Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC INJECT NERV BLCK,AXILLARY NERV

Facility

$3,469.00

Service Code	HCPCS 64417
Hospital Charge Code	3616441701
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,364.93
Rate for Payer: AlohaCare Medicaid	$1,044.87
Rate for Payer: AlohaCare Medicare	$1,044.87
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$1,149.36
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	$1,044.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,295.55
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: Humana Medicare	$1,044.87
Rate for Payer: Kaiser Permanente Commercial	$2,185.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,044.87
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$1,149.36
Rate for Payer: Ohana Health Plan Medicare	$1,044.87
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,044.87
Rate for Payer: University Health Alliance Commercial	$2,528.55

HC INJECT NERV BLCK,AXILLARY NERV

Facility

$3,469.00

Service Code	HCPCS 64417
Hospital Charge Code	3616441701
Hospital Revenue Code	450
Min. Negotiated Rate	$2,948.65
Max. Negotiated Rate	$3,364.93
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: MDX Hawaii PPO	$3,364.93

HC INJECT NERV BLCK,CELIAC PLEXUS

Facility

$3,543.00

Service Code	HCPCS 64530
Hospital Charge Code	3616453001
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,044.87
Rate for Payer: AlohaCare Medicare	$1,044.87
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Devoted Health Medicare	$1,149.36
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	$1,044.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Humana Medicare	$1,044.87
Rate for Payer: Kaiser Permanente Commercial	$2,232.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,044.87
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: Ohana Health Plan Medicaid	$1,149.36
Rate for Payer: Ohana Health Plan Medicare	$1,044.87
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,044.87
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,CELIAC PLEXUS

Facility

$3,543.00

Service Code	HCPCS 64530
Hospital Charge Code	3616453001
Hospital Revenue Code	361
Min. Negotiated Rate	$3,011.55
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: MDX Hawaii PPO	$3,436.71

HC INJECT NERV BLCK,GREAT OCCIPTL

Facility

$1,175.00

Service Code	HCPCS 64405
Hospital Charge Code	7616440501
Hospital Revenue Code	761
Min. Negotiated Rate	$47.73
Max. Negotiated Rate	$1,139.75
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$599.25
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$47.73
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$856.46

HC INJECT NERV BLCK,GREAT OCCIPTL

Facility

$1,175.00

Service Code	HCPCS 64405
Hospital Charge Code	7616440501
Hospital Revenue Code	761
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC INJECT NERV BLCK,ILIOINGU/ILIOHYP

Facility

$2,699.00

Service Code	HCPCS 64425
Hospital Charge Code	3616442501
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,618.03
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.05
Rate for Payer: Health Management Network Commercial	$2,294.15
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,700.37
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,618.03
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$1,967.30

HC INJECT NERV BLCK,ILIOINGU/ILIOHYP

Facility

$2,699.00

Service Code	HCPCS 64425
Hospital Charge Code	3616442501
Hospital Revenue Code	450
Min. Negotiated Rate	$2,294.15
Max. Negotiated Rate	$2,618.03
Rate for Payer: Cash Price	$1,619.40
Rate for Payer: Health Management Network Commercial	$2,294.15
Rate for Payer: MDX Hawaii PPO	$2,618.03

HC INJECT NERV BLCK,INTERCOSTAL,ONE

Facility

$2,756.00

Service Code	HCPCS 64420
Hospital Charge Code	3616442001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,008.85

HC INJECT NERV BLCK,INTERCOSTAL,ONE

Facility

$2,756.00

Service Code	HCPCS 64420
Hospital Charge Code	3616442001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC INJECT NERV BLCK,OTHR PERIPH NERV

Facility

$2,756.00

Service Code	HCPCS 64450
Hospital Charge Code	7616445001
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,OTHR PERIPH NERV

Facility

$2,756.00

Service Code	HCPCS 64450
Hospital Charge Code	7616445001
Hospital Revenue Code	761
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC INJECT NERV BLCK,PUDENDAL

Facility

$3,469.00

Service Code	HCPCS 64430
Hospital Charge Code	3616443001
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,044.87
Rate for Payer: AlohaCare Medicare	$1,044.87
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Devoted Health Medicare	$1,149.36
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	$1,044.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,295.55
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: Humana Medicare	$1,044.87
Rate for Payer: Kaiser Permanente Commercial	$2,185.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,044.87
Rate for Payer: MDX Hawaii PPO	$3,364.93
Rate for Payer: Ohana Health Plan Medicaid	$1,149.36
Rate for Payer: Ohana Health Plan Medicare	$1,044.87
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,044.87
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,PUDENDAL

Facility

$3,469.00

Service Code	HCPCS 64430
Hospital Charge Code	3616443001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,948.65
Max. Negotiated Rate	$3,364.93
Rate for Payer: Cash Price	$2,081.40
Rate for Payer: Health Management Network Commercial	$2,948.65
Rate for Payer: MDX Hawaii PPO	$3,364.93

HC INJECT NERV BLCK,SUPRASCAP N.

Facility

$2,756.00

Service Code	HCPCS 64418
Hospital Charge Code	3616441801
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,SUPRASCAP N.

Facility

$2,756.00

Service Code	HCPCS 64418
Hospital Charge Code	3616441801
Hospital Revenue Code	450
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HC INJECT NERV BLCK,TRIGEMINAL

Facility

$1,175.00

Service Code	HCPCS 64400
Hospital Charge Code	4506440001
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
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	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT NERV BLCK,TRIGEMINAL

Facility

$1,175.00

Service Code	HCPCS 64400
Hospital Charge Code	4506440001
Hospital Revenue Code	450
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH

Facility

$276.00

Service Code	HCPCS 93567
Hospital Charge Code	4819356701
Hospital Revenue Code	481
Min. Negotiated Rate	$30.17
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$173.88
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: UnitedHealthcare Medicaid	$30.17
Rate for Payer: University Health Alliance Commercial	$201.18

HC INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH

Facility

$276.00

Service Code	HCPCS 93567
Hospital Charge Code	4819356701
Hospital Revenue Code	481
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: MDX Hawaii PPO	$267.72

HC INJECT TRIGGER POINT, 1 OR 2

Facility

$1,175.00

Service Code	HCPCS 20552
Hospital Charge Code	7612055201
Hospital Revenue Code	761
Min. Negotiated Rate	$35.03
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Cash Price	$705.00
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association Commercial	$453.27
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,116.25
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$740.25
Rate for Payer: Kaiser Permanente Medicaid	$599.25
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,139.75
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$35.03
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC INJECT TRIGGER POINT, 1 OR 2

Facility

$1,175.00

Service Code	HCPCS 20552
Hospital Charge Code	7612055201
Hospital Revenue Code	761
Min. Negotiated Rate	$998.75
Max. Negotiated Rate	$1,139.75
Rate for Payer: Cash Price	$705.00
Rate for Payer: Health Management Network Commercial	$998.75
Rate for Payer: MDX Hawaii PPO	$1,139.75

HC INJ INTRA-ARTERIAL

Facility

$838.00

Service Code	HCPCS 96373
Hospital Charge Code	4509637301
Hospital Revenue Code	450
Min. Negotiated Rate	$251.28
Max. Negotiated Rate	$19,192.00
Rate for Payer: AlohaCare Medicaid	$251.28
Rate for Payer: AlohaCare Medicare	$251.28
Rate for Payer: Cash Price	$502.80
Rate for Payer: Cash Price	$502.80
Rate for Payer: Cash Price	$502.80
Rate for Payer: Devoted Health Medicare	$276.41
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$19,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$251.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,561.00
Rate for Payer: Hawaii Western Management Group Commercial	$796.10
Rate for Payer: Health Management Network Commercial	$712.30
Rate for Payer: Humana Medicare	$251.28
Rate for Payer: Kaiser Permanente Commercial	$527.94
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$251.28
Rate for Payer: MDX Hawaii PPO	$812.86
Rate for Payer: Ohana Health Plan Medicaid	$276.41
Rate for Payer: Ohana Health Plan Medicare	$251.28
Rate for Payer: UnitedHealthcare Medicare	$251.28
Rate for Payer: University Health Alliance Commercial	$610.82

HC INJ INTRA-ARTERIAL

Facility

$838.00

Service Code	HCPCS 96373
Hospital Charge Code	4509637301
Hospital Revenue Code	450
Min. Negotiated Rate	$712.30
Max. Negotiated Rate	$812.86
Rate for Payer: Cash Price	$502.80
Rate for Payer: Health Management Network Commercial	$712.30
Rate for Payer: MDX Hawaii PPO	$812.86

HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI

Facility

$893.00

Service Code	HCPCS 23350
Hospital Charge Code	3202335001
Hospital Revenue Code	320
Min. Negotiated Rate	$40.41
Max. Negotiated Rate	$2,536.00
Rate for Payer: Cash Price	$535.80
Rate for Payer: Cash Price	$535.80
Rate for Payer: Cash Price	$535.80
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 Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$848.35
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: Kaiser Permanente Commercial	$562.59
Rate for Payer: Kaiser Permanente Medicaid	$455.43
Rate for Payer: MDX Hawaii PPO	$866.21
Rate for Payer: UnitedHealthcare Medicaid	$40.41
Rate for Payer: University Health Alliance Commercial	$650.91

Know your out-of-pocket cost for care.

All Charges