Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION - NM PARATHYROID SPECT

Facility

$1,999.00

Service Code	HCPCS 78071
Hospital Charge Code	3417807101
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCUS AG CSF EA

Facility

$97.00

Service Code	HCPCS 86403
Hospital Charge Code	3028640302
Hospital Revenue Code	302
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: MDX Hawaii PPO	$94.09

HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCUS AG CSF EA

Facility

$97.00

Service Code	HCPCS 86403
Hospital Charge Code	3028640302
Hospital Revenue Code	302
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$11.54
Rate for Payer: AlohaCare Medicare	$11.54
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$12.69
Rate for Payer: Hawaii Medical Service Association ABD	$14.08
Rate for Payer: Hawaii Medical Service Association Commercial	$14.43
Rate for Payer: Hawaii Medical Service Association Medicare	$11.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.78
Rate for Payer: Hawaii Western Management Group Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$11.54
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$12.69
Rate for Payer: Ohana Health Plan Medicare	$11.54
Rate for Payer: UnitedHealthcare Medicaid	$14.08
Rate for Payer: UnitedHealthcare Medicare	$11.54
Rate for Payer: University Health Alliance Commercial	$26.34

HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCUS AG EA

Facility

$97.00

Service Code	HCPCS 86403
Hospital Charge Code	3028640303
Hospital Revenue Code	302
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: MDX Hawaii PPO	$94.09

HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCUS AG EA

Facility

$97.00

Service Code	HCPCS 86403
Hospital Charge Code	3028640303
Hospital Revenue Code	302
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$11.54
Rate for Payer: AlohaCare Medicare	$11.54
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$12.69
Rate for Payer: Hawaii Medical Service Association ABD	$14.08
Rate for Payer: Hawaii Medical Service Association Commercial	$14.43
Rate for Payer: Hawaii Medical Service Association Medicare	$11.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.78
Rate for Payer: Hawaii Western Management Group Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$11.54
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$12.69
Rate for Payer: Ohana Health Plan Medicare	$11.54
Rate for Payer: UnitedHealthcare Medicaid	$14.08
Rate for Payer: UnitedHealthcare Medicare	$11.54
Rate for Payer: University Health Alliance Commercial	$26.34

HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM - PARVOVIRUS B19 IGG SO

Facility

$126.00

Service Code	HCPCS 86747
Hospital Charge Code	3028674701
Hospital Revenue Code	302
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$15.03
Rate for Payer: AlohaCare Medicare	$15.03
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$16.53
Rate for Payer: Hawaii Medical Service Association ABD	$20.77
Rate for Payer: Hawaii Medical Service Association Commercial	$18.79
Rate for Payer: Hawaii Medical Service Association Medicare	$15.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.81
Rate for Payer: Hawaii Western Management Group Commercial	$15.03
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$15.03
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$15.03
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$16.53
Rate for Payer: Ohana Health Plan Medicare	$15.03
Rate for Payer: UnitedHealthcare Medicaid	$20.77
Rate for Payer: UnitedHealthcare Medicare	$15.03
Rate for Payer: University Health Alliance Commercial	$38.85

HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM - PARVOVIRUS B19 IGG SO

Facility

$126.00

Service Code	HCPCS 86747
Hospital Charge Code	3028674701
Hospital Revenue Code	302
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

HC PATH CONSULT IN SURG,W ADDN FRZ SEC - CONSULT ADDL TISS BLK W/FROZEN

Facility

$156.00

Service Code	HCPCS 88332
Hospital Charge Code	3108833201
Hospital Revenue Code	310
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HC PATH CONSULT IN SURG,W ADDN FRZ SEC - CONSULT ADDL TISS BLK W/FROZEN

Facility

$156.00

Service Code	HCPCS 88332
Hospital Charge Code	3108833201
Hospital Revenue Code	310
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Hawaii Medical Service Association ABD	$6.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.19
Rate for Payer: Hawaii Western Management Group Commercial	$148.20
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: UnitedHealthcare Medicaid	$6.29
Rate for Payer: University Health Alliance Commercial	$76.37

HC PATH CONSULT IN SURG,W FRZ SEC - BUNDLED CHARGE

Facility

$1,698.00

Service Code	HCPCS 88331
Hospital Charge Code	3108833101
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 PATH CONSULT IN SURG,W FRZ SEC - BUNDLED CHARGE

Facility

$1,698.00

Service Code	HCPCS 88331
Hospital Charge Code	3108833101
Hospital Revenue Code	310
Min. Negotiated Rate	$15.63
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	$15.63
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	$19.97
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	$15.63
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$171.09

HC PBB CLOSED RX CARPAL FX

Facility

$935.00

Service Code	HCPCS 25630
Hospital Charge Code	76125630PB
Hospital Revenue Code	761
Min. Negotiated Rate	$148.52
Max. Negotiated Rate	$906.95
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association Commercial	$364.25
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$589.05
Rate for Payer: Kaiser Permanente Medicaid	$476.85
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicaid	$148.52
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$681.52

HC PBB CLOSED RX CARPAL FX

Facility

$935.00

Service Code	HCPCS 25630
Hospital Charge Code	76125630PB
Hospital Revenue Code	761
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: MDX Hawaii PPO	$906.95

HC PBB CLOSED RX MANDIBLE FX+DENTAL FIX

Facility

$5,772.00

Service Code	HCPCS 21453
Hospital Charge Code	76121453PB
Hospital Revenue Code	761
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$7,692.70
Rate for Payer: AlohaCare Medicaid	$6,993.36
Rate for Payer: AlohaCare Medicare	$6,993.36
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Devoted Health Medicare	$7,692.70
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	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$5,483.40
Rate for Payer: Health Management Network Commercial	$4,906.20
Rate for Payer: Humana Medicare	$6,993.36
Rate for Payer: Kaiser Permanente Commercial	$3,636.36
Rate for Payer: Kaiser Permanente Medicaid	$2,943.72
Rate for Payer: Kaiser Permanente Medicare	$6,993.36
Rate for Payer: MDX Hawaii PPO	$5,598.84
Rate for Payer: Ohana Health Plan Medicaid	$7,692.70
Rate for Payer: Ohana Health Plan Medicare	$6,993.36
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,993.36
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC PBB CLOSED RX MANDIBLE FX+DENTAL FIX

Facility

$5,772.00

Service Code	HCPCS 21453
Hospital Charge Code	76121453PB
Hospital Revenue Code	761
Min. Negotiated Rate	$4,906.20
Max. Negotiated Rate	$5,598.84
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Health Management Network Commercial	$4,906.20
Rate for Payer: MDX Hawaii PPO	$5,598.84

HC PBB CLOSED RX NASAL SEPTAL FRACTURE

Facility

$12,906.00

Service Code	HCPCS 21337
Hospital Charge Code	76121337PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,518.82
Rate for Payer: AlohaCare Medicaid	$3,916.70
Rate for Payer: AlohaCare Medicare	$3,916.70
Rate for Payer: Cash Price	$7,743.60
Rate for Payer: Cash Price	$7,743.60
Rate for Payer: Cash Price	$7,743.60
Rate for Payer: Devoted Health Medicare	$4,308.37
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	$3,916.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$12,260.70
Rate for Payer: Health Management Network Commercial	$10,970.10
Rate for Payer: Humana Medicare	$3,916.70
Rate for Payer: Kaiser Permanente Commercial	$8,130.78
Rate for Payer: Kaiser Permanente Medicaid	$6,582.06
Rate for Payer: Kaiser Permanente Medicare	$3,916.70
Rate for Payer: MDX Hawaii PPO	$12,518.82
Rate for Payer: Ohana Health Plan Medicaid	$4,308.37
Rate for Payer: Ohana Health Plan Medicare	$3,916.70
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,916.70
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB CLOSED RX NASAL SEPTAL FRACTURE

Facility

$12,906.00

Service Code	HCPCS 21337
Hospital Charge Code	76121337PB
Hospital Revenue Code	761
Min. Negotiated Rate	$10,970.10
Max. Negotiated Rate	$12,518.82
Rate for Payer: Cash Price	$7,743.60
Rate for Payer: Health Management Network Commercial	$10,970.10
Rate for Payer: MDX Hawaii PPO	$12,518.82

HC PBB CLOSED RX NOSE FRACTURE, W/O STABILIZATION

Facility

$5,895.00

Service Code	HCPCS 21315
Hospital Charge Code	76121315PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,718.15
Rate for Payer: AlohaCare Medicaid	$1,832.96
Rate for Payer: AlohaCare Medicare	$1,832.96
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Devoted Health Medicare	$2,016.26
Rate for Payer: Hawaii Medical Service Association Commercial	$2,291.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,832.96
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.25
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: Humana Medicare	$1,832.96
Rate for Payer: Kaiser Permanente Commercial	$3,713.85
Rate for Payer: Kaiser Permanente Medicaid	$3,006.45
Rate for Payer: Kaiser Permanente Medicare	$1,832.96
Rate for Payer: MDX Hawaii PPO	$5,718.15
Rate for Payer: Ohana Health Plan Medicaid	$2,016.26
Rate for Payer: Ohana Health Plan Medicare	$1,832.96
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,832.96
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC PBB CLOSED RX NOSE FRACTURE, W/O STABILIZATION

Facility

$5,895.00

Service Code	HCPCS 21315
Hospital Charge Code	76121315PB
Hospital Revenue Code	761
Min. Negotiated Rate	$5,010.75
Max. Negotiated Rate	$5,718.15
Rate for Payer: Cash Price	$3,537.00
Rate for Payer: Health Management Network Commercial	$5,010.75
Rate for Payer: MDX Hawaii PPO	$5,718.15

HC PBB CLOSED RX PROX HUMERUS FRACTURE

Facility

$955.00

Service Code	HCPCS 23600
Hospital Charge Code	76123600PB
Hospital Revenue Code	761
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC PBB CLOSED RX PROX HUMERUS FRACTURE

Facility

$955.00

Service Code	HCPCS 23600
Hospital Charge Code	76123600PB
Hospital Revenue Code	761
Min. Negotiated Rate	$183.80
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
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	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$487.05
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicaid	$183.80
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC PBB CLOSED RX TARSAL FX,EACH

Facility

$955.00

Service Code	HCPCS 28450
Hospital Charge Code	76128450PB
Hospital Revenue Code	761
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC PBB CLOSED RX TARSAL FX,EACH

Facility

$955.00

Service Code	HCPCS 28450
Hospital Charge Code	76128450PB
Hospital Revenue Code	761
Min. Negotiated Rate	$126.55
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
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	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$487.05
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicaid	$126.55
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC PBB CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE

Facility

$935.00

Service Code	HCPCS 24670
Hospital Charge Code	76124670PB
Hospital Revenue Code	761
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: MDX Hawaii PPO	$906.95

HC PBB CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE

Facility

$935.00

Service Code	HCPCS 24670
Hospital Charge Code	76124670PB
Hospital Revenue Code	761
Min. Negotiated Rate	$149.15
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$320.54
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	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$589.05
Rate for Payer: Kaiser Permanente Medicaid	$476.85
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicaid	$149.15
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$681.52

Know your out-of-pocket cost for care.

All Charges