Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

neomyc-bacitrac-polymyx UD ointment [HHSC]

Facility

$3.00

Service Code	NDC 45802014370
Hospital Charge Code	2500098
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

neomyc-bacitrac-polymyx UD ointment [HHSC]

Facility

$3.00

Service Code	NDC 57896014314
Hospital Charge Code	2500098
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

neomyc-bacitrac-polymyx UD ointment [HHSC]

Facility

$3.00

Service Code	NDC 57896014314
Hospital Charge Code	2500098
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

neomyc-bacitrac-polymyx UD ointment [HHSC]

Facility

$3.00

Service Code	NDC 00904880567
Hospital Charge Code	2500098
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

neomyc-bacitrac-polymyx UD ointment [HHSC]

Facility

$3.00

Service Code	NDC 45802014370
Hospital Charge Code	2500098
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

neomyc-bacitrac-polymyx UD ointment [HHSC]

Facility

$3.00

Service Code	NDC 00904880567
Hospital Charge Code	2500098
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

neomy/polyB/grami 10ml ophth soln [HHSC]

Facility

$313.61

Service Code	NDC 24208079062
Hospital Charge Code	2500367
Hospital Revenue Code	250
Min. Negotiated Rate	$156.81
Max. Negotiated Rate	$304.20
Rate for Payer: AlohaCare Medicaid	$156.81
Rate for Payer: AlohaCare Medicare	$156.81
Rate for Payer: Cash Price	$203.85
Rate for Payer: Devoted Health Medicare	$172.49
Rate for Payer: Hawaii Medical Service Association Medicare	$156.81
Rate for Payer: Hawaii Western Management Group Commercial	$297.93
Rate for Payer: Health Management Network Commercial	$266.57
Rate for Payer: Humana Medicare	$156.81
Rate for Payer: Kaiser Permanente Commercial	$282.25
Rate for Payer: Kaiser Permanente Medicaid	$159.94
Rate for Payer: Kaiser Permanente Medicare	$156.81
Rate for Payer: MDX Hawaii PPO	$304.20
Rate for Payer: Ohana Health Plan Medicaid	$156.81
Rate for Payer: Ohana Health Plan Medicare	$156.81
Rate for Payer: UnitedHealthcare Medicaid	$188.17
Rate for Payer: UnitedHealthcare Medicare	$156.81
Rate for Payer: University Health Alliance Commercial	$228.59

neomy/polyB/grami 10ml ophth soln [HHSC]

Facility

$313.61

Service Code	NDC 24208079062
Hospital Charge Code	2500367
Hospital Revenue Code	250
Min. Negotiated Rate	$266.57
Max. Negotiated Rate	$304.20
Rate for Payer: Cash Price	$203.85
Rate for Payer: Health Management Network Commercial	$266.57
Rate for Payer: Kaiser Permanente Commercial	$282.25
Rate for Payer: MDX Hawaii PPO	$304.20

neomy/polyb/HC 10ml otic drops [HHSC]

Facility

$450.80

Service Code	NDC 24208063562
Hospital Charge Code	2500396
Hospital Revenue Code	250
Min. Negotiated Rate	$225.40
Max. Negotiated Rate	$437.28
Rate for Payer: AlohaCare Medicaid	$225.40
Rate for Payer: AlohaCare Medicare	$225.40
Rate for Payer: Cash Price	$293.02
Rate for Payer: Devoted Health Medicare	$247.94
Rate for Payer: Hawaii Medical Service Association Medicare	$225.40
Rate for Payer: Hawaii Western Management Group Commercial	$428.26
Rate for Payer: Health Management Network Commercial	$383.18
Rate for Payer: Humana Medicare	$225.40
Rate for Payer: Kaiser Permanente Commercial	$405.72
Rate for Payer: Kaiser Permanente Medicaid	$229.91
Rate for Payer: Kaiser Permanente Medicare	$225.40
Rate for Payer: MDX Hawaii PPO	$437.28
Rate for Payer: Ohana Health Plan Medicaid	$225.40
Rate for Payer: Ohana Health Plan Medicare	$225.40
Rate for Payer: UnitedHealthcare Medicaid	$270.48
Rate for Payer: UnitedHealthcare Medicare	$225.40
Rate for Payer: University Health Alliance Commercial	$328.59

neomy/polyb/HC 10ml otic drops [HHSC]

Facility

$489.08

Service Code	NDC 64980044801
Hospital Charge Code	2500396
Hospital Revenue Code	250
Min. Negotiated Rate	$415.72
Max. Negotiated Rate	$474.41
Rate for Payer: Cash Price	$317.90
Rate for Payer: Health Management Network Commercial	$415.72
Rate for Payer: Kaiser Permanente Commercial	$440.17
Rate for Payer: MDX Hawaii PPO	$474.41

neomy/polyb/HC 10ml otic drops [HHSC]

Facility

$450.80

Service Code	NDC 61314064511
Hospital Charge Code	2500396
Hospital Revenue Code	250
Min. Negotiated Rate	$383.18
Max. Negotiated Rate	$437.28
Rate for Payer: Cash Price	$293.02
Rate for Payer: Health Management Network Commercial	$383.18
Rate for Payer: Kaiser Permanente Commercial	$405.72
Rate for Payer: MDX Hawaii PPO	$437.28

neomy/polyb/HC 10ml otic drops [HHSC]

Facility

$489.08

Service Code	NDC 64980044801
Hospital Charge Code	2500396
Hospital Revenue Code	250
Min. Negotiated Rate	$244.54
Max. Negotiated Rate	$474.41
Rate for Payer: AlohaCare Medicaid	$244.54
Rate for Payer: AlohaCare Medicare	$244.54
Rate for Payer: Cash Price	$317.90
Rate for Payer: Devoted Health Medicare	$268.99
Rate for Payer: Hawaii Medical Service Association Medicare	$244.54
Rate for Payer: Hawaii Western Management Group Commercial	$464.63
Rate for Payer: Health Management Network Commercial	$415.72
Rate for Payer: Humana Medicare	$244.54
Rate for Payer: Kaiser Permanente Commercial	$440.17
Rate for Payer: Kaiser Permanente Medicaid	$249.43
Rate for Payer: Kaiser Permanente Medicare	$244.54
Rate for Payer: MDX Hawaii PPO	$474.41
Rate for Payer: Ohana Health Plan Medicaid	$244.54
Rate for Payer: Ohana Health Plan Medicare	$244.54
Rate for Payer: UnitedHealthcare Medicaid	$293.45
Rate for Payer: UnitedHealthcare Medicare	$244.54
Rate for Payer: University Health Alliance Commercial	$356.49

neomy/polyb/HC 10ml otic drops [HHSC]

Facility

$450.80

Service Code	NDC 61314064511
Hospital Charge Code	2500396
Hospital Revenue Code	250
Min. Negotiated Rate	$225.40
Max. Negotiated Rate	$437.28
Rate for Payer: AlohaCare Medicaid	$225.40
Rate for Payer: AlohaCare Medicare	$225.40
Rate for Payer: Cash Price	$293.02
Rate for Payer: Devoted Health Medicare	$247.94
Rate for Payer: Hawaii Medical Service Association Medicare	$225.40
Rate for Payer: Hawaii Western Management Group Commercial	$428.26
Rate for Payer: Health Management Network Commercial	$383.18
Rate for Payer: Humana Medicare	$225.40
Rate for Payer: Kaiser Permanente Commercial	$405.72
Rate for Payer: Kaiser Permanente Medicaid	$229.91
Rate for Payer: Kaiser Permanente Medicare	$225.40
Rate for Payer: MDX Hawaii PPO	$437.28
Rate for Payer: Ohana Health Plan Medicaid	$225.40
Rate for Payer: Ohana Health Plan Medicare	$225.40
Rate for Payer: UnitedHealthcare Medicaid	$270.48
Rate for Payer: UnitedHealthcare Medicare	$225.40
Rate for Payer: University Health Alliance Commercial	$328.59

neomy/polyb/HC 10ml otic drops [HHSC]

Facility

$450.80

Service Code	NDC 24208063562
Hospital Charge Code	2500396
Hospital Revenue Code	250
Min. Negotiated Rate	$383.18
Max. Negotiated Rate	$437.28
Rate for Payer: Cash Price	$293.02
Rate for Payer: Health Management Network Commercial	$383.18
Rate for Payer: Kaiser Permanente Commercial	$405.72
Rate for Payer: MDX Hawaii PPO	$437.28

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$69,298.13

Service Code	MSDRG 789
Min. Negotiated Rate	$69,298.13
Max. Negotiated Rate	$69,298.13
Rate for Payer: Hawaii Medical Service Association Commercial	$69,298.13

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$4,334.32

Service Code	MSDRG 794
Min. Negotiated Rate	$4,334.32
Max. Negotiated Rate	$4,334.32
Rate for Payer: Hawaii Medical Service Association Commercial	$4,334.32

neostigmine 10 mg/10 ml vial [HHSC]

Facility

$55.34

Service Code	HCPCS J2710
Hospital Charge Code	2500578
Hospital Revenue Code	250
Min. Negotiated Rate	$47.04
Max. Negotiated Rate	$53.68
Rate for Payer: Cash Price	$35.97
Rate for Payer: Cash Price	$71.66
Rate for Payer: Cash Price	$40.48
Rate for Payer: Cash Price	$9.54
Rate for Payer: Cash Price	$66.22
Rate for Payer: Health Management Network Commercial	$12.48
Rate for Payer: Health Management Network Commercial	$47.04
Rate for Payer: Health Management Network Commercial	$52.94
Rate for Payer: Health Management Network Commercial	$93.70
Rate for Payer: Health Management Network Commercial	$86.59
Rate for Payer: Kaiser Permanente Commercial	$13.21
Rate for Payer: Kaiser Permanente Commercial	$91.68
Rate for Payer: Kaiser Permanente Commercial	$99.22
Rate for Payer: Kaiser Permanente Commercial	$49.81
Rate for Payer: Kaiser Permanente Commercial	$56.05
Rate for Payer: MDX Hawaii PPO	$53.68
Rate for Payer: MDX Hawaii PPO	$106.93
Rate for Payer: MDX Hawaii PPO	$98.81
Rate for Payer: MDX Hawaii PPO	$14.24
Rate for Payer: MDX Hawaii PPO	$60.41

neostigmine 10 mg/10 ml vial [HHSC]

Facility

$62.28

Service Code	HCPCS J2710
Hospital Charge Code	2500578
Hospital Revenue Code	636
Min. Negotiated Rate	$31.14
Max. Negotiated Rate	$60.41
Rate for Payer: AlohaCare Medicaid	$31.14
Rate for Payer: AlohaCare Medicaid	$55.12
Rate for Payer: AlohaCare Medicaid	$7.34
Rate for Payer: AlohaCare Medicaid	$27.67
Rate for Payer: AlohaCare Medicaid	$50.94
Rate for Payer: AlohaCare Medicare	$27.67
Rate for Payer: AlohaCare Medicare	$31.14
Rate for Payer: AlohaCare Medicare	$7.34
Rate for Payer: AlohaCare Medicare	$55.12
Rate for Payer: AlohaCare Medicare	$50.94
Rate for Payer: Cash Price	$35.97
Rate for Payer: Cash Price	$9.54
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cash Price	$71.66
Rate for Payer: Cash Price	$40.48
Rate for Payer: Devoted Health Medicare	$56.03
Rate for Payer: Devoted Health Medicare	$34.25
Rate for Payer: Devoted Health Medicare	$8.07
Rate for Payer: Devoted Health Medicare	$60.63
Rate for Payer: Devoted Health Medicare	$30.44
Rate for Payer: Hawaii Medical Service Association Medicare	$31.14
Rate for Payer: Hawaii Medical Service Association Medicare	$50.94
Rate for Payer: Hawaii Medical Service Association Medicare	$27.67
Rate for Payer: Hawaii Medical Service Association Medicare	$7.34
Rate for Payer: Hawaii Medical Service Association Medicare	$55.12
Rate for Payer: Hawaii Western Management Group Commercial	$13.95
Rate for Payer: Hawaii Western Management Group Commercial	$104.73
Rate for Payer: Hawaii Western Management Group Commercial	$52.57
Rate for Payer: Hawaii Western Management Group Commercial	$96.78
Rate for Payer: Hawaii Western Management Group Commercial	$59.17
Rate for Payer: Health Management Network Commercial	$93.70
Rate for Payer: Health Management Network Commercial	$12.48
Rate for Payer: Health Management Network Commercial	$86.59
Rate for Payer: Health Management Network Commercial	$47.04
Rate for Payer: Health Management Network Commercial	$52.94
Rate for Payer: Humana Medicare	$55.12
Rate for Payer: Humana Medicare	$27.67
Rate for Payer: Humana Medicare	$31.14
Rate for Payer: Humana Medicare	$7.34
Rate for Payer: Humana Medicare	$50.94
Rate for Payer: Kaiser Permanente Commercial	$13.21
Rate for Payer: Kaiser Permanente Commercial	$91.68
Rate for Payer: Kaiser Permanente Commercial	$56.05
Rate for Payer: Kaiser Permanente Commercial	$99.22
Rate for Payer: Kaiser Permanente Commercial	$49.81
Rate for Payer: Kaiser Permanente Medicaid	$51.95
Rate for Payer: Kaiser Permanente Medicaid	$56.22
Rate for Payer: Kaiser Permanente Medicaid	$7.49
Rate for Payer: Kaiser Permanente Medicaid	$28.22
Rate for Payer: Kaiser Permanente Medicaid	$31.76
Rate for Payer: Kaiser Permanente Medicare	$7.34
Rate for Payer: Kaiser Permanente Medicare	$55.12
Rate for Payer: Kaiser Permanente Medicare	$50.94
Rate for Payer: Kaiser Permanente Medicare	$27.67
Rate for Payer: Kaiser Permanente Medicare	$31.14
Rate for Payer: MDX Hawaii PPO	$106.93
Rate for Payer: MDX Hawaii PPO	$14.24
Rate for Payer: MDX Hawaii PPO	$60.41
Rate for Payer: MDX Hawaii PPO	$53.68
Rate for Payer: MDX Hawaii PPO	$98.81
Rate for Payer: Ohana Health Plan Medicaid	$50.94
Rate for Payer: Ohana Health Plan Medicaid	$31.14
Rate for Payer: Ohana Health Plan Medicaid	$7.34
Rate for Payer: Ohana Health Plan Medicaid	$27.67
Rate for Payer: Ohana Health Plan Medicaid	$55.12
Rate for Payer: Ohana Health Plan Medicare	$55.12
Rate for Payer: Ohana Health Plan Medicare	$27.67
Rate for Payer: Ohana Health Plan Medicare	$7.34
Rate for Payer: Ohana Health Plan Medicare	$31.14
Rate for Payer: Ohana Health Plan Medicare	$50.94
Rate for Payer: UnitedHealthcare Medicaid	$37.37
Rate for Payer: UnitedHealthcare Medicaid	$8.81
Rate for Payer: UnitedHealthcare Medicaid	$66.14
Rate for Payer: UnitedHealthcare Medicaid	$61.12
Rate for Payer: UnitedHealthcare Medicaid	$33.20
Rate for Payer: UnitedHealthcare Medicare	$50.94
Rate for Payer: UnitedHealthcare Medicare	$55.12
Rate for Payer: UnitedHealthcare Medicare	$27.67
Rate for Payer: UnitedHealthcare Medicare	$31.14
Rate for Payer: UnitedHealthcare Medicare	$7.34
Rate for Payer: University Health Alliance Commercial	$74.25
Rate for Payer: University Health Alliance Commercial	$10.70
Rate for Payer: University Health Alliance Commercial	$80.35
Rate for Payer: University Health Alliance Commercial	$45.40
Rate for Payer: University Health Alliance Commercial	$40.34

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$25,725.46

Service Code	MSDRG 054
Min. Negotiated Rate	$25,725.46
Max. Negotiated Rate	$25,725.46
Rate for Payer: Hawaii Medical Service Association Commercial	$25,725.46

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$25,470.50

Service Code	MSDRG 055
Min. Negotiated Rate	$25,470.50
Max. Negotiated Rate	$25,470.50
Rate for Payer: Hawaii Medical Service Association Commercial	$25,470.50

NET CLOSURE DELTA TERRY DISP DSPNSR BX ADH HK WHITE 1X10YD 1RL

Facility

$108.00

Hospital Charge Code	12957405
Hospital Revenue Code	270
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$70.20
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

NET CLOSURE DELTA TERRY DISP DSPNSR BX ADH HK WHITE 1X10YD 1RL

Facility

$108.00

Hospital Charge Code	12957405
Hospital Revenue Code	270
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$54.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Devoted Health Medicare	$59.40
Rate for Payer: Hawaii Medical Service Association Medicare	$54.00
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$54.00
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$54.00
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$54.00
Rate for Payer: Ohana Health Plan Medicare	$54.00
Rate for Payer: UnitedHealthcare Medicare	$54.00
Rate for Payer: University Health Alliance Commercial	$78.72

NET CLOSURE DELTA TERRY DISP DSPNSR BX STRTCH LOOP WHT 1X15 1RL

Facility

$192.00

Hospital Charge Code	12957406
Hospital Revenue Code	270
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$96.00
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$105.60
Rate for Payer: Hawaii Medical Service Association Medicare	$96.00
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$96.00
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$96.00
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$96.00
Rate for Payer: Ohana Health Plan Medicare	$96.00
Rate for Payer: UnitedHealthcare Medicare	$96.00
Rate for Payer: University Health Alliance Commercial	$139.95

NET CLOSURE DELTA TERRY DISP DSPNSR BX STRTCH LOOP WHT 1X15 1RL

Facility

$192.00

Hospital Charge Code	12957406
Hospital Revenue Code	270
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

NEUROLOGICAL EYE DISORDERS

Facility

$17,898.19

Service Code	MSDRG 123
Min. Negotiated Rate	$17,898.19
Max. Negotiated Rate	$17,898.19
Rate for Payer: Hawaii Medical Service Association Commercial	$17,898.19

Know your out-of-pocket cost for care.

All Charges