Kohala Hospital

All Charges

Charge

Type

Setting

Price

ALLOPURINOL 100 MG PO TABLET

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.81
Rate for Payer: AlohaCare Medicaid	$0.92
Rate for Payer: AlohaCare Medicaid	$1.38
Rate for Payer: AlohaCare Medicare	$1.65
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cash Price	$1.79
Rate for Payer: Devoted Health Medicare	$1.81
Rate for Payer: Devoted Health Medicare	$2.73
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1.65
Rate for Payer: Hawaii Western Management Group Commercial	$2.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Health Management Network Commercial	$2.35
Rate for Payer: Humana Medicare	$1.65
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$2.48
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: Kaiser Permanente Medicaid	$1.41
Rate for Payer: Kaiser Permanente Medicare	$1.65
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: MDX Hawaii PPO	$2.68
Rate for Payer: Ohana Health Plan Medicaid	$1.65
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: Ohana Health Plan Medicare	$1.65
Rate for Payer: UnitedHealthcare Medicare	$1.65
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$1.33
Rate for Payer: University Health Alliance Commercial	$2.01

ALLOPURINOL 100 MG PO TABLET

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cash Price	$1.79
Rate for Payer: Health Management Network Commercial	$2.35
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: Kaiser Permanente Commercial	$2.48
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: MDX Hawaii PPO	$2.68

ALLOPURINOL 300 MG PO TABLET

Facility

$5.11

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5.06
Rate for Payer: AlohaCare Medicaid	$2.56
Rate for Payer: AlohaCare Medicare	$4.60
Rate for Payer: Cash Price	$3.32
Rate for Payer: Devoted Health Medicare	$5.06
Rate for Payer: Hawaii Medical Service Association Medicare	$4.60
Rate for Payer: Hawaii Western Management Group Commercial	$4.85
Rate for Payer: Health Management Network Commercial	$4.34
Rate for Payer: Humana Medicare	$4.60
Rate for Payer: Kaiser Permanente Commercial	$4.60
Rate for Payer: Kaiser Permanente Medicaid	$2.61
Rate for Payer: Kaiser Permanente Medicare	$4.60
Rate for Payer: MDX Hawaii PPO	$4.96
Rate for Payer: Ohana Health Plan Medicaid	$4.60
Rate for Payer: Ohana Health Plan Medicare	$4.60
Rate for Payer: UnitedHealthcare Medicare	$4.60
Rate for Payer: University Health Alliance Commercial	$3.72

ALLOPURINOL 300 MG PO TABLET

Facility

$5.11

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.32
Rate for Payer: Health Management Network Commercial	$4.34
Rate for Payer: Kaiser Permanente Commercial	$4.60
Rate for Payer: MDX Hawaii PPO	$4.96

ALPRAZOLAM 0.25 MG PO TABLET

Facility

$2.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.96
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Management Network Commercial	$1.72
Rate for Payer: Kaiser Permanente Commercial	$1.82
Rate for Payer: MDX Hawaii PPO	$1.96

ALPRAZOLAM 0.25 MG PO TABLET

Facility

$2.02

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.00
Rate for Payer: AlohaCare Medicaid	$1.01
Rate for Payer: AlohaCare Medicare	$1.82
Rate for Payer: Cash Price	$1.31
Rate for Payer: Devoted Health Medicare	$2.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1.82
Rate for Payer: Hawaii Western Management Group Commercial	$1.92
Rate for Payer: Health Management Network Commercial	$1.72
Rate for Payer: Humana Medicare	$1.82
Rate for Payer: Kaiser Permanente Commercial	$1.82
Rate for Payer: Kaiser Permanente Medicaid	$1.03
Rate for Payer: Kaiser Permanente Medicare	$1.82
Rate for Payer: MDX Hawaii PPO	$1.96
Rate for Payer: Ohana Health Plan Medicaid	$1.82
Rate for Payer: Ohana Health Plan Medicare	$1.82
Rate for Payer: UnitedHealthcare Medicare	$1.82
Rate for Payer: University Health Alliance Commercial	$1.47

ALPRAZOLAM 0.5 MG PO TABLET

Facility

$2.44

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.42
Rate for Payer: AlohaCare Medicaid	$1.22
Rate for Payer: AlohaCare Medicare	$2.20
Rate for Payer: Cash Price	$1.59
Rate for Payer: Devoted Health Medicare	$2.42
Rate for Payer: Hawaii Medical Service Association Medicare	$2.20
Rate for Payer: Hawaii Western Management Group Commercial	$2.32
Rate for Payer: Health Management Network Commercial	$2.07
Rate for Payer: Humana Medicare	$2.20
Rate for Payer: Kaiser Permanente Commercial	$2.20
Rate for Payer: Kaiser Permanente Medicaid	$1.24
Rate for Payer: Kaiser Permanente Medicare	$2.20
Rate for Payer: MDX Hawaii PPO	$2.37
Rate for Payer: Ohana Health Plan Medicaid	$2.20
Rate for Payer: Ohana Health Plan Medicare	$2.20
Rate for Payer: UnitedHealthcare Medicare	$2.20
Rate for Payer: University Health Alliance Commercial	$1.78

ALPRAZOLAM 0.5 MG PO TABLET

Facility

$2.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.37
Rate for Payer: Cash Price	$1.59
Rate for Payer: Health Management Network Commercial	$2.07
Rate for Payer: Kaiser Permanente Commercial	$2.20
Rate for Payer: MDX Hawaii PPO	$2.37

ALTEPLASE 2 MG INTRA-CATHET RECON.SOLN.

Facility

$624.42

Service Code	HCPCS J2997
Hospital Revenue Code	250
Min. Negotiated Rate	$530.76
Max. Negotiated Rate	$605.69
Rate for Payer: Cash Price	$405.87
Rate for Payer: Health Management Network Commercial	$530.76
Rate for Payer: Kaiser Permanente Commercial	$561.98
Rate for Payer: MDX Hawaii PPO	$605.69

ALTEPLASE 2 MG INTRA-CATHET RECON.SOLN.

Facility

$624.42

Service Code	HCPCS J2997
Hospital Revenue Code	636
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$618.18
Rate for Payer: AlohaCare Medicaid	$312.21
Rate for Payer: AlohaCare Medicare	$561.98
Rate for Payer: Cash Price	$405.87
Rate for Payer: Cash Price	$405.87
Rate for Payer: Devoted Health Medicare	$618.18
Rate for Payer: Hawaii Medical Service Association ABD	$94.15
Rate for Payer: Hawaii Medical Service Association Commercial	$118.86
Rate for Payer: Hawaii Medical Service Association Medicare	$561.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$94.15
Rate for Payer: Hawaii Western Management Group Commercial	$593.20
Rate for Payer: Health Management Network Commercial	$530.76
Rate for Payer: Humana Medicare	$561.98
Rate for Payer: Kaiser Permanente Commercial	$561.98
Rate for Payer: Kaiser Permanente Medicaid	$318.45
Rate for Payer: Kaiser Permanente Medicare	$561.98
Rate for Payer: MDX Hawaii PPO	$605.69
Rate for Payer: Ohana Health Plan Medicaid	$561.98
Rate for Payer: Ohana Health Plan Medicare	$561.98
Rate for Payer: UnitedHealthcare Medicaid	$374.65
Rate for Payer: UnitedHealthcare Medicare	$561.98
Rate for Payer: University Health Alliance Commercial	$455.14

ALUM-MAG HYDROXIDE-SIMETH 400-400-40 MG/5 ML PO SUSP

Facility

$4.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$4.35
Rate for Payer: Cash Price	$2.91
Rate for Payer: Cash Price	$16.26
Rate for Payer: Health Management Network Commercial	$3.81
Rate for Payer: Health Management Network Commercial	$21.26
Rate for Payer: Kaiser Permanente Commercial	$4.03
Rate for Payer: Kaiser Permanente Commercial	$22.51
Rate for Payer: MDX Hawaii PPO	$24.26
Rate for Payer: MDX Hawaii PPO	$4.35

ALUM-MAG HYDROXIDE-SIMETH 400-400-40 MG/5 ML PO SUSP

Facility

$25.01

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$12.51
Max. Negotiated Rate	$24.76
Rate for Payer: AlohaCare Medicaid	$12.51
Rate for Payer: AlohaCare Medicaid	$2.24
Rate for Payer: AlohaCare Medicare	$22.51
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$2.91
Rate for Payer: Cash Price	$16.26
Rate for Payer: Devoted Health Medicare	$24.76
Rate for Payer: Devoted Health Medicare	$4.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Medical Service Association Medicare	$22.51
Rate for Payer: Hawaii Western Management Group Commercial	$4.26
Rate for Payer: Hawaii Western Management Group Commercial	$23.76
Rate for Payer: Health Management Network Commercial	$21.26
Rate for Payer: Health Management Network Commercial	$3.81
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Humana Medicare	$22.51
Rate for Payer: Kaiser Permanente Commercial	$22.51
Rate for Payer: Kaiser Permanente Commercial	$4.03
Rate for Payer: Kaiser Permanente Medicaid	$2.28
Rate for Payer: Kaiser Permanente Medicaid	$12.76
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: Kaiser Permanente Medicare	$22.51
Rate for Payer: MDX Hawaii PPO	$4.35
Rate for Payer: MDX Hawaii PPO	$24.26
Rate for Payer: Ohana Health Plan Medicaid	$22.51
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$22.51
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$22.51
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$3.27
Rate for Payer: University Health Alliance Commercial	$18.23

AMANTADINE HCL 100 MG PO CAP

Facility

$19.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$18.65
Rate for Payer: Cash Price	$12.50
Rate for Payer: Health Management Network Commercial	$16.35
Rate for Payer: Kaiser Permanente Commercial	$17.31
Rate for Payer: MDX Hawaii PPO	$18.65

AMANTADINE HCL 100 MG PO CAP

Facility

$19.23

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$19.04
Rate for Payer: AlohaCare Medicaid	$9.62
Rate for Payer: AlohaCare Medicare	$17.31
Rate for Payer: Cash Price	$12.50
Rate for Payer: Devoted Health Medicare	$19.04
Rate for Payer: Hawaii Medical Service Association Medicare	$17.31
Rate for Payer: Hawaii Western Management Group Commercial	$18.27
Rate for Payer: Health Management Network Commercial	$16.35
Rate for Payer: Humana Medicare	$17.31
Rate for Payer: Kaiser Permanente Commercial	$17.31
Rate for Payer: Kaiser Permanente Medicaid	$9.81
Rate for Payer: Kaiser Permanente Medicare	$17.31
Rate for Payer: MDX Hawaii PPO	$18.65
Rate for Payer: Ohana Health Plan Medicaid	$17.31
Rate for Payer: Ohana Health Plan Medicare	$17.31
Rate for Payer: UnitedHealthcare Medicare	$17.31
Rate for Payer: University Health Alliance Commercial	$14.02

AMANTADINE HCL 50 MG/5 ML PO SOLN

Facility

$27.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$26.45
Rate for Payer: Cash Price	$17.73
Rate for Payer: Health Management Network Commercial	$23.18
Rate for Payer: Kaiser Permanente Commercial	$24.54
Rate for Payer: MDX Hawaii PPO	$26.45

AMANTADINE HCL 50 MG/5 ML PO SOLN

Facility

$27.27

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$27.00
Rate for Payer: AlohaCare Medicaid	$13.63
Rate for Payer: AlohaCare Medicare	$24.54
Rate for Payer: Cash Price	$17.73
Rate for Payer: Devoted Health Medicare	$27.00
Rate for Payer: Hawaii Medical Service Association Medicare	$24.54
Rate for Payer: Hawaii Western Management Group Commercial	$25.91
Rate for Payer: Health Management Network Commercial	$23.18
Rate for Payer: Humana Medicare	$24.54
Rate for Payer: Kaiser Permanente Commercial	$24.54
Rate for Payer: Kaiser Permanente Medicaid	$13.91
Rate for Payer: Kaiser Permanente Medicare	$24.54
Rate for Payer: MDX Hawaii PPO	$26.45
Rate for Payer: Ohana Health Plan Medicaid	$24.54
Rate for Payer: Ohana Health Plan Medicare	$24.54
Rate for Payer: UnitedHealthcare Medicare	$24.54
Rate for Payer: University Health Alliance Commercial	$19.88

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$48.29

Service Code	NDC 00641616710
Hospital Revenue Code	250
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$47.81
Rate for Payer: AlohaCare Medicaid	$24.14
Rate for Payer: AlohaCare Medicare	$43.46
Rate for Payer: Cash Price	$31.39
Rate for Payer: Devoted Health Medicare	$47.81
Rate for Payer: Hawaii Medical Service Association Medicare	$43.46
Rate for Payer: Hawaii Western Management Group Commercial	$45.88
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Humana Medicare	$43.46
Rate for Payer: Kaiser Permanente Commercial	$43.46
Rate for Payer: Kaiser Permanente Medicaid	$24.63
Rate for Payer: Kaiser Permanente Medicare	$43.46
Rate for Payer: MDX Hawaii PPO	$46.84
Rate for Payer: Ohana Health Plan Medicaid	$43.46
Rate for Payer: Ohana Health Plan Medicare	$43.46
Rate for Payer: UnitedHealthcare Medicaid	$28.97
Rate for Payer: UnitedHealthcare Medicare	$43.46
Rate for Payer: University Health Alliance Commercial	$35.20

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$48.29

Service Code	NDC 00641616701
Hospital Revenue Code	250
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$47.81
Rate for Payer: AlohaCare Medicaid	$24.14
Rate for Payer: AlohaCare Medicare	$43.46
Rate for Payer: Cash Price	$31.39
Rate for Payer: Devoted Health Medicare	$47.81
Rate for Payer: Hawaii Medical Service Association Medicare	$43.46
Rate for Payer: Hawaii Western Management Group Commercial	$45.88
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Humana Medicare	$43.46
Rate for Payer: Kaiser Permanente Commercial	$43.46
Rate for Payer: Kaiser Permanente Medicaid	$24.63
Rate for Payer: Kaiser Permanente Medicare	$43.46
Rate for Payer: MDX Hawaii PPO	$46.84
Rate for Payer: Ohana Health Plan Medicaid	$43.46
Rate for Payer: Ohana Health Plan Medicare	$43.46
Rate for Payer: UnitedHealthcare Medicaid	$28.97
Rate for Payer: UnitedHealthcare Medicare	$43.46
Rate for Payer: University Health Alliance Commercial	$35.20

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$45.87

Service Code	NDC 23155029031
Hospital Revenue Code	250
Min. Negotiated Rate	$22.93
Max. Negotiated Rate	$45.41
Rate for Payer: AlohaCare Medicaid	$22.93
Rate for Payer: AlohaCare Medicare	$41.28
Rate for Payer: Cash Price	$29.82
Rate for Payer: Devoted Health Medicare	$45.41
Rate for Payer: Hawaii Medical Service Association Medicare	$41.28
Rate for Payer: Hawaii Western Management Group Commercial	$43.58
Rate for Payer: Health Management Network Commercial	$38.99
Rate for Payer: Humana Medicare	$41.28
Rate for Payer: Kaiser Permanente Commercial	$41.28
Rate for Payer: Kaiser Permanente Medicaid	$23.39
Rate for Payer: Kaiser Permanente Medicare	$41.28
Rate for Payer: MDX Hawaii PPO	$44.49
Rate for Payer: Ohana Health Plan Medicaid	$41.28
Rate for Payer: Ohana Health Plan Medicare	$41.28
Rate for Payer: UnitedHealthcare Medicaid	$27.52
Rate for Payer: UnitedHealthcare Medicare	$41.28
Rate for Payer: University Health Alliance Commercial	$33.43

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$47.08

Service Code	NDC 25021017302
Hospital Revenue Code	250
Min. Negotiated Rate	$40.02
Max. Negotiated Rate	$45.67
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$40.02
Rate for Payer: Kaiser Permanente Commercial	$42.37
Rate for Payer: MDX Hawaii PPO	$45.67

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$48.29

Service Code	NDC 00641616701
Hospital Revenue Code	250
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$46.84
Rate for Payer: Cash Price	$31.39
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Kaiser Permanente Commercial	$43.46
Rate for Payer: MDX Hawaii PPO	$46.84

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$47.08

Service Code	NDC 25021017302
Hospital Revenue Code	250
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$46.61
Rate for Payer: AlohaCare Medicaid	$23.54
Rate for Payer: AlohaCare Medicare	$42.37
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$46.61
Rate for Payer: Hawaii Medical Service Association Medicare	$42.37
Rate for Payer: Hawaii Western Management Group Commercial	$44.73
Rate for Payer: Health Management Network Commercial	$40.02
Rate for Payer: Humana Medicare	$42.37
Rate for Payer: Kaiser Permanente Commercial	$42.37
Rate for Payer: Kaiser Permanente Medicaid	$24.01
Rate for Payer: Kaiser Permanente Medicare	$42.37
Rate for Payer: MDX Hawaii PPO	$45.67
Rate for Payer: Ohana Health Plan Medicaid	$42.37
Rate for Payer: Ohana Health Plan Medicare	$42.37
Rate for Payer: UnitedHealthcare Medicaid	$28.25
Rate for Payer: UnitedHealthcare Medicare	$42.37
Rate for Payer: University Health Alliance Commercial	$34.32

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$45.87

Service Code	NDC 23155029041
Hospital Revenue Code	250
Min. Negotiated Rate	$22.93
Max. Negotiated Rate	$45.41
Rate for Payer: AlohaCare Medicaid	$22.93
Rate for Payer: AlohaCare Medicare	$41.28
Rate for Payer: Cash Price	$29.82
Rate for Payer: Devoted Health Medicare	$45.41
Rate for Payer: Hawaii Medical Service Association Medicare	$41.28
Rate for Payer: Hawaii Western Management Group Commercial	$43.58
Rate for Payer: Health Management Network Commercial	$38.99
Rate for Payer: Humana Medicare	$41.28
Rate for Payer: Kaiser Permanente Commercial	$41.28
Rate for Payer: Kaiser Permanente Medicaid	$23.39
Rate for Payer: Kaiser Permanente Medicare	$41.28
Rate for Payer: MDX Hawaii PPO	$44.49
Rate for Payer: Ohana Health Plan Medicaid	$41.28
Rate for Payer: Ohana Health Plan Medicare	$41.28
Rate for Payer: UnitedHealthcare Medicaid	$27.52
Rate for Payer: UnitedHealthcare Medicare	$41.28
Rate for Payer: University Health Alliance Commercial	$33.43

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$48.29

Service Code	NDC 00641616710
Hospital Revenue Code	250
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$46.84
Rate for Payer: Cash Price	$31.39
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Kaiser Permanente Commercial	$43.46
Rate for Payer: MDX Hawaii PPO	$46.84

AMIKACIN 500 MG/2 ML (250 MG/ML) INJ SOLN FOR OTHER USE

Facility

$45.87

Service Code	NDC 23155029041
Hospital Revenue Code	250
Min. Negotiated Rate	$38.99
Max. Negotiated Rate	$44.49
Rate for Payer: Cash Price	$29.82
Rate for Payer: Health Management Network Commercial	$38.99
Rate for Payer: Kaiser Permanente Commercial	$41.28
Rate for Payer: MDX Hawaii PPO	$44.49

Know your out-of-pocket cost for care.

All Charges