Kau Hospital

All Charges

Charge

Type

Setting

Price

TICAGRELOR 60 MG TABLET [130191]

Facility

$28.00

Service Code	NDC 00186077660
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

TICAGRELOR 90 MG TABLET [110427]

Facility

$28.00

Service Code	NDC 00186077739
Hospital Revenue Code	637
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: University Health Alliance Commercial	$20.41

TICAGRELOR 90 MG TABLET [110427]

Facility

$28.00

Service Code	NDC 00186077739
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

TI END CAP 0MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$873.00
Rate for Payer: AlohaCare Medicaid	$450.00
Rate for Payer: AlohaCare Medicare	$279.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Devoted Health Medicare	$306.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Humana Medicare	$279.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: Kaiser Permanente Medicare	$279.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: Ohana Health Plan Medicaid	$279.00
Rate for Payer: Ohana Health Plan Medicare	$279.00
Rate for Payer: UnitedHealthcare Medicare	$279.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 0MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 10MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$873.00
Rate for Payer: AlohaCare Medicaid	$450.00
Rate for Payer: AlohaCare Medicare	$279.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Devoted Health Medicare	$306.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Humana Medicare	$279.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: Kaiser Permanente Medicare	$279.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: Ohana Health Plan Medicaid	$279.00
Rate for Payer: Ohana Health Plan Medicare	$279.00
Rate for Payer: UnitedHealthcare Medicare	$279.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 10MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 15MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$873.00
Rate for Payer: AlohaCare Medicaid	$450.00
Rate for Payer: AlohaCare Medicare	$279.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Devoted Health Medicare	$306.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Humana Medicare	$279.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: Kaiser Permanente Medicare	$279.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: Ohana Health Plan Medicaid	$279.00
Rate for Payer: Ohana Health Plan Medicare	$279.00
Rate for Payer: UnitedHealthcare Medicare	$279.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 15MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 5MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$873.00
Rate for Payer: AlohaCare Medicaid	$450.00
Rate for Payer: AlohaCare Medicare	$279.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Devoted Health Medicare	$306.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Humana Medicare	$279.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: Kaiser Permanente Medicare	$279.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: Ohana Health Plan Medicaid	$279.00
Rate for Payer: Ohana Health Plan Medicare	$279.00
Rate for Payer: UnitedHealthcare Medicare	$279.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP 5MM STRDRV T25

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

TI END CAP T40X0MM 04.003.000

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X0MM 04.003.000

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$442.96
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X10MM 04.003.002

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X10MM 04.003.002

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$442.96
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X15MM 04.003.003

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$442.96
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X15MM 04.003.003

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X20MM 04.003.004

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X20MM 04.003.004

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$442.96
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X5MM 04.003.001

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$442.96

TI END CAP T40X5MM 04.003.001

Facility

$791.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$442.96
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Hawaii Western Management Group Commercial	$553.70
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: University Health Alliance Commercial	$442.96

TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]

Facility

$235.00

Service Code	HCPCS J3243
Hospital Revenue Code	250
Min. Negotiated Rate	$199.75
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$141.00
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$168.60
Rate for Payer: Health Management Network Commercial	$238.85
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$252.90
Rate for Payer: Kaiser Permanente Commercial	$170.10
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: MDX Hawaii PPO	$183.33
Rate for Payer: MDX Hawaii PPO	$272.57

TIGECYCLINE 50 MG INTRAVENOUS SOLUTION [41652]

Facility

$235.00

Service Code	HCPCS J3243
Hospital Revenue Code	636
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$227.95
Rate for Payer: AlohaCare Medicaid	$117.50
Rate for Payer: AlohaCare Medicaid	$140.50
Rate for Payer: AlohaCare Medicaid	$94.50
Rate for Payer: AlohaCare Medicare	$87.11
Rate for Payer: AlohaCare Medicare	$58.59
Rate for Payer: AlohaCare Medicare	$72.85
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$168.60
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$168.60
Rate for Payer: Cash Price	$141.00
Rate for Payer: Cash Price	$141.00
Rate for Payer: Devoted Health Medicare	$95.54
Rate for Payer: Devoted Health Medicare	$79.90
Rate for Payer: Devoted Health Medicare	$64.26
Rate for Payer: Hawaii Medical Service Association ABD	$3.18
Rate for Payer: Hawaii Medical Service Association ABD	$3.18
Rate for Payer: Hawaii Medical Service Association ABD	$3.18
Rate for Payer: Hawaii Medical Service Association Medicare	$72.85
Rate for Payer: Hawaii Medical Service Association Medicare	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$58.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.18
Rate for Payer: Hawaii Western Management Group Commercial	$266.95
Rate for Payer: Hawaii Western Management Group Commercial	$179.55
Rate for Payer: Hawaii Western Management Group Commercial	$223.25
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Health Management Network Commercial	$238.85
Rate for Payer: Humana Medicare	$72.85
Rate for Payer: Humana Medicare	$58.59
Rate for Payer: Humana Medicare	$87.11
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: Kaiser Permanente Commercial	$252.90
Rate for Payer: Kaiser Permanente Commercial	$170.10
Rate for Payer: Kaiser Permanente Medicaid	$119.85
Rate for Payer: Kaiser Permanente Medicaid	$143.31
Rate for Payer: Kaiser Permanente Medicaid	$96.39
Rate for Payer: Kaiser Permanente Medicare	$72.85
Rate for Payer: Kaiser Permanente Medicare	$58.59
Rate for Payer: Kaiser Permanente Medicare	$87.11
Rate for Payer: MDX Hawaii PPO	$272.57
Rate for Payer: MDX Hawaii PPO	$183.33
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: Ohana Health Plan Medicaid	$72.85
Rate for Payer: Ohana Health Plan Medicaid	$87.11
Rate for Payer: Ohana Health Plan Medicaid	$58.59
Rate for Payer: Ohana Health Plan Medicare	$87.11
Rate for Payer: Ohana Health Plan Medicare	$58.59
Rate for Payer: Ohana Health Plan Medicare	$72.85
Rate for Payer: UnitedHealthcare Medicaid	$113.40
Rate for Payer: UnitedHealthcare Medicaid	$141.00
Rate for Payer: UnitedHealthcare Medicaid	$168.60
Rate for Payer: UnitedHealthcare Medicare	$58.59
Rate for Payer: UnitedHealthcare Medicare	$87.11
Rate for Payer: UnitedHealthcare Medicare	$72.85
Rate for Payer: University Health Alliance Commercial	$204.82
Rate for Payer: University Health Alliance Commercial	$171.29
Rate for Payer: University Health Alliance Commercial	$137.76

TIGHTROPE ABS 14MM AR-1588TB-1

Facility

$1,071.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.01
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$332.01
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$364.14
Rate for Payer: Hawaii Medical Service Association Medicare	$332.01
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$332.01
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$332.01
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$332.01
Rate for Payer: Ohana Health Plan Medicare	$332.01
Rate for Payer: UnitedHealthcare Medicare	$332.01
Rate for Payer: University Health Alliance Commercial	$599.76

TIGHTROPE ABS 14MM AR-1588TB-1

Facility

$1,071.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

Know your out-of-pocket cost for care.

All Charges