Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC ASSAY OF SERUM POTASSIUM - POTASSIUM

Facility

$40.00

Service Code	HCPCS 84132
Hospital Charge Code	3018413201
Hospital Revenue Code	301
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

HC ASSAY OF SERUM SODIUM - SODIUM

Facility

$40.00

Service Code	HCPCS 84295
Hospital Charge Code	3018429501
Hospital Revenue Code	301
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

HC ASSAY OF SERUM SODIUM - SODIUM

Facility

$40.00

Service Code	HCPCS 84295
Hospital Charge Code	3018429501
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$4.81
Rate for Payer: AlohaCare Medicare	$4.81
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
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	$34.00
Rate for Payer: Humana Medicare	$4.81
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$4.81
Rate for Payer: MDX Hawaii PPO	$38.80
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

HC ASSAY OF SODIUM, OTHER SOURCE - SODIUM STOOL

Facility

$41.00

Service Code	HCPCS 84302
Hospital Charge Code	3018430202
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$4.86
Rate for Payer: AlohaCare Medicare	$4.86
Rate for Payer: Cash Price	$24.60
Rate for Payer: Cash Price	$24.60
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	$34.85
Rate for Payer: Humana Medicare	$4.86
Rate for Payer: Kaiser Permanente Commercial	$25.83
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$4.86
Rate for Payer: MDX Hawaii PPO	$39.77
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

HC ASSAY OF SODIUM, OTHER SOURCE - SODIUM STOOL

Facility

$41.00

Service Code	HCPCS 84302
Hospital Charge Code	3018430202
Hospital Revenue Code	301
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$24.60
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: MDX Hawaii PPO	$39.77

HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR

Facility

$178.00

Service Code	HCPCS 84305
Hospital Charge Code	3018430501
Hospital Revenue Code	301
Min. Negotiated Rate	$151.30
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$106.80
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: MDX Hawaii PPO	$172.66

HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR

Facility

$178.00

Service Code	HCPCS 84305
Hospital Charge Code	3018430501
Hospital Revenue Code	301
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$172.66
Rate for Payer: AlohaCare Medicaid	$21.26
Rate for Payer: AlohaCare Medicare	$21.26
Rate for Payer: Cash Price	$106.80
Rate for Payer: Cash Price	$106.80
Rate for Payer: Devoted Health Medicare	$23.39
Rate for Payer: Hawaii Medical Service Association ABD	$29.38
Rate for Payer: Hawaii Medical Service Association Commercial	$26.57
Rate for Payer: Hawaii Medical Service Association Medicare	$21.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.85
Rate for Payer: Hawaii Western Management Group Commercial	$21.26
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: Humana Medicare	$21.26
Rate for Payer: Kaiser Permanente Commercial	$112.14
Rate for Payer: Kaiser Permanente Medicaid	$90.78
Rate for Payer: Kaiser Permanente Medicare	$21.26
Rate for Payer: MDX Hawaii PPO	$172.66
Rate for Payer: Ohana Health Plan Medicaid	$23.39
Rate for Payer: Ohana Health Plan Medicare	$21.26
Rate for Payer: UnitedHealthcare Medicaid	$29.38
Rate for Payer: UnitedHealthcare Medicare	$21.26
Rate for Payer: University Health Alliance Commercial	$54.95

HC ASSAY OF TACROLIMUS - TACROLIMUS

Facility

$115.00

Service Code	HCPCS 80197
Hospital Charge Code	3018019701
Hospital Revenue Code	301
Min. Negotiated Rate	$13.73
Max. Negotiated Rate	$111.55
Rate for Payer: AlohaCare Medicaid	$13.73
Rate for Payer: AlohaCare Medicare	$13.73
Rate for Payer: Cash Price	$69.00
Rate for Payer: Cash Price	$69.00
Rate for Payer: Devoted Health Medicare	$15.10
Rate for Payer: Hawaii Medical Service Association ABD	$18.97
Rate for Payer: Hawaii Medical Service Association Commercial	$17.16
Rate for Payer: Hawaii Medical Service Association Medicare	$13.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.92
Rate for Payer: Hawaii Western Management Group Commercial	$13.73
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Humana Medicare	$13.73
Rate for Payer: Kaiser Permanente Commercial	$72.45
Rate for Payer: Kaiser Permanente Medicaid	$58.65
Rate for Payer: Kaiser Permanente Medicare	$13.73
Rate for Payer: MDX Hawaii PPO	$111.55
Rate for Payer: Ohana Health Plan Medicaid	$15.10
Rate for Payer: Ohana Health Plan Medicare	$13.73
Rate for Payer: UnitedHealthcare Medicaid	$18.97
Rate for Payer: UnitedHealthcare Medicare	$13.73
Rate for Payer: University Health Alliance Commercial	$35.46

HC ASSAY OF TACROLIMUS - TACROLIMUS

Facility

$115.00

Service Code	HCPCS 80197
Hospital Charge Code	3018019701
Hospital Revenue Code	301
Min. Negotiated Rate	$97.75
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$69.00
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: MDX Hawaii PPO	$111.55

HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE

Facility

$214.00

Service Code	HCPCS 84402
Hospital Charge Code	3018440201
Hospital Revenue Code	301
Min. Negotiated Rate	$25.47
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$25.47
Rate for Payer: AlohaCare Medicare	$25.47
Rate for Payer: Cash Price	$128.40
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$28.02
Rate for Payer: Hawaii Medical Service Association ABD	$35.19
Rate for Payer: Hawaii Medical Service Association Commercial	$31.84
Rate for Payer: Hawaii Medical Service Association Medicare	$25.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.95
Rate for Payer: Hawaii Western Management Group Commercial	$25.47
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$25.47
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$25.47
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$28.02
Rate for Payer: Ohana Health Plan Medicare	$25.47
Rate for Payer: UnitedHealthcare Medicaid	$35.19
Rate for Payer: UnitedHealthcare Medicare	$25.47
Rate for Payer: University Health Alliance Commercial	$65.80

HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE

Facility

$214.00

Service Code	HCPCS 84402
Hospital Charge Code	3018440201
Hospital Revenue Code	301
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

HC ASSAY OF THEOPHYLLINE - THEOPHYLLINE

Facility

$119.00

Service Code	HCPCS 80198
Hospital Charge Code	3018019801
Hospital Revenue Code	301
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$14.14
Rate for Payer: AlohaCare Medicare	$14.14
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$15.55
Rate for Payer: Hawaii Medical Service Association ABD	$19.56
Rate for Payer: Hawaii Medical Service Association Commercial	$17.68
Rate for Payer: Hawaii Medical Service Association Medicare	$14.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.54
Rate for Payer: Hawaii Western Management Group Commercial	$14.14
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$14.14
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$14.14
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$15.55
Rate for Payer: Ohana Health Plan Medicare	$14.14
Rate for Payer: UnitedHealthcare Medicaid	$19.56
Rate for Payer: UnitedHealthcare Medicare	$14.14
Rate for Payer: University Health Alliance Commercial	$36.57

HC ASSAY OF THEOPHYLLINE - THEOPHYLLINE

Facility

$119.00

Service Code	HCPCS 80198
Hospital Charge Code	3018019801
Hospital Revenue Code	301
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HC ASSAY OF THIOCYANATE - THIOCYANATE, SERUM

Facility

$98.00

Service Code	HCPCS 84430
Hospital Charge Code	3018443001
Hospital Revenue Code	301
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$95.06

HC ASSAY OF THIOCYANATE - THIOCYANATE, SERUM

Facility

$98.00

Service Code	HCPCS 84430
Hospital Charge Code	3018443001
Hospital Revenue Code	301
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$11.63
Rate for Payer: AlohaCare Medicare	$11.63
Rate for Payer: Cash Price	$58.80
Rate for Payer: Cash Price	$58.80
Rate for Payer: Devoted Health Medicare	$12.79
Rate for Payer: Hawaii Medical Service Association ABD	$9.76
Rate for Payer: Hawaii Medical Service Association Commercial	$14.54
Rate for Payer: Hawaii Medical Service Association Medicare	$11.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.07
Rate for Payer: Hawaii Western Management Group Commercial	$11.63
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$11.63
Rate for Payer: Kaiser Permanente Commercial	$61.74
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$11.63
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$12.79
Rate for Payer: Ohana Health Plan Medicare	$11.63
Rate for Payer: UnitedHealthcare Medicaid	$9.76
Rate for Payer: UnitedHealthcare Medicare	$11.63
Rate for Payer: University Health Alliance Commercial	$30.08

HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN

Facility

$135.00

Service Code	HCPCS 84432
Hospital Charge Code	3018443201
Hospital Revenue Code	301
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN

Facility

$135.00

Service Code	HCPCS 84432
Hospital Charge Code	3018443201
Hospital Revenue Code	301
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$16.06
Rate for Payer: AlohaCare Medicare	$16.06
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$17.67
Rate for Payer: Hawaii Medical Service Association ABD	$22.20
Rate for Payer: Hawaii Medical Service Association Commercial	$20.07
Rate for Payer: Hawaii Medical Service Association Medicare	$16.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.06
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$16.06
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$16.06
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$17.67
Rate for Payer: Ohana Health Plan Medicare	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$16.06
Rate for Payer: University Health Alliance Commercial	$41.51

HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM

Facility

$427.00

Service Code	HCPCS 84445
Hospital Charge Code	3018444501
Hospital Revenue Code	301
Min. Negotiated Rate	$362.95
Max. Negotiated Rate	$414.19
Rate for Payer: Cash Price	$256.20
Rate for Payer: Health Management Network Commercial	$362.95
Rate for Payer: MDX Hawaii PPO	$414.19

HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM

Facility

$427.00

Service Code	HCPCS 84445
Hospital Charge Code	3018444501
Hospital Revenue Code	301
Min. Negotiated Rate	$32.92
Max. Negotiated Rate	$414.19
Rate for Payer: AlohaCare Medicaid	$50.86
Rate for Payer: AlohaCare Medicare	$50.86
Rate for Payer: Cash Price	$256.20
Rate for Payer: Cash Price	$256.20
Rate for Payer: Devoted Health Medicare	$55.95
Rate for Payer: Hawaii Medical Service Association ABD	$32.92
Rate for Payer: Hawaii Medical Service Association Commercial	$63.58
Rate for Payer: Hawaii Medical Service Association Medicare	$50.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34.57
Rate for Payer: Hawaii Western Management Group Commercial	$50.86
Rate for Payer: Health Management Network Commercial	$362.95
Rate for Payer: Humana Medicare	$50.86
Rate for Payer: Kaiser Permanente Commercial	$269.01
Rate for Payer: Kaiser Permanente Medicaid	$217.77
Rate for Payer: Kaiser Permanente Medicare	$50.86
Rate for Payer: MDX Hawaii PPO	$414.19
Rate for Payer: Ohana Health Plan Medicaid	$55.95
Rate for Payer: Ohana Health Plan Medicare	$50.86
Rate for Payer: UnitedHealthcare Medicaid	$32.92
Rate for Payer: UnitedHealthcare Medicare	$50.86
Rate for Payer: University Health Alliance Commercial	$61.57

HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN PEAK

Facility

$135.00

Service Code	HCPCS 80200
Hospital Charge Code	3018020001
Hospital Revenue Code	301
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN PEAK

Facility

$135.00

Service Code	HCPCS 80200
Hospital Charge Code	3018020001
Hospital Revenue Code	301
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$16.13
Rate for Payer: AlohaCare Medicare	$16.13
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$17.74
Rate for Payer: Hawaii Medical Service Association ABD	$22.27
Rate for Payer: Hawaii Medical Service Association Commercial	$20.16
Rate for Payer: Hawaii Medical Service Association Medicare	$16.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.38
Rate for Payer: Hawaii Western Management Group Commercial	$16.13
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$16.13
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$16.13
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$17.74
Rate for Payer: Ohana Health Plan Medicare	$16.13
Rate for Payer: UnitedHealthcare Medicaid	$22.27
Rate for Payer: UnitedHealthcare Medicare	$16.13
Rate for Payer: University Health Alliance Commercial	$41.66

HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN RANDOM

Facility

$135.00

Service Code	HCPCS 80200
Hospital Charge Code	3018020002
Hospital Revenue Code	301
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$16.13
Rate for Payer: AlohaCare Medicare	$16.13
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$17.74
Rate for Payer: Hawaii Medical Service Association ABD	$22.27
Rate for Payer: Hawaii Medical Service Association Commercial	$20.16
Rate for Payer: Hawaii Medical Service Association Medicare	$16.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.38
Rate for Payer: Hawaii Western Management Group Commercial	$16.13
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$16.13
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$16.13
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$17.74
Rate for Payer: Ohana Health Plan Medicare	$16.13
Rate for Payer: UnitedHealthcare Medicaid	$22.27
Rate for Payer: UnitedHealthcare Medicare	$16.13
Rate for Payer: University Health Alliance Commercial	$41.66

HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN RANDOM

Facility

$135.00

Service Code	HCPCS 80200
Hospital Charge Code	3018020002
Hospital Revenue Code	301
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN TROUGH

Facility

$135.00

Service Code	HCPCS 80200
Hospital Charge Code	3018020003
Hospital Revenue Code	301
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: MDX Hawaii PPO	$130.95

HC ASSAY OF TOBRAMYCIN - TOBRAMYCIN TROUGH

Facility

$135.00

Service Code	HCPCS 80200
Hospital Charge Code	3018020003
Hospital Revenue Code	301
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$16.13
Rate for Payer: AlohaCare Medicare	$16.13
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$17.74
Rate for Payer: Hawaii Medical Service Association ABD	$22.27
Rate for Payer: Hawaii Medical Service Association Commercial	$20.16
Rate for Payer: Hawaii Medical Service Association Medicare	$16.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.38
Rate for Payer: Hawaii Western Management Group Commercial	$16.13
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$16.13
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$16.13
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$17.74
Rate for Payer: Ohana Health Plan Medicare	$16.13
Rate for Payer: UnitedHealthcare Medicaid	$22.27
Rate for Payer: UnitedHealthcare Medicare	$16.13
Rate for Payer: University Health Alliance Commercial	$41.66

Know your out-of-pocket cost for care.

All Charges