Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC IMMUNOASSAY QUANT NOS NONAB - ALPHA SUBUNIT QT SO

Facility

$145.00

Service Code	HCPCS 83520
Hospital Charge Code	3018352003
Hospital Revenue Code	301
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HC IMMUNOASSAY QUANT NOS NONAB - ALPHA SUBUNIT QT SO

Facility

$145.00

Service Code	HCPCS 83520
Hospital Charge Code	3018352003
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$33.47

HC IMMUNOASSAY QUANT NOS NONAB - TSH RECEPTOR AB QT SO

Facility

$145.00

Service Code	HCPCS 83520
Hospital Charge Code	3018352001
Hospital Revenue Code	301
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HC IMMUNOASSAY QUANT NOS NONAB - TSH RECEPTOR AB QT SO

Facility

$145.00

Service Code	HCPCS 83520
Hospital Charge Code	3018352001
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$33.47

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125

Facility

$175.00

Service Code	HCPCS 86304
Hospital Charge Code	3028630401
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$20.81
Rate for Payer: AlohaCare Medicare	$20.81
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Devoted Health Medicare	$22.89
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$20.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$20.81
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$20.81
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$22.89
Rate for Payer: Ohana Health Plan Medicare	$20.81
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$20.81
Rate for Payer: University Health Alliance Commercial	$53.78

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125

Facility

$175.00

Service Code	HCPCS 86304
Hospital Charge Code	3028630401
Hospital Revenue Code	302
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3

Facility

$175.00

Service Code	HCPCS 86300
Hospital Charge Code	3028630001
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$20.81
Rate for Payer: AlohaCare Medicare	$20.81
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Devoted Health Medicare	$22.89
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$20.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$20.81
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$20.81
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$22.89
Rate for Payer: Ohana Health Plan Medicare	$20.81
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$20.81
Rate for Payer: University Health Alliance Commercial	$53.78

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3

Facility

$175.00

Service Code	HCPCS 86300
Hospital Charge Code	3028630001
Hospital Revenue Code	302
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29

Facility

$175.00

Service Code	HCPCS 86300
Hospital Charge Code	3028630002
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$20.81
Rate for Payer: AlohaCare Medicare	$20.81
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Devoted Health Medicare	$22.89
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$20.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$20.81
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$20.81
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$22.89
Rate for Payer: Ohana Health Plan Medicare	$20.81
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$20.81
Rate for Payer: University Health Alliance Commercial	$53.78

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29

Facility

$175.00

Service Code	HCPCS 86300
Hospital Charge Code	3028630002
Hospital Revenue Code	302
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9

Facility

$175.00

Service Code	HCPCS 86301
Hospital Charge Code	3028630101
Hospital Revenue Code	302
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9

Facility

$175.00

Service Code	HCPCS 86301
Hospital Charge Code	3028630101
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$20.81
Rate for Payer: AlohaCare Medicare	$20.81
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Devoted Health Medicare	$22.89
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$20.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$20.81
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$20.81
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$22.89
Rate for Payer: Ohana Health Plan Medicare	$20.81
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$20.81
Rate for Payer: University Health Alliance Commercial	$53.78

HC IMMUNOFIXATION ELP SERUM

Facility

$187.00

Service Code	HCPCS 86334
Hospital Charge Code	3028633401
Hospital Revenue Code	302
Min. Negotiated Rate	$22.34
Max. Negotiated Rate	$181.39
Rate for Payer: AlohaCare Medicaid	$22.34
Rate for Payer: AlohaCare Medicare	$22.34
Rate for Payer: Cash Price	$112.20
Rate for Payer: Cash Price	$112.20
Rate for Payer: Devoted Health Medicare	$24.57
Rate for Payer: Hawaii Medical Service Association ABD	$30.87
Rate for Payer: Hawaii Medical Service Association Commercial	$27.93
Rate for Payer: Hawaii Medical Service Association Medicare	$22.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.41
Rate for Payer: Hawaii Western Management Group Commercial	$22.34
Rate for Payer: Health Management Network Commercial	$158.95
Rate for Payer: Humana Medicare	$22.34
Rate for Payer: Kaiser Permanente Commercial	$117.81
Rate for Payer: Kaiser Permanente Medicaid	$95.37
Rate for Payer: Kaiser Permanente Medicare	$22.34
Rate for Payer: MDX Hawaii PPO	$181.39
Rate for Payer: Ohana Health Plan Medicaid	$24.57
Rate for Payer: Ohana Health Plan Medicare	$22.34
Rate for Payer: UnitedHealthcare Medicaid	$30.87
Rate for Payer: UnitedHealthcare Medicare	$22.34
Rate for Payer: University Health Alliance Commercial	$57.74

HC IMMUNOFIXATION ELP SERUM

Facility

$187.00

Service Code	HCPCS 86334
Hospital Charge Code	3028633401
Hospital Revenue Code	302
Min. Negotiated Rate	$158.95
Max. Negotiated Rate	$181.39
Rate for Payer: Cash Price	$112.20
Rate for Payer: Health Management Network Commercial	$158.95
Rate for Payer: MDX Hawaii PPO	$181.39

HC IMMUNOFLUOR AB STAIN ADD

Facility

$570.00

Service Code	HCPCS 88350
Hospital Charge Code	3108835001
Hospital Revenue Code	310
Min. Negotiated Rate	$484.50
Max. Negotiated Rate	$552.90
Rate for Payer: Cash Price	$342.00
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: MDX Hawaii PPO	$552.90

HC IMMUNOFLUOR AB STAIN ADD

Facility

$570.00

Service Code	HCPCS 88350
Hospital Charge Code	3108835001
Hospital Revenue Code	310
Min. Negotiated Rate	$30.47
Max. Negotiated Rate	$552.90
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Hawaii Medical Service Association ABD	$30.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$541.50
Rate for Payer: Health Management Network Commercial	$484.50
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$290.70
Rate for Payer: MDX Hawaii PPO	$552.90
Rate for Payer: UnitedHealthcare Medicaid	$76.49
Rate for Payer: University Health Alliance Commercial	$152.29

HC IMMUNOFLUORESCENT STUDY,INDIRECT - ANTI RIBONUCLEIC ACID

Facility

$1,698.00

Service Code	HCPCS 88346
Hospital Charge Code	3108834601
Hospital Revenue Code	310
Min. Negotiated Rate	$1,443.30
Max. Negotiated Rate	$1,647.06
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Health Management Network Commercial	$1,443.30
Rate for Payer: MDX Hawaii PPO	$1,647.06

HC IMMUNOFLUORESCENT STUDY,INDIRECT - ANTI RIBONUCLEIC ACID

Facility

$1,698.00

Service Code	HCPCS 88346
Hospital Charge Code	3108834601
Hospital Revenue Code	310
Min. Negotiated Rate	$39.51
Max. Negotiated Rate	$1,647.06
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Cash Price	$1,018.80
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$60.22
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.51
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$1,443.30
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$1,069.74
Rate for Payer: Kaiser Permanente Medicaid	$865.98
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$1,647.06
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$60.22
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$195.56

HC IMMUNOGL LT CHAIN FR SE SO

Facility

$145.00

Service Code	HCPCS 83521
Hospital Charge Code	3018352102
Hospital Revenue Code	301
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HC IMMUNOGL LT CHAIN FR SE SO

Facility

$145.00

Service Code	HCPCS 83521
Hospital Charge Code	3018352102
Hospital Revenue Code	301
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$105.69

HC IMMUNOGL LT CHAIN FR UR SO

Facility

$145.00

Service Code	HCPCS 83521
Hospital Charge Code	3018352101
Hospital Revenue Code	301
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$17.27
Rate for Payer: AlohaCare Medicare	$17.27
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$19.00
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$17.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$17.27
Rate for Payer: Kaiser Permanente Commercial	$91.35
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$17.27
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$19.00
Rate for Payer: Ohana Health Plan Medicare	$17.27
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: UnitedHealthcare Medicare	$17.27
Rate for Payer: University Health Alliance Commercial	$105.69

HC IMMUNOGL LT CHAIN FR UR SO

Facility

$145.00

Service Code	HCPCS 83521
Hospital Charge Code	3018352101
Hospital Revenue Code	301
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: MDX Hawaii PPO	$140.65

HC IMMUNOGLOBULIN ASSAY - PlT IMMUNOGLOB IGG SO

Facility

$105.00

Service Code	HCPCS 86023
Hospital Charge Code	3028602301
Hospital Revenue Code	302
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: MDX Hawaii PPO	$101.85

HC IMMUNOGLOBULIN ASSAY - PlT IMMUNOGLOB IGG SO

Facility

$105.00

Service Code	HCPCS 86023
Hospital Charge Code	3028602301
Hospital Revenue Code	302
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$12.46
Rate for Payer: AlohaCare Medicare	$12.46
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Devoted Health Medicare	$13.71
Rate for Payer: Hawaii Medical Service Association ABD	$15.20
Rate for Payer: Hawaii Medical Service Association Commercial	$15.57
Rate for Payer: Hawaii Medical Service Association Medicare	$12.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.21
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$12.46
Rate for Payer: Kaiser Permanente Commercial	$66.15
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$12.46
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$13.71
Rate for Payer: Ohana Health Plan Medicare	$12.46
Rate for Payer: UnitedHealthcare Medicaid	$15.20
Rate for Payer: UnitedHealthcare Medicare	$12.46
Rate for Payer: University Health Alliance Commercial	$32.19

HC IMMUNOHISTOCHEM EA MULT

Facility

$3,564.00

Service Code	HCPCS 88344
Hospital Charge Code	3108834401
Hospital Revenue Code	310
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$3,457.08
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$3,029.40
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$2,245.32
Rate for Payer: Kaiser Permanente Medicaid	$1,817.64
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$3,457.08
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$116.58
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$242.83

Know your out-of-pocket cost for care.

All Charges