Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CT GUIDANCE TISSUE ABLATION - CT GUIDED CRYOABLATION

Facility

$2,928.00

Service Code	HCPCS 77013
Hospital Charge Code	3507701301
Hospital Revenue Code	350
Min. Negotiated Rate	$2,488.80
Max. Negotiated Rate	$2,840.16
Rate for Payer: Cash Price	$1,756.80
Rate for Payer: Health Management Network Commercial	$2,488.80
Rate for Payer: MDX Hawaii PPO	$2,840.16

HC CT GUIDANCE TISSUE ABLATION - CT GUIDED CRYOABLATION

Facility

$2,928.00

Service Code	HCPCS 77013
Hospital Charge Code	3507701301
Hospital Revenue Code	350
Min. Negotiated Rate	$317.42
Max. Negotiated Rate	$2,840.16
Rate for Payer: Cash Price	$1,756.80
Rate for Payer: Cash Price	$1,756.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$317.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,781.60
Rate for Payer: Health Management Network Commercial	$2,488.80
Rate for Payer: Kaiser Permanente Commercial	$1,844.64
Rate for Payer: Kaiser Permanente Medicaid	$1,493.28
Rate for Payer: MDX Hawaii PPO	$2,840.16
Rate for Payer: University Health Alliance Commercial	$2,134.22

HC CT GUIDANCE TISSUE ABLATION - CT GUIDED RADIOFREQUENCY ABLATION

Facility

$2,928.00

Service Code	HCPCS 77013
Hospital Charge Code	3527701310
Hospital Revenue Code	352
Min. Negotiated Rate	$2,488.80
Max. Negotiated Rate	$2,840.16
Rate for Payer: Cash Price	$1,756.80
Rate for Payer: Health Management Network Commercial	$2,488.80
Rate for Payer: MDX Hawaii PPO	$2,840.16

HC CT GUIDANCE TISSUE ABLATION - CT GUIDED RADIOFREQUENCY ABLATION

Facility

$2,928.00

Service Code	HCPCS 77013
Hospital Charge Code	3527701310
Hospital Revenue Code	352
Min. Negotiated Rate	$317.42
Max. Negotiated Rate	$2,840.16
Rate for Payer: Cash Price	$1,756.80
Rate for Payer: Cash Price	$1,756.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$317.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,781.60
Rate for Payer: Health Management Network Commercial	$2,488.80
Rate for Payer: Kaiser Permanente Commercial	$1,844.64
Rate for Payer: Kaiser Permanente Medicaid	$1,493.28
Rate for Payer: MDX Hawaii PPO	$2,840.16
Rate for Payer: University Health Alliance Commercial	$2,134.22

HC CT HRT W/3D IMAGE - CT HEART STRUCTURE MORPHOLOGY WITH CONTRAST

Facility

$1,776.00

Service Code	HCPCS 75572
Hospital Charge Code	3527557201
Hospital Revenue Code	352
Min. Negotiated Rate	$97.41
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$97.41
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$157.44
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$97.41
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$544.75

HC CT HRT W/3D IMAGE - CT HEART STRUCTURE MORPHOLOGY WITH CONTRAST

Facility

$1,776.00

Service Code	HCPCS 75572
Hospital Charge Code	3527557201
Hospital Revenue Code	352
Min. Negotiated Rate	$1,509.60
Max. Negotiated Rate	$1,722.72
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: MDX Hawaii PPO	$1,722.72

HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST

Facility

$438.00

Service Code	HCPCS 75571
Hospital Charge Code	3527557101
Hospital Revenue Code	352
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: MDX Hawaii PPO	$424.86

HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST

Facility

$438.00

Service Code	HCPCS 75571
Hospital Charge Code	3527557101
Hospital Revenue Code	352
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$31.36
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	$50.09
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$275.94
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$31.36
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$150.03

HC CT LOW DOSE LUNG CA SCREEN

Facility

$529.00

Service Code	HCPCS 71271
Hospital Charge Code	3527127101
Hospital Revenue Code	352
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC CT LOW DOSE LUNG CA SCREEN

Facility

$529.00

Service Code	HCPCS 71271
Hospital Charge Code	3527127101
Hospital Revenue Code	352
Min. Negotiated Rate	$92.52
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$92.52
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$92.92
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$307.65

HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST

Facility

$885.00

Service Code	HCPCS 70492
Hospital Charge Code	3517049201
Hospital Revenue Code	351
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 CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST

Facility

$885.00

Service Code	HCPCS 70492
Hospital Charge Code	3517049201
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
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	$186.48
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	$253.12
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	$186.48
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$807.15

HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST

Facility

$885.00

Service Code	HCPCS 70491
Hospital Charge Code	3517049101
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
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	$186.48
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	$202.46
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	$186.48
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$671.68

HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST

Facility

$885.00

Service Code	HCPCS 70491
Hospital Charge Code	3517049101
Hospital Revenue Code	351
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 CTRL NOSEBLEED,ANTER,COMPLEX

Facility

$513.00

Service Code	HCPCS 30903
Hospital Charge Code	7613090301
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	$307.80
Rate for Payer: Cash Price	$307.80
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 ABD	$569.00
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	$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	$937.50
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 Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC CTRL NOSEBLEED,ANTER,COMPLEX

Facility

$513.00

Service Code	HCPCS 30903
Hospital Charge Code	7613090301
Hospital Revenue Code	450
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 CTRL NOSEBLEED,ANTER,SIMPLE

Facility

$513.00

Service Code	HCPCS 30901
Hospital Charge Code	7613090101
Hospital Revenue Code	761
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 CTRL NOSEBLEED,ANTER,SIMPLE

Facility

$513.00

Service Code	HCPCS 30901
Hospital Charge Code	7613090101
Hospital Revenue Code	761
Min. Negotiated Rate	$44.33
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	$44.33
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT

Facility

$513.00

Service Code	HCPCS 30905
Hospital Charge Code	7613090501
Hospital Revenue Code	761
Min. Negotiated Rate	$98.64
Max. Negotiated Rate	$5,509.00
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: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
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	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
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	$98.64
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT

Facility

$513.00

Service Code	HCPCS 30905
Hospital Charge Code	7613090501
Hospital Revenue Code	761
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 CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Facility

$11,415.00

Service Code	HCPCS 42962
Hospital Charge Code	3614296201
Hospital Revenue Code	361
Min. Negotiated Rate	$9,702.75
Max. Negotiated Rate	$11,072.55
Rate for Payer: Cash Price	$6,849.00
Rate for Payer: Health Management Network Commercial	$9,702.75
Rate for Payer: MDX Hawaii PPO	$11,072.55

HC CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Facility

$11,415.00

Service Code	HCPCS 42962
Hospital Charge Code	3614296201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,072.55
Rate for Payer: AlohaCare Medicaid	$3,916.70
Rate for Payer: AlohaCare Medicare	$3,916.70
Rate for Payer: Cash Price	$6,849.00
Rate for Payer: Cash Price	$6,849.00
Rate for Payer: Cash Price	$6,849.00
Rate for Payer: Devoted Health Medicare	$4,308.37
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	$3,916.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$9,702.75
Rate for Payer: Humana Medicare	$3,916.70
Rate for Payer: Kaiser Permanente Commercial	$7,191.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,916.70
Rate for Payer: MDX Hawaii PPO	$11,072.55
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	$5,160.40

HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST

Facility

$529.00

Service Code	HCPCS 72125
Hospital Charge Code	3527212501
Hospital Revenue Code	352
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST

Facility

$529.00

Service Code	HCPCS 72125
Hospital Charge Code	3527212501
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$194.84
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$211.43
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$194.84
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$502.27

HC CT SCAN CERV SPINE CONTRAST - CT CERVICAL SPINE W CONTRAST

Facility

$1,776.00

Service Code	HCPCS 72126
Hospital Charge Code	3527212601
Hospital Revenue Code	352
Min. Negotiated Rate	$232.90
Max. Negotiated Rate	$1,722.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Cash Price	$1,065.60
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,509.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,118.88
Rate for Payer: Kaiser Permanente Medicaid	$905.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,722.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$683.96

Know your out-of-pocket cost for care.

All Charges