Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC SIGMOIDOSCOPY,BIOPSY - ENDOSCOPY SIGMOID

Facility

$3,628.00

Service Code	HCPCS 45331
Hospital Charge Code	3604533101
Hospital Revenue Code	360
Min. Negotiated Rate	$3,083.80
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16

HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD - ENDOSCOPY SIGMOID

Facility

$3,628.00

Service Code	HCPCS 45330
Hospital Charge Code	3604533001
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,519.16
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$2,285.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$2,644.45

HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD - ENDOSCOPY SIGMOID

Facility

$3,628.00

Service Code	HCPCS 45330
Hospital Charge Code	3604533001
Hospital Revenue Code	360
Min. Negotiated Rate	$3,083.80
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: MDX Hawaii PPO	$3,519.16

HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY - ENDOSCOPY SIGMOID

Facility

$4,595.00

Service Code	HCPCS 45332
Hospital Charge Code	7504533201
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$4,365.25
Rate for Payer: Health Management Network Commercial	$3,905.75
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Commercial	$2,894.85
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: MDX Hawaii PPO	$4,457.15
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65
Rate for Payer: University Health Alliance Commercial	$3,349.30

HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY - ENDOSCOPY SIGMOID

Facility

$4,595.00

Service Code	HCPCS 45332
Hospital Charge Code	7504533201
Hospital Revenue Code	450
Min. Negotiated Rate	$3,905.75
Max. Negotiated Rate	$4,457.15
Rate for Payer: Cash Price	$2,757.00
Rate for Payer: Health Management Network Commercial	$3,905.75
Rate for Payer: MDX Hawaii PPO	$4,457.15

HC SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM

Facility

$1,590.00

Service Code	HCPCS 12017
Hospital Charge Code	4501201701
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$1,600.00
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	$1,158.95

HC SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM

Facility

$1,590.00

Service Code	HCPCS 12017
Hospital Charge Code	4501201701
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM

Facility

$791.00

Service Code	HCPCS 12018
Hospital Charge Code	4501201801
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM

Facility

$791.00

Service Code	HCPCS 12018
Hospital Charge Code	4501201801
Hospital Revenue Code	450
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$1,600.00
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	$576.56

HC SKIN TEST TB (PPD)

Facility

$97.00

Service Code	HCPCS 86580
Hospital Charge Code	3028658001
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 SKIN TEST TB (PPD)

Facility

$97.00

Service Code	HCPCS 86580
Hospital Charge Code	3028658001
Hospital Revenue Code	302
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$34.17
Rate for Payer: AlohaCare Medicare	$34.17
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$37.59
Rate for Payer: Hawaii Medical Service Association ABD	$6.68
Rate for Payer: Hawaii Medical Service Association Commercial	$42.71
Rate for Payer: Hawaii Medical Service Association Medicare	$34.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.23
Rate for Payer: Hawaii Western Management Group Commercial	$34.17
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$34.17
Rate for Payer: Kaiser Permanente Commercial	$61.11
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$34.17
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$37.59
Rate for Payer: Ohana Health Plan Medicare	$34.17
Rate for Payer: UnitedHealthcare Medicaid	$6.68
Rate for Payer: UnitedHealthcare Medicare	$34.17
Rate for Payer: University Health Alliance Commercial	$17.04

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI

Facility

$12,526.00

Service Code	HCPCS 36251
Hospital Charge Code	3613625101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI

Facility

$12,526.00

Service Code	HCPCS 36251
Hospital Charge Code	3613625101
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT

Facility

$12,526.00

Service Code	HCPCS 36252
Hospital Charge Code	3613625201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT

Facility

$12,526.00

Service Code	HCPCS 36252
Hospital Charge Code	3613625201
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

Facility

$21,513.00

Service Code	HCPCS 36223
Hospital Charge Code	3613622301
Hospital Revenue Code	361
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$20,867.61
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Devoted Health Medicare	$7,230.94
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	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$18,286.05
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Commercial	$13,553.19
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: MDX Hawaii PPO	$20,867.61
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$15,680.83

HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

Facility

$21,513.00

Service Code	HCPCS 36223
Hospital Charge Code	3613622301
Hospital Revenue Code	361
Min. Negotiated Rate	$18,286.05
Max. Negotiated Rate	$20,867.61
Rate for Payer: Cash Price	$12,907.80
Rate for Payer: Health Management Network Commercial	$18,286.05
Rate for Payer: MDX Hawaii PPO	$20,867.61

HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

Facility

$12,526.00

Service Code	HCPCS 36222
Hospital Charge Code	3613622201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Devoted Health Medicare	$4,103.08
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	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Commercial	$7,891.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: MDX Hawaii PPO	$12,150.22
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$9,130.20

HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

Facility

$12,526.00

Service Code	HCPCS 36222
Hospital Charge Code	3613622201
Hospital Revenue Code	361
Min. Negotiated Rate	$10,647.10
Max. Negotiated Rate	$12,150.22
Rate for Payer: Cash Price	$7,515.60
Rate for Payer: Health Management Network Commercial	$10,647.10
Rate for Payer: MDX Hawaii PPO	$12,150.22

HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART

Facility

$4,581.00

Service Code	HCPCS 36015
Hospital Charge Code	3613601501
Hospital Revenue Code	361
Min. Negotiated Rate	$157.82
Max. Negotiated Rate	$13,778.00
Rate for Payer: Cash Price	$2,748.60
Rate for Payer: Cash Price	$2,748.60
Rate for Payer: Cash Price	$2,748.60
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 Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$3,893.85
Rate for Payer: Kaiser Permanente Commercial	$2,886.03
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$4,443.57
Rate for Payer: UnitedHealthcare Medicaid	$157.82
Rate for Payer: University Health Alliance Commercial	$3,339.09

HC SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART

Facility

$4,581.00

Service Code	HCPCS 36015
Hospital Charge Code	3613601501
Hospital Revenue Code	361
Min. Negotiated Rate	$3,893.85
Max. Negotiated Rate	$4,443.57
Rate for Payer: Cash Price	$2,748.60
Rate for Payer: Health Management Network Commercial	$3,893.85
Rate for Payer: MDX Hawaii PPO	$4,443.57

HC SLP ASSESSMENT OF APHASIA

Facility

$454.00

Service Code	HCPCS 96105
Hospital Charge Code	4449610501
Hospital Revenue Code	444
Min. Negotiated Rate	$59.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Cash Price	$272.40
Rate for Payer: Hawaii Western Management Group Commercial	$431.30
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$286.02
Rate for Payer: Kaiser Permanente Medicaid	$231.54
Rate for Payer: MDX Hawaii PPO	$440.38
Rate for Payer: UnitedHealthcare Medicaid	$59.90
Rate for Payer: University Health Alliance Commercial	$330.92

HC SLP ASSESSMENT OF APHASIA

Facility

$454.00

Service Code	HCPCS 96105
Hospital Charge Code	4449610501
Hospital Revenue Code	444
Min. Negotiated Rate	$385.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: MDX Hawaii PPO	$440.38

HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Facility

$522.00

Service Code	HCPCS 92524
Hospital Charge Code	4449252401
Hospital Revenue Code	444
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$506.34
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cash Price	$313.20
Rate for Payer: Hawaii Western Management Group Commercial	$495.90
Rate for Payer: Health Management Network Commercial	$443.70
Rate for Payer: Kaiser Permanente Commercial	$328.86
Rate for Payer: Kaiser Permanente Medicaid	$266.22
Rate for Payer: MDX Hawaii PPO	$506.34
Rate for Payer: UnitedHealthcare Medicaid	$114.94
Rate for Payer: University Health Alliance Commercial	$380.49

HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Facility

$522.00

Service Code	HCPCS 92524
Hospital Charge Code	4449252401
Hospital Revenue Code	444
Min. Negotiated Rate	$443.70
Max. Negotiated Rate	$506.34
Rate for Payer: Cash Price	$313.20
Rate for Payer: Health Management Network Commercial	$443.70
Rate for Payer: MDX Hawaii PPO	$506.34

Know your out-of-pocket cost for care.

All Charges