Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HC CRITICAL CARE, E/M 30-74 MINUTES

Facility

$6,883.00

Service Code	HCPCS 99291
Hospital Charge Code	4509929101
Hospital Revenue Code	450
Min. Negotiated Rate	$5,850.55
Max. Negotiated Rate	$6,676.51
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Health Management Network Commercial	$5,850.55
Rate for Payer: Kaiser Permanente Commercial	$6,194.70
Rate for Payer: MDX Hawaii PPO	$6,676.51

HC CRITICAL CARE, E/M 30-74 MINUTES

Facility

$6,883.00

Service Code	HCPCS 99291
Hospital Charge Code	4509929101
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,676.51
Rate for Payer: AlohaCare Medicaid	$3,441.50
Rate for Payer: AlohaCare Medicare	$5,231.08
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Cash Price	$4,129.80
Rate for Payer: Devoted Health Medicare	$5,781.72
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,231.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,538.85
Rate for Payer: Health Management Network Commercial	$5,850.55
Rate for Payer: Humana Medicare	$5,231.08
Rate for Payer: Kaiser Permanente Commercial	$6,194.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$5,231.08
Rate for Payer: MDX Hawaii PPO	$6,676.51
Rate for Payer: Ohana Health Plan Medicaid	$5,231.08
Rate for Payer: Ohana Health Plan Medicare	$5,231.08
Rate for Payer: UnitedHealthcare Medicare	$5,231.08
Rate for Payer: University Health Alliance Commercial	$5,017.02

HC CTRL NOSEBLEED,ANTER,COMPLEX

Facility

$513.00

Service Code	HCPCS 30903
Hospital Charge Code	7613090301
Hospital Revenue Code	450
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$256.50
Rate for Payer: AlohaCare Medicare	$389.88
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$430.92
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$389.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$389.88
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$389.88
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$389.88
Rate for Payer: Ohana Health Plan Medicare	$389.88
Rate for Payer: UnitedHealthcare Medicare	$389.88
Rate for Payer: University Health Alliance Commercial	$373.93

HC CTRL NOSEBLEED,ANTER,COMPLEX

Facility

$513.00

Service Code	HCPCS 30903
Hospital Charge Code	7613090301
Hospital Revenue Code	450
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: Kaiser Permanente Commercial	$461.70
Rate for Payer: MDX Hawaii PPO	$497.61

HC CULT ANAEROBIC

Facility

$79.00

Service Code	HCPCS 87075
Hospital Charge Code	3068707501
Hospital Revenue Code	306
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$60.04
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$66.36
Rate for Payer: Hawaii Medical Service Association ABD	$13.08
Rate for Payer: Hawaii Medical Service Association Commercial	$11.84
Rate for Payer: Hawaii Medical Service Association Medicare	$60.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.73
Rate for Payer: Hawaii Western Management Group Commercial	$9.47
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$60.04
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$60.04
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$60.04
Rate for Payer: Ohana Health Plan Medicare	$60.04
Rate for Payer: UnitedHealthcare Medicaid	$13.08
Rate for Payer: UnitedHealthcare Medicare	$60.04
Rate for Payer: University Health Alliance Commercial	$24.46

HC CULT ANAEROBIC

Facility

$79.00

Service Code	HCPCS 87075
Hospital Charge Code	3068707501
Hospital Revenue Code	306
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

HC CULT ANAEROBIC ID EA

Facility

$68.00

Service Code	HCPCS 87076
Hospital Charge Code	3068707601
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$51.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$57.12
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$51.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.95
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$51.68
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$51.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$51.68
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$51.68
Rate for Payer: University Health Alliance Commercial	$20.89

HC CULT ANAEROBIC ID EA

Facility

$68.00

Service Code	HCPCS 87076
Hospital Charge Code	3068707601
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

HC CULT BLOOD

Facility

$87.00

Service Code	HCPCS 87040
Hospital Charge Code	3068704001
Hospital Revenue Code	306
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

HC CULT BLOOD

Facility

$87.00

Service Code	HCPCS 87040
Hospital Charge Code	3068704001
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$26.68

HC CULT BLOOD #2

Facility

$87.00

Service Code	HCPCS 87040
Hospital Charge Code	3068704002
Hospital Revenue Code	306
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

HC CULT BLOOD #2

Facility

$87.00

Service Code	HCPCS 87040
Hospital Charge Code	3068704002
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$26.68

HC CULT FLUID

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707004
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

HC CULT FLUID

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707004
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$54.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$54.72
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$54.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$54.72
Rate for Payer: Ohana Health Plan Medicare	$54.72
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$54.72
Rate for Payer: University Health Alliance Commercial	$22.26

HC CULT FUNGUS ID YEAST EA

Facility

$87.00

Service Code	HCPCS 87106
Hospital Charge Code	3068710601
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$66.12
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$73.08
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$66.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$66.12
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$66.12
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$66.12
Rate for Payer: Ohana Health Plan Medicare	$66.12
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$66.12
Rate for Payer: University Health Alliance Commercial	$26.68

HC CULT FUNGUS ID YEAST EA

Facility

$87.00

Service Code	HCPCS 87106
Hospital Charge Code	3068710601
Hospital Revenue Code	306
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

HC CULT SPUTUM

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707006
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$54.72
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$54.72
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$54.72
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$54.72
Rate for Payer: Ohana Health Plan Medicare	$54.72
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$54.72
Rate for Payer: University Health Alliance Commercial	$22.26

HC CULT SPUTUM

Facility

$72.00

Service Code	HCPCS 87070
Hospital Charge Code	3068707006
Hospital Revenue Code	306
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

HC CULT STOOL

Facility

$79.00

Service Code	HCPCS 87045
Hospital Charge Code	3068704501
Hospital Revenue Code	306
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$60.04
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$66.36
Rate for Payer: Hawaii Medical Service Association ABD	$13.04
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$60.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.69
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$60.04
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$60.04
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$60.04
Rate for Payer: Ohana Health Plan Medicare	$60.04
Rate for Payer: UnitedHealthcare Medicaid	$13.04
Rate for Payer: UnitedHealthcare Medicare	$60.04
Rate for Payer: University Health Alliance Commercial	$24.38

HC CULT STOOL

Facility

$79.00

Service Code	HCPCS 87045
Hospital Charge Code	3068704501
Hospital Revenue Code	306
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

HC CULTURE HERPES SO

Facility

$219.00

Service Code	HCPCS 87252
Hospital Charge Code	3068725201
Hospital Revenue Code	306
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$212.43
Rate for Payer: AlohaCare Medicaid	$109.50
Rate for Payer: AlohaCare Medicare	$166.44
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cash Price	$131.40
Rate for Payer: Devoted Health Medicare	$183.96
Rate for Payer: Hawaii Medical Service Association ABD	$36.02
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$166.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.82
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Humana Medicare	$166.44
Rate for Payer: Kaiser Permanente Commercial	$197.10
Rate for Payer: Kaiser Permanente Medicaid	$111.69
Rate for Payer: Kaiser Permanente Medicare	$166.44
Rate for Payer: MDX Hawaii PPO	$212.43
Rate for Payer: Ohana Health Plan Medicaid	$166.44
Rate for Payer: Ohana Health Plan Medicare	$166.44
Rate for Payer: UnitedHealthcare Medicaid	$36.02
Rate for Payer: UnitedHealthcare Medicare	$166.44
Rate for Payer: University Health Alliance Commercial	$67.38

HC CULTURE HERPES SO

Facility

$219.00

Service Code	HCPCS 87252
Hospital Charge Code	3068725201
Hospital Revenue Code	306
Min. Negotiated Rate	$186.15
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$131.40
Rate for Payer: Health Management Network Commercial	$186.15
Rate for Payer: Kaiser Permanente Commercial	$197.10
Rate for Payer: MDX Hawaii PPO	$212.43

HC CULT URINE

Facility

$68.00

Service Code	HCPCS 87086
Hospital Charge Code	3068708601
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$51.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$57.12
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$51.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$51.68
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$51.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$51.68
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$51.68
Rate for Payer: University Health Alliance Commercial	$20.87

HC CULT URINE

Facility

$68.00

Service Code	HCPCS 87086
Hospital Charge Code	3068708601
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

HC CULT URINE ID

Facility

$68.00

Service Code	HCPCS 87088
Hospital Charge Code	3068708801
Hospital Revenue Code	306
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

Know your out-of-pocket cost for care.

All Charges