Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC APPLY FOREARM CAST

Facility

$1,057.00

Service Code	HCPCS 29075
Hospital Charge Code	7002907501
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	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$1,004.15
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$665.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,025.29
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	$770.45

HC APPLY FOREARM CAST

Facility

$1,057.00

Service Code	HCPCS 29075
Hospital Charge Code	7002907501
Hospital Revenue Code	450
Min. Negotiated Rate	$898.45
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: MDX Hawaii PPO	$1,025.29

HC APPLY FOREARM SPLINT,STATIC

Facility

$513.00

Service Code	HCPCS 29125
Hospital Charge Code	7002912501
Hospital Revenue Code	700
Min. Negotiated Rate	$24.61
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$24.61
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC APPLY FOREARM SPLINT,STATIC

Facility

$513.00

Service Code	HCPCS 29125
Hospital Charge Code	7002912501
Hospital Revenue Code	700
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC APPLY LONG ARM CAST

Facility

$1,057.00

Service Code	HCPCS 29065
Hospital Charge Code	7002906501
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	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$1,004.15
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$665.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,025.29
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	$770.45

HC APPLY LONG ARM CAST

Facility

$1,057.00

Service Code	HCPCS 29065
Hospital Charge Code	7002906501
Hospital Revenue Code	450
Min. Negotiated Rate	$898.45
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: MDX Hawaii PPO	$1,025.29

HC APPLY LONG ARM SPLINT

Facility

$628.00

Service Code	HCPCS 29105
Hospital Charge Code	4502910501
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	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$596.60
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$395.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$609.16
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	$457.75

HC APPLY LONG ARM SPLINT

Facility

$628.00

Service Code	HCPCS 29105
Hospital Charge Code	4502910501
Hospital Revenue Code	450
Min. Negotiated Rate	$533.80
Max. Negotiated Rate	$609.16
Rate for Payer: Cash Price	$376.80
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: MDX Hawaii PPO	$609.16

HC APPLY LONG LEG CAST

Facility

$1,057.00

Service Code	HCPCS 29345
Hospital Charge Code	7002934501
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	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$1,004.15
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$665.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,025.29
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	$770.45

HC APPLY LONG LEG CAST

Facility

$1,057.00

Service Code	HCPCS 29345
Hospital Charge Code	7002934501
Hospital Revenue Code	450
Min. Negotiated Rate	$898.45
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: MDX Hawaii PPO	$1,025.29

HC APPLY LONG LEG CAST,WALKER

Facility

$1,035.00

Service Code	HCPCS 29355
Hospital Charge Code	7002935501
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	$621.00
Rate for Payer: Cash Price	$621.00
Rate for Payer: Cash Price	$621.00
Rate for Payer: Cash Price	$621.00
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$983.25
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$652.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,003.95
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	$754.41

HC APPLY LONG LEG CAST,WALKER

Facility

$1,035.00

Service Code	HCPCS 29355
Hospital Charge Code	7002935501
Hospital Revenue Code	450
Min. Negotiated Rate	$879.75
Max. Negotiated Rate	$1,003.95
Rate for Payer: Cash Price	$621.00
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: MDX Hawaii PPO	$1,003.95

HC APPLY LONG LEG SPLINT

Facility

$628.00

Service Code	HCPCS 29505
Hospital Charge Code	4502950501
Hospital Revenue Code	450
Min. Negotiated Rate	$533.80
Max. Negotiated Rate	$609.16
Rate for Payer: Cash Price	$376.80
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: MDX Hawaii PPO	$609.16

HC APPLY LONG LEG SPLINT

Facility

$628.00

Service Code	HCPCS 29505
Hospital Charge Code	4502950501
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	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$596.60
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$395.64
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$609.16
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	$457.75

HC APPLY LOWER LEG SPLINT

Facility

$628.00

Service Code	HCPCS 29515
Hospital Charge Code	7002951501
Hospital Revenue Code	700
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$609.16
Rate for Payer: AlohaCare Medicaid	$191.97
Rate for Payer: AlohaCare Medicare	$191.97
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Devoted Health Medicare	$211.17
Rate for Payer: Hawaii Medical Service Association Commercial	$239.96
Rate for Payer: Hawaii Medical Service Association Medicare	$191.97
Rate for Payer: Hawaii Western Management Group Commercial	$596.60
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: Humana Medicare	$191.97
Rate for Payer: Kaiser Permanente Commercial	$395.64
Rate for Payer: Kaiser Permanente Medicaid	$320.28
Rate for Payer: Kaiser Permanente Medicare	$191.97
Rate for Payer: MDX Hawaii PPO	$609.16
Rate for Payer: Ohana Health Plan Medicaid	$211.17
Rate for Payer: Ohana Health Plan Medicare	$191.97
Rate for Payer: UnitedHealthcare Medicaid	$29.94
Rate for Payer: UnitedHealthcare Medicare	$191.97
Rate for Payer: University Health Alliance Commercial	$457.75

HC APPLY LOWER LEG SPLINT

Facility

$628.00

Service Code	HCPCS 29515
Hospital Charge Code	7002951501
Hospital Revenue Code	700
Min. Negotiated Rate	$533.80
Max. Negotiated Rate	$609.16
Rate for Payer: Cash Price	$376.80
Rate for Payer: Health Management Network Commercial	$533.80
Rate for Payer: MDX Hawaii PPO	$609.16

HC APPLY SHORT LEG CAST

Facility

$1,057.00

Service Code	HCPCS 29405
Hospital Charge Code	7002940501
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	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$1,004.15
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$665.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,025.29
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	$770.45

HC APPLY SHORT LEG CAST

Facility

$1,057.00

Service Code	HCPCS 29405
Hospital Charge Code	7002940501
Hospital Revenue Code	450
Min. Negotiated Rate	$898.45
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: MDX Hawaii PPO	$1,025.29

HC APPLY SHORT LEG CAST,WALKER

Facility

$1,057.00

Service Code	HCPCS 29425
Hospital Charge Code	7002942501
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	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$363.45
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
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	$1,004.15
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$330.41
Rate for Payer: Kaiser Permanente Commercial	$665.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$330.41
Rate for Payer: MDX Hawaii PPO	$1,025.29
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	$770.45

HC APPLY SHORT LEG CAST,WALKER

Facility

$1,057.00

Service Code	HCPCS 29425
Hospital Charge Code	7002942501
Hospital Revenue Code	450
Min. Negotiated Rate	$898.45
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: MDX Hawaii PPO	$1,025.29

HC ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION; CUTDOWN

Facility

$254.00

Service Code	HCPCS 36625
Hospital Charge Code	4503662501
Hospital Revenue Code	450
Min. Negotiated Rate	$160.02
Max. Negotiated Rate	$2,536.00
Rate for Payer: Cash Price	$152.40
Rate for Payer: Cash Price	$152.40
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$241.30
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Kaiser Permanente Commercial	$160.02
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$246.38
Rate for Payer: University Health Alliance Commercial	$185.14

HC ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION; CUTDOWN

Facility

$254.00

Service Code	HCPCS 36625
Hospital Charge Code	4503662501
Hospital Revenue Code	450
Min. Negotiated Rate	$215.90
Max. Negotiated Rate	$246.38
Rate for Payer: Cash Price	$152.40
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: MDX Hawaii PPO	$246.38

HC ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT

Facility

$12,265.00

Service Code	HCPCS 36821
Hospital Charge Code	3613682101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,897.05
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Health Management Network Commercial	$10,425.25
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,726.95
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$11,897.05
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT

Facility

$12,265.00

Service Code	HCPCS 36821
Hospital Charge Code	3613682101
Hospital Revenue Code	361
Min. Negotiated Rate	$10,425.25
Max. Negotiated Rate	$11,897.05
Rate for Payer: Cash Price	$7,359.00
Rate for Payer: Health Management Network Commercial	$10,425.25
Rate for Payer: MDX Hawaii PPO	$11,897.05

HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

Facility

$1,175.00

Service Code	HCPCS 20605
Hospital Charge Code	3612060501
Hospital Revenue Code	361
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$42.08
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

All Charges