Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC REMOVAL OF NAIL PLATE

Facility

$791.00

Service Code	HCPCS 11730
Hospital Charge Code	4501173001
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$260.72
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	$237.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Commercial	$498.33
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicare	$237.02
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC REMOVAL OF NAIL PLATE

Facility

$791.00

Service Code	HCPCS 11730
Hospital Charge Code	4501173001
Hospital Revenue Code	450
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: MDX Hawaii PPO	$767.27

HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA

Facility

$57.00

Service Code	HCPCS 15853
Hospital Charge Code	4501585301
Hospital Revenue Code	450
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
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 Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$35.91
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: University Health Alliance Commercial	$41.55

HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA

Facility

$57.00

Service Code	HCPCS 15853
Hospital Charge Code	4501585301
Hospital Revenue Code	450
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: MDX Hawaii PPO	$55.29

HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP

Facility

$2,460.00

Service Code	HCPCS 36589
Hospital Charge Code	3613658901
Hospital Revenue Code	361
Min. Negotiated Rate	$2,091.00
Max. Negotiated Rate	$2,386.20
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: MDX Hawaii PPO	$2,386.20

HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP

Facility

$2,460.00

Service Code	HCPCS 36589
Hospital Charge Code	3613658901
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$741.06
Rate for Payer: AlohaCare Medicare	$741.06
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$815.17
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	$741.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$741.06
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$741.06
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$815.17
Rate for Payer: Ohana Health Plan Medicare	$741.06
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$741.06
Rate for Payer: University Health Alliance Commercial	$1,793.09

HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP

Facility

$6,182.00

Service Code	HCPCS 36590
Hospital Charge Code	3613659001
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,996.54
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Devoted Health Medicare	$2,045.58
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	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$5,254.70
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$3,894.66
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$5,996.54
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$4,506.06

HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP

Facility

$6,182.00

Service Code	HCPCS 36590
Hospital Charge Code	3613659001
Hospital Revenue Code	361
Min. Negotiated Rate	$5,254.70
Max. Negotiated Rate	$5,996.54
Rate for Payer: Cash Price	$3,709.20
Rate for Payer: Health Management Network Commercial	$5,254.70
Rate for Payer: MDX Hawaii PPO	$5,996.54

HC REMOVAL VAGINAL FOR.BODY W ANESTH

Facility

$12,653.00

Service Code	HCPCS 57415
Hospital Charge Code	7615741501
Hospital Revenue Code	450
Min. Negotiated Rate	$10,755.05
Max. Negotiated Rate	$12,273.41
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: MDX Hawaii PPO	$12,273.41

HC REMOVAL VAGINAL FOR.BODY W ANESTH

Facility

$12,653.00

Service Code	HCPCS 57415
Hospital Charge Code	7615741501
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$12,273.41
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Cash Price	$7,591.80
Rate for Payer: Devoted Health Medicare	$4,206.58
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	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$12,020.35
Rate for Payer: Health Management Network Commercial	$10,755.05
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Commercial	$7,971.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: MDX Hawaii PPO	$12,273.41
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVE CVA DEVICE OBSTRUCT - IR CATHETER OBSTRUCTION REMOVAL

Facility

$668.00

Service Code	HCPCS 75901
Hospital Charge Code	3207590101
Hospital Revenue Code	320
Min. Negotiated Rate	$53.94
Max. Negotiated Rate	$647.96
Rate for Payer: Cash Price	$400.80
Rate for Payer: Cash Price	$400.80
Rate for Payer: Hawaii Medical Service Association ABD	$53.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$63.10
Rate for Payer: Hawaii Western Management Group Commercial	$634.60
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: Kaiser Permanente Commercial	$420.84
Rate for Payer: Kaiser Permanente Medicaid	$340.68
Rate for Payer: MDX Hawaii PPO	$647.96
Rate for Payer: UnitedHealthcare Medicaid	$53.94
Rate for Payer: University Health Alliance Commercial	$298.92

HC REMOVE CVA DEVICE OBSTRUCT - IR CATHETER OBSTRUCTION REMOVAL

Facility

$668.00

Service Code	HCPCS 75901
Hospital Charge Code	3207590101
Hospital Revenue Code	320
Min. Negotiated Rate	$567.80
Max. Negotiated Rate	$647.96
Rate for Payer: Cash Price	$400.80
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: MDX Hawaii PPO	$647.96

HC REMOVE FOREIGN BODY COMPLIC

Facility

$6,448.00

Service Code	HCPCS 10121
Hospital Charge Code	7611012101
Hospital Revenue Code	450
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC REMOVE FOREIGN BODY COMPLIC

Facility

$6,448.00

Service Code	HCPCS 10121
Hospital Charge Code	7611012101
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	3611012001
Hospital Revenue Code	361
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$54.57
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	3611012001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	7611012001
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,510.50
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC REMOVE FOREIGN BODY SIMPLE

Facility

$1,590.00

Service Code	HCPCS 10120
Hospital Charge Code	7611012001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC REMOVE INTRAUTERINE DEVICE

Facility

$1,211.00

Service Code	HCPCS 58301
Hospital Charge Code	7615830101
Hospital Revenue Code	761
Min. Negotiated Rate	$1,029.35
Max. Negotiated Rate	$1,174.67
Rate for Payer: Cash Price	$726.60
Rate for Payer: Health Management Network Commercial	$1,029.35
Rate for Payer: MDX Hawaii PPO	$1,174.67

HC REMOVE INTRAUTERINE DEVICE

Facility

$1,211.00

Service Code	HCPCS 58301
Hospital Charge Code	7615830101
Hospital Revenue Code	761
Min. Negotiated Rate	$47.15
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$359.99
Rate for Payer: AlohaCare Medicare	$359.99
Rate for Payer: Cash Price	$726.60
Rate for Payer: Cash Price	$726.60
Rate for Payer: Cash Price	$726.60
Rate for Payer: Devoted Health Medicare	$395.99
Rate for Payer: Hawaii Medical Service Association Commercial	$449.99
Rate for Payer: Hawaii Medical Service Association Medicare	$359.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,150.45
Rate for Payer: Health Management Network Commercial	$1,029.35
Rate for Payer: Humana Medicare	$359.99
Rate for Payer: Kaiser Permanente Commercial	$762.93
Rate for Payer: Kaiser Permanente Medicaid	$617.61
Rate for Payer: Kaiser Permanente Medicare	$359.99
Rate for Payer: MDX Hawaii PPO	$1,174.67
Rate for Payer: Ohana Health Plan Medicaid	$395.99
Rate for Payer: Ohana Health Plan Medicare	$359.99
Rate for Payer: UnitedHealthcare Medicaid	$47.15
Rate for Payer: UnitedHealthcare Medicare	$359.99
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC REMOVE NASAL FOREIGN BODY

Facility

$513.00

Service Code	HCPCS 30300
Hospital Charge Code	7613030001
Hospital Revenue Code	761
Min. Negotiated Rate	$73.73
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$323.19
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$73.73
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$373.93

HC REMOVE NASAL FOREIGN BODY

Facility

$513.00

Service Code	HCPCS 30300
Hospital Charge Code	7613030001
Hospital Revenue Code	761
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: MDX Hawaii PPO	$497.61

HC REMOVE PHARYNX FOREIGN BODY

Facility

$1,588.00

Service Code	HCPCS 42809
Hospital Charge Code	4504280901
Hospital Revenue Code	450
Min. Negotiated Rate	$1,349.80
Max. Negotiated Rate	$1,540.36
Rate for Payer: Cash Price	$952.80
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: MDX Hawaii PPO	$1,540.36

HC REMOVE PHARYNX FOREIGN BODY

Facility

$1,588.00

Service Code	HCPCS 42809
Hospital Charge Code	4504280901
Hospital Revenue Code	450
Min. Negotiated Rate	$527.74
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Devoted Health Medicare	$580.51
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	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,508.60
Rate for Payer: Health Management Network Commercial	$1,349.80
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,000.44
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$1,540.36
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,157.49

HC REMOVE RENAL TUBE W/FLUORO

Facility

$2,656.00

Service Code	HCPCS 50389
Hospital Charge Code	3615038901
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$823.75
Rate for Payer: AlohaCare Medicare	$823.75
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Cash Price	$1,593.60
Rate for Payer: Devoted Health Medicare	$906.12
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	$823.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$2,257.60
Rate for Payer: Humana Medicare	$823.75
Rate for Payer: Kaiser Permanente Commercial	$1,673.28
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$823.75
Rate for Payer: MDX Hawaii PPO	$2,576.32
Rate for Payer: Ohana Health Plan Medicaid	$906.12
Rate for Payer: Ohana Health Plan Medicare	$823.75
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$823.75
Rate for Payer: University Health Alliance Commercial	$1,935.96

Know your out-of-pocket cost for care.

All Charges