Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bill Only Flow Cytometry Cell Cycle

Facility

$412.00

Service Code	HCPCS 88182 TC
Hospital Charge Code	8409274
Hospital Revenue Code	311
Min. Negotiated Rate	$350.20
Max. Negotiated Rate	$399.64
Rate for Payer: Cash Price	$267.80
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: MDX Hawaii PPO	$399.64

Bill Only Fungal ID DNA Seq

Facility

$1,072.00

Service Code	HCPCS 87153
Hospital Charge Code	8301469
Hospital Revenue Code	306
Min. Negotiated Rate	$911.20
Max. Negotiated Rate	$1,039.84
Rate for Payer: Cash Price	$696.80
Rate for Payer: Health Management Network Commercial	$911.20
Rate for Payer: Kaiser Permanente Commercial	$964.80
Rate for Payer: MDX Hawaii PPO	$1,039.84

Bill Only Fungal ID DNA Seq

Facility

$1,072.00

Service Code	HCPCS 87153
Hospital Charge Code	8301469
Hospital Revenue Code	306
Min. Negotiated Rate	$115.36
Max. Negotiated Rate	$1,039.84
Rate for Payer: AlohaCare Medicaid	$536.00
Rate for Payer: AlohaCare Medicare	$536.00
Rate for Payer: Cash Price	$696.80
Rate for Payer: Cash Price	$696.80
Rate for Payer: Devoted Health Medicare	$589.60
Rate for Payer: Hawaii Medical Service Association ABD	$165.22
Rate for Payer: Hawaii Medical Service Association Commercial	$144.20
Rate for Payer: Hawaii Medical Service Association Medicare	$536.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$150.38
Rate for Payer: Hawaii Western Management Group Commercial	$115.36
Rate for Payer: Health Management Network Commercial	$911.20
Rate for Payer: Humana Medicare	$536.00
Rate for Payer: Kaiser Permanente Commercial	$964.80
Rate for Payer: Kaiser Permanente Medicaid	$546.72
Rate for Payer: Kaiser Permanente Medicare	$536.00
Rate for Payer: MDX Hawaii PPO	$1,039.84
Rate for Payer: Ohana Health Plan Medicaid	$536.00
Rate for Payer: Ohana Health Plan Medicare	$536.00
Rate for Payer: UnitedHealthcare Medicaid	$165.22
Rate for Payer: UnitedHealthcare Medicare	$536.00
Rate for Payer: University Health Alliance Commercial	$300.31

Bill Only Glucose, 1 Hr Post Prand., Pregnancy

Facility

$46.00

Service Code	HCPCS 82950
Hospital Charge Code	12927333
Hospital Revenue Code	301
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

Bill Only Glucose, 1 Hr Post Prand., Pregnancy

Facility

$46.00

Service Code	HCPCS 82950
Hospital Charge Code	12927333
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$44.62
Rate for Payer: AlohaCare Medicaid	$23.00
Rate for Payer: AlohaCare Medicare	$23.00
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Devoted Health Medicare	$25.30
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$23.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Humana Medicare	$23.00
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: Kaiser Permanente Medicaid	$23.46
Rate for Payer: Kaiser Permanente Medicare	$23.00
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: Ohana Health Plan Medicaid	$23.00
Rate for Payer: Ohana Health Plan Medicare	$23.00
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$23.00
Rate for Payer: University Health Alliance Commercial	$12.28

Bill Only Glucose, 2 Hour Post Prandial

Facility

$48.00

Service Code	HCPCS 82950
Hospital Charge Code	12925324
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

Bill Only Glucose, 2 Hour Post Prandial

Facility

$48.00

Service Code	HCPCS 82950
Hospital Charge Code	12925324
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$24.00
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$26.40
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$24.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$24.00
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$24.00
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$24.00
Rate for Payer: Ohana Health Plan Medicare	$24.00
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$24.00
Rate for Payer: University Health Alliance Commercial	$12.28

Bill Only HCG Qual, Reflex to Quant

Facility

$89.00

Service Code	HCPCS 84703
Hospital Charge Code	12925322
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$44.50
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Devoted Health Medicare	$48.95
Rate for Payer: Hawaii Medical Service Association ABD	$10.38
Rate for Payer: Hawaii Medical Service Association Commercial	$9.40
Rate for Payer: Hawaii Medical Service Association Medicare	$44.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.90
Rate for Payer: Hawaii Western Management Group Commercial	$7.52
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$44.50
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$44.50
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$44.50
Rate for Payer: Ohana Health Plan Medicare	$44.50
Rate for Payer: UnitedHealthcare Medicaid	$10.38
Rate for Payer: UnitedHealthcare Medicare	$44.50
Rate for Payer: University Health Alliance Commercial	$19.41

Bill Only HCG Qual, Reflex to Quant

Facility

$89.00

Service Code	HCPCS 84703
Hospital Charge Code	12925322
Hospital Revenue Code	301
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Bill Only Hexagonal Phase Charge

Facility

$205.00

Service Code	HCPCS 85597
Hospital Charge Code	8301492
Hospital Revenue Code	305
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$133.25
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: MDX Hawaii PPO	$198.85

Bill Only Hexagonal Phase Charge

Facility

$205.00

Service Code	HCPCS 85597
Hospital Charge Code	8301492
Hospital Revenue Code	305
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$102.50
Rate for Payer: AlohaCare Medicare	$102.50
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Devoted Health Medicare	$112.75
Rate for Payer: Hawaii Medical Service Association ABD	$24.84
Rate for Payer: Hawaii Medical Service Association Commercial	$22.48
Rate for Payer: Hawaii Medical Service Association Medicare	$102.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.08
Rate for Payer: Hawaii Western Management Group Commercial	$17.98
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Humana Medicare	$102.50
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: Kaiser Permanente Medicare	$102.50
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: Ohana Health Plan Medicaid	$102.50
Rate for Payer: Ohana Health Plan Medicare	$102.50
Rate for Payer: UnitedHealthcare Medicaid	$24.84
Rate for Payer: UnitedHealthcare Medicare	$102.50
Rate for Payer: University Health Alliance Commercial	$46.47

Bill Only HSV 1 Amp Probe CSF/Swab FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8418342
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$90.72

Bill Only HSV 1 Amp Probe CSF/Swab FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8418342
Hospital Revenue Code	306
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

Bill Only Immunofluorescence Each

Facility

$1,075.00

Service Code	HCPCS 88346 TC
Hospital Charge Code	8409280
Hospital Revenue Code	310
Min. Negotiated Rate	$39.51
Max. Negotiated Rate	$1,042.75
Rate for Payer: AlohaCare Medicaid	$537.50
Rate for Payer: AlohaCare Medicare	$537.50
Rate for Payer: Cash Price	$698.75
Rate for Payer: Cash Price	$698.75
Rate for Payer: Devoted Health Medicare	$591.25
Rate for Payer: Hawaii Medical Service Association ABD	$60.22
Rate for Payer: Hawaii Medical Service Association Medicare	$537.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,021.25
Rate for Payer: Health Management Network Commercial	$913.75
Rate for Payer: Humana Medicare	$537.50
Rate for Payer: Kaiser Permanente Commercial	$967.50
Rate for Payer: Kaiser Permanente Medicaid	$548.25
Rate for Payer: Kaiser Permanente Medicare	$537.50
Rate for Payer: MDX Hawaii PPO	$1,042.75
Rate for Payer: Ohana Health Plan Medicaid	$537.50
Rate for Payer: Ohana Health Plan Medicare	$537.50
Rate for Payer: UnitedHealthcare Medicaid	$60.22
Rate for Payer: UnitedHealthcare Medicare	$537.50
Rate for Payer: University Health Alliance Commercial	$117.20

Bill Only Immunofluorescence Each

Facility

$1,075.00

Service Code	HCPCS 88346 TC
Hospital Charge Code	8409280
Hospital Revenue Code	310
Min. Negotiated Rate	$913.75
Max. Negotiated Rate	$1,042.75
Rate for Payer: Cash Price	$698.75
Rate for Payer: Health Management Network Commercial	$913.75
Rate for Payer: Kaiser Permanente Commercial	$967.50
Rate for Payer: MDX Hawaii PPO	$1,042.75

Bill Only Immunofluorscence Add

Facility

$564.00

Service Code	HCPCS 88350 TC
Hospital Charge Code	8409282
Hospital Revenue Code	310
Min. Negotiated Rate	$30.47
Max. Negotiated Rate	$547.08
Rate for Payer: AlohaCare Medicaid	$282.00
Rate for Payer: AlohaCare Medicare	$282.00
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cash Price	$366.60
Rate for Payer: Devoted Health Medicare	$310.20
Rate for Payer: Hawaii Medical Service Association ABD	$30.47
Rate for Payer: Hawaii Medical Service Association Medicare	$282.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.00
Rate for Payer: Hawaii Western Management Group Commercial	$535.80
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Humana Medicare	$282.00
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: Kaiser Permanente Medicaid	$287.64
Rate for Payer: Kaiser Permanente Medicare	$282.00
Rate for Payer: MDX Hawaii PPO	$547.08
Rate for Payer: Ohana Health Plan Medicaid	$282.00
Rate for Payer: Ohana Health Plan Medicare	$282.00
Rate for Payer: UnitedHealthcare Medicaid	$76.49
Rate for Payer: UnitedHealthcare Medicare	$282.00
Rate for Payer: University Health Alliance Commercial	$94.24

Bill Only Immunofluorscence Add

Facility

$564.00

Service Code	HCPCS 88350 TC
Hospital Charge Code	8409282
Hospital Revenue Code	310
Min. Negotiated Rate	$479.40
Max. Negotiated Rate	$547.08
Rate for Payer: Cash Price	$366.60
Rate for Payer: Health Management Network Commercial	$479.40
Rate for Payer: Kaiser Permanente Commercial	$507.60
Rate for Payer: MDX Hawaii PPO	$547.08

Bill Only Immunohistochem Each Add

Facility

$437.00

Service Code	HCPCS 88341 TC
Hospital Charge Code	8409278
Hospital Revenue Code	310
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$423.89
Rate for Payer: AlohaCare Medicaid	$218.50
Rate for Payer: AlohaCare Medicare	$218.50
Rate for Payer: Cash Price	$284.05
Rate for Payer: Cash Price	$284.05
Rate for Payer: Devoted Health Medicare	$240.35
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
Rate for Payer: Hawaii Medical Service Association Medicare	$218.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$415.15
Rate for Payer: Health Management Network Commercial	$371.45
Rate for Payer: Humana Medicare	$218.50
Rate for Payer: Kaiser Permanente Commercial	$393.30
Rate for Payer: Kaiser Permanente Medicaid	$222.87
Rate for Payer: Kaiser Permanente Medicare	$218.50
Rate for Payer: MDX Hawaii PPO	$423.89
Rate for Payer: Ohana Health Plan Medicaid	$218.50
Rate for Payer: Ohana Health Plan Medicare	$218.50
Rate for Payer: UnitedHealthcare Medicaid	$60.64
Rate for Payer: UnitedHealthcare Medicare	$218.50
Rate for Payer: University Health Alliance Commercial	$99.23

Bill Only Immunohistochem Each Add

Facility

$437.00

Service Code	HCPCS 88341 TC
Hospital Charge Code	8409278
Hospital Revenue Code	310
Min. Negotiated Rate	$371.45
Max. Negotiated Rate	$423.89
Rate for Payer: Cash Price	$284.05
Rate for Payer: Health Management Network Commercial	$371.45
Rate for Payer: Kaiser Permanente Commercial	$393.30
Rate for Payer: MDX Hawaii PPO	$423.89

Bill Only Immunohistochem Each Mult

Facility

$1,080.00

Service Code	HCPCS 88344 TC
Hospital Charge Code	8409279
Hospital Revenue Code	310
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,047.60
Rate for Payer: Cash Price	$702.00
Rate for Payer: Health Management Network Commercial	$918.00
Rate for Payer: Kaiser Permanente Commercial	$972.00
Rate for Payer: MDX Hawaii PPO	$1,047.60

Bill Only Immunohistochem Each Mult

Facility

$1,080.00

Service Code	HCPCS 88344 TC
Hospital Charge Code	8409279
Hospital Revenue Code	310
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$1,047.60
Rate for Payer: AlohaCare Medicaid	$540.00
Rate for Payer: AlohaCare Medicare	$540.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Devoted Health Medicare	$594.00
Rate for Payer: Hawaii Medical Service Association ABD	$28.15
Rate for Payer: Hawaii Medical Service Association Medicare	$540.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$35.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,026.00
Rate for Payer: Health Management Network Commercial	$918.00
Rate for Payer: Humana Medicare	$540.00
Rate for Payer: Kaiser Permanente Commercial	$972.00
Rate for Payer: Kaiser Permanente Medicaid	$550.80
Rate for Payer: Kaiser Permanente Medicare	$540.00
Rate for Payer: MDX Hawaii PPO	$1,047.60
Rate for Payer: Ohana Health Plan Medicaid	$540.00
Rate for Payer: Ohana Health Plan Medicare	$540.00
Rate for Payer: UnitedHealthcare Medicaid	$116.58
Rate for Payer: UnitedHealthcare Medicare	$540.00
Rate for Payer: University Health Alliance Commercial	$165.11

Bill Only Inf Ag Drug Susc Phenot FSI

Facility

$957.00

Service Code	HCPCS 87900
Hospital Charge Code	8418340
Hospital Revenue Code	306
Min. Negotiated Rate	$813.45
Max. Negotiated Rate	$928.29
Rate for Payer: Cash Price	$622.05
Rate for Payer: Health Management Network Commercial	$813.45
Rate for Payer: Kaiser Permanente Commercial	$861.30
Rate for Payer: MDX Hawaii PPO	$928.29

Bill Only Inf Ag Drug Susc Phenot FSI

Facility

$957.00

Service Code	HCPCS 87900
Hospital Charge Code	8418340
Hospital Revenue Code	306
Min. Negotiated Rate	$127.48
Max. Negotiated Rate	$928.29
Rate for Payer: AlohaCare Medicaid	$478.50
Rate for Payer: AlohaCare Medicare	$478.50
Rate for Payer: Cash Price	$622.05
Rate for Payer: Cash Price	$622.05
Rate for Payer: Devoted Health Medicare	$526.35
Rate for Payer: Hawaii Medical Service Association ABD	$127.48
Rate for Payer: Hawaii Medical Service Association Commercial	$162.94
Rate for Payer: Hawaii Medical Service Association Medicare	$478.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$180.03
Rate for Payer: Hawaii Western Management Group Commercial	$130.35
Rate for Payer: Health Management Network Commercial	$813.45
Rate for Payer: Humana Medicare	$478.50
Rate for Payer: Kaiser Permanente Commercial	$861.30
Rate for Payer: Kaiser Permanente Medicaid	$488.07
Rate for Payer: Kaiser Permanente Medicare	$478.50
Rate for Payer: MDX Hawaii PPO	$928.29
Rate for Payer: Ohana Health Plan Medicaid	$478.50
Rate for Payer: Ohana Health Plan Medicare	$478.50
Rate for Payer: UnitedHealthcare Medicaid	$127.48
Rate for Payer: UnitedHealthcare Medicare	$478.50
Rate for Payer: University Health Alliance Commercial	$336.90

Bill Only In Situ Hybrid Ea Multipl

Facility

$1,078.00

Service Code	HCPCS 88366 TC
Hospital Charge Code	8409285
Hospital Revenue Code	310
Min. Negotiated Rate	$916.30
Max. Negotiated Rate	$1,045.66
Rate for Payer: Cash Price	$700.70
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: MDX Hawaii PPO	$1,045.66

Bill Only In Situ Hybrid Ea Multipl

Facility

$1,078.00

Service Code	HCPCS 88366 TC
Hospital Charge Code	8409285
Hospital Revenue Code	310
Min. Negotiated Rate	$86.17
Max. Negotiated Rate	$1,045.66
Rate for Payer: UnitedHealthcare Medicaid	$182.87
Rate for Payer: AlohaCare Medicaid	$539.00
Rate for Payer: AlohaCare Medicare	$539.00
Rate for Payer: Cash Price	$700.70
Rate for Payer: Cash Price	$700.70
Rate for Payer: Devoted Health Medicare	$592.90
Rate for Payer: Hawaii Medical Service Association Medicare	$539.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$86.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,024.10
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Humana Medicare	$539.00
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: Kaiser Permanente Medicaid	$549.78
Rate for Payer: Kaiser Permanente Medicare	$539.00
Rate for Payer: MDX Hawaii PPO	$1,045.66
Rate for Payer: Ohana Health Plan Medicaid	$539.00
Rate for Payer: Ohana Health Plan Medicare	$539.00
Rate for Payer: UnitedHealthcare Medicare	$539.00
Rate for Payer: University Health Alliance Commercial	$487.85

Know your out-of-pocket cost for care.

All Charges