Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC REVSC EVASC FPVT ANGIOP UNI CPLX LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37265
Hospital Charge Code	4813726501
Hospital Revenue Code	481
Min. Negotiated Rate	$16,656.60
Max. Negotiated Rate	$19,008.12
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: MDX Hawaii PPO	$19,008.12

HC REVSC EVASC FPVT ANGIOP UNI SF LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37263
Hospital Charge Code	4813726301
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$19,008.12
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Devoted Health Medicare	$7,396.07
Rate for Payer: Hawaii Medical Service Association Commercial	$8,404.62
Rate for Payer: Hawaii Medical Service Association Medicare	$6,723.70
Rate for Payer: Hawaii Western Management Group Commercial	$18,616.20
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$12,345.48
Rate for Payer: Kaiser Permanente Medicaid	$9,993.96
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$19,008.12
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$14,283.52

HC REVSC EVASC FPVT ANGIOP UNI SF LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37263
Hospital Charge Code	4813726301
Hospital Revenue Code	481
Min. Negotiated Rate	$16,656.60
Max. Negotiated Rate	$19,008.12
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: MDX Hawaii PPO	$19,008.12

HC REVSC EVASC FPVT ATHRC UNI CPLX LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37273
Hospital Charge Code	4813727301
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$61,222.52
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Western Management Group Commercial	$59,960.20
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$39,763.08
Rate for Payer: Kaiser Permanente Medicaid	$32,189.16
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$61,222.52
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	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$46,005.25

HC REVSC EVASC FPVT ATHRC UNI CPLX LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37273
Hospital Charge Code	4813727301
Hospital Revenue Code	481
Min. Negotiated Rate	$53,648.60
Max. Negotiated Rate	$61,222.52
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: MDX Hawaii PPO	$61,222.52

HC REVSC EVASC FPVT ATHRC UNI SF LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37271
Hospital Charge Code	4813727101
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$61,222.52
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Western Management Group Commercial	$59,960.20
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$39,763.08
Rate for Payer: Kaiser Permanente Medicaid	$32,189.16
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$61,222.52
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	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$46,005.25

HC REVSC EVASC FPVT ATHRC UNI SF LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37271
Hospital Charge Code	4813727101
Hospital Revenue Code	481
Min. Negotiated Rate	$53,648.60
Max. Negotiated Rate	$61,222.52
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: MDX Hawaii PPO	$61,222.52

HC REVSC EVASC FPVT ST ATHRC UNI CPLX LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37277
Hospital Charge Code	4813727701
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$61,222.52
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Western Management Group Commercial	$59,960.20
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$39,763.08
Rate for Payer: Kaiser Permanente Medicaid	$32,189.16
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$61,222.52
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	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$46,005.25

HC REVSC EVASC FPVT ST ATHRC UNI CPLX LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37277
Hospital Charge Code	4813727701
Hospital Revenue Code	481
Min. Negotiated Rate	$53,648.60
Max. Negotiated Rate	$61,222.52
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: MDX Hawaii PPO	$61,222.52

HC REVSC EVASC FPVT ST ATHRC UNI SF LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37275
Hospital Charge Code	4813727501
Hospital Revenue Code	481
Min. Negotiated Rate	$53,648.60
Max. Negotiated Rate	$61,222.52
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: MDX Hawaii PPO	$61,222.52

HC REVSC EVASC FPVT ST ATHRC UNI SF LES 1ST VSL

Facility

$63,116.00

Service Code	HCPCS 37275
Hospital Charge Code	4813727501
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$61,222.52
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Cash Price	$37,869.60
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Hawaii Western Management Group Commercial	$59,960.20
Rate for Payer: Health Management Network Commercial	$53,648.60
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Commercial	$39,763.08
Rate for Payer: Kaiser Permanente Medicaid	$32,189.16
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: MDX Hawaii PPO	$61,222.52
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	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98
Rate for Payer: University Health Alliance Commercial	$46,005.25

HC REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37269
Hospital Charge Code	4813726901
Hospital Revenue Code	481
Min. Negotiated Rate	$33,784.95
Max. Negotiated Rate	$38,554.59
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: MDX Hawaii PPO	$38,554.59

HC REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37269
Hospital Charge Code	4813726901
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$38,554.59
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$37,759.65
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$25,040.61
Rate for Payer: Kaiser Permanente Medicaid	$20,270.97
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$38,554.59
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$28,971.59

HC REVSC EVASC FPVT ST PLMT UNI SF LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37267
Hospital Charge Code	4813726701
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$38,554.59
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$37,759.65
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$25,040.61
Rate for Payer: Kaiser Permanente Medicaid	$20,270.97
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$38,554.59
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$28,971.59

HC REVSC EVASC FPVT ST PLMT UNI SF LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37267
Hospital Charge Code	4813726701
Hospital Revenue Code	481
Min. Negotiated Rate	$33,784.95
Max. Negotiated Rate	$38,554.59
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: MDX Hawaii PPO	$38,554.59

HC REVSC EVASC IVT ANGIOP UNI CPLX LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37256
Hospital Charge Code	4813725601
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$19,008.12
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Devoted Health Medicare	$7,396.07
Rate for Payer: Hawaii Medical Service Association Commercial	$8,404.62
Rate for Payer: Hawaii Medical Service Association Medicare	$6,723.70
Rate for Payer: Hawaii Western Management Group Commercial	$18,616.20
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$12,345.48
Rate for Payer: Kaiser Permanente Medicaid	$9,993.96
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$19,008.12
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$14,283.52

HC REVSC EVASC IVT ANGIOP UNI CPLX LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37256
Hospital Charge Code	4813725601
Hospital Revenue Code	481
Min. Negotiated Rate	$16,656.60
Max. Negotiated Rate	$19,008.12
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: MDX Hawaii PPO	$19,008.12

HC REVSC EVASC IVT ANGIOP UNI SF LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37254
Hospital Charge Code	4813725401
Hospital Revenue Code	481
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$19,008.12
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Devoted Health Medicare	$7,396.07
Rate for Payer: Hawaii Medical Service Association Commercial	$8,404.62
Rate for Payer: Hawaii Medical Service Association Medicare	$6,723.70
Rate for Payer: Hawaii Western Management Group Commercial	$18,616.20
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Commercial	$12,345.48
Rate for Payer: Kaiser Permanente Medicaid	$9,993.96
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: MDX Hawaii PPO	$19,008.12
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$14,283.52

HC REVSC EVASC IVT ANGIOP UNI SF LES 1ST VSL

Facility

$19,596.00

Service Code	HCPCS 37254
Hospital Charge Code	4813725401
Hospital Revenue Code	481
Min. Negotiated Rate	$16,656.60
Max. Negotiated Rate	$19,008.12
Rate for Payer: Cash Price	$11,757.60
Rate for Payer: Health Management Network Commercial	$16,656.60
Rate for Payer: MDX Hawaii PPO	$19,008.12

HC REVSC EVASC IVT ST PLMT UNI CPLX LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37260
Hospital Charge Code	4813726001
Hospital Revenue Code	481
Min. Negotiated Rate	$33,784.95
Max. Negotiated Rate	$38,554.59
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: MDX Hawaii PPO	$38,554.59

HC REVSC EVASC IVT ST PLMT UNI CPLX LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37260
Hospital Charge Code	4813726001
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$38,554.59
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$37,759.65
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$25,040.61
Rate for Payer: Kaiser Permanente Medicaid	$20,270.97
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$38,554.59
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$28,971.59

HC REVSC EVASC IVT ST PLMT UNI CPLX LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37261
Hospital Charge Code	4813726101
Hospital Revenue Code	481
Min. Negotiated Rate	$7,722.93
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Hawaii Western Management Group Commercial	$14,385.85
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: Kaiser Permanente Commercial	$9,540.09
Rate for Payer: Kaiser Permanente Medicaid	$7,722.93
Rate for Payer: MDX Hawaii PPO	$14,688.71
Rate for Payer: University Health Alliance Commercial	$11,037.73

HC REVSC EVASC IVT ST PLMT UNI CPLX LES EA ADDL VSL

Facility

$15,143.00

Service Code	HCPCS 37261
Hospital Charge Code	4813726101
Hospital Revenue Code	481
Min. Negotiated Rate	$12,871.55
Max. Negotiated Rate	$14,688.71
Rate for Payer: Cash Price	$9,085.80
Rate for Payer: Health Management Network Commercial	$12,871.55
Rate for Payer: MDX Hawaii PPO	$14,688.71

HC REVSC EVASC IVT ST PLMT UNI SF LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37258
Hospital Charge Code	4813725801
Hospital Revenue Code	481
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$38,554.59
Rate for Payer: AlohaCare Medicaid	$13,637.67
Rate for Payer: AlohaCare Medicare	$13,637.67
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Devoted Health Medicare	$15,001.44
Rate for Payer: Hawaii Medical Service Association Commercial	$17,047.09
Rate for Payer: Hawaii Medical Service Association Medicare	$13,637.67
Rate for Payer: Hawaii Western Management Group Commercial	$37,759.65
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: Humana Medicare	$13,637.67
Rate for Payer: Kaiser Permanente Commercial	$25,040.61
Rate for Payer: Kaiser Permanente Medicaid	$20,270.97
Rate for Payer: Kaiser Permanente Medicare	$13,637.67
Rate for Payer: MDX Hawaii PPO	$38,554.59
Rate for Payer: Ohana Health Plan Medicaid	$15,001.44
Rate for Payer: Ohana Health Plan Medicare	$13,637.67
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$13,637.67
Rate for Payer: University Health Alliance Commercial	$28,971.59

HC REVSC EVASC IVT ST PLMT UNI SF LES 1ST VSL

Facility

$39,747.00

Service Code	HCPCS 37258
Hospital Charge Code	4813725801
Hospital Revenue Code	481
Min. Negotiated Rate	$33,784.95
Max. Negotiated Rate	$38,554.59
Rate for Payer: Cash Price	$23,848.20
Rate for Payer: Health Management Network Commercial	$33,784.95
Rate for Payer: MDX Hawaii PPO	$38,554.59

Know your out-of-pocket cost for care.

All Charges