Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

XR Arthrogram Shoulder Right

Facility

$1,898.00

Service Code	HCPCS 73040
Hospital Charge Code	8127606
Hospital Revenue Code	322
Min. Negotiated Rate	$69.25
Max. Negotiated Rate	$1,841.06
Rate for Payer: AlohaCare Medicaid	$949.00
Rate for Payer: AlohaCare Medicare	$949.00
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Devoted Health Medicare	$1,043.90
Rate for Payer: Hawaii Medical Service Association ABD	$69.25
Rate for Payer: Hawaii Medical Service Association Commercial	$445.54
Rate for Payer: Hawaii Medical Service Association Medicare	$949.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$356.43
Rate for Payer: Health Management Network Commercial	$1,613.30
Rate for Payer: Humana Medicare	$949.00
Rate for Payer: Kaiser Permanente Commercial	$1,708.20
Rate for Payer: Kaiser Permanente Medicaid	$967.98
Rate for Payer: Kaiser Permanente Medicare	$949.00
Rate for Payer: MDX Hawaii PPO	$1,841.06
Rate for Payer: Ohana Health Plan Medicaid	$949.00
Rate for Payer: Ohana Health Plan Medicare	$949.00
Rate for Payer: UnitedHealthcare Medicaid	$69.25
Rate for Payer: UnitedHealthcare Medicare	$949.00
Rate for Payer: University Health Alliance Commercial	$222.87

XR Arthrogram Shoulder Right

Facility

$1,898.00

Service Code	HCPCS 73040
Hospital Charge Code	8127606
Hospital Revenue Code	322
Min. Negotiated Rate	$1,613.30
Max. Negotiated Rate	$1,841.06
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Health Management Network Commercial	$1,613.30
Rate for Payer: Kaiser Permanente Commercial	$1,708.20
Rate for Payer: MDX Hawaii PPO	$1,841.06

XR Arthrogram Wrist Left

Facility

$1,898.00

Service Code	HCPCS 73115
Hospital Charge Code	8127609
Hospital Revenue Code	322
Min. Negotiated Rate	$1,613.30
Max. Negotiated Rate	$1,841.06
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Health Management Network Commercial	$1,613.30
Rate for Payer: Kaiser Permanente Commercial	$1,708.20
Rate for Payer: MDX Hawaii PPO	$1,841.06

XR Arthrogram Wrist Left

Facility

$1,898.00

Service Code	HCPCS 73115
Hospital Charge Code	8127609
Hospital Revenue Code	322
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$1,841.06
Rate for Payer: AlohaCare Medicaid	$949.00
Rate for Payer: AlohaCare Medicare	$949.00
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Devoted Health Medicare	$1,043.90
Rate for Payer: Hawaii Medical Service Association ABD	$52.22
Rate for Payer: Hawaii Medical Service Association Commercial	$445.54
Rate for Payer: Hawaii Medical Service Association Medicare	$949.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.72
Rate for Payer: Hawaii Western Management Group Commercial	$356.43
Rate for Payer: Health Management Network Commercial	$1,613.30
Rate for Payer: Humana Medicare	$949.00
Rate for Payer: Kaiser Permanente Commercial	$1,708.20
Rate for Payer: Kaiser Permanente Medicaid	$967.98
Rate for Payer: Kaiser Permanente Medicare	$949.00
Rate for Payer: MDX Hawaii PPO	$1,841.06
Rate for Payer: Ohana Health Plan Medicaid	$949.00
Rate for Payer: Ohana Health Plan Medicare	$949.00
Rate for Payer: UnitedHealthcare Medicaid	$52.22
Rate for Payer: UnitedHealthcare Medicare	$949.00
Rate for Payer: University Health Alliance Commercial	$203.43

XR Arthrogram Wrist Right

Facility

$1,898.00

Service Code	HCPCS 73115
Hospital Charge Code	8127612
Hospital Revenue Code	322
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$1,841.06
Rate for Payer: AlohaCare Medicaid	$949.00
Rate for Payer: AlohaCare Medicare	$949.00
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Devoted Health Medicare	$1,043.90
Rate for Payer: Hawaii Medical Service Association ABD	$52.22
Rate for Payer: Hawaii Medical Service Association Commercial	$445.54
Rate for Payer: Hawaii Medical Service Association Medicare	$949.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.72
Rate for Payer: Hawaii Western Management Group Commercial	$356.43
Rate for Payer: Health Management Network Commercial	$1,613.30
Rate for Payer: Humana Medicare	$949.00
Rate for Payer: Kaiser Permanente Commercial	$1,708.20
Rate for Payer: Kaiser Permanente Medicaid	$967.98
Rate for Payer: Kaiser Permanente Medicare	$949.00
Rate for Payer: MDX Hawaii PPO	$1,841.06
Rate for Payer: Ohana Health Plan Medicaid	$949.00
Rate for Payer: Ohana Health Plan Medicare	$949.00
Rate for Payer: UnitedHealthcare Medicaid	$52.22
Rate for Payer: UnitedHealthcare Medicare	$949.00
Rate for Payer: University Health Alliance Commercial	$203.43

XR Arthrogram Wrist Right

Facility

$1,898.00

Service Code	HCPCS 73115
Hospital Charge Code	8127612
Hospital Revenue Code	322
Min. Negotiated Rate	$1,613.30
Max. Negotiated Rate	$1,841.06
Rate for Payer: Cash Price	$1,233.70
Rate for Payer: Health Management Network Commercial	$1,613.30
Rate for Payer: Kaiser Permanente Commercial	$1,708.20
Rate for Payer: MDX Hawaii PPO	$1,841.06

XR Barium Enema Complete

Facility

$1,061.00

Service Code	HCPCS 74270
Hospital Charge Code	1170002
Hospital Revenue Code	320
Min. Negotiated Rate	$901.85
Max. Negotiated Rate	$1,029.17
Rate for Payer: Cash Price	$689.65
Rate for Payer: Health Management Network Commercial	$901.85
Rate for Payer: Kaiser Permanente Commercial	$954.90
Rate for Payer: MDX Hawaii PPO	$1,029.17

XR Barium Enema Complete

Facility

$1,061.00

Service Code	HCPCS 74270
Hospital Charge Code	1170002
Hospital Revenue Code	320
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$1,029.17
Rate for Payer: AlohaCare Medicaid	$530.50
Rate for Payer: AlohaCare Medicare	$530.50
Rate for Payer: Cash Price	$689.65
Rate for Payer: Cash Price	$689.65
Rate for Payer: Devoted Health Medicare	$583.55
Rate for Payer: Hawaii Medical Service Association ABD	$56.53
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$530.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$61.14
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$901.85
Rate for Payer: Humana Medicare	$530.50
Rate for Payer: Kaiser Permanente Commercial	$954.90
Rate for Payer: Kaiser Permanente Medicaid	$541.11
Rate for Payer: Kaiser Permanente Medicare	$530.50
Rate for Payer: MDX Hawaii PPO	$1,029.17
Rate for Payer: Ohana Health Plan Medicaid	$530.50
Rate for Payer: Ohana Health Plan Medicare	$530.50
Rate for Payer: UnitedHealthcare Medicaid	$56.53
Rate for Payer: UnitedHealthcare Medicare	$530.50
Rate for Payer: University Health Alliance Commercial	$246.75

XR Barium Enema Complete - Report

Professional

Both

$244.00

Service Code	HCPCS 74270 26
Hospital Charge Code	627609
Hospital Revenue Code	972
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$207.40
Rate for Payer: AlohaCare Medicaid	$101.76
Rate for Payer: AlohaCare Medicare	$48.57
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Devoted Health Medicare	$53.43
Rate for Payer: Hawaii Medical Service Association Medicare	$48.57
Rate for Payer: Hawaii Western Management Group Commercial	$113.38
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$53.43
Rate for Payer: Kaiser Permanente Medicaid	$53.43
Rate for Payer: Kaiser Permanente Medicare	$53.43
Rate for Payer: Ohana Health Plan Medicaid	$101.76
Rate for Payer: Ohana Health Plan Medicare	$48.57
Rate for Payer: UnitedHealthcare Medicaid	$101.76
Rate for Payer: UnitedHealthcare Medicare	$48.57

XR Barium Enema w/ Air Complete

Facility

$1,116.00

Service Code	HCPCS 74280
Hospital Charge Code	1170006
Hospital Revenue Code	320
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$1,082.52
Rate for Payer: AlohaCare Medicaid	$558.00
Rate for Payer: AlohaCare Medicare	$558.00
Rate for Payer: Cash Price	$725.40
Rate for Payer: Cash Price	$725.40
Rate for Payer: Devoted Health Medicare	$613.80
Rate for Payer: Hawaii Medical Service Association ABD	$89.58
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$558.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$86.80
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: Humana Medicare	$558.00
Rate for Payer: Kaiser Permanente Commercial	$1,004.40
Rate for Payer: Kaiser Permanente Medicaid	$569.16
Rate for Payer: Kaiser Permanente Medicare	$558.00
Rate for Payer: MDX Hawaii PPO	$1,082.52
Rate for Payer: Ohana Health Plan Medicaid	$558.00
Rate for Payer: Ohana Health Plan Medicare	$558.00
Rate for Payer: UnitedHealthcare Medicaid	$89.58
Rate for Payer: UnitedHealthcare Medicare	$558.00
Rate for Payer: University Health Alliance Commercial	$370.48

XR Barium Enema w/ Air Complete

Facility

$1,116.00

Service Code	HCPCS 74280
Hospital Charge Code	1170006
Hospital Revenue Code	320
Min. Negotiated Rate	$948.60
Max. Negotiated Rate	$1,082.52
Rate for Payer: Cash Price	$725.40
Rate for Payer: Health Management Network Commercial	$948.60
Rate for Payer: Kaiser Permanente Commercial	$1,004.40
Rate for Payer: MDX Hawaii PPO	$1,082.52

XR Barium Enema w/ Air Complete - Report

Professional

Both

$300.00

Service Code	HCPCS 74280 26
Hospital Charge Code	627613
Hospital Revenue Code	972
Min. Negotiated Rate	$58.77
Max. Negotiated Rate	$255.00
Rate for Payer: AlohaCare Medicaid	$146.42
Rate for Payer: AlohaCare Medicare	$58.77
Rate for Payer: Cash Price	$195.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$64.65
Rate for Payer: Hawaii Medical Service Association Medicare	$58.77
Rate for Payer: Hawaii Western Management Group Commercial	$152.40
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$64.65
Rate for Payer: Kaiser Permanente Medicaid	$64.65
Rate for Payer: Kaiser Permanente Medicare	$64.65
Rate for Payer: Ohana Health Plan Medicaid	$146.42
Rate for Payer: Ohana Health Plan Medicare	$58.77
Rate for Payer: UnitedHealthcare Medicaid	$146.42
Rate for Payer: UnitedHealthcare Medicare	$58.77

XR Bone Age Studies

Facility

$352.00

Service Code	HCPCS 77072
Hospital Charge Code	1170014
Hospital Revenue Code	320
Min. Negotiated Rate	$299.20
Max. Negotiated Rate	$341.44
Rate for Payer: Cash Price	$228.80
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: MDX Hawaii PPO	$341.44

XR Bone Age Studies

Facility

$352.00

Service Code	HCPCS 77072
Hospital Charge Code	1170014
Hospital Revenue Code	320
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$341.44
Rate for Payer: AlohaCare Medicaid	$176.00
Rate for Payer: AlohaCare Medicare	$176.00
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Devoted Health Medicare	$193.60
Rate for Payer: Hawaii Medical Service Association ABD	$10.46
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$176.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$299.20
Rate for Payer: Humana Medicare	$176.00
Rate for Payer: Kaiser Permanente Commercial	$316.80
Rate for Payer: Kaiser Permanente Medicaid	$179.52
Rate for Payer: Kaiser Permanente Medicare	$176.00
Rate for Payer: MDX Hawaii PPO	$341.44
Rate for Payer: Ohana Health Plan Medicaid	$176.00
Rate for Payer: Ohana Health Plan Medicare	$176.00
Rate for Payer: UnitedHealthcare Medicaid	$10.46
Rate for Payer: UnitedHealthcare Medicare	$176.00
Rate for Payer: University Health Alliance Commercial	$47.17

XR Bone Age Studies - Report

Professional

Both

$70.00

Service Code	HCPCS 77072 26
Hospital Charge Code	627629
Hospital Revenue Code	972
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$59.50
Rate for Payer: AlohaCare Medicaid	$17.10
Rate for Payer: AlohaCare Medicare	$9.20
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Devoted Health Medicare	$10.12
Rate for Payer: Hawaii Medical Service Association Medicare	$9.20
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$10.12
Rate for Payer: Kaiser Permanente Medicaid	$10.12
Rate for Payer: Kaiser Permanente Medicare	$10.12
Rate for Payer: Ohana Health Plan Medicaid	$17.10
Rate for Payer: Ohana Health Plan Medicare	$9.20
Rate for Payer: UnitedHealthcare Medicaid	$17.10
Rate for Payer: UnitedHealthcare Medicare	$9.20

XR Bone Length Studies Scanograms

Facility

$708.00

Service Code	HCPCS 77073
Hospital Charge Code	1170016
Hospital Revenue Code	320
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

XR Bone Length Studies Scanograms

Facility

$708.00

Service Code	HCPCS 77073
Hospital Charge Code	1170016
Hospital Revenue Code	320
Min. Negotiated Rate	$22.30
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
Rate for Payer: Hawaii Medical Service Association ABD	$22.30
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.19
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$22.30
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$82.49

XR Bone Length Studies Scanograms - Report

Professional

Both

$145.00

Service Code	HCPCS 77073 26
Hospital Charge Code	627647
Hospital Revenue Code	972
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$30.08
Rate for Payer: AlohaCare Medicare	$13.29
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$14.62
Rate for Payer: Hawaii Medical Service Association Medicare	$13.29
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$14.62
Rate for Payer: Kaiser Permanente Medicaid	$14.62
Rate for Payer: Kaiser Permanente Medicare	$14.62
Rate for Payer: Ohana Health Plan Medicaid	$30.08
Rate for Payer: Ohana Health Plan Medicare	$13.29
Rate for Payer: UnitedHealthcare Medicaid	$30.08
Rate for Payer: UnitedHealthcare Medicare	$13.29

XR Calcaneus Bilateral

Facility

$307.00

Service Code	HCPCS 73650 50
Hospital Charge Code	1170030
Hospital Revenue Code	320
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$297.79
Rate for Payer: AlohaCare Medicaid	$153.50
Rate for Payer: AlohaCare Medicare	$153.50
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$168.85
Rate for Payer: Hawaii Medical Service Association ABD	$17.03
Rate for Payer: Hawaii Medical Service Association Medicare	$153.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$291.65
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Humana Medicare	$153.50
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: Kaiser Permanente Medicaid	$156.57
Rate for Payer: Kaiser Permanente Medicare	$153.50
Rate for Payer: MDX Hawaii PPO	$297.79
Rate for Payer: Ohana Health Plan Medicaid	$153.50
Rate for Payer: Ohana Health Plan Medicare	$153.50
Rate for Payer: UnitedHealthcare Medicaid	$17.03
Rate for Payer: UnitedHealthcare Medicare	$153.50
Rate for Payer: University Health Alliance Commercial	$53.87

XR Calcaneus Bilateral

Facility

$307.00

Service Code	HCPCS 73650 50
Hospital Charge Code	1170030
Hospital Revenue Code	320
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$297.79
Rate for Payer: Cash Price	$199.55
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: MDX Hawaii PPO	$297.79

XR Calcaneus Bilateral - Report

Professional

Both

$60.00

Service Code	HCPCS 73650 26,50
Hospital Charge Code	629617
Hospital Revenue Code	972
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicaid	$19.02
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$29.54
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Ohana Health Plan Medicaid	$19.02
Rate for Payer: UnitedHealthcare Medicaid	$19.02

XR Calcaneus Left

Facility

$307.00

Service Code	HCPCS 73650 LT
Hospital Charge Code	1170032
Hospital Revenue Code	320
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$297.79
Rate for Payer: Cash Price	$199.55
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: MDX Hawaii PPO	$297.79

XR Calcaneus Left

Facility

$307.00

Service Code	HCPCS 73650 LT
Hospital Charge Code	1170032
Hospital Revenue Code	320
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$297.79
Rate for Payer: AlohaCare Medicaid	$153.50
Rate for Payer: AlohaCare Medicare	$153.50
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$168.85
Rate for Payer: Hawaii Medical Service Association ABD	$17.03
Rate for Payer: Hawaii Medical Service Association Medicare	$153.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$291.65
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Humana Medicare	$153.50
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: Kaiser Permanente Medicaid	$156.57
Rate for Payer: Kaiser Permanente Medicare	$153.50
Rate for Payer: MDX Hawaii PPO	$297.79
Rate for Payer: Ohana Health Plan Medicaid	$153.50
Rate for Payer: Ohana Health Plan Medicare	$153.50
Rate for Payer: UnitedHealthcare Medicaid	$17.03
Rate for Payer: UnitedHealthcare Medicare	$153.50
Rate for Payer: University Health Alliance Commercial	$53.87

XR Calcaneus Left - Report

Professional

Both

$60.00

Service Code	HCPCS 73650 26,LT
Hospital Charge Code	629619
Hospital Revenue Code	972
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicaid	$19.02
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$29.54
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Ohana Health Plan Medicaid	$19.02
Rate for Payer: UnitedHealthcare Medicaid	$19.02

XR Calcaneus Right

Facility

$307.00

Service Code	HCPCS 73650 RT
Hospital Charge Code	1170034
Hospital Revenue Code	320
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$297.79
Rate for Payer: Cash Price	$199.55
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: MDX Hawaii PPO	$297.79

Know your out-of-pocket cost for care.

All Charges