Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC HEXAGONAL PHOS NEUTRAL SO

Facility

$151.00

Service Code	HCPCS 85598
Hospital Charge Code	3058559801
Hospital Revenue Code	305
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$146.47
Rate for Payer: AlohaCare Medicaid	$17.98
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$90.60
Rate for Payer: Cash Price	$90.60
Rate for Payer: Devoted Health Medicare	$19.78
Rate for Payer: Hawaii Medical Service Association ABD	$25.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22.48
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.08
Rate for Payer: Hawaii Western Management Group Commercial	$17.98
Rate for Payer: Health Management Network Commercial	$128.35
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$95.13
Rate for Payer: Kaiser Permanente Medicaid	$77.01
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$146.47
Rate for Payer: Ohana Health Plan Medicaid	$19.78
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicaid	$25.30
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$110.06

HC HEXAGONAL PHOS NEUTRAL SO

Facility

$151.00

Service Code	HCPCS 85598
Hospital Charge Code	3058559801
Hospital Revenue Code	305
Min. Negotiated Rate	$128.35
Max. Negotiated Rate	$146.47
Rate for Payer: Cash Price	$90.60
Rate for Payer: Health Management Network Commercial	$128.35
Rate for Payer: MDX Hawaii PPO	$146.47

HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT

Facility

$548.00

Service Code	HCPCS 81256
Hospital Charge Code	3108125601
Hospital Revenue Code	310
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$531.56
Rate for Payer: AlohaCare Medicaid	$65.36
Rate for Payer: AlohaCare Medicare	$65.36
Rate for Payer: Cash Price	$328.80
Rate for Payer: Cash Price	$328.80
Rate for Payer: Devoted Health Medicare	$71.90
Rate for Payer: Hawaii Medical Service Association ABD	$87.49
Rate for Payer: Hawaii Medical Service Association Commercial	$81.70
Rate for Payer: Hawaii Medical Service Association Medicare	$65.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$87.49
Rate for Payer: Hawaii Western Management Group Commercial	$65.36
Rate for Payer: Health Management Network Commercial	$465.80
Rate for Payer: Humana Medicare	$65.36
Rate for Payer: Kaiser Permanente Commercial	$345.24
Rate for Payer: Kaiser Permanente Medicaid	$279.48
Rate for Payer: Kaiser Permanente Medicare	$65.36
Rate for Payer: MDX Hawaii PPO	$531.56
Rate for Payer: Ohana Health Plan Medicaid	$71.90
Rate for Payer: Ohana Health Plan Medicare	$65.36
Rate for Payer: UnitedHealthcare Medicaid	$42.12
Rate for Payer: UnitedHealthcare Medicare	$65.36
Rate for Payer: University Health Alliance Commercial	$164.96

HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT

Facility

$548.00

Service Code	HCPCS 81256
Hospital Charge Code	3108125601
Hospital Revenue Code	310
Min. Negotiated Rate	$465.80
Max. Negotiated Rate	$531.56
Rate for Payer: Cash Price	$328.80
Rate for Payer: Health Management Network Commercial	$465.80
Rate for Payer: MDX Hawaii PPO	$531.56

HC HFO W/O JOINTS CF

Facility

$977.00

Service Code	HCPCS L3913
Hospital Charge Code	274L391301
Hospital Revenue Code	274
Min. Negotiated Rate	$547.12
Max. Negotiated Rate	$947.69
Rate for Payer: Cash Price	$586.20
Rate for Payer: Hawaii Western Management Group Commercial	$683.90
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: MDX Hawaii PPO	$947.69
Rate for Payer: University Health Alliance Commercial	$547.12

HC HFO W/O JOINTS CF

Facility

$977.00

Service Code	HCPCS L3913
Hospital Charge Code	274L391301
Hospital Revenue Code	274
Min. Negotiated Rate	$116.21
Max. Negotiated Rate	$947.69
Rate for Payer: Cash Price	$586.20
Rate for Payer: Cash Price	$586.20
Rate for Payer: Hawaii Western Management Group Commercial	$683.90
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: Kaiser Permanente Commercial	$615.51
Rate for Payer: Kaiser Permanente Medicaid	$498.27
Rate for Payer: MDX Hawaii PPO	$947.69
Rate for Payer: UnitedHealthcare Medicaid	$116.21
Rate for Payer: University Health Alliance Commercial	$547.12

HC HHV-6, DNA, AMP PROBE - HHV-6 DNA PROBE, AMPLIFIED

Facility

$294.00

Service Code	HCPCS 87532
Hospital Charge Code	3068753201
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
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	$29.42
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	$48.48
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	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HC HHV-6, DNA, AMP PROBE - HHV-6 DNA PROBE, AMPLIFIED

Facility

$294.00

Service Code	HCPCS 87532
Hospital Charge Code	3068753201
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 HISTOCHEM STAIN W/INTERP&RPT

Facility

$91.00

Service Code	HCPCS 88314
Hospital Charge Code	3108831401
Hospital Revenue Code	310
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$191.29
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Medical Service Association ABD	$47.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$65.07
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: UnitedHealthcare Medicaid	$47.86
Rate for Payer: University Health Alliance Commercial	$191.29

HC HISTOCHEM STAIN W/INTERP&RPT

Facility

$91.00

Service Code	HCPCS 88314
Hospital Charge Code	3108831401
Hospital Revenue Code	310
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

HC HIV 1/2 AG AB W/RFX W/BLOT

Facility

$202.00

Service Code	HCPCS 87389
Hospital Charge Code	3068738902
Hospital Revenue Code	306
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$24.08
Rate for Payer: AlohaCare Medicare	$24.08
Rate for Payer: Cash Price	$121.20
Rate for Payer: Cash Price	$121.20
Rate for Payer: Devoted Health Medicare	$26.49
Rate for Payer: Hawaii Medical Service Association ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$24.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$24.08
Rate for Payer: Kaiser Permanente Commercial	$127.26
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$24.08
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$26.49
Rate for Payer: Ohana Health Plan Medicare	$24.08
Rate for Payer: UnitedHealthcare Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$24.08
Rate for Payer: University Health Alliance Commercial	$63.12

HC HIV 1/2 AG AB W/RFX W/BLOT

Facility

$202.00

Service Code	HCPCS 87389
Hospital Charge Code	3068738902
Hospital Revenue Code	306
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$121.20
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: MDX Hawaii PPO	$195.94

HC HIV-1 AG W/HIV 1/2 ABS

Facility

$202.00

Service Code	HCPCS 87389
Hospital Charge Code	3068738903
Hospital Revenue Code	306
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$121.20
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: MDX Hawaii PPO	$195.94

HC HIV-1 AG W/HIV 1/2 ABS

Facility

$202.00

Service Code	HCPCS 87389
Hospital Charge Code	3068738903
Hospital Revenue Code	306
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$24.08
Rate for Payer: AlohaCare Medicare	$24.08
Rate for Payer: Cash Price	$121.20
Rate for Payer: Cash Price	$121.20
Rate for Payer: Devoted Health Medicare	$26.49
Rate for Payer: Hawaii Medical Service Association ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$24.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$24.08
Rate for Payer: Kaiser Permanente Commercial	$127.26
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$24.08
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$26.49
Rate for Payer: Ohana Health Plan Medicare	$24.08
Rate for Payer: UnitedHealthcare Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$24.08
Rate for Payer: University Health Alliance Commercial	$63.12

HC HIV-1 GENOTYPING SO

Facility

$2,160.00

Service Code	HCPCS 87901
Hospital Charge Code	3068790101
Hospital Revenue Code	306
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,095.20
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: MDX Hawaii PPO	$2,095.20

HC HIV-1 GENOTYPING SO

Facility

$2,160.00

Service Code	HCPCS 87901
Hospital Charge Code	3068790101
Hospital Revenue Code	306
Min. Negotiated Rate	$257.45
Max. Negotiated Rate	$2,095.20
Rate for Payer: AlohaCare Medicaid	$257.45
Rate for Payer: AlohaCare Medicare	$257.45
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Devoted Health Medicare	$283.19
Rate for Payer: Hawaii Medical Service Association ABD	$355.78
Rate for Payer: Hawaii Medical Service Association Commercial	$321.81
Rate for Payer: Hawaii Medical Service Association Medicare	$257.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$373.57
Rate for Payer: Hawaii Western Management Group Commercial	$257.45
Rate for Payer: Health Management Network Commercial	$1,836.00
Rate for Payer: Humana Medicare	$257.45
Rate for Payer: Kaiser Permanente Commercial	$1,360.80
Rate for Payer: Kaiser Permanente Medicaid	$1,101.60
Rate for Payer: Kaiser Permanente Medicare	$257.45
Rate for Payer: MDX Hawaii PPO	$2,095.20
Rate for Payer: Ohana Health Plan Medicaid	$283.19
Rate for Payer: Ohana Health Plan Medicare	$257.45
Rate for Payer: UnitedHealthcare Medicaid	$355.78
Rate for Payer: UnitedHealthcare Medicare	$257.45
Rate for Payer: University Health Alliance Commercial	$665.43

HC HIV-1 - HIV 1 ANTIBODY EIA

Facility

$75.00

Service Code	HCPCS 86701
Hospital Charge Code	3028670101
Hospital Revenue Code	302
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: MDX Hawaii PPO	$72.75

HC HIV-1 - HIV 1 ANTIBODY EIA

Facility

$75.00

Service Code	HCPCS 86701
Hospital Charge Code	3028670101
Hospital Revenue Code	302
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$72.75
Rate for Payer: AlohaCare Medicaid	$8.89
Rate for Payer: AlohaCare Medicare	$8.89
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Devoted Health Medicare	$9.78
Rate for Payer: Hawaii Medical Service Association ABD	$12.28
Rate for Payer: Hawaii Medical Service Association Commercial	$11.11
Rate for Payer: Hawaii Medical Service Association Medicare	$8.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.89
Rate for Payer: Hawaii Western Management Group Commercial	$8.89
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Humana Medicare	$8.89
Rate for Payer: Kaiser Permanente Commercial	$47.25
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: Kaiser Permanente Medicare	$8.89
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: Ohana Health Plan Medicaid	$9.78
Rate for Payer: Ohana Health Plan Medicare	$8.89
Rate for Payer: UnitedHealthcare Medicaid	$12.28
Rate for Payer: UnitedHealthcare Medicare	$8.89
Rate for Payer: University Health Alliance Commercial	$22.96

HC HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 AMP PROBE SO

Facility

$294.00

Service Code	HCPCS 87535
Hospital Charge Code	3068753501
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 HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 AMP PROBE SO

Facility

$294.00

Service Code	HCPCS 87535
Hospital Charge Code	3068753501
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 HIV-1 PROBE&REVERSE TRNSCRPJ - HIV 1 RNA QUAL TMA SO (HVRNA1)

Facility

$294.00

Service Code	HCPCS 87535
Hospital Charge Code	3068753502
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 HIV-1 PROBE&REVERSE TRNSCRPJ - HIV 1 RNA QUAL TMA SO (HVRNA1)

Facility

$294.00

Service Code	HCPCS 87535
Hospital Charge Code	3068753502
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 HIV-1 QUANT&REVRSE TRNSCRPJ - HIV-1 QUANT SO

Facility

$714.00

Service Code	HCPCS 87536
Hospital Charge Code	3068753601
Hospital Revenue Code	306
Min. Negotiated Rate	$85.10
Max. Negotiated Rate	$692.58
Rate for Payer: AlohaCare Medicaid	$85.10
Rate for Payer: AlohaCare Medicare	$85.10
Rate for Payer: Cash Price	$428.40
Rate for Payer: Cash Price	$428.40
Rate for Payer: Devoted Health Medicare	$93.61
Rate for Payer: Hawaii Medical Service Association ABD	$117.59
Rate for Payer: Hawaii Medical Service Association Commercial	$106.38
Rate for Payer: Hawaii Medical Service Association Medicare	$85.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$123.47
Rate for Payer: Hawaii Western Management Group Commercial	$85.10
Rate for Payer: Health Management Network Commercial	$606.90
Rate for Payer: Humana Medicare	$85.10
Rate for Payer: Kaiser Permanente Commercial	$449.82
Rate for Payer: Kaiser Permanente Medicaid	$364.14
Rate for Payer: Kaiser Permanente Medicare	$85.10
Rate for Payer: MDX Hawaii PPO	$692.58
Rate for Payer: Ohana Health Plan Medicaid	$93.61
Rate for Payer: Ohana Health Plan Medicare	$85.10
Rate for Payer: UnitedHealthcare Medicaid	$117.59
Rate for Payer: UnitedHealthcare Medicare	$85.10
Rate for Payer: University Health Alliance Commercial	$219.95

HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV-1 QUANT SO

Facility

$714.00

Service Code	HCPCS 87536
Hospital Charge Code	3068753601
Hospital Revenue Code	306
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$692.58
Rate for Payer: Cash Price	$428.40
Rate for Payer: Health Management Network Commercial	$606.90
Rate for Payer: MDX Hawaii PPO	$692.58

HC HIV-2 - HIV-2 ANTIBODIES

Facility

$113.00

Service Code	HCPCS 86702
Hospital Charge Code	3028670201
Hospital Revenue Code	302
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$13.52
Rate for Payer: AlohaCare Medicare	$13.52
Rate for Payer: Cash Price	$67.80
Rate for Payer: Cash Price	$67.80
Rate for Payer: Devoted Health Medicare	$14.87
Rate for Payer: Hawaii Medical Service Association ABD	$18.69
Rate for Payer: Hawaii Medical Service Association Commercial	$16.90
Rate for Payer: Hawaii Medical Service Association Medicare	$13.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.62
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Humana Medicare	$13.52
Rate for Payer: Kaiser Permanente Commercial	$71.19
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: Kaiser Permanente Medicare	$13.52
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: Ohana Health Plan Medicaid	$14.87
Rate for Payer: Ohana Health Plan Medicare	$13.52
Rate for Payer: UnitedHealthcare Medicaid	$18.69
Rate for Payer: UnitedHealthcare Medicare	$13.52
Rate for Payer: University Health Alliance Commercial	$34.93

Know your out-of-pocket cost for care.

All Charges