Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC EC OPIOIDS/OPIATE 5 OR MOR SO

Facility

$960.00

Service Code	HCPCS 80364
Hospital Charge Code	3008036401
Hospital Revenue Code	300
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 EC OPIOIDS/OPIATE 5 OR MOR SO

Facility

$960.00

Service Code	HCPCS 80364
Hospital Charge Code	3008036401
Hospital Revenue Code	300
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$931.20
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Hawaii Medical Service Association ABD	$26.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.23
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 EC X-RAY SM INT F-THRU STD

Facility

$768.00

Service Code	HCPCS 74248
Hospital Charge Code	3207424801
Hospital Revenue Code	320
Min. Negotiated Rate	$43.61
Max. Negotiated Rate	$744.96
Rate for Payer: Cash Price	$460.80
Rate for Payer: Cash Price	$460.80
Rate for Payer: Hawaii Medical Service Association ABD	$65.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.61
Rate for Payer: Hawaii Western Management Group Commercial	$729.60
Rate for Payer: Health Management Network Commercial	$652.80
Rate for Payer: Kaiser Permanente Commercial	$483.84
Rate for Payer: Kaiser Permanente Medicaid	$391.68
Rate for Payer: MDX Hawaii PPO	$744.96
Rate for Payer: UnitedHealthcare Medicaid	$54.01
Rate for Payer: University Health Alliance Commercial	$176.51

HC EC X-RAY SM INT F-THRU STD

Facility

$768.00

Service Code	HCPCS 74248
Hospital Charge Code	3207424801
Hospital Revenue Code	320
Min. Negotiated Rate	$652.80
Max. Negotiated Rate	$744.96
Rate for Payer: Cash Price	$460.80
Rate for Payer: Health Management Network Commercial	$652.80
Rate for Payer: MDX Hawaii PPO	$744.96

HC EEG,EXTENDED MONITORING,41-60 MINUTES - EEG

Facility

$1,239.00

Service Code	HCPCS 95812
Hospital Charge Code	7409581201
Hospital Revenue Code	740
Min. Negotiated Rate	$1,053.15
Max. Negotiated Rate	$1,201.83
Rate for Payer: Cash Price	$743.40
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: MDX Hawaii PPO	$1,201.83

HC EEG,EXTENDED MONITORING,41-60 MINUTES - EEG

Facility

$1,239.00

Service Code	HCPCS 95812
Hospital Charge Code	7409581201
Hospital Revenue Code	740
Min. Negotiated Rate	$92.69
Max. Negotiated Rate	$1,201.83
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$92.69
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$181.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,177.05
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$780.57
Rate for Payer: Kaiser Permanente Medicaid	$631.89
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,201.83
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$92.69
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$903.11

HC EEG EXTENDED MONITORING 61-119 MINUTES

Facility

$1,239.00

Service Code	HCPCS 95813
Hospital Charge Code	4509581301
Hospital Revenue Code	450
Min. Negotiated Rate	$1,053.15
Max. Negotiated Rate	$1,201.83
Rate for Payer: Cash Price	$743.40
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: MDX Hawaii PPO	$1,201.83

HC EEG EXTENDED MONITORING 61-119 MINUTES

Facility

$1,239.00

Service Code	HCPCS 95813
Hospital Charge Code	4509581301
Hospital Revenue Code	450
Min. Negotiated Rate	$255.08
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Devoted Health Medicare	$280.59
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	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,177.05
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$780.57
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,201.83
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$903.11

HC EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM - EGD

Facility

$7,549.00

Service Code	HCPCS 43249
Hospital Charge Code	3604324901
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,322.53
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Devoted Health Medicare	$2,493.58
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	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$4,755.87
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$7,322.53
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM - EGD

Facility

$7,549.00

Service Code	HCPCS 43249
Hospital Charge Code	3604324901
Hospital Revenue Code	360
Min. Negotiated Rate	$6,416.65
Max. Negotiated Rate	$7,322.53
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: MDX Hawaii PPO	$7,322.53

HC EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Facility

$7,549.00

Service Code	HCPCS 43250
Hospital Charge Code	3604325001
Hospital Revenue Code	360
Min. Negotiated Rate	$6,416.65
Max. Negotiated Rate	$7,322.53
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: MDX Hawaii PPO	$7,322.53

HC EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Facility

$7,549.00

Service Code	HCPCS 43250
Hospital Charge Code	3604325001
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,322.53
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Devoted Health Medicare	$2,493.58
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	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$4,755.87
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$7,322.53
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH - EGD

Facility

$7,549.00

Service Code	HCPCS 43251
Hospital Charge Code	3604325101
Hospital Revenue Code	360
Min. Negotiated Rate	$6,416.65
Max. Negotiated Rate	$7,322.53
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: MDX Hawaii PPO	$7,322.53

HC EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH - EGD

Facility

$7,549.00

Service Code	HCPCS 43251
Hospital Charge Code	3604325101
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,322.53
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Cash Price	$4,529.40
Rate for Payer: Devoted Health Medicare	$2,493.58
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	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$6,416.65
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$4,755.87
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$7,322.53
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD

Facility

$3,731.00

Service Code	HCPCS 43239
Hospital Charge Code	3604323901
Hospital Revenue Code	360
Min. Negotiated Rate	$3,171.35
Max. Negotiated Rate	$3,619.07
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Health Management Network Commercial	$3,171.35
Rate for Payer: MDX Hawaii PPO	$3,619.07

HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD

Facility

$3,731.00

Service Code	HCPCS 43239
Hospital Charge Code	3604323901
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$3,171.35
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,350.53
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$3,619.07
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC EGFR GENE COM VARIANTS SO

Facility

$2,723.00

Service Code	HCPCS 81235
Hospital Charge Code	3108123501
Hospital Revenue Code	310
Min. Negotiated Rate	$2,314.55
Max. Negotiated Rate	$2,641.31
Rate for Payer: Cash Price	$1,633.80
Rate for Payer: Health Management Network Commercial	$2,314.55
Rate for Payer: MDX Hawaii PPO	$2,641.31

HC EGFR GENE COM VARIANTS SO

Facility

$2,723.00

Service Code	HCPCS 81235
Hospital Charge Code	3108123501
Hospital Revenue Code	310
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$2,641.31
Rate for Payer: AlohaCare Medicaid	$324.58
Rate for Payer: AlohaCare Medicare	$324.58
Rate for Payer: Cash Price	$1,633.80
Rate for Payer: Cash Price	$1,633.80
Rate for Payer: Devoted Health Medicare	$357.04
Rate for Payer: Hawaii Medical Service Association Commercial	$405.73
Rate for Payer: Hawaii Medical Service Association Medicare	$324.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$323.80
Rate for Payer: Hawaii Western Management Group Commercial	$324.58
Rate for Payer: Health Management Network Commercial	$2,314.55
Rate for Payer: Humana Medicare	$324.58
Rate for Payer: Kaiser Permanente Commercial	$1,715.49
Rate for Payer: Kaiser Permanente Medicaid	$1,388.73
Rate for Payer: Kaiser Permanente Medicare	$324.58
Rate for Payer: MDX Hawaii PPO	$2,641.31
Rate for Payer: Ohana Health Plan Medicaid	$357.04
Rate for Payer: Ohana Health Plan Medicare	$324.58
Rate for Payer: UnitedHealthcare Medicaid	$135.00
Rate for Payer: UnitedHealthcare Medicare	$324.58
Rate for Payer: University Health Alliance Commercial	$1,984.79

HC ELASTASE PANCREATIC FECAL QUANTITATIVE

Facility

$193.00

Service Code	HCPCS 82653
Hospital Charge Code	3018265301
Hospital Revenue Code	301
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$115.80
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: MDX Hawaii PPO	$187.21

HC ELASTASE PANCREATIC FECAL QUANTITATIVE

Facility

$193.00

Service Code	HCPCS 82653
Hospital Charge Code	3018265301
Hospital Revenue Code	301
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$22.97
Rate for Payer: AlohaCare Medicare	$22.97
Rate for Payer: Cash Price	$115.80
Rate for Payer: Cash Price	$115.80
Rate for Payer: Devoted Health Medicare	$25.27
Rate for Payer: Hawaii Medical Service Association ABD	$23.79
Rate for Payer: Hawaii Medical Service Association Commercial	$28.71
Rate for Payer: Hawaii Medical Service Association Medicare	$22.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.98
Rate for Payer: Hawaii Western Management Group Commercial	$22.97
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$22.97
Rate for Payer: Kaiser Permanente Commercial	$121.59
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$22.97
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$25.27
Rate for Payer: Ohana Health Plan Medicare	$22.97
Rate for Payer: UnitedHealthcare Medicaid	$13.78
Rate for Payer: UnitedHealthcare Medicare	$22.97
Rate for Payer: University Health Alliance Commercial	$140.68

HC ELECTROCARDIOGRAM, TRACING

Facility

$236.00

Service Code	HCPCS 93005
Hospital Charge Code	7309300501
Hospital Revenue Code	730
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$76.66
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$69.69
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$148.68
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicaid	$15.16
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$172.02

HC ELECTROCARDIOGRAM, TRACING

Facility

$236.00

Service Code	HCPCS 93005
Hospital Charge Code	7309300501
Hospital Revenue Code	730
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: MDX Hawaii PPO	$228.92

HC ELECTROLYTE PANEL - BUNDLED CHARGE

Facility

$59.00

Service Code	HCPCS 80051
Hospital Charge Code	3018005101
Hospital Revenue Code	301
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$7.01
Rate for Payer: AlohaCare Medicare	$7.01
Rate for Payer: Cash Price	$35.40
Rate for Payer: Cash Price	$35.40
Rate for Payer: Devoted Health Medicare	$7.71
Rate for Payer: Hawaii Medical Service Association ABD	$9.69
Rate for Payer: Hawaii Medical Service Association Commercial	$8.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.17
Rate for Payer: Hawaii Western Management Group Commercial	$7.01
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$7.01
Rate for Payer: Kaiser Permanente Commercial	$37.17
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$7.01
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$7.71
Rate for Payer: Ohana Health Plan Medicare	$7.01
Rate for Payer: UnitedHealthcare Medicaid	$9.69
Rate for Payer: UnitedHealthcare Medicare	$7.01
Rate for Payer: University Health Alliance Commercial	$18.13

HC ELECTROLYTE PANEL - BUNDLED CHARGE

Facility

$59.00

Service Code	HCPCS 80051
Hospital Charge Code	3018005101
Hospital Revenue Code	301
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$35.40
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: MDX Hawaii PPO	$57.23

HC ELECTRON MICROSCOPY SO

Facility

$8,094.00

Service Code	HCPCS 88348
Hospital Charge Code	3108834801
Hospital Revenue Code	310
Min. Negotiated Rate	$273.83
Max. Negotiated Rate	$7,851.18
Rate for Payer: AlohaCare Medicaid	$951.79
Rate for Payer: AlohaCare Medicare	$951.79
Rate for Payer: Cash Price	$4,856.40
Rate for Payer: Cash Price	$4,856.40
Rate for Payer: Devoted Health Medicare	$1,046.97
Rate for Payer: Hawaii Medical Service Association ABD	$273.83
Rate for Payer: Hawaii Medical Service Association Commercial	$1,189.74
Rate for Payer: Hawaii Medical Service Association Medicare	$951.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$276.33
Rate for Payer: Hawaii Western Management Group Commercial	$951.79
Rate for Payer: Health Management Network Commercial	$6,879.90
Rate for Payer: Humana Medicare	$951.79
Rate for Payer: Kaiser Permanente Commercial	$5,099.22
Rate for Payer: Kaiser Permanente Medicaid	$4,127.94
Rate for Payer: Kaiser Permanente Medicare	$951.79
Rate for Payer: MDX Hawaii PPO	$7,851.18
Rate for Payer: Ohana Health Plan Medicaid	$1,046.97
Rate for Payer: Ohana Health Plan Medicare	$951.79
Rate for Payer: UnitedHealthcare Medicaid	$273.83
Rate for Payer: UnitedHealthcare Medicare	$951.79
Rate for Payer: University Health Alliance Commercial	$1,206.83

Know your out-of-pocket cost for care.

All Charges