotiated Rate	$1,082.52
Rate for Payer: Cash Price	$725.40
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: MDX Hawaii PPO	$1,082.52

HCHG SMALL BOWEL SERIES

Facility

$1,116.00

Service Code	HCPCS 74250
Hospital Charge Code	H3200768
Hospital Revenue Code	320
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$1,082.52
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$725.40
Rate for Payer: Cash Price	$725.40
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$42.98
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.81
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$703.08
Rate for Payer: Kaiser Permanente Medicaid	$569.16
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,082.52
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$42.98
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$191.35

HCHG SMEAR COMPLEX SP STAIN

Facility

$305.00

Service Code	HCPCS 87209
Hospital Charge Code	K3060022
Hospital Revenue Code	306
Min. Negotiated Rate	$259.25
Max. Negotiated Rate	$295.85
Rate for Payer: Cash Price	$198.25
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: MDX Hawaii PPO	$295.85

HCHG SMEAR COMPLEX SP STAIN

Facility

$305.00

Service Code	HCPCS 87209
Hospital Charge Code	K3060022
Hospital Revenue Code	306
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$295.85
Rate for Payer: AlohaCare Medicaid	$17.98
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$198.25
Rate for Payer: Cash Price	$198.25
Rate for Payer: Devoted Health Medicare	$19.78
Rate for Payer: Hawaii Medical Service Association ABD	$17.57
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	$24.82
Rate for Payer: Hawaii Western Management Group Commercial	$17.98
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$192.15
Rate for Payer: Kaiser Permanente Medicaid	$155.55
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$295.85
Rate for Payer: Ohana Health Plan Medicaid	$19.78
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicaid	$17.57
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$46.45

HCHG SMEAR SPECIAL FOR CRYPTO

Facility

$91.00

Service Code	HCPCS 87206
Hospital Charge Code	H3060466
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$5.39
Rate for Payer: AlohaCare Medicare	$5.39
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$5.93
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$5.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$5.39
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$5.39
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.39
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$5.39
Rate for Payer: University Health Alliance Commercial	$13.88

HCHG SMEAR SPECIAL FOR CRYPTO

Facility

$91.00

Service Code	HCPCS 87206
Hospital Charge Code	H3060466
Hospital Revenue Code	306
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

HCHG SM INT FOLLOW-THRU

Facility

$616.00

Service Code	HCPCS 74248
Hospital Charge Code	H3201002
Hospital Revenue Code	320
Min. Negotiated Rate	$523.60
Max. Negotiated Rate	$597.52
Rate for Payer: Cash Price	$400.40
Rate for Payer: Health Management Network Commercial	$523.60
Rate for Payer: MDX Hawaii PPO	$597.52

HCHG SM INT FOLLOW-THRU

Facility

$616.00

Service Code	HCPCS 74248
Hospital Charge Code	H3201002
Hospital Revenue Code	320
Min. Negotiated Rate	$43.61
Max. Negotiated Rate	$597.52
Rate for Payer: Cash Price	$400.40
Rate for Payer: Cash Price	$400.40
Rate for Payer: Hawaii Medical Service Association ABD	$65.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.61
Rate for Payer: Hawaii Western Management Group Commercial	$585.20
Rate for Payer: Health Management Network Commercial	$523.60
Rate for Payer: Kaiser Permanente Commercial	$388.08
Rate for Payer: Kaiser Permanente Medicaid	$314.16
Rate for Payer: MDX Hawaii PPO	$597.52
Rate for Payer: UnitedHealthcare Medicaid	$54.01
Rate for Payer: University Health Alliance Commercial	$176.51

HCHG SODIUM FECES

Facility

$63.00

Service Code	HCPCS 84302
Hospital Charge Code	H3011164
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$4.86
Rate for Payer: AlohaCare Medicare	$4.86
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Devoted Health Medicare	$5.35
Rate for Payer: Hawaii Medical Service Association ABD	$6.79
Rate for Payer: Hawaii Medical Service Association Commercial	$6.08
Rate for Payer: Hawaii Medical Service Association Medicare	$4.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$4.86
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$4.86
Rate for Payer: Kaiser Permanente Commercial	$39.69
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$4.86
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$5.35
Rate for Payer: Ohana Health Plan Medicare	$4.86
Rate for Payer: UnitedHealthcare Medicaid	$6.79
Rate for Payer: UnitedHealthcare Medicare	$4.86
Rate for Payer: University Health Alliance Commercial	$12.56

HCHG SODIUM FECES

Facility

$63.00

Service Code	HCPCS 84302
Hospital Charge Code	H3011164
Hospital Revenue Code	301
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: MDX Hawaii PPO	$61.11

HCHG SODIUM SERUM/PLASMA/WHOLE BLOOD

Facility

$65.00

Service Code	HCPCS 84295
Hospital Charge Code	H3011158
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$4.81
Rate for Payer: AlohaCare Medicare	$4.81
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$5.29
Rate for Payer: Hawaii Medical Service Association ABD	$6.65
Rate for Payer: Hawaii Medical Service Association Commercial	$6.01
Rate for Payer: Hawaii Medical Service Association Medicare	$4.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.81
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$4.81
Rate for Payer: Kaiser Permanente Commercial	$40.95
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$4.81
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$5.29
Rate for Payer: Ohana Health Plan Medicare	$4.81
Rate for Payer: UnitedHealthcare Medicaid	$6.65
Rate for Payer: UnitedHealthcare Medicare	$4.81
Rate for Payer: University Health Alliance Commercial	$12.43

Know your out-of-pocket cost for care.

All Charges