Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT

Facility

$13,726.00

Service Code	HCPCS 50693
Hospital Charge Code	3615069301
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,314.22
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$8,235.60
Rate for Payer: Cash Price	$8,235.60
Rate for Payer: Cash Price	$8,235.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$11,667.10
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$8,647.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$13,314.22
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$6,743.44

HC PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT

Facility

$13,726.00

Service Code	HCPCS 50693
Hospital Charge Code	3615069301
Hospital Revenue Code	361
Min. Negotiated Rate	$11,667.10
Max. Negotiated Rate	$13,314.22
Rate for Payer: Cash Price	$8,235.60
Rate for Payer: Health Management Network Commercial	$11,667.10
Rate for Payer: MDX Hawaii PPO	$13,314.22

HC PNEUMO JIROVECII PCR

Facility

$294.00

Service Code	HCPCS 87594
Hospital Charge Code	3068759401
Hospital Revenue Code	306
Min. Negotiated Rate	$0.02
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 Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
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	$0.02
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$214.30

HC PNEUMO JIROVECII PCR

Facility

$294.00

Service Code	HCPCS 87594
Hospital Charge Code	3068759401
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 PORPHOBILINOGEN UR QN SO

Facility

$71.00

Service Code	HCPCS 84110
Hospital Charge Code	3018411001
Hospital Revenue Code	301
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$8.44
Rate for Payer: AlohaCare Medicare	$8.44
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$42.60
Rate for Payer: Devoted Health Medicare	$9.28
Rate for Payer: Hawaii Medical Service Association ABD	$11.68
Rate for Payer: Hawaii Medical Service Association Commercial	$10.55
Rate for Payer: Hawaii Medical Service Association Medicare	$8.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.26
Rate for Payer: Hawaii Western Management Group Commercial	$8.44
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$8.44
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$8.44
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$9.28
Rate for Payer: Ohana Health Plan Medicare	$8.44
Rate for Payer: UnitedHealthcare Medicaid	$11.68
Rate for Payer: UnitedHealthcare Medicare	$8.44
Rate for Payer: University Health Alliance Commercial	$21.83

HC PORPHOBILINOGEN UR QN SO

Facility

$71.00

Service Code	HCPCS 84110
Hospital Charge Code	3018411001
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: MDX Hawaii PPO	$68.87

HC PRENATAL HIV 1/2 COMBO

Facility

$202.00

Service Code	HCPCS 87389
Hospital Charge Code	3068738901
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 PRENATAL HIV 1/2 COMBO

Facility

$202.00

Service Code	HCPCS 87389
Hospital Charge Code	3068738901
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 PRETREAT OF RBC W/DRUGS

Facility

$589.00

Service Code	HCPCS 86970
Hospital Charge Code	3008697001
Hospital Revenue Code	300
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$353.40
Rate for Payer: Cash Price	$353.40
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	$69.69
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$371.07
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicaid	$44.55
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$429.32

HC PRETREAT OF RBC W/DRUGS

Facility

$589.00

Service Code	HCPCS 86970
Hospital Charge Code	3008697001
Hospital Revenue Code	300
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$353.40
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: MDX Hawaii PPO	$571.33

HC PRETREAT SERUM BY DILUT SO

Facility

$243.00

Service Code	HCPCS 86976
Hospital Charge Code	3008697601
Hospital Revenue Code	300
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: MDX Hawaii PPO	$235.71

HC PRETREAT SERUM BY DILUT SO

Facility

$243.00

Service Code	HCPCS 86976
Hospital Charge Code	3008697601
Hospital Revenue Code	300
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$34.17
Rate for Payer: AlohaCare Medicare	$34.17
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cash Price	$145.80
Rate for Payer: Devoted Health Medicare	$37.59
Rate for Payer: Hawaii Medical Service Association Commercial	$42.71
Rate for Payer: Hawaii Medical Service Association Medicare	$34.17
Rate for Payer: Hawaii Western Management Group Commercial	$34.17
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$34.17
Rate for Payer: Kaiser Permanente Commercial	$153.09
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$34.17
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$37.59
Rate for Payer: Ohana Health Plan Medicare	$34.17
Rate for Payer: UnitedHealthcare Medicaid	$18.37
Rate for Payer: UnitedHealthcare Medicare	$34.17
Rate for Payer: University Health Alliance Commercial	$177.12

HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

Facility

$71,461.00

Service Code	HCPCS 37184
Hospital Charge Code	3613718401
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$69,317.17
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$42,876.60
Rate for Payer: Cash Price	$42,876.60
Rate for Payer: Cash Price	$42,876.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$60,741.85
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$45,020.43
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$69,317.17
Rate for Payer: Ohana Health Plan Medicaid	$23,821.58
Rate for Payer: Ohana Health Plan Medicare	$21,655.98
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$52,087.92

HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

Facility

$71,461.00

Service Code	HCPCS 37184
Hospital Charge Code	3613718401
Hospital Revenue Code	361
Min. Negotiated Rate	$60,741.85
Max. Negotiated Rate	$69,317.17
Rate for Payer: Cash Price	$42,876.60
Rate for Payer: Health Management Network Commercial	$60,741.85
Rate for Payer: MDX Hawaii PPO	$69,317.17

HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

Facility

$37,185.00

Service Code	HCPCS 37185
Hospital Charge Code	3613718501
Hospital Revenue Code	361
Min. Negotiated Rate	$31,607.25
Max. Negotiated Rate	$36,069.45
Rate for Payer: Cash Price	$22,311.00
Rate for Payer: Health Management Network Commercial	$31,607.25
Rate for Payer: MDX Hawaii PPO	$36,069.45

HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

Facility

$37,185.00

Service Code	HCPCS 37185
Hospital Charge Code	3613718501
Hospital Revenue Code	361
Min. Negotiated Rate	$118.97
Max. Negotiated Rate	$36,069.45
Rate for Payer: Cash Price	$22,311.00
Rate for Payer: Cash Price	$22,311.00
Rate for Payer: Cash Price	$22,311.00
Rate for Payer: Health Management Network Commercial	$31,607.25
Rate for Payer: Kaiser Permanente Commercial	$23,426.55
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$36,069.45
Rate for Payer: UnitedHealthcare Medicaid	$118.97
Rate for Payer: University Health Alliance Commercial	$27,104.15

HC PROCALCITONIN

Facility

$228.00

Service Code	HCPCS 84145
Hospital Charge Code	3018414501
Hospital Revenue Code	301
Min. Negotiated Rate	$27.22
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$27.22
Rate for Payer: AlohaCare Medicare	$27.22
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Devoted Health Medicare	$29.94
Rate for Payer: Hawaii Medical Service Association ABD	$27.76
Rate for Payer: Hawaii Medical Service Association Commercial	$34.02
Rate for Payer: Hawaii Medical Service Association Medicare	$27.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$27.22
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$27.22
Rate for Payer: Kaiser Permanente Commercial	$143.64
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$27.22
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$29.94
Rate for Payer: Ohana Health Plan Medicare	$27.22
Rate for Payer: UnitedHealthcare Medicaid	$27.76
Rate for Payer: UnitedHealthcare Medicare	$27.22
Rate for Payer: University Health Alliance Commercial	$51.36

HC PROCALCITONIN

Facility

$228.00

Service Code	HCPCS 84145
Hospital Charge Code	3018414501
Hospital Revenue Code	301
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: MDX Hawaii PPO	$221.16

HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID

Facility

$10,686.00

Service Code	HCPCS 45307
Hospital Charge Code	7504530701
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,365.42
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Devoted Health Medicare	$3,606.91
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	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$10,151.70
Rate for Payer: Health Management Network Commercial	$9,083.10
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Commercial	$6,732.18
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: MDX Hawaii PPO	$10,365.42
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$7,789.03

HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID

Facility

$10,686.00

Service Code	HCPCS 45307
Hospital Charge Code	7504530701
Hospital Revenue Code	450
Min. Negotiated Rate	$9,083.10
Max. Negotiated Rate	$10,365.42
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Health Management Network Commercial	$9,083.10
Rate for Payer: MDX Hawaii PPO	$10,365.42

HC PROSTATE BIOPSY 10-20

Facility

$3,564.00

Service Code	HCPCS G0416
Hospital Charge Code	314G041601
Hospital Revenue Code	314
Min. Negotiated Rate	$309.32
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 Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,385.80
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	$309.32
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$2,597.80

HC PROSTATE BIOPSY 10-20

Facility

$3,564.00

Service Code	HCPCS G0416
Hospital Charge Code	314G041601
Hospital Revenue Code	314
Min. Negotiated Rate	$3,029.40
Max. Negotiated Rate	$3,457.08
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Health Management Network Commercial	$3,029.40
Rate for Payer: MDX Hawaii PPO	$3,457.08

HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA

Facility

$154.00

Service Code	HCPCS 84153
Hospital Charge Code	3018415301
Hospital Revenue Code	301
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$18.39
Rate for Payer: AlohaCare Medicare	$18.39
Rate for Payer: Cash Price	$92.40
Rate for Payer: Cash Price	$92.40
Rate for Payer: Devoted Health Medicare	$20.23
Rate for Payer: Hawaii Medical Service Association ABD	$25.42
Rate for Payer: Hawaii Medical Service Association Commercial	$22.99
Rate for Payer: Hawaii Medical Service Association Medicare	$18.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.69
Rate for Payer: Hawaii Western Management Group Commercial	$18.39
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$18.39
Rate for Payer: Kaiser Permanente Commercial	$97.02
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$18.39
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$20.23
Rate for Payer: Ohana Health Plan Medicare	$18.39
Rate for Payer: UnitedHealthcare Medicaid	$25.42
Rate for Payer: UnitedHealthcare Medicare	$18.39
Rate for Payer: University Health Alliance Commercial	$47.55

HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA

Facility

$154.00

Service Code	HCPCS 84153
Hospital Charge Code	3018415301
Hospital Revenue Code	301
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$92.40
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: MDX Hawaii PPO	$149.38

HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM

Facility

$90.00

Service Code	HCPCS 84165
Hospital Charge Code	3018416501
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$10.74
Rate for Payer: AlohaCare Medicare	$10.74
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$11.81
Rate for Payer: Hawaii Medical Service Association ABD	$14.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13.43
Rate for Payer: Hawaii Medical Service Association Medicare	$10.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.58
Rate for Payer: Hawaii Western Management Group Commercial	$10.74
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$10.74
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$10.74
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$11.81
Rate for Payer: Ohana Health Plan Medicare	$10.74
Rate for Payer: UnitedHealthcare Medicaid	$14.84
Rate for Payer: UnitedHealthcare Medicare	$10.74
Rate for Payer: University Health Alliance Commercial	$27.77

Know your out-of-pocket cost for care.

All Charges