Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRIATHLON 38X11MM 5551-G-381-E

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.52
Max. Negotiated Rate	$2,247.49
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: University Health Alliance Commercial	$1,297.52

TRIATHLON 38X11MM 5551-G-381-E

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.50
Max. Negotiated Rate	$2,247.49
Rate for Payer: Kaiser Permanente Medicare	$1,760.92
Rate for Payer: AlohaCare Medicaid	$1,158.50
Rate for Payer: AlohaCare Medicare	$1,760.92
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Devoted Health Medicare	$1,946.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,760.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Humana Medicare	$1,760.92
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: Kaiser Permanente Medicaid	$1,181.67
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: Ohana Health Plan Medicaid	$1,760.92
Rate for Payer: Ohana Health Plan Medicare	$1,760.92
Rate for Payer: UnitedHealthcare Medicare	$1,760.92
Rate for Payer: University Health Alliance Commercial	$1,297.52

TRIATHLON ALL POLY 5534-A-511

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,622.00
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$2,465.44
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$2,724.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,465.44
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$2,465.44
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$2,465.44
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$2,465.44
Rate for Payer: Ohana Health Plan Medicare	$2,465.44
Rate for Payer: UnitedHealthcare Medicare	$2,465.44
Rate for Payer: University Health Alliance Commercial	$1,816.64

TRIATHLON ALL POLY 5534-A-511

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

TRIATHLON ALLPOLY 5534-A-713

Facility

$3,211.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.50
Max. Negotiated Rate	$3,114.67
Rate for Payer: AlohaCare Medicaid	$1,605.50
Rate for Payer: AlohaCare Medicare	$2,440.36
Rate for Payer: Cash Price	$1,926.60
Rate for Payer: Devoted Health Medicare	$2,697.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,440.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,247.70
Rate for Payer: Health Management Network Commercial	$2,729.35
Rate for Payer: Humana Medicare	$2,440.36
Rate for Payer: Kaiser Permanente Commercial	$2,889.90
Rate for Payer: Kaiser Permanente Medicaid	$1,637.61
Rate for Payer: Kaiser Permanente Medicare	$2,440.36
Rate for Payer: MDX Hawaii PPO	$3,114.67
Rate for Payer: Ohana Health Plan Medicaid	$2,440.36
Rate for Payer: Ohana Health Plan Medicare	$2,440.36
Rate for Payer: UnitedHealthcare Medicare	$2,440.36
Rate for Payer: University Health Alliance Commercial	$1,798.16

TRIATHLON ALLPOLY 5534-A-713

Facility

$3,211.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.16
Max. Negotiated Rate	$3,114.67
Rate for Payer: Cash Price	$1,926.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,247.70
Rate for Payer: Health Management Network Commercial	$2,729.35
Rate for Payer: Kaiser Permanente Commercial	$2,889.90
Rate for Payer: MDX Hawaii PPO	$3,114.67
Rate for Payer: University Health Alliance Commercial	$1,798.16

TRIATHLON CR FEM 5517-F-701

Facility

$5,887.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,296.72
Max. Negotiated Rate	$5,710.39
Rate for Payer: Cash Price	$3,532.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,120.90
Rate for Payer: Health Management Network Commercial	$5,003.95
Rate for Payer: Kaiser Permanente Commercial	$5,298.30
Rate for Payer: MDX Hawaii PPO	$5,710.39
Rate for Payer: University Health Alliance Commercial	$3,296.72

TRIATHLON CR FEM 5517-F-701

Facility

$5,887.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,943.50
Max. Negotiated Rate	$5,710.39
Rate for Payer: AlohaCare Medicaid	$2,943.50
Rate for Payer: AlohaCare Medicare	$4,474.12
Rate for Payer: Cash Price	$3,532.20
Rate for Payer: Devoted Health Medicare	$4,945.08
Rate for Payer: Hawaii Medical Service Association Medicare	$4,474.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,120.90
Rate for Payer: Health Management Network Commercial	$5,003.95
Rate for Payer: Humana Medicare	$4,474.12
Rate for Payer: Kaiser Permanente Commercial	$5,298.30
Rate for Payer: Kaiser Permanente Medicaid	$3,002.37
Rate for Payer: Kaiser Permanente Medicare	$4,474.12
Rate for Payer: MDX Hawaii PPO	$5,710.39
Rate for Payer: Ohana Health Plan Medicaid	$4,474.12
Rate for Payer: Ohana Health Plan Medicare	$4,474.12
Rate for Payer: UnitedHealthcare Medicare	$4,474.12
Rate for Payer: University Health Alliance Commercial	$3,296.72

TRIATHLON CR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicaid	$2,162.50
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: AlohaCare Medicare	$3,287.00
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Devoted Health Medicare	$3,633.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,287.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Humana Medicare	$3,287.00
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicaid	$2,205.75
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Medicare	$3,287.00
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicaid	$3,287.00
Rate for Payer: Ohana Health Plan Medicare	$3,287.00
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,287.00
Rate for Payer: University Health Alliance Commercial	$2,397.92
Rate for Payer: University Health Alliance Commercial	$2,422.00

TRIATHLON CR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: University Health Alliance Commercial	$2,422.00
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLONCR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLONCR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CR FEMUR COMP

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CR FEMUR COMP

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CRUCIATE 5510-F-201

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CRUCIATE 5510-F-201

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON FEM SZ2 5515-F-201

Facility

$4,325.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,162.50
Max. Negotiated Rate	$4,195.25
Rate for Payer: AlohaCare Medicaid	$2,162.50
Rate for Payer: AlohaCare Medicare	$3,287.00
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Devoted Health Medicare	$3,633.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,287.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Humana Medicare	$3,287.00
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: Kaiser Permanente Medicaid	$2,205.75
Rate for Payer: Kaiser Permanente Medicare	$3,287.00
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: Ohana Health Plan Medicaid	$3,287.00
Rate for Payer: Ohana Health Plan Medicare	$3,287.00
Rate for Payer: UnitedHealthcare Medicare	$3,287.00
Rate for Payer: University Health Alliance Commercial	$2,422.00

TRIATHLON FEM SZ2 5515-F-201

Facility

$4,325.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.00
Max. Negotiated Rate	$4,195.25
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: University Health Alliance Commercial	$2,422.00

TRIATHLON FEM SZ#4 5515-F-402

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON FEM SZ#4 5515-F-402

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON INSERT 5531-G-513-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

TRIATHLON INSERT 5531-G-513-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

TRIATHLON INSERT 5531-G-609-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.00
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$2,033.76
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$2,247.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,033.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$2,033.76
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$2,033.76
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$2,033.76
Rate for Payer: Ohana Health Plan Medicare	$2,033.76
Rate for Payer: UnitedHealthcare Medicare	$2,033.76
Rate for Payer: University Health Alliance Commercial	$1,498.56

TRIATHLON INSERT 5531-G-609-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

TRIATHLON INSERT 5531-G-809-E

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

Know your out-of-pocket cost for care.

All Charges