Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG SARS ANTIGEN - QW

Facility

$268.00

Service Code	HCPCS 87811
Hospital Charge Code	H3060763
Hospital Revenue Code	306
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$265.32
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$241.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Devoted Health Medicare	$265.32
Rate for Payer: Hawaii Medical Service Association ABD	$41.38
Rate for Payer: Hawaii Medical Service Association Commercial	$51.73
Rate for Payer: Hawaii Medical Service Association Medicare	$241.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$41.38
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$241.20
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$241.20
Rate for Payer: Ohana Health Plan Medicare	$241.20
Rate for Payer: UnitedHealthcare Medicaid	$41.38
Rate for Payer: UnitedHealthcare Medicare	$241.20
Rate for Payer: University Health Alliance Commercial	$195.35

HCHG SARS ANTIGEN - QW

Facility

$268.00

Service Code	HCPCS 87811
Hospital Charge Code	H3060763
Hospital Revenue Code	306
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$174.20
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96

HCHG SARS-COV-2 (COVID-19) AMPLIFIED PROBE TECHNIQUE

Facility

$334.00

Service Code	HCPCS 87635
Hospital Charge Code	H3060781
Hospital Revenue Code	306
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$217.10
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98

HCHG SARS-COV-2 (COVID-19) AMPLIFIED PROBE TECHNIQUE

Facility

$334.00

Service Code	HCPCS 87635
Hospital Charge Code	H3060781
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$330.66
Rate for Payer: AlohaCare Medicaid	$167.00
Rate for Payer: AlohaCare Medicare	$300.60
Rate for Payer: Cash Price	$217.10
Rate for Payer: Cash Price	$217.10
Rate for Payer: Devoted Health Medicare	$330.66
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$300.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$300.60
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$300.60
Rate for Payer: Ohana Health Plan Medicare	$300.60
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$300.60
Rate for Payer: University Health Alliance Commercial	$94.96

HCHG SARS-COV-2 COVID 19 AMP PRB - HIGH THROUGHPUT TECH - 90

Facility

$334.00

Service Code	HCPCS 87635
Hospital Charge Code	H3060743
Hospital Revenue Code	306
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$217.10
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98

HCHG SARS-COV-2 COVID 19 AMP PRB - HIGH THROUGHPUT TECH - 90

Facility

$334.00

Service Code	HCPCS 87635
Hospital Charge Code	H3060743
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$330.66
Rate for Payer: AlohaCare Medicaid	$167.00
Rate for Payer: AlohaCare Medicare	$300.60
Rate for Payer: Cash Price	$217.10
Rate for Payer: Cash Price	$217.10
Rate for Payer: Devoted Health Medicare	$330.66
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$300.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$300.60
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$300.60
Rate for Payer: Ohana Health Plan Medicare	$300.60
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$300.60
Rate for Payer: University Health Alliance Commercial	$94.96

HCHG SARS-COV-2 COVID 19 AMP PRB-NON CDC TESTING KITS

Facility

$334.00

Service Code	HCPCS U0002
Hospital Charge Code	H3060749
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$330.66
Rate for Payer: AlohaCare Medicaid	$167.00
Rate for Payer: AlohaCare Medicare	$300.60
Rate for Payer: Cash Price	$217.10
Rate for Payer: Cash Price	$217.10
Rate for Payer: Devoted Health Medicare	$330.66
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$300.60
Rate for Payer: Hawaii Western Management Group Commercial	$317.30
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Humana Medicare	$300.60
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: Kaiser Permanente Medicaid	$170.34
Rate for Payer: Kaiser Permanente Medicare	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98
Rate for Payer: Ohana Health Plan Medicaid	$300.60
Rate for Payer: Ohana Health Plan Medicare	$300.60
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$300.60
Rate for Payer: University Health Alliance Commercial	$243.45

HCHG SARS-COV-2 COVID 19 AMP PRB-NON CDC TESTING KITS

Facility

$334.00

Service Code	HCPCS U0002
Hospital Charge Code	H3060749
Hospital Revenue Code	306
Min. Negotiated Rate	$283.90
Max. Negotiated Rate	$323.98
Rate for Payer: Cash Price	$217.10
Rate for Payer: Health Management Network Commercial	$283.90
Rate for Payer: Kaiser Permanente Commercial	$300.60
Rate for Payer: MDX Hawaii PPO	$323.98

HCHG SARSCOV2 & INF A&B AMP PRB

Facility

$781.00

Service Code	HCPCS 87636
Hospital Charge Code	K3060052
Hospital Revenue Code	306
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$773.19
Rate for Payer: AlohaCare Medicaid	$390.50
Rate for Payer: AlohaCare Medicare	$702.90
Rate for Payer: Cash Price	$507.65
Rate for Payer: Cash Price	$507.65
Rate for Payer: Devoted Health Medicare	$773.19
Rate for Payer: Hawaii Medical Service Association ABD	$142.63
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$702.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$142.63
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Humana Medicare	$702.90
Rate for Payer: Kaiser Permanente Commercial	$702.90
Rate for Payer: Kaiser Permanente Medicaid	$398.31
Rate for Payer: Kaiser Permanente Medicare	$702.90
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: Ohana Health Plan Medicaid	$702.90
Rate for Payer: Ohana Health Plan Medicare	$702.90
Rate for Payer: UnitedHealthcare Medicaid	$142.63
Rate for Payer: UnitedHealthcare Medicare	$702.90
Rate for Payer: University Health Alliance Commercial	$569.27

HCHG SARSCOV2 & INF A&B AMP PRB

Facility

$781.00

Service Code	HCPCS 87636
Hospital Charge Code	K3060052
Hospital Revenue Code	306
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Kaiser Permanente Commercial	$702.90
Rate for Payer: MDX Hawaii PPO	$757.57

HCHG SARSCOV2&INF A&B&RSV AMP PRB

Facility

$804.00

Service Code	HCPCS 87637
Hospital Charge Code	K3060053
Hospital Revenue Code	306
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$795.96
Rate for Payer: AlohaCare Medicaid	$402.00
Rate for Payer: AlohaCare Medicare	$723.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Devoted Health Medicare	$795.96
Rate for Payer: Hawaii Medical Service Association ABD	$142.63
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$723.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$142.63
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Humana Medicare	$723.60
Rate for Payer: Kaiser Permanente Commercial	$723.60
Rate for Payer: Kaiser Permanente Medicaid	$410.04
Rate for Payer: Kaiser Permanente Medicare	$723.60
Rate for Payer: MDX Hawaii PPO	$779.88
Rate for Payer: Ohana Health Plan Medicaid	$723.60
Rate for Payer: Ohana Health Plan Medicare	$723.60
Rate for Payer: UnitedHealthcare Medicaid	$142.63
Rate for Payer: UnitedHealthcare Medicare	$723.60
Rate for Payer: University Health Alliance Commercial	$586.04

HCHG SARSCOV2&INF A&B&RSV AMP PRB

Facility

$804.00

Service Code	HCPCS 87637
Hospital Charge Code	K3060053
Hospital Revenue Code	306
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Kaiser Permanente Commercial	$723.60
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG SARS-COV-2 INFLU A/B RSV XP

Facility

$804.00

Service Code	HCPCS 0241U
Hospital Charge Code	K3060003
Hospital Revenue Code	306
Min. Negotiated Rate	$683.40
Max. Negotiated Rate	$779.88
Rate for Payer: Cash Price	$522.60
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Kaiser Permanente Commercial	$723.60
Rate for Payer: MDX Hawaii PPO	$779.88

HCHG SARS-COV-2 INFLU A/B RSV XP

Facility

$804.00

Service Code	HCPCS 0241U
Hospital Charge Code	K3060003
Hospital Revenue Code	306
Min. Negotiated Rate	$402.00
Max. Negotiated Rate	$795.96
Rate for Payer: AlohaCare Medicaid	$402.00
Rate for Payer: AlohaCare Medicare	$723.60
Rate for Payer: Cash Price	$522.60
Rate for Payer: Devoted Health Medicare	$795.96
Rate for Payer: Hawaii Medical Service Association Medicare	$723.60
Rate for Payer: Hawaii Western Management Group Commercial	$763.80
Rate for Payer: Health Management Network Commercial	$683.40
Rate for Payer: Humana Medicare	$723.60
Rate for Payer: Kaiser Permanente Commercial	$723.60
Rate for Payer: Kaiser Permanente Medicaid	$410.04
Rate for Payer: Kaiser Permanente Medicare	$723.60
Rate for Payer: MDX Hawaii PPO	$779.88
Rate for Payer: Ohana Health Plan Medicaid	$723.60
Rate for Payer: Ohana Health Plan Medicare	$723.60
Rate for Payer: UnitedHealthcare Medicare	$723.60
Rate for Payer: University Health Alliance Commercial	$586.04

HCHG SARS-COV-2 INFLU A/B RSV XP 3 TRGT

Facility

$781.00

Service Code	HCPCS 0240U
Hospital Charge Code	H3001127
Hospital Revenue Code	300
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$773.19
Rate for Payer: AlohaCare Medicaid	$390.50
Rate for Payer: AlohaCare Medicare	$702.90
Rate for Payer: Cash Price	$507.65
Rate for Payer: Devoted Health Medicare	$773.19
Rate for Payer: Hawaii Medical Service Association Medicare	$702.90
Rate for Payer: Hawaii Western Management Group Commercial	$741.95
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Humana Medicare	$702.90
Rate for Payer: Kaiser Permanente Commercial	$702.90
Rate for Payer: Kaiser Permanente Medicaid	$398.31
Rate for Payer: Kaiser Permanente Medicare	$702.90
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: Ohana Health Plan Medicaid	$702.90
Rate for Payer: Ohana Health Plan Medicare	$702.90
Rate for Payer: UnitedHealthcare Medicare	$702.90
Rate for Payer: University Health Alliance Commercial	$569.27

HCHG SARS-COV-2 INFLU A/B RSV XP 3 TRGT

Facility

$781.00

Service Code	HCPCS 0240U
Hospital Charge Code	H3001127
Hospital Revenue Code	300
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Kaiser Permanente Commercial	$702.90
Rate for Payer: MDX Hawaii PPO	$757.57

HCHG SARSCOV CORONAVIRUS AG IA

Facility

$257.00

Service Code	HCPCS 87426
Hospital Charge Code	H3060773
Hospital Revenue Code	306
Min. Negotiated Rate	$35.33
Max. Negotiated Rate	$254.43
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$231.30
Rate for Payer: Cash Price	$167.05
Rate for Payer: Cash Price	$167.05
Rate for Payer: Devoted Health Medicare	$254.43
Rate for Payer: Hawaii Medical Service Association ABD	$45.00
Rate for Payer: Hawaii Medical Service Association Commercial	$44.16
Rate for Payer: Hawaii Medical Service Association Medicare	$231.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$35.33
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$231.30
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$231.30
Rate for Payer: Ohana Health Plan Medicare	$231.30
Rate for Payer: UnitedHealthcare Medicaid	$35.33
Rate for Payer: UnitedHealthcare Medicare	$231.30
Rate for Payer: University Health Alliance Commercial	$187.33

HCHG SARSCOV CORONAVIRUS AG IA

Facility

$257.00

Service Code	HCPCS 87426
Hospital Charge Code	H3060773
Hospital Revenue Code	306
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$167.05
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

HCHG SCLERODERMA AB SCL-70 90

Facility

$133.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020770
Hospital Revenue Code	302
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

HCHG SCLERODERMA AB SCL-70 90

Facility

$133.00

Service Code	HCPCS 86235
Hospital Charge Code	H3020770
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$131.67
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$119.70
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$131.67
Rate for Payer: Hawaii Medical Service Association ABD	$24.78
Rate for Payer: Hawaii Medical Service Association Commercial	$22.41
Rate for Payer: Hawaii Medical Service Association Medicare	$119.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$119.70
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$119.70
Rate for Payer: Ohana Health Plan Medicare	$119.70
Rate for Payer: UnitedHealthcare Medicaid	$24.78
Rate for Payer: UnitedHealthcare Medicare	$119.70
Rate for Payer: University Health Alliance Commercial	$46.36

HCHG SEDIMENTATION RATE AUTO

Facility

$21.00

Service Code	HCPCS 85652
Hospital Charge Code	H3050285
Hospital Revenue Code	305
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$13.65
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

HCHG SEDIMENTATION RATE AUTO

Facility

$21.00

Service Code	HCPCS 85652
Hospital Charge Code	H3050285
Hospital Revenue Code	305
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$20.79
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$18.90
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Devoted Health Medicare	$20.79
Rate for Payer: Hawaii Medical Service Association ABD	$3.73
Rate for Payer: Hawaii Medical Service Association Commercial	$3.38
Rate for Payer: Hawaii Medical Service Association Medicare	$18.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.92
Rate for Payer: Hawaii Western Management Group Commercial	$2.70
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$18.90
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$18.90
Rate for Payer: Ohana Health Plan Medicare	$18.90
Rate for Payer: UnitedHealthcare Medicaid	$3.73
Rate for Payer: UnitedHealthcare Medicare	$18.90
Rate for Payer: University Health Alliance Commercial	$6.97

HCHG SENSITIVITY DISK

Facility

$103.00

Service Code	HCPCS 87184
Hospital Charge Code	K3060016
Hospital Revenue Code	306
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

HCHG SENSITIVITY DISK

Facility

$103.00

Service Code	HCPCS 87184
Hospital Charge Code	K3060016
Hospital Revenue Code	306
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$101.97
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: AlohaCare Medicare	$92.70
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Devoted Health Medicare	$101.97
Rate for Payer: Hawaii Medical Service Association ABD	$9.53
Rate for Payer: Hawaii Medical Service Association Commercial	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$92.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.01
Rate for Payer: Hawaii Western Management Group Commercial	$7.48
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$92.70
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$92.70
Rate for Payer: Ohana Health Plan Medicare	$92.70
Rate for Payer: UnitedHealthcare Medicaid	$9.53
Rate for Payer: UnitedHealthcare Medicare	$92.70
Rate for Payer: University Health Alliance Commercial	$17.82

HCHG SENSITIVITY ENZYME

Facility

$46.00

Service Code	HCPCS 87185
Hospital Charge Code	K3060017
Hospital Revenue Code	306
Min. Negotiated Rate	$39.10
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$29.90
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: MDX Hawaii PPO	$44.62

Know your out-of-pocket cost for care.

All Charges