Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC DETECT AGENT NOS, DNA, AMP - M HOMINIS AMP PROBE SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779803
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 DETECT AGENT NOS, DNA, AMP - M TB AMP PROBE RESIST EA SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779808
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 DETECT AGENT NOS, DNA, AMP - M TB AMP PROBE RESIST EA SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779808
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - NORVOVIRUS GRP 1 PCR SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779802
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - NORVOVIRUS GRP 1 PCR SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779802
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 DETECT AGENT NOS, DNA, AMP - U PARVUM AMP PROBE SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779805
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - U PARVUM AMP PROBE SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779805
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 DETECT AGENT NOS, DNA, AMP - U UREALYTICUM AMP PROB SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779804
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$185.22
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC DETECT AGENT NOS, DNA, AMP - U UREALYTICUM AMP PROB SO

Facility

$294.00

Service Code	HCPCS 87798
Hospital Charge Code	3068779804
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 DETECT AGENT NOS, DNA, QUANT - BK VIRUS, DNA, QUANTITATIVE

Facility

$359.00

Service Code	HCPCS 87799
Hospital Charge Code	3068779901
Hospital Revenue Code	306
Min. Negotiated Rate	$305.15
Max. Negotiated Rate	$348.23
Rate for Payer: Cash Price	$215.40
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: MDX Hawaii PPO	$348.23

HC DETECT AGENT NOS, DNA, QUANT - BK VIRUS, DNA, QUANTITATIVE

Facility

$359.00

Service Code	HCPCS 87799
Hospital Charge Code	3068779901
Hospital Revenue Code	306
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$348.23
Rate for Payer: AlohaCare Medicaid	$42.84
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$215.40
Rate for Payer: Cash Price	$215.40
Rate for Payer: Devoted Health Medicare	$47.12
Rate for Payer: Hawaii Medical Service Association ABD	$35.91
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.17
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$226.17
Rate for Payer: Kaiser Permanente Medicaid	$183.09
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$348.23
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$35.91
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$110.72

HC DETECT AGENT NOS, DNA, QUANT - EPSTEIN-BARR VIRUS DNA, QUANTITATIVE

Facility

$359.00

Service Code	HCPCS 87799
Hospital Charge Code	3068779902
Hospital Revenue Code	306
Min. Negotiated Rate	$305.15
Max. Negotiated Rate	$348.23
Rate for Payer: Cash Price	$215.40
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: MDX Hawaii PPO	$348.23

HC DETECT AGENT NOS, DNA, QUANT - EPSTEIN-BARR VIRUS DNA, QUANTITATIVE

Facility

$359.00

Service Code	HCPCS 87799
Hospital Charge Code	3068779902
Hospital Revenue Code	306
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$348.23
Rate for Payer: AlohaCare Medicaid	$42.84
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$215.40
Rate for Payer: Cash Price	$215.40
Rate for Payer: Devoted Health Medicare	$47.12
Rate for Payer: Hawaii Medical Service Association ABD	$35.91
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.17
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$226.17
Rate for Payer: Kaiser Permanente Medicaid	$183.09
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$348.23
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$35.91
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$110.72

HC DIAGNOSTIC BONE MARROW ASPIRATIONS

Facility

$6,448.00

Service Code	HCPCS 38220
Hospital Charge Code	3613822001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC DIAGNOSTIC BONE MARROW ASPIRATIONS

Facility

$6,448.00

Service Code	HCPCS 38220
Hospital Charge Code	3613822001
Hospital Revenue Code	361
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC DIAGNOSTIC BONE MARROW BIOPSIES

Facility

$6,448.00

Service Code	HCPCS 38221
Hospital Charge Code	3613822101
Hospital Revenue Code	361
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC DIAGNOSTIC BONE MARROW BIOPSIES

Facility

$6,448.00

Service Code	HCPCS 38221
Hospital Charge Code	3613822101
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Facility

$11,153.00

Service Code	HCPCS 38222
Hospital Charge Code	7613822201
Hospital Revenue Code	761
Min. Negotiated Rate	$9,480.05
Max. Negotiated Rate	$10,818.41
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: MDX Hawaii PPO	$10,818.41

HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Facility

$11,153.00

Service Code	HCPCS 38222
Hospital Charge Code	7613822201
Hospital Revenue Code	761
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$10,818.41
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$10,595.35
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$7,026.39
Rate for Payer: Kaiser Permanente Medicaid	$5,688.03
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$10,818.41
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$8,129.42

HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Facility

$11,153.00

Service Code	HCPCS 38222
Hospital Charge Code	3613822201
Hospital Revenue Code	361
Min. Negotiated Rate	$9,480.05
Max. Negotiated Rate	$10,818.41
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: MDX Hawaii PPO	$10,818.41

HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Facility

$11,153.00

Service Code	HCPCS 38222
Hospital Charge Code	3613822201
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$10,818.41
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Cash Price	$6,691.80
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$9,480.05
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Commercial	$7,026.39
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: MDX Hawaii PPO	$10,818.41
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$8,129.42

HC DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

Facility

$6,352.00

Service Code	HCPCS 36909
Hospital Charge Code	3613690901
Hospital Revenue Code	361
Min. Negotiated Rate	$5,399.20
Max. Negotiated Rate	$6,161.44
Rate for Payer: Cash Price	$3,811.20
Rate for Payer: Health Management Network Commercial	$5,399.20
Rate for Payer: MDX Hawaii PPO	$6,161.44

HC DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

Facility

$6,352.00

Service Code	HCPCS 36909
Hospital Charge Code	3613690901
Hospital Revenue Code	361
Min. Negotiated Rate	$190.20
Max. Negotiated Rate	$6,161.44
Rate for Payer: Cash Price	$3,811.20
Rate for Payer: Cash Price	$3,811.20
Rate for Payer: Cash Price	$3,811.20
Rate for Payer: Health Management Network Commercial	$5,399.20
Rate for Payer: Kaiser Permanente Commercial	$4,001.76
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$6,161.44
Rate for Payer: UnitedHealthcare Medicaid	$190.20
Rate for Payer: University Health Alliance Commercial	$4,629.97

HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - PERITONEAL DIALYSIS

Facility

$1,695.00

Service Code	HCPCS 90945
Hospital Charge Code	8319094501
Hospital Revenue Code	831
Min. Negotiated Rate	$1,440.75
Max. Negotiated Rate	$1,644.15
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Health Management Network Commercial	$1,440.75
Rate for Payer: MDX Hawaii PPO	$1,644.15

HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - PERITONEAL DIALYSIS

Facility

$1,695.00

Service Code	HCPCS 90945
Hospital Charge Code	8319094501
Hospital Revenue Code	831
Min. Negotiated Rate	$63.76
Max. Negotiated Rate	$1,644.15
Rate for Payer: AlohaCare Medicaid	$492.93
Rate for Payer: AlohaCare Medicare	$492.93
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Cash Price	$1,017.00
Rate for Payer: Devoted Health Medicare	$542.22
Rate for Payer: Hawaii Medical Service Association Commercial	$616.16
Rate for Payer: Hawaii Medical Service Association Medicare	$492.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,610.25
Rate for Payer: Health Management Network Commercial	$1,440.75
Rate for Payer: Humana Medicare	$492.93
Rate for Payer: Kaiser Permanente Commercial	$1,067.85
Rate for Payer: Kaiser Permanente Medicaid	$864.45
Rate for Payer: Kaiser Permanente Medicare	$492.93
Rate for Payer: MDX Hawaii PPO	$1,644.15
Rate for Payer: Ohana Health Plan Medicaid	$542.22
Rate for Payer: Ohana Health Plan Medicare	$492.93
Rate for Payer: UnitedHealthcare Medicaid	$63.76
Rate for Payer: UnitedHealthcare Medicare	$492.93
Rate for Payer: University Health Alliance Commercial	$1,235.49

Know your out-of-pocket cost for care.

All Charges