|
DRILL 3.3X110MM 4806-110-33
|
Facility
|
OP
|
$638.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.78 |
| Max. Negotiated Rate |
$618.86 |
| Rate for Payer: AlohaCare Medicaid |
$319.00
|
| Rate for Payer: AlohaCare Medicare |
$197.78
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Devoted Health Medicare |
$216.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.10
|
| Rate for Payer: Health Management Network Commercial |
$542.30
|
| Rate for Payer: Humana Medicare |
$197.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$574.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.78
|
| Rate for Payer: MDX Hawaii PPO |
$618.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$197.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.78
|
| Rate for Payer: University Health Alliance Commercial |
$465.04
|
|
|
DRILL 3.5 700353
|
Facility
|
IP
|
$1,043.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.55 |
| Max. Negotiated Rate |
$1,011.71 |
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Health Management Network Commercial |
$886.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$938.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,011.71
|
|
|
DRILL 3.5 700353
|
Facility
|
OP
|
$1,043.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$323.33 |
| Max. Negotiated Rate |
$1,011.71 |
| Rate for Payer: AlohaCare Medicaid |
$521.50
|
| Rate for Payer: AlohaCare Medicare |
$323.33
|
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Devoted Health Medicare |
$354.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$323.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$990.85
|
| Rate for Payer: Health Management Network Commercial |
$886.55
|
| Rate for Payer: Humana Medicare |
$323.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$938.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.33
|
| Rate for Payer: MDX Hawaii PPO |
$1,011.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$323.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$323.33
|
| Rate for Payer: University Health Alliance Commercial |
$760.24
|
|
|
DRILL 3.5X130 1806-3550S
|
Facility
|
IP
|
$739.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.15 |
| Max. Negotiated Rate |
$716.83 |
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Health Management Network Commercial |
$628.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$665.10
|
| Rate for Payer: MDX Hawaii PPO |
$716.83
|
|
|
DRILL 3.5X130 1806-3550S
|
Facility
|
OP
|
$739.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$716.83 |
| Rate for Payer: AlohaCare Medicaid |
$369.50
|
| Rate for Payer: AlohaCare Medicare |
$229.09
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Devoted Health Medicare |
$251.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$229.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$702.05
|
| Rate for Payer: Health Management Network Commercial |
$628.15
|
| Rate for Payer: Humana Medicare |
$229.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$665.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.09
|
| Rate for Payer: MDX Hawaii PPO |
$716.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$229.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$229.09
|
| Rate for Payer: University Health Alliance Commercial |
$538.66
|
|
|
DRILL 4.0 220MM DRILL-4.0/220C
|
Facility
|
OP
|
$1,278.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.18 |
| Max. Negotiated Rate |
$1,239.66 |
| Rate for Payer: AlohaCare Medicaid |
$639.00
|
| Rate for Payer: AlohaCare Medicare |
$396.18
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Devoted Health Medicare |
$434.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$396.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,214.10
|
| Rate for Payer: Health Management Network Commercial |
$1,086.30
|
| Rate for Payer: Humana Medicare |
$396.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,150.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$651.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.18
|
| Rate for Payer: MDX Hawaii PPO |
$1,239.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$396.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$396.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$396.18
|
| Rate for Payer: University Health Alliance Commercial |
$931.53
|
|
|
DRILL 4.0 220MM DRILL-4.0/220C
|
Facility
|
IP
|
$1,278.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,086.30 |
| Max. Negotiated Rate |
$1,239.66 |
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Health Management Network Commercial |
$1,086.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,150.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,239.66
|
|
|
DRILL 4.2X180MM 1806-4270S
|
Facility
|
OP
|
$1,253.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.43 |
| Max. Negotiated Rate |
$1,215.41 |
| Rate for Payer: AlohaCare Medicaid |
$626.50
|
| Rate for Payer: AlohaCare Medicare |
$388.43
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Devoted Health Medicare |
$426.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$388.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,190.35
|
| Rate for Payer: Health Management Network Commercial |
$1,065.05
|
| Rate for Payer: Humana Medicare |
$388.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,127.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$639.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$388.43
|
| Rate for Payer: MDX Hawaii PPO |
$1,215.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$388.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$388.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$388.43
|
| Rate for Payer: University Health Alliance Commercial |
$913.31
|
|
|
DRILL 4.2X180MM 1806-4270S
|
Facility
|
IP
|
$1,253.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,065.05 |
| Max. Negotiated Rate |
$1,215.41 |
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Health Management Network Commercial |
$1,065.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,127.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,215.41
|
|
|
DRILL 4.2X230MM 1806-4290S
|
Facility
|
OP
|
$1,257.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.67 |
| Max. Negotiated Rate |
$1,219.29 |
| Rate for Payer: AlohaCare Medicaid |
$628.50
|
| Rate for Payer: AlohaCare Medicare |
$389.67
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Devoted Health Medicare |
$427.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,194.15
|
| Rate for Payer: Health Management Network Commercial |
$1,068.45
|
| Rate for Payer: Humana Medicare |
$389.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,131.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$641.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.67
|
| Rate for Payer: MDX Hawaii PPO |
$1,219.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.67
|
| Rate for Payer: University Health Alliance Commercial |
$916.23
|
|
|
DRILL 4.2X230MM 1806-4290S
|
Facility
|
IP
|
$1,257.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,068.45 |
| Max. Negotiated Rate |
$1,219.29 |
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Health Management Network Commercial |
$1,068.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,131.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,219.29
|
|
|
DRILL 4.2X300MM 1320-3042S
|
Facility
|
IP
|
$944.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.40 |
| Max. Negotiated Rate |
$915.68 |
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Health Management Network Commercial |
$802.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$849.60
|
| Rate for Payer: MDX Hawaii PPO |
$915.68
|
|
|
DRILL 4.2X300MM 1320-3042S
|
Facility
|
OP
|
$944.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.64 |
| Max. Negotiated Rate |
$915.68 |
| Rate for Payer: AlohaCare Medicaid |
$472.00
|
| Rate for Payer: AlohaCare Medicare |
$292.64
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Devoted Health Medicare |
$320.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$292.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$896.80
|
| Rate for Payer: Health Management Network Commercial |
$802.40
|
| Rate for Payer: Humana Medicare |
$292.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$849.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$292.64
|
| Rate for Payer: MDX Hawaii PPO |
$915.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$292.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$292.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$292.64
|
| Rate for Payer: University Health Alliance Commercial |
$688.08
|
|
|
DRILL 4.2X340MM 1806-4260S
|
Facility
|
IP
|
$898.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$763.30 |
| Max. Negotiated Rate |
$871.06 |
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Health Management Network Commercial |
$763.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$808.20
|
| Rate for Payer: MDX Hawaii PPO |
$871.06
|
|
|
DRILL 4.2X340MM 1806-4260S
|
Facility
|
OP
|
$898.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.38 |
| Max. Negotiated Rate |
$871.06 |
| Rate for Payer: AlohaCare Medicaid |
$449.00
|
| Rate for Payer: AlohaCare Medicare |
$278.38
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Devoted Health Medicare |
$305.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$853.10
|
| Rate for Payer: Health Management Network Commercial |
$763.30
|
| Rate for Payer: Humana Medicare |
$278.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$808.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$457.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.38
|
| Rate for Payer: MDX Hawaii PPO |
$871.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$278.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.38
|
| Rate for Payer: University Health Alliance Commercial |
$654.55
|
|
|
DRILL 4.5/6.5X485MM 03.010.078
|
Facility
|
IP
|
$1,809.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.65 |
| Max. Negotiated Rate |
$1,754.73 |
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Health Management Network Commercial |
$1,537.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,628.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,754.73
|
|
|
DRILL 4.5/6.5X485MM 03.010.078
|
Facility
|
OP
|
$1,809.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.79 |
| Max. Negotiated Rate |
$1,754.73 |
| Rate for Payer: AlohaCare Medicaid |
$904.50
|
| Rate for Payer: AlohaCare Medicare |
$560.79
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Devoted Health Medicare |
$615.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$560.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,718.55
|
| Rate for Payer: Health Management Network Commercial |
$1,537.65
|
| Rate for Payer: Humana Medicare |
$560.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,628.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$922.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$560.79
|
| Rate for Payer: MDX Hawaii PPO |
$1,754.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$560.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$560.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$560.79
|
| Rate for Payer: University Health Alliance Commercial |
$1,318.58
|
|
|
DRILL 4.6X220MM P99-110-4622
|
Facility
|
IP
|
$1,037.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.45 |
| Max. Negotiated Rate |
$1,005.89 |
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Health Management Network Commercial |
$881.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$933.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,005.89
|
|
|
DRILL 4.6X220MM P99-110-4622
|
Facility
|
OP
|
$1,037.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.47 |
| Max. Negotiated Rate |
$1,005.89 |
| Rate for Payer: AlohaCare Medicaid |
$518.50
|
| Rate for Payer: AlohaCare Medicare |
$321.47
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Devoted Health Medicare |
$352.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$985.15
|
| Rate for Payer: Health Management Network Commercial |
$881.45
|
| Rate for Payer: Humana Medicare |
$321.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$933.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$528.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.47
|
| Rate for Payer: MDX Hawaii PPO |
$1,005.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$321.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.47
|
| Rate for Payer: University Health Alliance Commercial |
$755.87
|
|
|
DRILL 4.7MM CANN QR 316-0016
|
Facility
|
IP
|
$1,225.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,041.25 |
| Max. Negotiated Rate |
$1,188.25 |
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Health Management Network Commercial |
$1,041.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,102.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,188.25
|
|
|
DRILL 4.7MM CANN QR 316-0016
|
Facility
|
OP
|
$1,225.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.75 |
| Max. Negotiated Rate |
$1,188.25 |
| Rate for Payer: AlohaCare Medicaid |
$612.50
|
| Rate for Payer: AlohaCare Medicare |
$379.75
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Devoted Health Medicare |
$416.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,163.75
|
| Rate for Payer: Health Management Network Commercial |
$1,041.25
|
| Rate for Payer: Humana Medicare |
$379.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$624.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,188.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.75
|
| Rate for Payer: University Health Alliance Commercial |
$892.90
|
|
|
DRILL 5.0X230 1806-5000S
|
Facility
|
OP
|
$898.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.38 |
| Max. Negotiated Rate |
$871.06 |
| Rate for Payer: AlohaCare Medicaid |
$449.00
|
| Rate for Payer: AlohaCare Medicare |
$278.38
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Devoted Health Medicare |
$305.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$853.10
|
| Rate for Payer: Health Management Network Commercial |
$763.30
|
| Rate for Payer: Humana Medicare |
$278.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$808.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$457.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$278.38
|
| Rate for Payer: MDX Hawaii PPO |
$871.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$278.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.38
|
| Rate for Payer: University Health Alliance Commercial |
$654.55
|
|
|
DRILL 5.0X230 1806-5000S
|
Facility
|
IP
|
$898.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$763.30 |
| Max. Negotiated Rate |
$871.06 |
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Health Management Network Commercial |
$763.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$808.20
|
| Rate for Payer: MDX Hawaii PPO |
$871.06
|
|
|
DRILL 6/5MM THREADED 395.923
|
Facility
|
OP
|
$896.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.76 |
| Max. Negotiated Rate |
$869.12 |
| Rate for Payer: AlohaCare Medicaid |
$448.00
|
| Rate for Payer: AlohaCare Medicare |
$277.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Devoted Health Medicare |
$304.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$851.20
|
| Rate for Payer: Health Management Network Commercial |
$761.60
|
| Rate for Payer: Humana Medicare |
$277.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$806.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$456.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$277.76
|
| Rate for Payer: MDX Hawaii PPO |
$869.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$277.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$277.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$277.76
|
| Rate for Payer: University Health Alliance Commercial |
$653.09
|
|
|
DRILL 6/5MM THREADED 395.923
|
Facility
|
IP
|
$896.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.60 |
| Max. Negotiated Rate |
$869.12 |
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Health Management Network Commercial |
$761.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$806.40
|
| Rate for Payer: MDX Hawaii PPO |
$869.12
|
|