Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

87634

Facility

$77.00

Service Code	HCPCS 87634
Hospital Charge Code	13416109
Hospital Revenue Code	300
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$50.05
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

87660 - Trichomonas Vag Direct

Facility

$206.00

Service Code	HCPCS 87660
Hospital Charge Code	8728879
Hospital Revenue Code	306
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$199.82
Rate for Payer: AlohaCare Medicaid	$103.00
Rate for Payer: AlohaCare Medicare	$103.00
Rate for Payer: Cash Price	$133.90
Rate for Payer: Cash Price	$133.90
Rate for Payer: Devoted Health Medicare	$113.30
Rate for Payer: Hawaii Medical Service Association ABD	$20.17
Rate for Payer: Hawaii Medical Service Association Commercial	$25.06
Rate for Payer: Hawaii Medical Service Association Medicare	$103.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.70
Rate for Payer: Hawaii Western Management Group Commercial	$20.05
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Humana Medicare	$103.00
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: Kaiser Permanente Medicaid	$105.06
Rate for Payer: Kaiser Permanente Medicare	$103.00
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: Ohana Health Plan Medicaid	$103.00
Rate for Payer: Ohana Health Plan Medicare	$103.00
Rate for Payer: UnitedHealthcare Medicaid	$20.17
Rate for Payer: UnitedHealthcare Medicare	$103.00
Rate for Payer: University Health Alliance Commercial	$51.84

87660 - Trichomonas Vag Direct

Facility

$206.00

Service Code	HCPCS 87660
Hospital Charge Code	8728879
Hospital Revenue Code	306
Min. Negotiated Rate	$175.10
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$133.90
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: MDX Hawaii PPO	$199.82

87804 Rapid Flu Rfx CoV-2

Facility

$134.00

Service Code	HCPCS 87804 RT,26
Hospital Charge Code	8860997
Hospital Revenue Code	300
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

87804 Rapid Flu Rfx CoV-2

Facility

$134.00

Service Code	HCPCS 87804 RT,26
Hospital Charge Code	8860997
Hospital Revenue Code	300
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$67.00
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$73.70
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Medicare	$67.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$67.00
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$67.00
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$67.00
Rate for Payer: Ohana Health Plan Medicare	$67.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$67.00
Rate for Payer: University Health Alliance Commercial	$31.01

87804 Rapid Flu Rfx PCR Rfx CoV-2

Facility

$134.00

Service Code	HCPCS 87804 RT,26
Hospital Charge Code	8860998
Hospital Revenue Code	300
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$67.00
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$73.70
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Medicare	$67.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$67.00
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$67.00
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$67.00
Rate for Payer: Ohana Health Plan Medicare	$67.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$67.00
Rate for Payer: University Health Alliance Commercial	$31.01

87804 Rapid Flu Rfx PCR Rfx CoV-2

Facility

$134.00

Service Code	HCPCS 87804 RT,26
Hospital Charge Code	8860998
Hospital Revenue Code	300
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

88312 AP Bill Special Stains Group I

Facility

$274.00

Service Code	HCPCS 88312 TC
Hospital Charge Code	295362
Hospital Revenue Code	310
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$265.78
Rate for Payer: AlohaCare Medicaid	$137.00
Rate for Payer: AlohaCare Medicare	$137.00
Rate for Payer: Cash Price	$178.10
Rate for Payer: Cash Price	$178.10
Rate for Payer: Devoted Health Medicare	$150.70
Rate for Payer: Hawaii Medical Service Association ABD	$32.77
Rate for Payer: Hawaii Medical Service Association Medicare	$137.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.86
Rate for Payer: Hawaii Western Management Group Commercial	$260.30
Rate for Payer: Health Management Network Commercial	$232.90
Rate for Payer: Humana Medicare	$137.00
Rate for Payer: Kaiser Permanente Commercial	$246.60
Rate for Payer: Kaiser Permanente Medicaid	$139.74
Rate for Payer: Kaiser Permanente Medicare	$137.00
Rate for Payer: MDX Hawaii PPO	$265.78
Rate for Payer: Ohana Health Plan Medicaid	$137.00
Rate for Payer: Ohana Health Plan Medicare	$137.00
Rate for Payer: UnitedHealthcare Medicaid	$32.77
Rate for Payer: UnitedHealthcare Medicare	$137.00
Rate for Payer: University Health Alliance Commercial	$138.31

88312 AP Bill Special Stains Group I

Facility

$274.00

Service Code	HCPCS 88312 TC
Hospital Charge Code	295362
Hospital Revenue Code	310
Min. Negotiated Rate	$232.90
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$178.10
Rate for Payer: Health Management Network Commercial	$232.90
Rate for Payer: Kaiser Permanente Commercial	$246.60
Rate for Payer: MDX Hawaii PPO	$265.78

88313 AP Bill Special Stains Group II

Facility

$274.00

Service Code	HCPCS 88313 TC
Hospital Charge Code	295364
Hospital Revenue Code	310
Min. Negotiated Rate	$232.90
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$178.10
Rate for Payer: Health Management Network Commercial	$232.90
Rate for Payer: Kaiser Permanente Commercial	$246.60
Rate for Payer: MDX Hawaii PPO	$265.78

88313 AP Bill Special Stains Group II

Facility

$274.00

Service Code	HCPCS 88313 TC
Hospital Charge Code	295364
Hospital Revenue Code	310
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$265.78
Rate for Payer: AlohaCare Medicaid	$137.00
Rate for Payer: AlohaCare Medicare	$137.00
Rate for Payer: Cash Price	$178.10
Rate for Payer: Cash Price	$178.10
Rate for Payer: Devoted Health Medicare	$150.70
Rate for Payer: Hawaii Medical Service Association ABD	$37.43
Rate for Payer: Hawaii Medical Service Association Medicare	$137.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.18
Rate for Payer: Hawaii Western Management Group Commercial	$260.30
Rate for Payer: Health Management Network Commercial	$232.90
Rate for Payer: Humana Medicare	$137.00
Rate for Payer: Kaiser Permanente Commercial	$246.60
Rate for Payer: Kaiser Permanente Medicaid	$139.74
Rate for Payer: Kaiser Permanente Medicare	$137.00
Rate for Payer: MDX Hawaii PPO	$265.78
Rate for Payer: Ohana Health Plan Medicaid	$137.00
Rate for Payer: Ohana Health Plan Medicare	$137.00
Rate for Payer: UnitedHealthcare Medicaid	$37.43
Rate for Payer: UnitedHealthcare Medicare	$137.00
Rate for Payer: University Health Alliance Commercial	$122.28

89051 Cell Count Body Fluid with Diff

Facility

$69.00

Service Code	HCPCS 89051
Hospital Charge Code	10047281
Hospital Revenue Code	309
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

89051 Cell Count Body Fluid with Diff

Facility

$69.00

Service Code	HCPCS 89051
Hospital Charge Code	10047281
Hospital Revenue Code	309
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$34.50
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Devoted Health Medicare	$37.95
Rate for Payer: Hawaii Medical Service Association ABD	$7.61
Rate for Payer: Hawaii Medical Service Association Commercial	$7.00
Rate for Payer: Hawaii Medical Service Association Medicare	$34.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.99
Rate for Payer: Hawaii Western Management Group Commercial	$5.60
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$34.50
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$34.50
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$34.50
Rate for Payer: Ohana Health Plan Medicare	$34.50
Rate for Payer: UnitedHealthcare Medicaid	$7.61
Rate for Payer: UnitedHealthcare Medicare	$34.50
Rate for Payer: University Health Alliance Commercial	$14.24

90471 ADM VACCINE SINGLE CHARGE.

Facility

$185.00

Service Code	HCPCS 90471
Hospital Charge Code	8242919
Hospital Revenue Code	771
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$120.25
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: MDX Hawaii PPO	$179.45

90471 ADM VACCINE SINGLE CHARGE.

Facility

$185.00

Service Code	HCPCS 90471
Hospital Charge Code	8242919
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$92.50
Rate for Payer: AlohaCare Medicare	$92.50
Rate for Payer: Cash Price	$120.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Devoted Health Medicare	$101.75
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Commercial	$91.95
Rate for Payer: Hawaii Medical Service Association Medicare	$92.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.56
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$92.50
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$92.50
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$92.50
Rate for Payer: Ohana Health Plan Medicare	$92.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$92.50
Rate for Payer: University Health Alliance Commercial	$134.85

90471 IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TechFee

Facility

$179.00

Service Code	HCPCS 90471
Hospital Charge Code	8023461
Hospital Revenue Code	771
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

90471 IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TechFee

Facility

$179.00

Service Code	HCPCS 90471
Hospital Charge Code	8023461
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$89.50
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Devoted Health Medicare	$98.45
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Commercial	$91.95
Rate for Payer: Hawaii Medical Service Association Medicare	$89.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.56
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$89.50
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$89.50
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$89.50
Rate for Payer: Ohana Health Plan Medicare	$89.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$89.50
Rate for Payer: University Health Alliance Commercial	$130.47

90471 Immunization administration: first vaccine

Facility

$185.00

Service Code	HCPCS 90471
Hospital Charge Code	8041199
Hospital Revenue Code	771
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$120.25
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: MDX Hawaii PPO	$179.45

90471 Immunization administration: first vaccine

Facility

$185.00

Service Code	HCPCS 90471
Hospital Charge Code	8041199
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$92.50
Rate for Payer: AlohaCare Medicare	$92.50
Rate for Payer: Cash Price	$120.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Devoted Health Medicare	$101.75
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Commercial	$91.95
Rate for Payer: Hawaii Medical Service Association Medicare	$92.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.56
Rate for Payer: Hawaii Western Management Group Commercial	$175.75
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$92.50
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$92.50
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$92.50
Rate for Payer: Ohana Health Plan Medicare	$92.50
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$92.50
Rate for Payer: University Health Alliance Commercial	$134.85

90471-Vaccine Administration

Facility

$101.00

Service Code	HCPCS 90471
Hospital Charge Code	8079990
Hospital Revenue Code	450
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$50.50
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Devoted Health Medicare	$55.55
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$50.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$50.50
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$50.50
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$50.50
Rate for Payer: Ohana Health Plan Medicare	$50.50
Rate for Payer: UnitedHealthcare Medicare	$50.50
Rate for Payer: University Health Alliance Commercial	$73.62

90471-Vaccine Administration

Facility

$101.00

Service Code	HCPCS 90471
Hospital Charge Code	8079990
Hospital Revenue Code	450
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$65.65
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: MDX Hawaii PPO	$97.97

90472 IMMUNIZATION ADMIN VAC EA ADDITIONAL CHARGE

Facility

$120.00

Service Code	HCPCS 90472
Hospital Charge Code	8170176
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$60.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$66.00
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Medicare	$60.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.28
Rate for Payer: Hawaii Western Management Group Commercial	$114.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$60.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$60.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$60.00
Rate for Payer: Ohana Health Plan Medicare	$60.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$60.00
Rate for Payer: University Health Alliance Commercial	$87.47

90472 IMMUNIZATION ADMIN VAC EA ADDITIONAL CHARGE

Facility

$120.00

Service Code	HCPCS 90472
Hospital Charge Code	8170176
Hospital Revenue Code	771
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40

90472-Vaccine Administration Each Addl

Facility

$120.00

Service Code	HCPCS 90472
Hospital Charge Code	8079991
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$60.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$66.00
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Medicare	$60.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.28
Rate for Payer: Hawaii Western Management Group Commercial	$114.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$60.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$60.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$60.00
Rate for Payer: Ohana Health Plan Medicare	$60.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$60.00
Rate for Payer: University Health Alliance Commercial	$87.47

90472-Vaccine Administration Each Addl

Facility

$120.00

Service Code	HCPCS 90472
Hospital Charge Code	8079991
Hospital Revenue Code	771
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40

Know your out-of-pocket cost for care.

All Charges