Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

OMNIFIT HIP STEM#4 #6097-0425

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#4 #6097-0425

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.00
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$2,352.96
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$2,600.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,352.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$2,352.96
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$2,352.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$2,352.96
Rate for Payer: Ohana Health Plan Medicare	$2,352.96
Rate for Payer: UnitedHealthcare Medicare	$2,352.96
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#5 #6097-0530

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.00
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$2,352.96
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$2,600.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,352.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$2,352.96
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$2,352.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$2,352.96
Rate for Payer: Ohana Health Plan Medicare	$2,352.96
Rate for Payer: UnitedHealthcare Medicare	$2,352.96
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#5 #6097-0530

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#6 #6097-0630

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,751.12
Max. Negotiated Rate	$3,033.19
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: Kaiser Permanente Commercial	$2,814.30
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM#6 #6097-0630

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,563.50
Max. Negotiated Rate	$3,033.19
Rate for Payer: AlohaCare Medicaid	$1,563.50
Rate for Payer: AlohaCare Medicare	$2,376.52
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Devoted Health Medicare	$2,626.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,376.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: Humana Medicare	$2,376.52
Rate for Payer: Kaiser Permanente Commercial	$2,814.30
Rate for Payer: Kaiser Permanente Medicaid	$1,594.77
Rate for Payer: Kaiser Permanente Medicare	$2,376.52
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: Ohana Health Plan Medicaid	$2,376.52
Rate for Payer: Ohana Health Plan Medicare	$2,376.52
Rate for Payer: UnitedHealthcare Medicare	$2,376.52
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM #7 6097-0735

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,563.50
Max. Negotiated Rate	$3,033.19
Rate for Payer: AlohaCare Medicaid	$1,563.50
Rate for Payer: AlohaCare Medicare	$2,376.52
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Devoted Health Medicare	$2,626.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,376.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: Humana Medicare	$2,376.52
Rate for Payer: Kaiser Permanente Commercial	$2,814.30
Rate for Payer: Kaiser Permanente Medicaid	$1,594.77
Rate for Payer: Kaiser Permanente Medicare	$2,376.52
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: Ohana Health Plan Medicaid	$2,376.52
Rate for Payer: Ohana Health Plan Medicare	$2,376.52
Rate for Payer: UnitedHealthcare Medicare	$2,376.52
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM #7 6097-0735

Facility

$3,127.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,751.12
Max. Negotiated Rate	$3,033.19
Rate for Payer: Cash Price	$1,876.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,188.90
Rate for Payer: Health Management Network Commercial	$2,657.95
Rate for Payer: Kaiser Permanente Commercial	$2,814.30
Rate for Payer: MDX Hawaii PPO	$3,033.19
Rate for Payer: University Health Alliance Commercial	$1,751.12

OMNIFIT HIP STEM #8 #6097-0835

Facility

$10,332.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,785.92
Max. Negotiated Rate	$10,022.04
Rate for Payer: Cash Price	$6,199.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,232.40
Rate for Payer: Health Management Network Commercial	$8,782.20
Rate for Payer: Kaiser Permanente Commercial	$9,298.80
Rate for Payer: MDX Hawaii PPO	$10,022.04
Rate for Payer: University Health Alliance Commercial	$5,785.92

OMNIFIT HIP STEM #8 #6097-0835

Facility

$10,332.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,166.00
Max. Negotiated Rate	$10,022.04
Rate for Payer: AlohaCare Medicaid	$5,166.00
Rate for Payer: AlohaCare Medicare	$7,852.32
Rate for Payer: Cash Price	$6,199.20
Rate for Payer: Devoted Health Medicare	$8,678.88
Rate for Payer: Hawaii Medical Service Association Medicare	$7,852.32
Rate for Payer: Hawaii Western Management Group Commercial	$7,232.40
Rate for Payer: Health Management Network Commercial	$8,782.20
Rate for Payer: Humana Medicare	$7,852.32
Rate for Payer: Kaiser Permanente Commercial	$9,298.80
Rate for Payer: Kaiser Permanente Medicaid	$5,269.32
Rate for Payer: Kaiser Permanente Medicare	$7,852.32
Rate for Payer: MDX Hawaii PPO	$10,022.04
Rate for Payer: Ohana Health Plan Medicaid	$7,852.32
Rate for Payer: Ohana Health Plan Medicare	$7,852.32
Rate for Payer: UnitedHealthcare Medicare	$7,852.32
Rate for Payer: University Health Alliance Commercial	$5,785.92

OMNIFIT HIP STEM#9 #6097-0940

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,548.00
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$2,352.96
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$2,600.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,352.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$2,352.96
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$2,352.96
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$2,352.96
Rate for Payer: Ohana Health Plan Medicare	$2,352.96
Rate for Payer: UnitedHealthcare Medicare	$2,352.96
Rate for Payer: University Health Alliance Commercial	$1,733.76

OMNIFIT HIP STEM#9 #6097-0940

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [100610]

Facility

$1,172.00

Service Code	HCPCS J0585
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$1,136.84
Rate for Payer: AlohaCare Medicaid	$586.00
Rate for Payer: AlohaCare Medicare	$890.72
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Devoted Health Medicare	$984.48
Rate for Payer: Hawaii Medical Service Association ABD	$6.50
Rate for Payer: Hawaii Medical Service Association Commercial	$8.14
Rate for Payer: Hawaii Medical Service Association Medicare	$890.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,113.40
Rate for Payer: Health Management Network Commercial	$996.20
Rate for Payer: Humana Medicare	$890.72
Rate for Payer: Kaiser Permanente Commercial	$1,054.80
Rate for Payer: Kaiser Permanente Medicaid	$597.72
Rate for Payer: Kaiser Permanente Medicare	$890.72
Rate for Payer: MDX Hawaii PPO	$1,136.84
Rate for Payer: Ohana Health Plan Medicaid	$890.72
Rate for Payer: Ohana Health Plan Medicare	$890.72
Rate for Payer: UnitedHealthcare Medicaid	$703.20
Rate for Payer: UnitedHealthcare Medicare	$890.72
Rate for Payer: University Health Alliance Commercial	$854.27

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [100610]

Facility

$1,172.00

Service Code	HCPCS J0585
Hospital Revenue Code	250
Min. Negotiated Rate	$996.20
Max. Negotiated Rate	$1,136.84
Rate for Payer: Cash Price	$703.20
Rate for Payer: Health Management Network Commercial	$996.20
Rate for Payer: Kaiser Permanente Commercial	$1,054.80
Rate for Payer: MDX Hawaii PPO	$1,136.84

ONCONTROL BONE LESION TRAY

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: MDX Hawaii PPO	$582.00

ONCONTROL BONE LESION TRAY

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$582.00
Rate for Payer: AlohaCare Medicaid	$300.00
Rate for Payer: AlohaCare Medicare	$456.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Devoted Health Medicare	$504.00
Rate for Payer: Hawaii Medical Service Association Medicare	$456.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Humana Medicare	$456.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: Kaiser Permanente Medicare	$456.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: Ohana Health Plan Medicaid	$456.00
Rate for Payer: Ohana Health Plan Medicare	$456.00
Rate for Payer: UnitedHealthcare Medicare	$456.00
Rate for Payer: University Health Alliance Commercial	$437.34

ONCONTROL BONE MARROW TRAY

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$582.00
Rate for Payer: AlohaCare Medicaid	$300.00
Rate for Payer: AlohaCare Medicare	$456.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Devoted Health Medicare	$504.00
Rate for Payer: Hawaii Medical Service Association Medicare	$456.00
Rate for Payer: Hawaii Western Management Group Commercial	$570.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Humana Medicare	$456.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: Kaiser Permanente Medicare	$456.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: Ohana Health Plan Medicaid	$456.00
Rate for Payer: Ohana Health Plan Medicare	$456.00
Rate for Payer: UnitedHealthcare Medicare	$456.00
Rate for Payer: University Health Alliance Commercial	$437.34

ONCONTROL BONE MARROW TRAY

Facility

$600.00

Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: MDX Hawaii PPO	$582.00

ONDANSETRON 16 MG IN 50 ML NS IVPB-CNR FROM MDV (SIMPLE) [4080023]

Facility

$16.00

Service Code	HCPCS J2405
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

ONDANSETRON 16 MG IN 50 ML NS IVPB-CNR FROM MDV (SIMPLE) [4080023]

Facility

$16.00

Service Code	HCPCS J2405
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]

Facility

$58.00

Service Code	HCPCS Q0162
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$29.00
Rate for Payer: AlohaCare Medicaid	$28.00
Rate for Payer: AlohaCare Medicare	$42.56
Rate for Payer: AlohaCare Medicare	$44.08
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$47.04
Rate for Payer: Devoted Health Medicare	$48.72
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$42.56
Rate for Payer: Hawaii Medical Service Association Medicare	$44.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$53.20
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$42.56
Rate for Payer: Humana Medicare	$44.08
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$42.56
Rate for Payer: Kaiser Permanente Medicare	$44.08
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$44.08
Rate for Payer: Ohana Health Plan Medicaid	$42.56
Rate for Payer: Ohana Health Plan Medicare	$42.56
Rate for Payer: Ohana Health Plan Medicare	$44.08
Rate for Payer: UnitedHealthcare Medicaid	$33.60
Rate for Payer: UnitedHealthcare Medicaid	$34.80
Rate for Payer: UnitedHealthcare Medicare	$44.08
Rate for Payer: UnitedHealthcare Medicare	$42.56
Rate for Payer: University Health Alliance Commercial	$40.82
Rate for Payer: University Health Alliance Commercial	$42.28

ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]

Facility

$56.00

Service Code	HCPCS Q0162
Hospital Revenue Code	250
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: MDX Hawaii PPO	$56.26

ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]

Facility

$37.00

Service Code	HCPCS J2405
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]

Facility

$37.00

Service Code	HCPCS J2405
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$28.12
Rate for Payer: Cash Price	$22.20
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$31.08
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$28.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$28.12
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$28.12
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$28.12
Rate for Payer: Ohana Health Plan Medicare	$28.12
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$28.12
Rate for Payer: University Health Alliance Commercial	$26.97

ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]

Facility

$7.00

Service Code	HCPCS J2405
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: MDX Hawaii PPO	$5.82

Know your out-of-pocket cost for care.

All Charges