Kohala Hospital

All Charges

Charge

Type

Setting

Price

CEFTRIAXONE 1 GRAM INJ RECON.SOLN.

Facility

$11.04

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$10.71
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$8.61
Rate for Payer: Health Management Network Commercial	$11.26
Rate for Payer: Health Management Network Commercial	$9.38
Rate for Payer: Kaiser Permanente Commercial	$9.94
Rate for Payer: Kaiser Permanente Commercial	$11.93
Rate for Payer: MDX Hawaii PPO	$10.71
Rate for Payer: MDX Hawaii PPO	$12.85

CEFTRIAXONE 1 GRAM INJ RECON.SOLN.

Facility

$13.25

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$13.12
Rate for Payer: AlohaCare Medicaid	$6.62
Rate for Payer: AlohaCare Medicaid	$5.52
Rate for Payer: AlohaCare Medicare	$9.94
Rate for Payer: AlohaCare Medicare	$11.93
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$8.61
Rate for Payer: Cash Price	$8.61
Rate for Payer: Devoted Health Medicare	$10.93
Rate for Payer: Devoted Health Medicare	$13.12
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Medicare	$9.94
Rate for Payer: Hawaii Medical Service Association Medicare	$11.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$10.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.59
Rate for Payer: Health Management Network Commercial	$9.38
Rate for Payer: Health Management Network Commercial	$11.26
Rate for Payer: Humana Medicare	$9.94
Rate for Payer: Humana Medicare	$11.93
Rate for Payer: Kaiser Permanente Commercial	$11.93
Rate for Payer: Kaiser Permanente Commercial	$9.94
Rate for Payer: Kaiser Permanente Medicaid	$5.63
Rate for Payer: Kaiser Permanente Medicaid	$6.76
Rate for Payer: Kaiser Permanente Medicare	$9.94
Rate for Payer: Kaiser Permanente Medicare	$11.93
Rate for Payer: MDX Hawaii PPO	$10.71
Rate for Payer: MDX Hawaii PPO	$12.85
Rate for Payer: Ohana Health Plan Medicaid	$11.93
Rate for Payer: Ohana Health Plan Medicaid	$9.94
Rate for Payer: Ohana Health Plan Medicare	$9.94
Rate for Payer: Ohana Health Plan Medicare	$11.93
Rate for Payer: UnitedHealthcare Medicaid	$6.62
Rate for Payer: UnitedHealthcare Medicaid	$7.95
Rate for Payer: UnitedHealthcare Medicare	$11.93
Rate for Payer: UnitedHealthcare Medicare	$9.94
Rate for Payer: University Health Alliance Commercial	$8.05
Rate for Payer: University Health Alliance Commercial	$9.66

CEFTRIAXONE 2 GRAM INJ RECON.SOLN.

Facility

$415.16

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$352.89
Max. Negotiated Rate	$402.71
Rate for Payer: Cash Price	$269.85
Rate for Payer: Health Management Network Commercial	$352.89
Rate for Payer: Kaiser Permanente Commercial	$373.64
Rate for Payer: MDX Hawaii PPO	$402.71

CEFTRIAXONE 2 GRAM INJ RECON.SOLN.

Facility

$415.16

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$411.01
Rate for Payer: AlohaCare Medicaid	$207.58
Rate for Payer: AlohaCare Medicare	$373.64
Rate for Payer: Cash Price	$269.85
Rate for Payer: Cash Price	$269.85
Rate for Payer: Devoted Health Medicare	$411.01
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Medicare	$373.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$394.40
Rate for Payer: Health Management Network Commercial	$352.89
Rate for Payer: Humana Medicare	$373.64
Rate for Payer: Kaiser Permanente Commercial	$373.64
Rate for Payer: Kaiser Permanente Medicaid	$211.73
Rate for Payer: Kaiser Permanente Medicare	$373.64
Rate for Payer: MDX Hawaii PPO	$402.71
Rate for Payer: Ohana Health Plan Medicaid	$373.64
Rate for Payer: Ohana Health Plan Medicare	$373.64
Rate for Payer: UnitedHealthcare Medicaid	$249.10
Rate for Payer: UnitedHealthcare Medicare	$373.64
Rate for Payer: University Health Alliance Commercial	$302.61

CEFTRIAXONE 500 MG INJ RECON.SOLN.

Facility

$6.90

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$6.69
Rate for Payer: Cash Price	$4.49
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: Kaiser Permanente Commercial	$6.21
Rate for Payer: MDX Hawaii PPO	$6.69

CEFTRIAXONE 500 MG INJ RECON.SOLN.

Facility

$6.90

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$3.45
Rate for Payer: AlohaCare Medicare	$6.21
Rate for Payer: Cash Price	$4.49
Rate for Payer: Cash Price	$4.49
Rate for Payer: Devoted Health Medicare	$6.83
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Medicare	$6.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$6.55
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: Humana Medicare	$6.21
Rate for Payer: Kaiser Permanente Commercial	$6.21
Rate for Payer: Kaiser Permanente Medicaid	$3.52
Rate for Payer: Kaiser Permanente Medicare	$6.21
Rate for Payer: MDX Hawaii PPO	$6.69
Rate for Payer: Ohana Health Plan Medicaid	$6.21
Rate for Payer: Ohana Health Plan Medicare	$6.21
Rate for Payer: UnitedHealthcare Medicaid	$4.14
Rate for Payer: UnitedHealthcare Medicare	$6.21
Rate for Payer: University Health Alliance Commercial	$5.03

CEFTRIAXONE-DEXTROSE (ISO-OSM) 1 G/50 ML IV IVPB PREMIX

Facility

$99.48

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$96.50
Rate for Payer: Cash Price	$64.66
Rate for Payer: Health Management Network Commercial	$84.56
Rate for Payer: Kaiser Permanente Commercial	$89.53
Rate for Payer: MDX Hawaii PPO	$96.50

CEFTRIAXONE-DEXTROSE (ISO-OSM) 1 G/50 ML IV IVPB PREMIX

Facility

$99.48

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$98.49
Rate for Payer: AlohaCare Medicaid	$49.74
Rate for Payer: AlohaCare Medicare	$89.53
Rate for Payer: Cash Price	$64.66
Rate for Payer: Cash Price	$64.66
Rate for Payer: Devoted Health Medicare	$98.49
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Medicare	$89.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$94.51
Rate for Payer: Health Management Network Commercial	$84.56
Rate for Payer: Humana Medicare	$89.53
Rate for Payer: Kaiser Permanente Commercial	$89.53
Rate for Payer: Kaiser Permanente Medicaid	$50.73
Rate for Payer: Kaiser Permanente Medicare	$89.53
Rate for Payer: MDX Hawaii PPO	$96.50
Rate for Payer: Ohana Health Plan Medicaid	$89.53
Rate for Payer: Ohana Health Plan Medicare	$89.53
Rate for Payer: UnitedHealthcare Medicaid	$59.69
Rate for Payer: UnitedHealthcare Medicare	$89.53
Rate for Payer: University Health Alliance Commercial	$72.51

CEFTRIAXONE IN DEXTROSE,ISO-OS 2 GRAM/50 ML IV IVPB

Facility

$126.64

Service Code	HCPCS J0696
Hospital Revenue Code	250
Min. Negotiated Rate	$107.64
Max. Negotiated Rate	$122.84
Rate for Payer: Cash Price	$82.32
Rate for Payer: Health Management Network Commercial	$107.64
Rate for Payer: Kaiser Permanente Commercial	$113.98
Rate for Payer: MDX Hawaii PPO	$122.84

CEFTRIAXONE IN DEXTROSE,ISO-OS 2 GRAM/50 ML IV IVPB

Facility

$126.64

Service Code	HCPCS J0696
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$125.37
Rate for Payer: AlohaCare Medicaid	$63.32
Rate for Payer: AlohaCare Medicare	$113.98
Rate for Payer: Cash Price	$82.32
Rate for Payer: Cash Price	$82.32
Rate for Payer: Devoted Health Medicare	$125.37
Rate for Payer: Hawaii Medical Service Association ABD	$9.70
Rate for Payer: Hawaii Medical Service Association Medicare	$113.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$120.31
Rate for Payer: Health Management Network Commercial	$107.64
Rate for Payer: Humana Medicare	$113.98
Rate for Payer: Kaiser Permanente Commercial	$113.98
Rate for Payer: Kaiser Permanente Medicaid	$64.59
Rate for Payer: Kaiser Permanente Medicare	$113.98
Rate for Payer: MDX Hawaii PPO	$122.84
Rate for Payer: Ohana Health Plan Medicaid	$113.98
Rate for Payer: Ohana Health Plan Medicare	$113.98
Rate for Payer: UnitedHealthcare Medicaid	$75.98
Rate for Payer: UnitedHealthcare Medicare	$113.98
Rate for Payer: University Health Alliance Commercial	$92.31

CEFUROXIME AXETIL 250 MG PO TABLET

Facility

$31.39

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$31.08
Rate for Payer: AlohaCare Medicaid	$15.70
Rate for Payer: AlohaCare Medicare	$28.25
Rate for Payer: Cash Price	$20.40
Rate for Payer: Devoted Health Medicare	$31.08
Rate for Payer: Hawaii Medical Service Association Medicare	$28.25
Rate for Payer: Hawaii Western Management Group Commercial	$29.82
Rate for Payer: Health Management Network Commercial	$26.68
Rate for Payer: Humana Medicare	$28.25
Rate for Payer: Kaiser Permanente Commercial	$28.25
Rate for Payer: Kaiser Permanente Medicaid	$16.01
Rate for Payer: Kaiser Permanente Medicare	$28.25
Rate for Payer: MDX Hawaii PPO	$30.45
Rate for Payer: Ohana Health Plan Medicaid	$28.25
Rate for Payer: Ohana Health Plan Medicare	$28.25
Rate for Payer: UnitedHealthcare Medicare	$28.25
Rate for Payer: University Health Alliance Commercial	$22.88

CEFUROXIME AXETIL 250 MG PO TABLET

Facility

$31.39

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$30.45
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$26.68
Rate for Payer: Kaiser Permanente Commercial	$28.25
Rate for Payer: MDX Hawaii PPO	$30.45

CELECOXIB 200 MG PO CAP

Facility

$46.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$44.84
Rate for Payer: Cash Price	$30.05
Rate for Payer: Health Management Network Commercial	$39.30
Rate for Payer: Kaiser Permanente Commercial	$41.61
Rate for Payer: MDX Hawaii PPO	$44.84

CELECOXIB 200 MG PO CAP

Facility

$46.23

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$23.11
Max. Negotiated Rate	$45.77
Rate for Payer: AlohaCare Medicaid	$23.11
Rate for Payer: AlohaCare Medicare	$41.61
Rate for Payer: Cash Price	$30.05
Rate for Payer: Devoted Health Medicare	$45.77
Rate for Payer: Hawaii Medical Service Association Medicare	$41.61
Rate for Payer: Hawaii Western Management Group Commercial	$43.92
Rate for Payer: Health Management Network Commercial	$39.30
Rate for Payer: Humana Medicare	$41.61
Rate for Payer: Kaiser Permanente Commercial	$41.61
Rate for Payer: Kaiser Permanente Medicaid	$23.58
Rate for Payer: Kaiser Permanente Medicare	$41.61
Rate for Payer: MDX Hawaii PPO	$44.84
Rate for Payer: Ohana Health Plan Medicaid	$41.61
Rate for Payer: Ohana Health Plan Medicare	$41.61
Rate for Payer: UnitedHealthcare Medicare	$41.61
Rate for Payer: University Health Alliance Commercial	$33.70

CELLULITIS WITH MCC

Facility

$23,986.42

Service Code	MSDRG 602
Min. Negotiated Rate	$23,986.42
Max. Negotiated Rate	$23,986.42
Rate for Payer: Hawaii Medical Service Association Commercial	$23,986.42

CELLULITIS WITHOUT MCC

Facility

$16,141.06

Service Code	MSDRG 603
Min. Negotiated Rate	$16,141.06
Max. Negotiated Rate	$16,141.06
Rate for Payer: Hawaii Medical Service Association Commercial	$16,141.06

CEPHALEXIN 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$116.54

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$58.27
Max. Negotiated Rate	$115.37
Rate for Payer: AlohaCare Medicaid	$58.27
Rate for Payer: AlohaCare Medicare	$104.89
Rate for Payer: Cash Price	$75.75
Rate for Payer: Devoted Health Medicare	$115.37
Rate for Payer: Hawaii Medical Service Association Medicare	$104.89
Rate for Payer: Hawaii Western Management Group Commercial	$110.71
Rate for Payer: Health Management Network Commercial	$99.06
Rate for Payer: Humana Medicare	$104.89
Rate for Payer: Kaiser Permanente Commercial	$104.89
Rate for Payer: Kaiser Permanente Medicaid	$59.44
Rate for Payer: Kaiser Permanente Medicare	$104.89
Rate for Payer: MDX Hawaii PPO	$113.04
Rate for Payer: Ohana Health Plan Medicaid	$104.89
Rate for Payer: Ohana Health Plan Medicare	$104.89
Rate for Payer: UnitedHealthcare Medicare	$104.89
Rate for Payer: University Health Alliance Commercial	$84.95

CEPHALEXIN 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$116.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$99.06
Max. Negotiated Rate	$113.04
Rate for Payer: Cash Price	$75.75
Rate for Payer: Health Management Network Commercial	$99.06
Rate for Payer: Kaiser Permanente Commercial	$104.89
Rate for Payer: MDX Hawaii PPO	$113.04

CEPHALEXIN 250 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$137.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$116.65
Max. Negotiated Rate	$133.12
Rate for Payer: Cash Price	$89.21
Rate for Payer: Cash Price	$73.33
Rate for Payer: Health Management Network Commercial	$95.89
Rate for Payer: Health Management Network Commercial	$116.65
Rate for Payer: Kaiser Permanente Commercial	$101.53
Rate for Payer: Kaiser Permanente Commercial	$123.52
Rate for Payer: MDX Hawaii PPO	$133.12
Rate for Payer: MDX Hawaii PPO	$109.43

CEPHALEXIN 250 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$137.24

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$68.62
Max. Negotiated Rate	$135.87
Rate for Payer: AlohaCare Medicaid	$68.62
Rate for Payer: AlohaCare Medicaid	$56.41
Rate for Payer: AlohaCare Medicare	$101.53
Rate for Payer: AlohaCare Medicare	$123.52
Rate for Payer: Cash Price	$73.33
Rate for Payer: Cash Price	$89.21
Rate for Payer: Devoted Health Medicare	$111.68
Rate for Payer: Devoted Health Medicare	$135.87
Rate for Payer: Hawaii Medical Service Association Medicare	$123.52
Rate for Payer: Hawaii Medical Service Association Medicare	$101.53
Rate for Payer: Hawaii Western Management Group Commercial	$130.38
Rate for Payer: Hawaii Western Management Group Commercial	$107.17
Rate for Payer: Health Management Network Commercial	$95.89
Rate for Payer: Health Management Network Commercial	$116.65
Rate for Payer: Humana Medicare	$101.53
Rate for Payer: Humana Medicare	$123.52
Rate for Payer: Kaiser Permanente Commercial	$101.53
Rate for Payer: Kaiser Permanente Commercial	$123.52
Rate for Payer: Kaiser Permanente Medicaid	$57.53
Rate for Payer: Kaiser Permanente Medicaid	$69.99
Rate for Payer: Kaiser Permanente Medicare	$123.52
Rate for Payer: Kaiser Permanente Medicare	$101.53
Rate for Payer: MDX Hawaii PPO	$133.12
Rate for Payer: MDX Hawaii PPO	$109.43
Rate for Payer: Ohana Health Plan Medicaid	$101.53
Rate for Payer: Ohana Health Plan Medicaid	$123.52
Rate for Payer: Ohana Health Plan Medicare	$101.53
Rate for Payer: Ohana Health Plan Medicare	$123.52
Rate for Payer: UnitedHealthcare Medicare	$101.53
Rate for Payer: UnitedHealthcare Medicare	$123.52
Rate for Payer: University Health Alliance Commercial	$82.23
Rate for Payer: University Health Alliance Commercial	$100.03

CEPHALEXIN 250 MG PO CAP

Facility

$3.84

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$3.72
Rate for Payer: Cash Price	$2.50
Rate for Payer: Health Management Network Commercial	$3.26
Rate for Payer: Kaiser Permanente Commercial	$3.46
Rate for Payer: MDX Hawaii PPO	$3.72

CEPHALEXIN 250 MG PO CAP

Facility

$3.84

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$3.80
Rate for Payer: AlohaCare Medicaid	$1.92
Rate for Payer: AlohaCare Medicare	$3.46
Rate for Payer: Cash Price	$2.50
Rate for Payer: Devoted Health Medicare	$3.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3.46
Rate for Payer: Hawaii Western Management Group Commercial	$3.65
Rate for Payer: Health Management Network Commercial	$3.26
Rate for Payer: Humana Medicare	$3.46
Rate for Payer: Kaiser Permanente Commercial	$3.46
Rate for Payer: Kaiser Permanente Medicaid	$1.96
Rate for Payer: Kaiser Permanente Medicare	$3.46
Rate for Payer: MDX Hawaii PPO	$3.72
Rate for Payer: Ohana Health Plan Medicaid	$3.46
Rate for Payer: Ohana Health Plan Medicare	$3.46
Rate for Payer: UnitedHealthcare Medicare	$3.46
Rate for Payer: University Health Alliance Commercial	$2.80

CEPHALEXIN 500 MG PO CAP

Facility

$7.47

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$7.40
Rate for Payer: AlohaCare Medicaid	$3.73
Rate for Payer: AlohaCare Medicaid	$3.38
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: AlohaCare Medicare	$6.72
Rate for Payer: Cash Price	$4.39
Rate for Payer: Cash Price	$4.86
Rate for Payer: Devoted Health Medicare	$7.40
Rate for Payer: Devoted Health Medicare	$6.68
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Medical Service Association Medicare	$6.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.41
Rate for Payer: Hawaii Western Management Group Commercial	$7.10
Rate for Payer: Health Management Network Commercial	$6.35
Rate for Payer: Health Management Network Commercial	$5.74
Rate for Payer: Humana Medicare	$6.72
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$6.08
Rate for Payer: Kaiser Permanente Commercial	$6.72
Rate for Payer: Kaiser Permanente Medicaid	$3.81
Rate for Payer: Kaiser Permanente Medicaid	$3.44
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: Kaiser Permanente Medicare	$6.72
Rate for Payer: MDX Hawaii PPO	$6.55
Rate for Payer: MDX Hawaii PPO	$7.25
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicaid	$6.72
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.72
Rate for Payer: UnitedHealthcare Medicare	$6.72
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.44
Rate for Payer: University Health Alliance Commercial	$4.92

CEPHALEXIN 500 MG PO CAP

Facility

$6.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.55
Rate for Payer: Cash Price	$4.39
Rate for Payer: Cash Price	$4.86
Rate for Payer: Health Management Network Commercial	$5.74
Rate for Payer: Health Management Network Commercial	$6.35
Rate for Payer: Kaiser Permanente Commercial	$6.08
Rate for Payer: Kaiser Permanente Commercial	$6.72
Rate for Payer: MDX Hawaii PPO	$7.25
Rate for Payer: MDX Hawaii PPO	$6.55

CERVICAL SPINAL FUSION WITH CC

Facility

$50,129.73

Service Code	MSDRG 472
Min. Negotiated Rate	$50,129.73
Max. Negotiated Rate	$50,129.73
Rate for Payer: Hawaii Medical Service Association Commercial	$50,129.73

Know your out-of-pocket cost for care.

All Charges