Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG SP VIDEOESOPHAGRAM

Facility

$704.00

Service Code	HCPCS 92611
Hospital Charge Code	H4440114
Hospital Revenue Code	444
Min. Negotiated Rate	$598.40
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$457.60
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: MDX Hawaii PPO	$682.88

HCHG SP VIDEOESOPHAGRAM

Facility

$704.00

Service Code	HCPCS 92611
Hospital Charge Code	H4440114
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$457.60
Rate for Payer: Cash Price	$457.60
Rate for Payer: Hawaii Western Management Group Commercial	$668.80
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Kaiser Permanente Commercial	$443.52
Rate for Payer: Kaiser Permanente Medicaid	$359.04
Rate for Payer: MDX Hawaii PPO	$682.88
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: University Health Alliance Commercial	$513.15

HCHG SSDNA IGG ANTIBODY

Facility

$156.00

Service Code	HCPCS 86226
Hospital Charge Code	H3020992
Hospital Revenue Code	302
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 SSDNA IGG ANTIBODY

Facility

$156.00

Service Code	HCPCS 86226
Hospital Charge Code	H3020992
Hospital Revenue Code	302
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$12.11
Rate for Payer: AlohaCare Medicare	$12.11
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$13.32
Rate for Payer: Hawaii Medical Service Association ABD	$16.73
Rate for Payer: Hawaii Medical Service Association Commercial	$15.14
Rate for Payer: Hawaii Medical Service Association Medicare	$12.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$12.11
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$12.11
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$12.11
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$13.32
Rate for Payer: Ohana Health Plan Medicare	$12.11
Rate for Payer: UnitedHealthcare Medicaid	$16.73
Rate for Payer: UnitedHealthcare Medicare	$12.11
Rate for Payer: University Health Alliance Commercial	$31.30

HCHG STERNUM MIN 2 VIEWS

Facility

$518.00

Service Code	HCPCS 71120
Hospital Charge Code	H3200780
Hospital Revenue Code	320
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$502.46
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$21.34
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	$23.43
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$326.34
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$21.34
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$69.73

HCHG STERNUM MIN 2 VIEWS

Facility

$518.00

Service Code	HCPCS 71120
Hospital Charge Code	H3200780
Hospital Revenue Code	320
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$336.70
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: MDX Hawaii PPO	$502.46

HCHG STONE CALCULI ANALYS 90 INFRARED

Facility

$142.00

Service Code	HCPCS 82365
Hospital Charge Code	H3011180
Hospital Revenue Code	301
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: MDX Hawaii PPO	$137.74

HCHG STONE CALCULI ANALYS 90 INFRARED

Facility

$142.00

Service Code	HCPCS 82365
Hospital Charge Code	H3011180
Hospital Revenue Code	301
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$12.90
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Hawaii Medical Service Association ABD	$11.44
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Medicare	$12.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.01
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$12.90
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$12.90
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$14.19
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicaid	$11.44
Rate for Payer: UnitedHealthcare Medicare	$12.90
Rate for Payer: University Health Alliance Commercial	$21.40

HCHG STOOL CULTR AEROBIC BACT EA

Facility

$144.00

Service Code	HCPCS 87046
Hospital Charge Code	H3000122
Hospital Revenue Code	306
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$9.44
Rate for Payer: AlohaCare Medicare	$9.44
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$10.38
Rate for Payer: Hawaii Medical Service Association ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.65
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$9.44
Rate for Payer: Kaiser Permanente Commercial	$90.72
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$9.44
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicare	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$9.44
Rate for Payer: University Health Alliance Commercial	$24.38

HCHG STOOL CULTR AEROBIC BACT EA

Facility

$144.00

Service Code	HCPCS 87046
Hospital Charge Code	H3000122
Hospital Revenue Code	306
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$139.68

HCHG STOOL GI PATHOGEN PANEL, PCR

Facility

$1,766.00

Service Code	HCPCS 87507
Hospital Charge Code	H3060713
Hospital Revenue Code	306
Min. Negotiated Rate	$1,501.10
Max. Negotiated Rate	$1,713.02
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: MDX Hawaii PPO	$1,713.02

HCHG STOOL GI PATHOGEN PANEL, PCR

Facility

$1,766.00

Service Code	HCPCS 87507
Hospital Charge Code	H3060713
Hospital Revenue Code	306
Min. Negotiated Rate	$312.59
Max. Negotiated Rate	$1,713.02
Rate for Payer: AlohaCare Medicaid	$416.78
Rate for Payer: AlohaCare Medicare	$416.78
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Devoted Health Medicare	$458.46
Rate for Payer: Hawaii Medical Service Association Commercial	$520.98
Rate for Payer: Hawaii Medical Service Association Medicare	$416.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$599.94
Rate for Payer: Hawaii Western Management Group Commercial	$416.78
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: Humana Medicare	$416.78
Rate for Payer: Kaiser Permanente Commercial	$1,112.58
Rate for Payer: Kaiser Permanente Medicaid	$900.66
Rate for Payer: Kaiser Permanente Medicare	$416.78
Rate for Payer: MDX Hawaii PPO	$1,713.02
Rate for Payer: Ohana Health Plan Medicaid	$458.46
Rate for Payer: Ohana Health Plan Medicare	$416.78
Rate for Payer: UnitedHealthcare Medicaid	$312.59
Rate for Payer: UnitedHealthcare Medicare	$416.78
Rate for Payer: University Health Alliance Commercial	$1,287.24

HCHG STOOL GI PATHOGEN PANEL, PCR - 90

Facility

$1,766.00

Service Code	HCPCS 87507
Hospital Charge Code	H3060800
Hospital Revenue Code	306
Min. Negotiated Rate	$312.59
Max. Negotiated Rate	$1,713.02
Rate for Payer: AlohaCare Medicaid	$416.78
Rate for Payer: AlohaCare Medicare	$416.78
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Devoted Health Medicare	$458.46
Rate for Payer: Hawaii Medical Service Association Commercial	$520.98
Rate for Payer: Hawaii Medical Service Association Medicare	$416.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$599.94
Rate for Payer: Hawaii Western Management Group Commercial	$416.78
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: Humana Medicare	$416.78
Rate for Payer: Kaiser Permanente Commercial	$1,112.58
Rate for Payer: Kaiser Permanente Medicaid	$900.66
Rate for Payer: Kaiser Permanente Medicare	$416.78
Rate for Payer: MDX Hawaii PPO	$1,713.02
Rate for Payer: Ohana Health Plan Medicaid	$458.46
Rate for Payer: Ohana Health Plan Medicare	$416.78
Rate for Payer: UnitedHealthcare Medicaid	$312.59
Rate for Payer: UnitedHealthcare Medicare	$416.78
Rate for Payer: University Health Alliance Commercial	$1,287.24

HCHG STOOL GI PATHOGEN PANEL, PCR - 90

Facility

$1,766.00

Service Code	HCPCS 87507
Hospital Charge Code	H3060800
Hospital Revenue Code	306
Min. Negotiated Rate	$1,501.10
Max. Negotiated Rate	$1,713.02
Rate for Payer: Cash Price	$1,147.90
Rate for Payer: Health Management Network Commercial	$1,501.10
Rate for Payer: MDX Hawaii PPO	$1,713.02

HCHG STRAPPING ANKLE

Facility

$1,001.00

Service Code	HCPCS 29540
Hospital Charge Code	H4500694
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 STRAPPING ANKLE

Facility

$1,001.00

Service Code	HCPCS 29540
Hospital Charge Code	H4500694
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 STRAPPING ELBOW OR WRIST

Facility

$428.00

Service Code	HCPCS 29260
Hospital Charge Code	H4500696
Hospital Revenue Code	450
Min. Negotiated Rate	$69.69
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$76.66
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	$69.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$269.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$311.97

HCHG STRAPPING ELBOW OR WRIST

Facility

$428.00

Service Code	HCPCS 29260
Hospital Charge Code	H4500696
Hospital Revenue Code	450
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: MDX Hawaii PPO	$415.16

HCHG STRAPPING HAND OR FINGER

Facility

$428.00

Service Code	HCPCS 29280
Hospital Charge Code	H4500698
Hospital Revenue Code	450
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: MDX Hawaii PPO	$415.16

HCHG STRAPPING HAND OR FINGER

Facility

$428.00

Service Code	HCPCS 29280
Hospital Charge Code	H4500698
Hospital Revenue Code	450
Min. Negotiated Rate	$69.69
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$76.66
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	$69.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$269.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$311.97

HCHG STRAPPING KNEE

Facility

$816.00

Service Code	HCPCS 29530
Hospital Charge Code	H4500700
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 STRAPPING KNEE

Facility

$816.00

Service Code	HCPCS 29530
Hospital Charge Code	H4500700
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 STRAPPING SHLDR

Facility

$539.00

Service Code	HCPCS 29240
Hospital Charge Code	H4500704
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	$350.35
Rate for Payer: Cash Price	$350.35
Rate for Payer: Cash Price	$350.35
Rate for Payer: Cash Price	$350.35
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	$512.05
Rate for Payer: Health Management Network Commercial	$458.15
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$339.57
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$522.83
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	$392.88

HCHG STRAPPING SHLDR

Facility

$539.00

Service Code	HCPCS 29240
Hospital Charge Code	H4500704
Hospital Revenue Code	450
Min. Negotiated Rate	$458.15
Max. Negotiated Rate	$522.83
Rate for Payer: Cash Price	$350.35
Rate for Payer: Health Management Network Commercial	$458.15
Rate for Payer: MDX Hawaii PPO	$522.83

HCHG STRAPPING THORAX

Facility

$1,040.00

Service Code	HCPCS 29200
Hospital Charge Code	H4500706
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	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
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	$988.00
Rate for Payer: Health Management Network Commercial	$884.00
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$1,008.80
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	$758.06

Know your out-of-pocket cost for care.

All Charges