Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA AMP PROBE

Facility

$294.00

Service Code	HCPCS 87491
Hospital Charge Code	3068749102
Hospital Revenue Code	306
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: MDX Hawaii PPO	$285.18

HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH

Facility

$885.00

Service Code	HCPCS 74230
Hospital Charge Code	3207423001
Hospital Revenue Code	320
Min. Negotiated Rate	$752.25
Max. Negotiated Rate	$858.45
Rate for Payer: Cash Price	$531.00
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: MDX Hawaii PPO	$858.45

HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH

Facility

$885.00

Service Code	HCPCS 74230
Hospital Charge Code	3207423001
Hospital Revenue Code	320
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$858.45
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
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	$752.25
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$557.55
Rate for Payer: Kaiser Permanente Medicaid	$451.35
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$858.45
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	$175.55

HC CIRCUMCISION CLAMP OTH DV

Facility

$8,152.00

Service Code	HCPCS 54150
Hospital Charge Code	3615415001
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,907.44
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,929.20
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$5,135.76
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$7,907.44
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC CIRCUMCISION CLAMP OTH DV

Facility

$8,152.00

Service Code	HCPCS 54150
Hospital Charge Code	3615415001
Hospital Revenue Code	361
Min. Negotiated Rate	$6,929.20
Max. Negotiated Rate	$7,907.44
Rate for Payer: Cash Price	$4,891.20
Rate for Payer: Health Management Network Commercial	$6,929.20
Rate for Payer: MDX Hawaii PPO	$7,907.44

HC CISTERNOGRAPHY,POS CONTRAST - FL CISTERNOGRAM

Facility

$3,079.00

Service Code	HCPCS 70015
Hospital Charge Code	3207001501
Hospital Revenue Code	320
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$2,986.63
Rate for Payer: AlohaCare Medicaid	$926.08
Rate for Payer: AlohaCare Medicare	$926.08
Rate for Payer: Cash Price	$1,847.40
Rate for Payer: Cash Price	$1,847.40
Rate for Payer: Devoted Health Medicare	$1,018.69
Rate for Payer: Hawaii Medical Service Association ABD	$44.80
Rate for Payer: Hawaii Medical Service Association Commercial	$1,157.60
Rate for Payer: Hawaii Medical Service Association Medicare	$926.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.44
Rate for Payer: Hawaii Western Management Group Commercial	$926.08
Rate for Payer: Health Management Network Commercial	$2,617.15
Rate for Payer: Humana Medicare	$926.08
Rate for Payer: Kaiser Permanente Commercial	$1,939.77
Rate for Payer: Kaiser Permanente Medicaid	$1,570.29
Rate for Payer: Kaiser Permanente Medicare	$926.08
Rate for Payer: MDX Hawaii PPO	$2,986.63
Rate for Payer: Ohana Health Plan Medicaid	$1,018.69
Rate for Payer: Ohana Health Plan Medicare	$926.08
Rate for Payer: UnitedHealthcare Medicaid	$44.80
Rate for Payer: UnitedHealthcare Medicare	$926.08
Rate for Payer: University Health Alliance Commercial	$268.92

HC CISTERNOGRAPHY,POS CONTRAST - FL CISTERNOGRAM

Facility

$3,079.00

Service Code	HCPCS 70015
Hospital Charge Code	3207001501
Hospital Revenue Code	320
Min. Negotiated Rate	$2,617.15
Max. Negotiated Rate	$2,986.63
Rate for Payer: Cash Price	$1,847.40
Rate for Payer: Health Management Network Commercial	$2,617.15
Rate for Payer: MDX Hawaii PPO	$2,986.63

HC CISTERNOGRAPHY,POS CONTRAST - XR CISTERNOGRAM

Facility

$3,079.00

Service Code	HCPCS 70015
Hospital Charge Code	3207001502
Hospital Revenue Code	320
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$2,986.63
Rate for Payer: AlohaCare Medicaid	$926.08
Rate for Payer: AlohaCare Medicare	$926.08
Rate for Payer: Cash Price	$1,847.40
Rate for Payer: Cash Price	$1,847.40
Rate for Payer: Devoted Health Medicare	$1,018.69
Rate for Payer: Hawaii Medical Service Association ABD	$44.80
Rate for Payer: Hawaii Medical Service Association Commercial	$1,157.60
Rate for Payer: Hawaii Medical Service Association Medicare	$926.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.44
Rate for Payer: Hawaii Western Management Group Commercial	$926.08
Rate for Payer: Health Management Network Commercial	$2,617.15
Rate for Payer: Humana Medicare	$926.08
Rate for Payer: Kaiser Permanente Commercial	$1,939.77
Rate for Payer: Kaiser Permanente Medicaid	$1,570.29
Rate for Payer: Kaiser Permanente Medicare	$926.08
Rate for Payer: MDX Hawaii PPO	$2,986.63
Rate for Payer: Ohana Health Plan Medicaid	$1,018.69
Rate for Payer: Ohana Health Plan Medicare	$926.08
Rate for Payer: UnitedHealthcare Medicaid	$44.80
Rate for Payer: UnitedHealthcare Medicare	$926.08
Rate for Payer: University Health Alliance Commercial	$268.92

HC CISTERNOGRAPHY,POS CONTRAST - XR CISTERNOGRAM

Facility

$3,079.00

Service Code	HCPCS 70015
Hospital Charge Code	3207001502
Hospital Revenue Code	320
Min. Negotiated Rate	$2,617.15
Max. Negotiated Rate	$2,986.63
Rate for Payer: Cash Price	$1,847.40
Rate for Payer: Health Management Network Commercial	$2,617.15
Rate for Payer: MDX Hawaii PPO	$2,986.63

HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL

Facility

$960.00

Service Code	HCPCS 84999
Hospital Charge Code	3018499901
Hospital Revenue Code	301
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Western Management Group Commercial	$912.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: Kaiser Permanente Commercial	$604.80
Rate for Payer: Kaiser Permanente Medicaid	$489.60
Rate for Payer: MDX Hawaii PPO	$931.20
Rate for Payer: University Health Alliance Commercial	$699.74

HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL

Facility

$960.00

Service Code	HCPCS 84999
Hospital Charge Code	3018499901
Hospital Revenue Code	301
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Health Management Network Commercial	$816.00
Rate for Payer: MDX Hawaii PPO	$931.20

HC CLOSED RX ACETABULAR FX

Facility

$935.00

Service Code	HCPCS 27220
Hospital Charge Code	7612722001
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$320.54
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 Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$589.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX ACETABULAR FX

Facility

$935.00

Service Code	HCPCS 27220
Hospital Charge Code	7612722001
Hospital Revenue Code	450
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: MDX Hawaii PPO	$906.95

HC CLOSED RX ANKLE DISLOCATN

Facility

$955.00

Service Code	HCPCS 27840
Hospital Charge Code	7612784001
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
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 Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX ANKLE DISLOCATN

Facility

$955.00

Service Code	HCPCS 27840
Hospital Charge Code	7612784001
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSED RX BIG TOE FX,MANIP

Facility

$955.00

Service Code	HCPCS 28495
Hospital Charge Code	4502849501
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
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	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX BIG TOE FX,MANIP

Facility

$955.00

Service Code	HCPCS 28495
Hospital Charge Code	4502849501
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSED RX CARPAL FX,MAIPULATN

Facility

$6,369.00

Service Code	HCPCS 25635
Hospital Charge Code	7612563501
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.55
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,012.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX CARPAL FX,MAIPULATN

Facility

$6,369.00

Service Code	HCPCS 25635
Hospital Charge Code	7612563501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65

HC CLOSED RX CLAVICLE FX,MANIPULATN

Facility

$6,236.00

Service Code	HCPCS 23505
Hospital Charge Code	7612350501
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,048.92
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Devoted Health Medicare	$2,089.55
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 Medicare	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$5,924.20
Rate for Payer: Health Management Network Commercial	$5,300.60
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$3,928.68
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,048.92
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,545.42

HC CLOSED RX CLAVICLE FX,MANIPULATN

Facility

$6,236.00

Service Code	HCPCS 23505
Hospital Charge Code	7612350501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,300.60
Max. Negotiated Rate	$6,048.92
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Health Management Network Commercial	$5,300.60
Rate for Payer: MDX Hawaii PPO	$6,048.92

HC CLOSED RX CONDYLAR FX

Facility

$935.00

Service Code	HCPCS 27501
Hospital Charge Code	7612750101
Hospital Revenue Code	450
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: MDX Hawaii PPO	$906.95

HC CLOSED RX CONDYLAR FX

Facility

$935.00

Service Code	HCPCS 27501
Hospital Charge Code	7612750101
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$320.54
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 Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$589.05
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX DENTAL RIDGE FX

Facility

$12,637.00

Service Code	HCPCS 21440
Hospital Charge Code	7612144001
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$12,257.89
Rate for Payer: AlohaCare Medicaid	$3,916.70
Rate for Payer: AlohaCare Medicare	$3,916.70
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Devoted Health Medicare	$4,308.37
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 Medicare	$3,916.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$12,005.15
Rate for Payer: Health Management Network Commercial	$10,741.45
Rate for Payer: Humana Medicare	$3,916.70
Rate for Payer: Kaiser Permanente Commercial	$7,961.31
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,916.70
Rate for Payer: MDX Hawaii PPO	$12,257.89
Rate for Payer: Ohana Health Plan Medicaid	$4,308.37
Rate for Payer: Ohana Health Plan Medicare	$3,916.70
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,916.70
Rate for Payer: University Health Alliance Commercial	$9,211.11

HC CLOSED RX DENTAL RIDGE FX

Facility

$12,637.00

Service Code	HCPCS 21440
Hospital Charge Code	7612144001
Hospital Revenue Code	450
Min. Negotiated Rate	$10,741.45
Max. Negotiated Rate	$12,257.89
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Health Management Network Commercial	$10,741.45
Rate for Payer: MDX Hawaii PPO	$12,257.89

Know your out-of-pocket cost for care.

All Charges