Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

BUSPIRONE 15 MG TABLET [17464]

Facility

$8.00

Service Code	NDC 68382018201
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

BUSPIRONE 15 MG TABLET [17464]

Facility

$8.00

Service Code	NDC 29300024601
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

BUSPIRONE 15 MG TABLET [17464]

Facility

$8.00

Service Code	NDC 68382018201
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

BUSPIRONE 15 MG TABLET [17464]

Facility

$8.00

Service Code	NDC 29300024601
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

BUSPIRONE 15 MG TABLET [17464]

Facility

$3.00

Service Code	NDC 60687082301
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

BUSPIRONE 15 MG TABLET [17464]

Facility

$3.00

Service Code	NDC 60687082311
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

BUSPIRONE 15 MG TABLET [17464]

Facility

$3.00

Service Code	NDC 60687082311
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

BUSPIRONE 5 MG TABLET [9324]

Facility

$3.00

Service Code	NDC 51079098520
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

BUSPIRONE 5 MG TABLET [9324]

Facility

$3.00

Service Code	NDC 00093005301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

BUSPIRONE 5 MG TABLET [9324]

Facility

$3.00

Service Code	NDC 00093005301
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

BUSPIRONE 5 MG TABLET [9324]

Facility

$3.00

Service Code	NDC 29300024401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

BUSPIRONE 5 MG TABLET [9324]

Facility

$3.00

Service Code	NDC 29300024401
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

BUSPIRONE 5 MG TABLET [9324]

Facility

$3.00

Service Code	NDC 51079098520
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

BUTTON DOG BONE AR-2270

Facility

$1,752.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$981.12
Max. Negotiated Rate	$1,699.44
Rate for Payer: Cash Price	$1,051.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,226.40
Rate for Payer: Health Management Network Commercial	$1,489.20
Rate for Payer: Kaiser Permanente Commercial	$1,576.80
Rate for Payer: MDX Hawaii PPO	$1,699.44
Rate for Payer: University Health Alliance Commercial	$981.12

BUTTON DOG BONE AR-2270

Facility

$1,752.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$876.00
Max. Negotiated Rate	$1,699.44
Rate for Payer: AlohaCare Medicaid	$876.00
Rate for Payer: AlohaCare Medicare	$1,331.52
Rate for Payer: Cash Price	$1,051.20
Rate for Payer: Devoted Health Medicare	$1,471.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,331.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,226.40
Rate for Payer: Health Management Network Commercial	$1,489.20
Rate for Payer: Humana Medicare	$1,331.52
Rate for Payer: Kaiser Permanente Commercial	$1,576.80
Rate for Payer: Kaiser Permanente Medicaid	$893.52
Rate for Payer: Kaiser Permanente Medicare	$1,331.52
Rate for Payer: MDX Hawaii PPO	$1,699.44
Rate for Payer: Ohana Health Plan Medicaid	$1,331.52
Rate for Payer: Ohana Health Plan Medicare	$1,331.52
Rate for Payer: UnitedHealthcare Medicare	$1,331.52
Rate for Payer: University Health Alliance Commercial	$981.12

BUTTRESS DORSAL PIN 27MM BP27

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$647.50
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$984.20
Rate for Payer: Cash Price	$777.00
Rate for Payer: Devoted Health Medicare	$1,087.80
Rate for Payer: Hawaii Medical Service Association Medicare	$984.20
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$984.20
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$984.20
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$984.20
Rate for Payer: Ohana Health Plan Medicare	$984.20
Rate for Payer: UnitedHealthcare Medicare	$984.20
Rate for Payer: University Health Alliance Commercial	$725.20

BUTTRESS DORSAL PIN 27MM BP27

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

BUTTRESS DORSAL PIN 32MM BP32

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$647.50
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$984.20
Rate for Payer: Cash Price	$777.00
Rate for Payer: Devoted Health Medicare	$1,087.80
Rate for Payer: Hawaii Medical Service Association Medicare	$984.20
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$984.20
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$984.20
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$984.20
Rate for Payer: Ohana Health Plan Medicare	$984.20
Rate for Payer: UnitedHealthcare Medicare	$984.20
Rate for Payer: University Health Alliance Commercial	$725.20

BUTTRESS DORSAL PIN 32MM BP32

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION [105644]

Facility

$12,160.00

Service Code	HCPCS J9043
Hospital Revenue Code	250
Min. Negotiated Rate	$10,336.00
Max. Negotiated Rate	$11,795.20
Rate for Payer: Cash Price	$7,296.00
Rate for Payer: Cash Price	$3,751.20
Rate for Payer: Health Management Network Commercial	$10,336.00
Rate for Payer: Health Management Network Commercial	$5,314.20
Rate for Payer: Kaiser Permanente Commercial	$10,944.00
Rate for Payer: Kaiser Permanente Commercial	$5,626.80
Rate for Payer: MDX Hawaii PPO	$6,064.44
Rate for Payer: MDX Hawaii PPO	$11,795.20

CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION [105644]

Facility

$12,160.00

Service Code	HCPCS J9043
Hospital Revenue Code	636
Min. Negotiated Rate	$227.10
Max. Negotiated Rate	$11,795.20
Rate for Payer: AlohaCare Medicaid	$6,080.00
Rate for Payer: AlohaCare Medicaid	$3,126.00
Rate for Payer: AlohaCare Medicare	$4,751.52
Rate for Payer: AlohaCare Medicare	$9,241.60
Rate for Payer: Cash Price	$3,751.20
Rate for Payer: Cash Price	$7,296.00
Rate for Payer: Cash Price	$3,751.20
Rate for Payer: Cash Price	$7,296.00
Rate for Payer: Devoted Health Medicare	$10,214.40
Rate for Payer: Devoted Health Medicare	$5,251.68
Rate for Payer: Hawaii Medical Service Association ABD	$227.10
Rate for Payer: Hawaii Medical Service Association ABD	$227.10
Rate for Payer: Hawaii Medical Service Association Commercial	$288.81
Rate for Payer: Hawaii Medical Service Association Commercial	$288.81
Rate for Payer: Hawaii Medical Service Association Medicare	$4,751.52
Rate for Payer: Hawaii Medical Service Association Medicare	$9,241.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$227.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$227.10
Rate for Payer: Hawaii Western Management Group Commercial	$11,552.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,939.40
Rate for Payer: Health Management Network Commercial	$5,314.20
Rate for Payer: Health Management Network Commercial	$10,336.00
Rate for Payer: Humana Medicare	$9,241.60
Rate for Payer: Humana Medicare	$4,751.52
Rate for Payer: Kaiser Permanente Commercial	$10,944.00
Rate for Payer: Kaiser Permanente Commercial	$5,626.80
Rate for Payer: Kaiser Permanente Medicaid	$3,188.52
Rate for Payer: Kaiser Permanente Medicaid	$6,201.60
Rate for Payer: Kaiser Permanente Medicare	$9,241.60
Rate for Payer: Kaiser Permanente Medicare	$4,751.52
Rate for Payer: MDX Hawaii PPO	$11,795.20
Rate for Payer: MDX Hawaii PPO	$6,064.44
Rate for Payer: Ohana Health Plan Medicaid	$4,751.52
Rate for Payer: Ohana Health Plan Medicaid	$9,241.60
Rate for Payer: Ohana Health Plan Medicare	$9,241.60
Rate for Payer: Ohana Health Plan Medicare	$4,751.52
Rate for Payer: UnitedHealthcare Medicaid	$3,751.20
Rate for Payer: UnitedHealthcare Medicaid	$7,296.00
Rate for Payer: UnitedHealthcare Medicare	$9,241.60
Rate for Payer: UnitedHealthcare Medicare	$4,751.52
Rate for Payer: University Health Alliance Commercial	$8,863.42
Rate for Payer: University Health Alliance Commercial	$4,557.08

CABAZITAXEL 60 MG/6ML IV (AFTER FIRST DILUTION) (WET SOLN VIAL) [430105644]

Facility

$12,160.00

Service Code	HCPCS J9043
Hospital Revenue Code	636
Min. Negotiated Rate	$227.10
Max. Negotiated Rate	$11,795.20
Rate for Payer: AlohaCare Medicaid	$6,080.00
Rate for Payer: AlohaCare Medicare	$9,241.60
Rate for Payer: Cash Price	$7,296.00
Rate for Payer: Cash Price	$7,296.00
Rate for Payer: Devoted Health Medicare	$10,214.40
Rate for Payer: Hawaii Medical Service Association ABD	$227.10
Rate for Payer: Hawaii Medical Service Association Commercial	$288.81
Rate for Payer: Hawaii Medical Service Association Medicare	$9,241.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$227.10
Rate for Payer: Hawaii Western Management Group Commercial	$11,552.00
Rate for Payer: Health Management Network Commercial	$10,336.00
Rate for Payer: Humana Medicare	$9,241.60
Rate for Payer: Kaiser Permanente Commercial	$10,944.00
Rate for Payer: Kaiser Permanente Medicaid	$6,201.60
Rate for Payer: Kaiser Permanente Medicare	$9,241.60
Rate for Payer: MDX Hawaii PPO	$11,795.20
Rate for Payer: Ohana Health Plan Medicaid	$9,241.60
Rate for Payer: Ohana Health Plan Medicare	$9,241.60
Rate for Payer: UnitedHealthcare Medicaid	$7,296.00
Rate for Payer: UnitedHealthcare Medicare	$9,241.60
Rate for Payer: University Health Alliance Commercial	$8,863.42

CABAZITAXEL 60 MG/6ML IV (AFTER FIRST DILUTION) (WET SOLN VIAL) [430105644]

Facility

$12,160.00

Service Code	HCPCS J9043
Hospital Revenue Code	250
Min. Negotiated Rate	$10,336.00
Max. Negotiated Rate	$11,795.20
Rate for Payer: Cash Price	$7,296.00
Rate for Payer: Health Management Network Commercial	$10,336.00
Rate for Payer: Kaiser Permanente Commercial	$10,944.00
Rate for Payer: MDX Hawaii PPO	$11,795.20

CABLE 1.7X750MM #298.801.01S

Facility

$1,745.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$872.50
Max. Negotiated Rate	$1,692.65
Rate for Payer: AlohaCare Medicaid	$872.50
Rate for Payer: AlohaCare Medicare	$1,326.20
Rate for Payer: Cash Price	$1,047.00
Rate for Payer: Devoted Health Medicare	$1,465.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,326.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,657.75
Rate for Payer: Health Management Network Commercial	$1,483.25
Rate for Payer: Humana Medicare	$1,326.20
Rate for Payer: Kaiser Permanente Commercial	$1,570.50
Rate for Payer: Kaiser Permanente Medicaid	$889.95
Rate for Payer: Kaiser Permanente Medicare	$1,326.20
Rate for Payer: MDX Hawaii PPO	$1,692.65
Rate for Payer: Ohana Health Plan Medicaid	$1,326.20
Rate for Payer: Ohana Health Plan Medicare	$1,326.20
Rate for Payer: UnitedHealthcare Medicare	$1,326.20
Rate for Payer: University Health Alliance Commercial	$1,271.93

CABLE 1.7X750MM #298.801.01S

Facility

$1,745.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$1,483.25
Max. Negotiated Rate	$1,692.65
Rate for Payer: Cash Price	$1,047.00
Rate for Payer: Health Management Network Commercial	$1,483.25
Rate for Payer: Kaiser Permanente Commercial	$1,570.50
Rate for Payer: MDX Hawaii PPO	$1,692.65

Know your out-of-pocket cost for care.

All Charges