Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CLOSED RX RAD/ULNA SHAFT FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 25565
Hospital Charge Code	4502556501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX SCAPULA FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 23575
Hospital Charge Code	4502357501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX SCAPULA FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 23575
Hospital Charge Code	4502357501
Hospital Revenue Code	450
Min. Negotiated Rate	$695.00
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: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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 SHLDR DISLOC,ANESTHESIA

Facility

$6,369.00

Service Code	HCPCS 23655
Hospital Charge Code	4502365501
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
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: 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	$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 Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC CLOSED RX SHLDR DISLOC,ANESTHESIA

Facility

$6,369.00

Service Code	HCPCS 23655
Hospital Charge Code	4502365501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX SHLDR DISLOCATION

Facility

$955.00

Service Code	HCPCS 23650
Hospital Charge Code	7612365001
Hospital Revenue Code	761
Min. Negotiated Rate	$180.50
Max. Negotiated Rate	$926.35
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: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association Commercial	$364.25
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
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	$487.05
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 Medicaid	$180.50
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX SHLDR DISLOCATION

Facility

$955.00

Service Code	HCPCS 23650
Hospital Charge Code	7612365001
Hospital Revenue Code	761
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 SHLDR DISLOC,GR TUB FX

Facility

$6,369.00

Service Code	HCPCS 23665
Hospital Charge Code	4502366501
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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: 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	$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 Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX SHLDR DISLOC,GR TUB FX

Facility

$6,369.00

Service Code	HCPCS 23665
Hospital Charge Code	4502366501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX TALUS FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 28435
Hospital Charge Code	7612843501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX TALUS FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 28435
Hospital Charge Code	7612843501
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
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 Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX TIBIAL PLATEAU FX

Facility

$935.00

Service Code	HCPCS 27530
Hospital Charge Code	7612753001
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 TIBIAL PLATEAU FX

Facility

$935.00

Service Code	HCPCS 27530
Hospital Charge Code	7612753001
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 TIBIA SHAFT FX

Facility

$935.00

Service Code	HCPCS 27750
Hospital Charge Code	7612775001
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 TIBIA SHAFT FX

Facility

$935.00

Service Code	HCPCS 27750
Hospital Charge Code	7612775001
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 TIBIA SHAFT FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 27752
Hospital Charge Code	7612775201
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
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: 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	$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 Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC CLOSED RX TIBIA SHAFT FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 27752
Hospital Charge Code	7612775201
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX TIB PLAT FX+MANIP

Facility

$12,912.00

Service Code	HCPCS 27532
Hospital Charge Code	7612753201
Hospital Revenue Code	450
Min. Negotiated Rate	$10,975.20
Max. Negotiated Rate	$12,524.64
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: MDX Hawaii PPO	$12,524.64

HC CLOSED RX TIB PLAT FX+MANIP

Facility

$12,912.00

Service Code	HCPCS 27532
Hospital Charge Code	7612753201
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,524.64
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$12,266.40
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Commercial	$8,134.56
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: MDX Hawaii PPO	$12,524.64
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$9,411.56

HC CLOSED RX TOE FX

Facility

$955.00

Service Code	HCPCS 28510
Hospital Charge Code	7612851001
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 TOE FX

Facility

$955.00

Service Code	HCPCS 28510
Hospital Charge Code	7612851001
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 TOE FX,MANIPULATN

Facility

$955.00

Service Code	HCPCS 28515
Hospital Charge Code	4502851501
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 TOE FX,MANIPULATN

Facility

$955.00

Service Code	HCPCS 28515
Hospital Charge Code	4502851501
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 TRAUMA HIP DISLOC,ANESTH

Facility

$6,369.00

Service Code	HCPCS 27252
Hospital Charge Code	7612725201
Hospital Revenue Code	450
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC CLOSED RX TRAUMA HIP DISLOC,ANESTH

Facility

$6,369.00

Service Code	HCPCS 27252
Hospital Charge Code	7612725201
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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: 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	$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 Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$5,160.40

Know your out-of-pocket cost for care.

All Charges