Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH

Professional

Both

$2,833.00

Service Code	HCPCS 33880
Min. Negotiated Rate	$1,220.51
Max. Negotiated Rate	$2,408.05
Rate for Payer: AlohaCare Medicaid	$1,664.06
Rate for Payer: AlohaCare Medicare	$1,220.51
Rate for Payer: Cash Price	$1,699.80
Rate for Payer: Cash Price	$1,699.80
Rate for Payer: Devoted Health Medicare	$1,342.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,220.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,807.52
Rate for Payer: Health Management Network Commercial	$2,408.05
Rate for Payer: Kaiser Permanente Commercial	$1,464.61
Rate for Payer: Kaiser Permanente Medicaid	$1,464.61
Rate for Payer: Kaiser Permanente Medicare	$1,464.61
Rate for Payer: Ohana Health Plan Medicaid	$1,664.06
Rate for Payer: Ohana Health Plan Medicare	$1,220.51
Rate for Payer: UnitedHealthcare Medicaid	$1,664.06
Rate for Payer: UnitedHealthcare Medicare	$1,220.51

PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI

Professional

Both

$691.00

Service Code	HCPCS 34717
Min. Negotiated Rate	$369.80
Max. Negotiated Rate	$647.67
Rate for Payer: AlohaCare Medicaid	$406.07
Rate for Payer: AlohaCare Medicare	$369.80
Rate for Payer: Cash Price	$414.60
Rate for Payer: Cash Price	$414.60
Rate for Payer: Devoted Health Medicare	$406.78
Rate for Payer: Hawaii Medical Service Association Medicare	$369.80
Rate for Payer: Hawaii Western Management Group Commercial	$451.88
Rate for Payer: Health Management Network Commercial	$587.35
Rate for Payer: Kaiser Permanente Commercial	$443.76
Rate for Payer: Kaiser Permanente Medicaid	$443.76
Rate for Payer: Kaiser Permanente Medicare	$443.76
Rate for Payer: Ohana Health Plan Medicaid	$406.07
Rate for Payer: Ohana Health Plan Medicare	$369.80
Rate for Payer: UnitedHealthcare Medicaid	$406.07
Rate for Payer: UnitedHealthcare Medicare	$369.80
Rate for Payer: University Health Alliance Commercial	$647.67

PREVENA DRSG 13CM PRE1155US

Facility

$1,033.00

Hospital Revenue Code	272
Min. Negotiated Rate	$526.83
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$981.35
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$650.79
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$752.95

PREVENA DRSG 13CM PRE1155US

Facility

$1,033.00

Hospital Revenue Code	272
Min. Negotiated Rate	$878.05
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: MDX Hawaii PPO	$1,002.01

PREVENA DRSG 20CM PRE1055US

Facility

$1,057.00

Hospital Revenue Code	272
Min. Negotiated Rate	$898.45
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: MDX Hawaii PPO	$1,025.29

PREVENA DRSG 20CM PRE1055US

Facility

$1,057.00

Hospital Revenue Code	272
Min. Negotiated Rate	$539.07
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.15
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Kaiser Permanente Commercial	$665.91
Rate for Payer: Kaiser Permanente Medicaid	$539.07
Rate for Payer: MDX Hawaii PPO	$1,025.29
Rate for Payer: University Health Alliance Commercial	$770.45

PREVENA PLUS 125 PRE4000US

Facility

$1,950.00

Service Code	HCPCS 97608
Hospital Revenue Code	360
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$1,891.50
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Health Management Network Commercial	$1,657.50
Rate for Payer: MDX Hawaii PPO	$1,891.50

PREVENA PLUS 125 PRE4000US

Facility

$1,950.00

Service Code	HCPCS 97608
Hospital Revenue Code	360
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
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	$1,657.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,228.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,891.50
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$24.26
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,421.36

PREVENA PLUS 150ML PRE4095

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: MDX Hawaii PPO	$201.76

PREVENA PLUS 150ML PRE4095

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$131.04
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: University Health Alliance Commercial	$151.61

PREVENA PLUS DRSG PRE4055US

Facility

$1,327.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,127.95
Max. Negotiated Rate	$1,287.19
Rate for Payer: Cash Price	$796.20
Rate for Payer: Health Management Network Commercial	$1,127.95
Rate for Payer: MDX Hawaii PPO	$1,287.19

PREVENA PLUS DRSG PRE4055US

Facility

$1,327.00

Hospital Revenue Code	272
Min. Negotiated Rate	$676.77
Max. Negotiated Rate	$1,287.19
Rate for Payer: Cash Price	$796.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,260.65
Rate for Payer: Health Management Network Commercial	$1,127.95
Rate for Payer: Kaiser Permanente Commercial	$836.01
Rate for Payer: Kaiser Permanente Medicaid	$676.77
Rate for Payer: MDX Hawaii PPO	$1,287.19
Rate for Payer: University Health Alliance Commercial	$967.25

PR EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR

Professional

Both

$27,890.00

Service Code	HCPCS 0505T
Min. Negotiated Rate	$907.11
Max. Negotiated Rate	$23,706.50
Rate for Payer: Cash Price	$16,734.00
Rate for Payer: Cash Price	$16,734.00
Rate for Payer: Hawaii Medical Service Association Commercial	$907.11
Rate for Payer: Health Management Network Commercial	$23,706.50

PR EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS

Professional

Both

$16.00

Service Code	HCPCS 92558
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Medical Service Association ABD	$8.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.52
Rate for Payer: Hawaii Western Management Group Commercial	$10.08
Rate for Payer: Health Management Network Commercial	$13.60

PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<

Professional

Both

$270.69

Service Code	HCPCS 11440
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$230.09
Rate for Payer: AlohaCare Medicaid	$116.56
Rate for Payer: AlohaCare Medicare	$104.55
Rate for Payer: Cash Price	$162.41
Rate for Payer: Cash Price	$162.41
Rate for Payer: Devoted Health Medicare	$115.00
Rate for Payer: Hawaii Medical Service Association ABD	$116.56
Rate for Payer: Hawaii Medical Service Association Commercial	$186.43
Rate for Payer: Hawaii Medical Service Association Medicare	$104.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$116.56
Rate for Payer: Hawaii Western Management Group Commercial	$83.98
Rate for Payer: Health Management Network Commercial	$230.09
Rate for Payer: Kaiser Permanente Commercial	$125.46
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$125.46
Rate for Payer: Ohana Health Plan Medicaid	$116.56
Rate for Payer: Ohana Health Plan Medicare	$104.55
Rate for Payer: UnitedHealthcare Medicaid	$116.56
Rate for Payer: UnitedHealthcare Medicare	$104.55
Rate for Payer: University Health Alliance Commercial	$126.34

PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM

Professional

Both

$733.20

Service Code	HCPCS 11446
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$623.22
Rate for Payer: AlohaCare Medicaid	$327.38
Rate for Payer: AlohaCare Medicare	$287.19
Rate for Payer: Cash Price	$439.92
Rate for Payer: Cash Price	$439.92
Rate for Payer: Devoted Health Medicare	$315.91
Rate for Payer: Hawaii Medical Service Association ABD	$327.38
Rate for Payer: Hawaii Medical Service Association Commercial	$546.06
Rate for Payer: Hawaii Medical Service Association Medicare	$287.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$327.38
Rate for Payer: Hawaii Western Management Group Commercial	$114.40
Rate for Payer: Health Management Network Commercial	$623.22
Rate for Payer: Kaiser Permanente Commercial	$344.63
Rate for Payer: Kaiser Permanente Medicaid	$344.63
Rate for Payer: Kaiser Permanente Medicare	$344.63
Rate for Payer: Ohana Health Plan Medicaid	$327.38
Rate for Payer: Ohana Health Plan Medicare	$287.19
Rate for Payer: UnitedHealthcare Medicaid	$327.38
Rate for Payer: UnitedHealthcare Medicare	$287.19
Rate for Payer: University Health Alliance Commercial	$357.86

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<

Professional

Both

$236.97

Service Code	HCPCS 11420
Min. Negotiated Rate	$70.98
Max. Negotiated Rate	$201.42
Rate for Payer: AlohaCare Medicaid	$87.79
Rate for Payer: AlohaCare Medicare	$79.96
Rate for Payer: Cash Price	$142.18
Rate for Payer: Cash Price	$142.18
Rate for Payer: Devoted Health Medicare	$87.96
Rate for Payer: Hawaii Medical Service Association ABD	$87.79
Rate for Payer: Hawaii Medical Service Association Commercial	$143.47
Rate for Payer: Hawaii Medical Service Association Medicare	$79.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$87.79
Rate for Payer: Hawaii Western Management Group Commercial	$70.98
Rate for Payer: Health Management Network Commercial	$201.42
Rate for Payer: Kaiser Permanente Commercial	$95.95
Rate for Payer: Kaiser Permanente Medicaid	$95.95
Rate for Payer: Kaiser Permanente Medicare	$95.95
Rate for Payer: Ohana Health Plan Medicaid	$87.79
Rate for Payer: Ohana Health Plan Medicare	$79.96
Rate for Payer: UnitedHealthcare Medicaid	$87.79
Rate for Payer: UnitedHealthcare Medicare	$79.96
Rate for Payer: University Health Alliance Commercial	$95.50

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM

Professional

Both

$300.02

Service Code	HCPCS 11421
Min. Negotiated Rate	$96.46
Max. Negotiated Rate	$255.02
Rate for Payer: AlohaCare Medicaid	$115.22
Rate for Payer: AlohaCare Medicare	$102.70
Rate for Payer: Cash Price	$180.01
Rate for Payer: Cash Price	$180.01
Rate for Payer: Devoted Health Medicare	$112.97
Rate for Payer: Hawaii Medical Service Association ABD	$115.22
Rate for Payer: Hawaii Medical Service Association Commercial	$188.76
Rate for Payer: Hawaii Medical Service Association Medicare	$102.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$115.22
Rate for Payer: Hawaii Western Management Group Commercial	$96.46
Rate for Payer: Health Management Network Commercial	$255.02
Rate for Payer: Kaiser Permanente Commercial	$123.24
Rate for Payer: Kaiser Permanente Medicaid	$123.24
Rate for Payer: Kaiser Permanente Medicare	$123.24
Rate for Payer: Ohana Health Plan Medicaid	$115.22
Rate for Payer: Ohana Health Plan Medicare	$102.70
Rate for Payer: UnitedHealthcare Medicaid	$115.22
Rate for Payer: UnitedHealthcare Medicare	$102.70
Rate for Payer: University Health Alliance Commercial	$125.31

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM

Professional

Both

$337.58

Service Code	HCPCS 11422
Min. Negotiated Rate	$114.14
Max. Negotiated Rate	$286.94
Rate for Payer: AlohaCare Medicaid	$144.37
Rate for Payer: AlohaCare Medicare	$129.86
Rate for Payer: Cash Price	$202.55
Rate for Payer: Cash Price	$202.55
Rate for Payer: Devoted Health Medicare	$142.85
Rate for Payer: Hawaii Medical Service Association ABD	$144.37
Rate for Payer: Hawaii Medical Service Association Commercial	$235.26
Rate for Payer: Hawaii Medical Service Association Medicare	$129.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$144.37
Rate for Payer: Hawaii Western Management Group Commercial	$114.14
Rate for Payer: Health Management Network Commercial	$286.94
Rate for Payer: Kaiser Permanente Commercial	$155.83
Rate for Payer: Kaiser Permanente Medicaid	$155.83
Rate for Payer: Kaiser Permanente Medicare	$155.83
Rate for Payer: Ohana Health Plan Medicaid	$144.37
Rate for Payer: Ohana Health Plan Medicare	$129.86
Rate for Payer: UnitedHealthcare Medicaid	$144.37
Rate for Payer: UnitedHealthcare Medicare	$129.86
Rate for Payer: University Health Alliance Commercial	$157.79

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM

Professional

Both

$390.48

Service Code	HCPCS 11423
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$331.91
Rate for Payer: AlohaCare Medicaid	$165.79
Rate for Payer: AlohaCare Medicare	$149.07
Rate for Payer: Cash Price	$234.29
Rate for Payer: Cash Price	$234.29
Rate for Payer: Devoted Health Medicare	$163.98
Rate for Payer: Hawaii Medical Service Association ABD	$165.79
Rate for Payer: Hawaii Medical Service Association Commercial	$268.51
Rate for Payer: Hawaii Medical Service Association Medicare	$149.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$165.79
Rate for Payer: Hawaii Western Management Group Commercial	$140.40
Rate for Payer: Health Management Network Commercial	$331.91
Rate for Payer: Kaiser Permanente Commercial	$178.88
Rate for Payer: Kaiser Permanente Medicaid	$178.88
Rate for Payer: Kaiser Permanente Medicare	$178.88
Rate for Payer: Ohana Health Plan Medicaid	$165.79
Rate for Payer: Ohana Health Plan Medicare	$149.07
Rate for Payer: UnitedHealthcare Medicaid	$165.79
Rate for Payer: UnitedHealthcare Medicare	$149.07
Rate for Payer: University Health Alliance Commercial	$181.51

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM

Professional

Both

$453.70

Service Code	HCPCS 11424
Min. Negotiated Rate	$160.16
Max. Negotiated Rate	$385.64
Rate for Payer: AlohaCare Medicaid	$189.29
Rate for Payer: AlohaCare Medicare	$169.64
Rate for Payer: Cash Price	$272.22
Rate for Payer: Cash Price	$272.22
Rate for Payer: Devoted Health Medicare	$186.60
Rate for Payer: Hawaii Medical Service Association ABD	$189.29
Rate for Payer: Hawaii Medical Service Association Commercial	$304.76
Rate for Payer: Hawaii Medical Service Association Medicare	$169.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$189.29
Rate for Payer: Hawaii Western Management Group Commercial	$160.16
Rate for Payer: Health Management Network Commercial	$385.64
Rate for Payer: Kaiser Permanente Commercial	$203.57
Rate for Payer: Kaiser Permanente Medicaid	$203.57
Rate for Payer: Kaiser Permanente Medicare	$203.57
Rate for Payer: Ohana Health Plan Medicaid	$189.29
Rate for Payer: Ohana Health Plan Medicare	$169.64
Rate for Payer: UnitedHealthcare Medicaid	$189.29
Rate for Payer: UnitedHealthcare Medicare	$169.64
Rate for Payer: University Health Alliance Commercial	$206.64

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM

Professional

Both

$623.74

Service Code	HCPCS 11426
Min. Negotiated Rate	$227.24
Max. Negotiated Rate	$530.18
Rate for Payer: AlohaCare Medicaid	$275.66
Rate for Payer: AlohaCare Medicare	$248.18
Rate for Payer: Cash Price	$374.24
Rate for Payer: Cash Price	$374.24
Rate for Payer: Devoted Health Medicare	$273.00
Rate for Payer: Hawaii Medical Service Association ABD	$275.66
Rate for Payer: Hawaii Medical Service Association Commercial	$462.94
Rate for Payer: Hawaii Medical Service Association Medicare	$248.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$275.66
Rate for Payer: Hawaii Western Management Group Commercial	$227.24
Rate for Payer: Health Management Network Commercial	$530.18
Rate for Payer: Kaiser Permanente Commercial	$297.82
Rate for Payer: Kaiser Permanente Medicaid	$297.82
Rate for Payer: Kaiser Permanente Medicare	$297.82
Rate for Payer: Ohana Health Plan Medicaid	$275.66
Rate for Payer: Ohana Health Plan Medicare	$248.18
Rate for Payer: UnitedHealthcare Medicaid	$275.66
Rate for Payer: UnitedHealthcare Medicare	$248.18
Rate for Payer: University Health Alliance Commercial	$301.65

PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<

Professional

Both

$243.90

Service Code	HCPCS 11400
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$207.31
Rate for Payer: AlohaCare Medicaid	$90.72
Rate for Payer: AlohaCare Medicare	$80.89
Rate for Payer: Cash Price	$146.34
Rate for Payer: Cash Price	$146.34
Rate for Payer: Devoted Health Medicare	$88.98
Rate for Payer: Hawaii Medical Service Association ABD	$90.72
Rate for Payer: Hawaii Medical Service Association Commercial	$142.63
Rate for Payer: Hawaii Medical Service Association Medicare	$80.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$90.72
Rate for Payer: Hawaii Western Management Group Commercial	$69.42
Rate for Payer: Health Management Network Commercial	$207.31
Rate for Payer: Kaiser Permanente Commercial	$97.07
Rate for Payer: Kaiser Permanente Medicaid	$97.07
Rate for Payer: Kaiser Permanente Medicare	$97.07
Rate for Payer: Ohana Health Plan Medicaid	$90.72
Rate for Payer: Ohana Health Plan Medicare	$80.89
Rate for Payer: UnitedHealthcare Medicaid	$90.72
Rate for Payer: UnitedHealthcare Medicare	$80.89
Rate for Payer: University Health Alliance Commercial	$105.00

PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM

Professional

Both

$293.14

Service Code	HCPCS 11401
Min. Negotiated Rate	$88.66
Max. Negotiated Rate	$249.17
Rate for Payer: AlohaCare Medicaid	$112.53
Rate for Payer: AlohaCare Medicare	$98.77
Rate for Payer: Cash Price	$175.88
Rate for Payer: Cash Price	$175.88
Rate for Payer: Devoted Health Medicare	$108.65
Rate for Payer: Hawaii Medical Service Association ABD	$112.53
Rate for Payer: Hawaii Medical Service Association Commercial	$183.79
Rate for Payer: Hawaii Medical Service Association Medicare	$98.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.53
Rate for Payer: Hawaii Western Management Group Commercial	$88.66
Rate for Payer: Health Management Network Commercial	$249.17
Rate for Payer: Kaiser Permanente Commercial	$118.52
Rate for Payer: Kaiser Permanente Medicaid	$118.52
Rate for Payer: Kaiser Permanente Medicare	$118.52
Rate for Payer: Ohana Health Plan Medicaid	$112.53
Rate for Payer: Ohana Health Plan Medicare	$98.77
Rate for Payer: UnitedHealthcare Medicaid	$112.53
Rate for Payer: UnitedHealthcare Medicare	$98.77
Rate for Payer: University Health Alliance Commercial	$122.20

PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM

Professional

Both

$323.10

Service Code	HCPCS 11402
Min. Negotiated Rate	$106.78
Max. Negotiated Rate	$274.63
Rate for Payer: AlohaCare Medicaid	$122.57
Rate for Payer: AlohaCare Medicare	$106.78
Rate for Payer: Cash Price	$193.86
Rate for Payer: Cash Price	$193.86
Rate for Payer: Devoted Health Medicare	$117.46
Rate for Payer: Hawaii Medical Service Association ABD	$122.57
Rate for Payer: Hawaii Medical Service Association Commercial	$200.87
Rate for Payer: Hawaii Medical Service Association Medicare	$106.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$122.57
Rate for Payer: Hawaii Western Management Group Commercial	$107.12
Rate for Payer: Health Management Network Commercial	$274.63
Rate for Payer: Kaiser Permanente Commercial	$128.14
Rate for Payer: Kaiser Permanente Medicaid	$128.14
Rate for Payer: Kaiser Permanente Medicare	$128.14
Rate for Payer: Ohana Health Plan Medicaid	$122.57
Rate for Payer: Ohana Health Plan Medicare	$106.78
Rate for Payer: UnitedHealthcare Medicaid	$122.57
Rate for Payer: UnitedHealthcare Medicare	$106.78
Rate for Payer: University Health Alliance Commercial	$133.24

Know your out-of-pocket cost for care.

All Charges