Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$35,363.38

Service Code	MSDRG 147
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$35,363.38

Service Code	MSDRG 146
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$35,363.38

Service Code	MSDRG 148
Min. Negotiated Rate	$35,363.38
Max. Negotiated Rate	$35,363.38
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38

EAR SYRINGE

Facility

$199.00

Hospital Charge Code	8091
Hospital Revenue Code	270
Min. Negotiated Rate	$83.58
Max. Negotiated Rate	$193.03
Rate for Payer: AlohaCare Medicaid	$99.50
Rate for Payer: AlohaCare Medicare	$83.58
Rate for Payer: Cash Price	$129.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$183.08
Rate for Payer: Devoted Health Medicare	$83.58
Rate for Payer: Hawaii Medical Service Association Medicare	$83.58
Rate for Payer: Hawaii Western Management Group Commercial	$189.05
Rate for Payer: Health Management Network Commercial	$169.15
Rate for Payer: Humana Medicare	$83.58
Rate for Payer: Kaiser Permanente Commercial	$179.10
Rate for Payer: Kaiser Permanente Medicaid	$101.49
Rate for Payer: Kaiser Permanente Medicare	$83.58
Rate for Payer: MDX Hawaii PPO	$193.03
Rate for Payer: Ohana Health Plan Medicaid	$83.58
Rate for Payer: Ohana Health Plan Medicare	$83.58
Rate for Payer: UnitedHealthcare Medicare	$83.58
Rate for Payer: University Health Alliance Commercial	$145.05

EAR SYRINGE

Facility

$199.00

Hospital Charge Code	8091
Hospital Revenue Code	270
Min. Negotiated Rate	$169.15
Max. Negotiated Rate	$193.03
Rate for Payer: Cash Price	$129.35
Rate for Payer: Health Management Network Commercial	$169.15
Rate for Payer: Kaiser Permanente Commercial	$179.10
Rate for Payer: MDX Hawaii PPO	$193.03

EBV Antibody to Nuclear Ag, IgG DLS

Facility

$49.00

Service Code	HCPCS 86663
Hospital Charge Code	422866635
Hospital Revenue Code	302
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$47.53
Rate for Payer: AlohaCare Medicaid	$24.50
Rate for Payer: AlohaCare Medicare	$20.58
Rate for Payer: Cash Price	$31.85
Rate for Payer: Cash Price	$31.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$45.08
Rate for Payer: Devoted Health Medicare	$20.58
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.13
Rate for Payer: Hawaii Medical Service Association Commercial	$16.40
Rate for Payer: Hawaii Medical Service Association Medicare	$20.58
Rate for Payer: Hawaii Western Management Group Commercial	$13.12
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Humana Medicare	$20.58
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$24.99
Rate for Payer: Kaiser Permanente Medicare	$20.58
Rate for Payer: MDX Hawaii PPO	$47.53
Rate for Payer: Ohana Health Plan Medicaid	$20.58
Rate for Payer: Ohana Health Plan Medicare	$20.58
Rate for Payer: UnitedHealthcare Medicaid	$18.13
Rate for Payer: UnitedHealthcare Medicare	$20.58
Rate for Payer: University Health Alliance Commercial	$33.91

EBV Antibody to Nuclear Ag, IgG DLS

Facility

$49.00

Service Code	HCPCS 86663
Hospital Charge Code	422866635
Hospital Revenue Code	302
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$31.85
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: MDX Hawaii PPO	$47.53

EBV Antibody to VCA, IgG DLS

Facility

$21.00

Service Code	HCPCS 86644
Hospital Charge Code	422866635
Hospital Revenue Code	302
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$37.20
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$8.82
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19.32
Rate for Payer: Devoted Health Medicare	$8.82
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$8.82
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$8.82
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$8.82
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$8.82
Rate for Payer: Ohana Health Plan Medicare	$8.82
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$8.82
Rate for Payer: University Health Alliance Commercial	$37.20

EBV Antibody to VCA, IgG DLS

Facility

$21.00

Service Code	HCPCS 86644
Hospital Charge Code	422866635
Hospital Revenue Code	302
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$13.65
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

EBV Antibody to VCA, IgM DLS

Facility

$203.00

Service Code	HCPCS 86665
Hospital Charge Code	422866635
Hospital Revenue Code	302
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$196.91
Rate for Payer: AlohaCare Medicaid	$101.50
Rate for Payer: AlohaCare Medicare	$85.26
Rate for Payer: Cash Price	$131.95
Rate for Payer: Cash Price	$131.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$186.76
Rate for Payer: Devoted Health Medicare	$85.26
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$25.07
Rate for Payer: Hawaii Medical Service Association Commercial	$22.68
Rate for Payer: Hawaii Medical Service Association Medicare	$85.26
Rate for Payer: Hawaii Western Management Group Commercial	$18.14
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Humana Medicare	$85.26
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: Kaiser Permanente Medicare	$85.26
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: Ohana Health Plan Medicaid	$85.26
Rate for Payer: Ohana Health Plan Medicare	$85.26
Rate for Payer: UnitedHealthcare Medicaid	$25.07
Rate for Payer: UnitedHealthcare Medicare	$85.26
Rate for Payer: University Health Alliance Commercial	$46.90

EBV Antibody to VCA, IgM DLS

Facility

$203.00

Service Code	HCPCS 86665
Hospital Charge Code	422866635
Hospital Revenue Code	302
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$131.95
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: MDX Hawaii PPO	$196.91

ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY

Professional

Both

$28.00

Service Code	HCPCS 93010
Hospital Revenue Code	730
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$23.80
Rate for Payer: AlohaCare Medicaid	$8.14
Rate for Payer: AlohaCare Medicare	$8.53
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$8.53
Rate for Payer: Hawaii Western Management Group Commercial	$11.56
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$10.24
Rate for Payer: Kaiser Permanente Medicaid	$10.24
Rate for Payer: Kaiser Permanente Medicare	$10.24
Rate for Payer: Ohana Health Plan Medicaid	$8.14
Rate for Payer: Ohana Health Plan Medicare	$8.53
Rate for Payer: UnitedHealthcare Medicaid	$8.14
Rate for Payer: UnitedHealthcare Medicare	$8.53

ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R

Professional

Both

$101.00

Service Code	HCPCS 93005
Hospital Revenue Code	730
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$85.85
Rate for Payer: AlohaCare Medicaid	$7.07
Rate for Payer: AlohaCare Medicare	$7.79
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Devoted Health Medicare	$7.79
Rate for Payer: Hawaii Medical Service Association Medicare	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$19.01
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$9.35
Rate for Payer: Kaiser Permanente Medicaid	$9.35
Rate for Payer: Kaiser Permanente Medicare	$9.35
Rate for Payer: Ohana Health Plan Medicaid	$7.07
Rate for Payer: Ohana Health Plan Medicare	$7.79
Rate for Payer: UnitedHealthcare Medicaid	$7.07
Rate for Payer: UnitedHealthcare Medicare	$7.79

ECG ROUTINE ECG W/LEAST 12 LDS W/I&R

Professional

Both

$53.00

Service Code	HCPCS 93000
Hospital Revenue Code	730
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$45.05
Rate for Payer: AlohaCare Medicaid	$15.21
Rate for Payer: AlohaCare Medicare	$16.32
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$16.32
Rate for Payer: Hawaii Medical Service Association Medicare	$16.32
Rate for Payer: Hawaii Western Management Group Commercial	$30.55
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$19.58
Rate for Payer: Kaiser Permanente Medicaid	$19.58
Rate for Payer: Kaiser Permanente Medicare	$19.58
Rate for Payer: Ohana Health Plan Medicaid	$15.21
Rate for Payer: Ohana Health Plan Medicare	$16.32
Rate for Payer: UnitedHealthcare Medicaid	$15.21
Rate for Payer: UnitedHealthcare Medicare	$16.32

ECHOCARDIOGRAM F U OR LIMITED

Facility

$534.00

Service Code	HCPCS 93308
Hospital Charge Code	424933080
Hospital Revenue Code	483
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$517.98
Rate for Payer: AlohaCare Medicaid	$267.00
Rate for Payer: AlohaCare Medicare	$224.28
Rate for Payer: Cash Price	$347.10
Rate for Payer: Cash Price	$347.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$491.28
Rate for Payer: Devoted Health Medicare	$224.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$64.51
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$224.28
Rate for Payer: Hawaii Western Management Group Commercial	$507.30
Rate for Payer: Health Management Network Commercial	$453.90
Rate for Payer: Humana Medicare	$224.28
Rate for Payer: Kaiser Permanente Commercial	$480.60
Rate for Payer: Kaiser Permanente Medicaid	$272.34
Rate for Payer: Kaiser Permanente Medicare	$224.28
Rate for Payer: MDX Hawaii PPO	$517.98
Rate for Payer: Ohana Health Plan Medicaid	$224.28
Rate for Payer: Ohana Health Plan Medicare	$224.28
Rate for Payer: UnitedHealthcare Medicaid	$64.51
Rate for Payer: UnitedHealthcare Medicare	$224.28
Rate for Payer: University Health Alliance Commercial	$389.23

ECHOCARDIOGRAM F U OR LIMITED

Facility

$534.00

Service Code	HCPCS 93308
Hospital Charge Code	424933080
Hospital Revenue Code	483
Min. Negotiated Rate	$453.90
Max. Negotiated Rate	$517.98
Rate for Payer: Cash Price	$347.10
Rate for Payer: Health Management Network Commercial	$453.90
Rate for Payer: Kaiser Permanente Commercial	$480.60
Rate for Payer: MDX Hawaii PPO	$517.98

Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording;

Facility

$361.00

Service Code	HCPCS 76825
Hospital Charge Code	424768259
Hospital Revenue Code	972
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$234.65
Rate for Payer: Cash Price	$221.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: MDX Hawaii PPO	$350.17

Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording;

Facility

$340.00

Service Code	HCPCS 76825
Hospital Charge Code	424768259
Hospital Revenue Code	972
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$806.88
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicaid	$180.50
Rate for Payer: AlohaCare Medicare	$151.62
Rate for Payer: AlohaCare Medicare	$142.80
Rate for Payer: Cash Price	$221.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Cash Price	$234.65
Rate for Payer: Cash Price	$234.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$332.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$312.80
Rate for Payer: Devoted Health Medicare	$142.80
Rate for Payer: Devoted Health Medicare	$151.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$64.94
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$64.94
Rate for Payer: Hawaii Medical Service Association Commercial	$806.88
Rate for Payer: Hawaii Medical Service Association Commercial	$806.88
Rate for Payer: Hawaii Medical Service Association Medicare	$142.80
Rate for Payer: Hawaii Medical Service Association Medicare	$151.62
Rate for Payer: Hawaii Western Management Group Commercial	$645.50
Rate for Payer: Hawaii Western Management Group Commercial	$645.50
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$142.80
Rate for Payer: Humana Medicare	$151.62
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: Kaiser Permanente Medicare	$151.62
Rate for Payer: Kaiser Permanente Medicare	$142.80
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: Ohana Health Plan Medicaid	$142.80
Rate for Payer: Ohana Health Plan Medicaid	$151.62
Rate for Payer: Ohana Health Plan Medicare	$142.80
Rate for Payer: Ohana Health Plan Medicare	$151.62
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicare	$151.62
Rate for Payer: UnitedHealthcare Medicare	$142.80
Rate for Payer: University Health Alliance Commercial	$350.61
Rate for Payer: University Health Alliance Commercial	$350.61

Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abno

Facility

$138.00

Service Code	HCPCS 76506
Hospital Charge Code	424765069
Hospital Revenue Code	972
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$89.70
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abno

Facility

$138.00

Service Code	HCPCS 76506
Hospital Charge Code	424765069
Hospital Revenue Code	972
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$185.93
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$57.96
Rate for Payer: Cash Price	$89.70
Rate for Payer: Cash Price	$89.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$126.96
Rate for Payer: Devoted Health Medicare	$57.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$46.98
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$57.96
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$57.96
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$57.96
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$57.96
Rate for Payer: Ohana Health Plan Medicare	$57.96
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$57.96
Rate for Payer: University Health Alliance Commercial	$185.93

Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnor

Facility

$131.00

Service Code	HCPCS 76506
Hospital Charge Code	424765069
Hospital Revenue Code	972
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$85.15
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

Facility

$131.00

Service Code	HCPCS 76506
Hospital Charge Code	424765069
Hospital Revenue Code	972
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$185.93
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$55.02
Rate for Payer: Cash Price	$85.15
Rate for Payer: Cash Price	$85.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$120.52
Rate for Payer: Devoted Health Medicare	$55.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$46.98
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$55.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$55.02
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$55.02
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$55.02
Rate for Payer: Ohana Health Plan Medicare	$55.02
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$55.02
Rate for Payer: University Health Alliance Commercial	$185.93

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$466,787.19

Service Code	MSDRG 003
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$466,787.19
Rate for Payer: Hawaii Medical Service Association Commercial	$466,787.19
Rate for Payer: University Health Alliance Commercial	$10,400.00

econazole topical 1% Cream [KMC]

Facility

$28.98

Service Code	NDC 51672130302
Hospital Revenue Code	250
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$28.11
Rate for Payer: AlohaCare Medicaid	$14.49
Rate for Payer: AlohaCare Medicare	$12.17
Rate for Payer: Cash Price	$18.84
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$26.66
Rate for Payer: Devoted Health Medicare	$12.17
Rate for Payer: Hawaii Medical Service Association Medicare	$12.17
Rate for Payer: Hawaii Western Management Group Commercial	$27.53
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Humana Medicare	$12.17
Rate for Payer: Kaiser Permanente Commercial	$26.08
Rate for Payer: Kaiser Permanente Medicaid	$14.78
Rate for Payer: Kaiser Permanente Medicare	$12.17
Rate for Payer: MDX Hawaii PPO	$28.11
Rate for Payer: Ohana Health Plan Medicaid	$12.17
Rate for Payer: Ohana Health Plan Medicare	$12.17
Rate for Payer: UnitedHealthcare Medicaid	$17.39
Rate for Payer: UnitedHealthcare Medicare	$12.17
Rate for Payer: University Health Alliance Commercial	$21.12

econazole topical 1% Cream [KMC]

Facility

$28.98

Service Code	NDC 51672130302
Hospital Revenue Code	250
Min. Negotiated Rate	$24.63
Max. Negotiated Rate	$28.11
Rate for Payer: Cash Price	$18.84
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Kaiser Permanente Commercial	$26.08
Rate for Payer: MDX Hawaii PPO	$28.11

Know your out-of-pocket cost for care.

All Charges