Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

ANTEGRADE FEMORAL NAIL, RT, 9MM X 30CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971694
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 30CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971694
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 32CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971693
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 32CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971693
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 34CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971686
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 34CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971686
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 36CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 36CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 38CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971682
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 38CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971682
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 40CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 40CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 42CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971681
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 42CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971681
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 44CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971680
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 44CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971680
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 46CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971691
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

ANTEGRADE FEMORAL NAIL, RT, 9MM X 46CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12971691
Hospital Revenue Code	278
Min. Negotiated Rate	$2,305.00
Max. Negotiated Rate	$4,471.70
Rate for Payer: AlohaCare Medicaid	$2,305.00
Rate for Payer: AlohaCare Medicare	$2,305.00
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Devoted Health Medicare	$2,535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,305.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Humana Medicare	$2,305.00
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: Kaiser Permanente Medicaid	$2,351.10
Rate for Payer: Kaiser Permanente Medicare	$2,305.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: Ohana Health Plan Medicaid	$2,305.00
Rate for Payer: Ohana Health Plan Medicare	$2,305.00
Rate for Payer: UnitedHealthcare Medicare	$2,305.00
Rate for Payer: University Health Alliance Commercial	$2,581.60

Antibody Id. (Elution)

Facility

$235.00

Service Code	HCPCS 86860
Hospital Charge Code	12499852
Hospital Revenue Code	300
Min. Negotiated Rate	$199.75
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$152.75
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: MDX Hawaii PPO	$227.95

Antibody Id. (Elution)

Facility

$235.00

Service Code	HCPCS 86860
Hospital Charge Code	12499852
Hospital Revenue Code	300
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$227.95
Rate for Payer: AlohaCare Medicaid	$117.50
Rate for Payer: AlohaCare Medicare	$117.50
Rate for Payer: Cash Price	$152.75
Rate for Payer: Cash Price	$152.75
Rate for Payer: Devoted Health Medicare	$129.25
Rate for Payer: Hawaii Medical Service Association ABD	$16.20
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$117.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.52
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Humana Medicare	$117.50
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: Kaiser Permanente Medicaid	$119.85
Rate for Payer: Kaiser Permanente Medicare	$117.50
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: Ohana Health Plan Medicaid	$117.50
Rate for Payer: Ohana Health Plan Medicare	$117.50
Rate for Payer: UnitedHealthcare Medicaid	$16.20
Rate for Payer: UnitedHealthcare Medicare	$117.50
Rate for Payer: University Health Alliance Commercial	$131.60

Antibody Identification

Facility

$173.00

Service Code	HCPCS 86870
Hospital Charge Code	12516212
Hospital Revenue Code	302
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$457.76
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicare	$86.50
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Devoted Health Medicare	$95.15
Rate for Payer: Hawaii Medical Service Association ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$457.76
Rate for Payer: Hawaii Medical Service Association Medicare	$86.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$366.21
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$86.50
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$86.50
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$86.50
Rate for Payer: Ohana Health Plan Medicare	$86.50
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$86.50
Rate for Payer: University Health Alliance Commercial	$96.88

Antibody Identification

Facility

$173.00

Service Code	HCPCS 86870
Hospital Charge Code	12516212
Hospital Revenue Code	302
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

Antibody Screen FSI

Facility

$236.00

Service Code	HCPCS 86850
Hospital Charge Code	8117847
Hospital Revenue Code	302
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$118.00
Rate for Payer: Cash Price	$153.40
Rate for Payer: Cash Price	$153.40
Rate for Payer: Devoted Health Medicare	$129.80
Rate for Payer: Hawaii Medical Service Association ABD	$19.65
Rate for Payer: Hawaii Medical Service Association Commercial	$12.21
Rate for Payer: Hawaii Medical Service Association Medicare	$118.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.51
Rate for Payer: Hawaii Western Management Group Commercial	$9.77
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$118.00
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$118.00
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$118.00
Rate for Payer: Ohana Health Plan Medicare	$118.00
Rate for Payer: UnitedHealthcare Medicaid	$19.65
Rate for Payer: UnitedHealthcare Medicare	$118.00
Rate for Payer: University Health Alliance Commercial	$50.88

Antibody Screen FSI

Facility

$236.00

Service Code	HCPCS 86850
Hospital Charge Code	8117847
Hospital Revenue Code	302
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$153.40
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

.Antibody Titer to BBH FSI

Facility

$1,301.00

Service Code	HCPCS 86886
Hospital Charge Code	8117848
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$1,261.97
Rate for Payer: AlohaCare Medicaid	$650.50
Rate for Payer: AlohaCare Medicare	$650.50
Rate for Payer: Cash Price	$845.65
Rate for Payer: Cash Price	$845.65
Rate for Payer: Devoted Health Medicare	$715.55
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	$650.50
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	$1,105.85
Rate for Payer: Humana Medicare	$650.50
Rate for Payer: Kaiser Permanente Commercial	$1,170.90
Rate for Payer: Kaiser Permanente Medicaid	$663.51
Rate for Payer: Kaiser Permanente Medicare	$650.50
Rate for Payer: MDX Hawaii PPO	$1,261.97
Rate for Payer: Ohana Health Plan Medicaid	$650.50
Rate for Payer: Ohana Health Plan Medicare	$650.50
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$650.50
Rate for Payer: University Health Alliance Commercial	$13.38

Know your out-of-pocket cost for care.

All Charges