Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

albuterol 2.5mg/3ml neb soln [HHSC]

Facility

$4.45

Service Code	HCPCS J7613
Hospital Charge Code	2500030
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$4.32
Rate for Payer: Cash Price	$2.89
Rate for Payer: Health Management Network Commercial	$3.78
Rate for Payer: Kaiser Permanente Commercial	$4.00
Rate for Payer: MDX Hawaii PPO	$4.32

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$132.10

Service Code	NDC 00173068224
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$128.14
Rate for Payer: AlohaCare Medicaid	$66.05
Rate for Payer: AlohaCare Medicare	$66.05
Rate for Payer: Cash Price	$85.86
Rate for Payer: Devoted Health Medicare	$72.66
Rate for Payer: Hawaii Medical Service Association Medicare	$66.05
Rate for Payer: Hawaii Western Management Group Commercial	$125.50
Rate for Payer: Health Management Network Commercial	$112.28
Rate for Payer: Humana Medicare	$66.05
Rate for Payer: Kaiser Permanente Commercial	$118.89
Rate for Payer: Kaiser Permanente Medicaid	$67.37
Rate for Payer: Kaiser Permanente Medicare	$66.05
Rate for Payer: MDX Hawaii PPO	$128.14
Rate for Payer: Ohana Health Plan Medicaid	$66.05
Rate for Payer: Ohana Health Plan Medicare	$66.05
Rate for Payer: UnitedHealthcare Medicaid	$79.26
Rate for Payer: UnitedHealthcare Medicare	$66.05
Rate for Payer: University Health Alliance Commercial	$96.29

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$132.10

Service Code	NDC 00173068224
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$112.28
Max. Negotiated Rate	$128.14
Rate for Payer: Cash Price	$85.86
Rate for Payer: Health Management Network Commercial	$112.28
Rate for Payer: Kaiser Permanente Commercial	$118.89
Rate for Payer: MDX Hawaii PPO	$128.14

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$304.94

Service Code	NDC 45802008801
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$152.47
Max. Negotiated Rate	$295.79
Rate for Payer: AlohaCare Medicaid	$152.47
Rate for Payer: AlohaCare Medicare	$152.47
Rate for Payer: Cash Price	$198.21
Rate for Payer: Devoted Health Medicare	$167.72
Rate for Payer: Hawaii Medical Service Association Medicare	$152.47
Rate for Payer: Hawaii Western Management Group Commercial	$289.69
Rate for Payer: Health Management Network Commercial	$259.20
Rate for Payer: Humana Medicare	$152.47
Rate for Payer: Kaiser Permanente Commercial	$274.45
Rate for Payer: Kaiser Permanente Medicaid	$155.52
Rate for Payer: Kaiser Permanente Medicare	$152.47
Rate for Payer: MDX Hawaii PPO	$295.79
Rate for Payer: Ohana Health Plan Medicaid	$152.47
Rate for Payer: Ohana Health Plan Medicare	$152.47
Rate for Payer: UnitedHealthcare Medicaid	$182.96
Rate for Payer: UnitedHealthcare Medicare	$152.47
Rate for Payer: University Health Alliance Commercial	$222.27

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$304.94

Service Code	NDC 45802008801
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$259.20
Max. Negotiated Rate	$295.79
Rate for Payer: Cash Price	$198.21
Rate for Payer: Health Management Network Commercial	$259.20
Rate for Payer: Kaiser Permanente Commercial	$274.45
Rate for Payer: MDX Hawaii PPO	$295.79

albuterol-ipratropium 2.5-0.5 mg/3ml neb soln [HHSC]

Facility

$3.45

Service Code	HCPCS J7620
Hospital Charge Code	2500033
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$3.35
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cash Price	$7.99
Rate for Payer: Health Management Network Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$10.88
Rate for Payer: Kaiser Permanente Commercial	$11.52
Rate for Payer: Kaiser Permanente Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$11.06
Rate for Payer: MDX Hawaii PPO	$12.42
Rate for Payer: MDX Hawaii PPO	$11.92
Rate for Payer: MDX Hawaii PPO	$3.35

albuterol-ipratropium 2.5-0.5 mg/3ml neb soln [HHSC]

Facility

$12.29

Service Code	HCPCS J7620
Hospital Charge Code	2500033
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$11.92
Rate for Payer: AlohaCare Medicaid	$6.14
Rate for Payer: AlohaCare Medicaid	$1.73
Rate for Payer: AlohaCare Medicaid	$6.40
Rate for Payer: AlohaCare Medicare	$6.40
Rate for Payer: AlohaCare Medicare	$6.14
Rate for Payer: AlohaCare Medicare	$1.73
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cash Price	$7.99
Rate for Payer: Cash Price	$7.99
Rate for Payer: Cash Price	$2.24
Rate for Payer: Devoted Health Medicare	$6.76
Rate for Payer: Devoted Health Medicare	$1.90
Rate for Payer: Devoted Health Medicare	$7.04
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Medicare	$6.14
Rate for Payer: Hawaii Medical Service Association Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$6.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Western Management Group Commercial	$12.16
Rate for Payer: Hawaii Western Management Group Commercial	$11.68
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$10.88
Rate for Payer: Humana Medicare	$6.14
Rate for Payer: Humana Medicare	$6.40
Rate for Payer: Humana Medicare	$1.73
Rate for Payer: Kaiser Permanente Commercial	$11.06
Rate for Payer: Kaiser Permanente Commercial	$11.52
Rate for Payer: Kaiser Permanente Commercial	$3.10
Rate for Payer: Kaiser Permanente Medicaid	$1.76
Rate for Payer: Kaiser Permanente Medicaid	$6.53
Rate for Payer: Kaiser Permanente Medicaid	$6.27
Rate for Payer: Kaiser Permanente Medicare	$6.14
Rate for Payer: Kaiser Permanente Medicare	$6.40
Rate for Payer: Kaiser Permanente Medicare	$1.73
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: MDX Hawaii PPO	$12.42
Rate for Payer: MDX Hawaii PPO	$11.92
Rate for Payer: Ohana Health Plan Medicaid	$6.40
Rate for Payer: Ohana Health Plan Medicaid	$6.14
Rate for Payer: Ohana Health Plan Medicaid	$1.73
Rate for Payer: Ohana Health Plan Medicare	$6.40
Rate for Payer: Ohana Health Plan Medicare	$6.14
Rate for Payer: Ohana Health Plan Medicare	$1.73
Rate for Payer: UnitedHealthcare Medicaid	$7.68
Rate for Payer: UnitedHealthcare Medicaid	$7.37
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: UnitedHealthcare Medicare	$6.40
Rate for Payer: UnitedHealthcare Medicare	$6.14
Rate for Payer: UnitedHealthcare Medicare	$1.73
Rate for Payer: University Health Alliance Commercial	$8.96
Rate for Payer: University Health Alliance Commercial	$9.33
Rate for Payer: University Health Alliance Commercial	$2.51

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$8,461.61

Service Code	MSDRG 894
Min. Negotiated Rate	$8,461.61
Max. Negotiated Rate	$8,461.61
Rate for Payer: Hawaii Medical Service Association Commercial	$8,461.61

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$22,588.01

Service Code	MSDRG 896
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$14,410.82

Service Code	MSDRG 897
Min. Negotiated Rate	$14,410.82
Max. Negotiated Rate	$14,410.82
Rate for Payer: Hawaii Medical Service Association Commercial	$14,410.82

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$22,588.01

Service Code	MSDRG 895
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

Alcohol Level FSI

Facility

$1,384.00

Service Code	HCPCS 82077
Hospital Charge Code	8228834
Hospital Revenue Code	301
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$899.60
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: MDX Hawaii PPO	$1,342.48

Alcohol Level FSI

Facility

$1,384.00

Service Code	HCPCS 82077
Hospital Charge Code	8228834
Hospital Revenue Code	301
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$775.04

Aldosterone/Renin Activity Ratio FSI

Facility

$230.00

Service Code	HCPCS 82088
Hospital Charge Code	8117770
Hospital Revenue Code	300
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

Aldosterone/Renin Activity Ratio FSI

Facility

$230.00

Service Code	HCPCS 82088
Hospital Charge Code	8117770
Hospital Revenue Code	300
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$115.00
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$126.50
Rate for Payer: Hawaii Medical Service Association ABD	$56.32
Rate for Payer: Hawaii Medical Service Association Commercial	$50.94
Rate for Payer: Hawaii Medical Service Association Medicare	$115.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.14
Rate for Payer: Hawaii Western Management Group Commercial	$40.75
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$115.00
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$115.00
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$115.00
Rate for Payer: Ohana Health Plan Medicare	$115.00
Rate for Payer: UnitedHealthcare Medicaid	$56.32
Rate for Payer: UnitedHealthcare Medicare	$115.00
Rate for Payer: University Health Alliance Commercial	$105.34

Alkaline Phosphatase Fractionation FSI

Facility

$211.00

Service Code	HCPCS 84080
Hospital Charge Code	8404555
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$105.50
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$116.05
Rate for Payer: Hawaii Medical Service Association ABD	$20.44
Rate for Payer: Hawaii Medical Service Association Commercial	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$105.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.46
Rate for Payer: Hawaii Western Management Group Commercial	$14.78
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$105.50
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$105.50
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$105.50
Rate for Payer: Ohana Health Plan Medicare	$105.50
Rate for Payer: UnitedHealthcare Medicaid	$20.44
Rate for Payer: UnitedHealthcare Medicare	$105.50
Rate for Payer: University Health Alliance Commercial	$38.22

Alkaline Phosphatase Fractionation FSI

Facility

$211.00

Service Code	HCPCS 84080
Hospital Charge Code	8404555
Hospital Revenue Code	301
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

Alkaline Phosphatase FSI

Facility

$92.00

Service Code	HCPCS 84075
Hospital Charge Code	8117771
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$46.00
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Devoted Health Medicare	$50.60
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$46.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$46.00
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$46.00
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$46.00
Rate for Payer: Ohana Health Plan Medicare	$46.00
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$46.00
Rate for Payer: University Health Alliance Commercial	$13.38

Alkaline Phosphatase FSI

Facility

$92.00

Service Code	HCPCS 84075
Hospital Charge Code	8117771
Hospital Revenue Code	301
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$59.80
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

Allergen Adult Foods SO

Facility

$146.00

Service Code	HCPCS 86003
Hospital Charge Code	8301848
Hospital Revenue Code	301
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$94.90
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: MDX Hawaii PPO	$141.62

Allergen Adult Foods SO

Facility

$146.00

Service Code	HCPCS 86003
Hospital Charge Code	8301848
Hospital Revenue Code	301
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$73.00
Rate for Payer: AlohaCare Medicare	$73.00
Rate for Payer: Cash Price	$94.90
Rate for Payer: Cash Price	$94.90
Rate for Payer: Devoted Health Medicare	$80.30
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$73.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.58
Rate for Payer: Hawaii Western Management Group Commercial	$5.22
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Humana Medicare	$73.00
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: Kaiser Permanente Medicare	$73.00
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: Ohana Health Plan Medicaid	$73.00
Rate for Payer: Ohana Health Plan Medicare	$73.00
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$73.00
Rate for Payer: University Health Alliance Commercial	$13.51

Allergen Almond, IgE FSI

Facility

$149.00

Service Code	HCPCS 86003
Hospital Charge Code	8117772
Hospital Revenue Code	302
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

Allergen Almond, IgE FSI

Facility

$149.00

Service Code	HCPCS 86003
Hospital Charge Code	8117772
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$74.50
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$81.95
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$74.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.58
Rate for Payer: Hawaii Western Management Group Commercial	$5.22
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$74.50
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$74.50
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$74.50
Rate for Payer: Ohana Health Plan Medicare	$74.50
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$74.50
Rate for Payer: University Health Alliance Commercial	$13.51

Allergen Alpha-Lactalbumin, IgE FSI

Facility

$78.00

Service Code	HCPCS 86008
Hospital Charge Code	8117773
Hospital Revenue Code	302
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$39.00
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Devoted Health Medicare	$42.90
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	$39.00
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	$66.30
Rate for Payer: Humana Medicare	$39.00
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$39.00
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$39.00
Rate for Payer: Ohana Health Plan Medicare	$39.00
Rate for Payer: UnitedHealthcare Medicaid	$13.45
Rate for Payer: UnitedHealthcare Medicare	$39.00
Rate for Payer: University Health Alliance Commercial	$43.68

Allergen Alpha-Lactalbumin, IgE FSI

Facility

$78.00

Service Code	HCPCS 86008
Hospital Charge Code	8117773
Hospital Revenue Code	302
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

Know your out-of-pocket cost for care.

All Charges