Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

GYN CURRETTE, DISPOSABLE VAGINAL 10mm CURVED

Facility

$29.00

Hospital Charge Code	8274157
Hospital Revenue Code	272
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$14.50
Rate for Payer: Cash Price	$18.85
Rate for Payer: Devoted Health Medicare	$15.95
Rate for Payer: Hawaii Medical Service Association Medicare	$14.50
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$14.50
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$14.50
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$14.50
Rate for Payer: Ohana Health Plan Medicare	$14.50
Rate for Payer: UnitedHealthcare Medicare	$14.50
Rate for Payer: University Health Alliance Commercial	$21.14

GYN CURRETTE, DISPOSABLE VAGINAL 10mm CURVED

Facility

$29.00

Hospital Charge Code	8274157
Hospital Revenue Code	272
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$18.85
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

GYN CURRETTE, DISPOSABLE VAGINAL 16mm CURVED

Facility

$34.00

Hospital Charge Code	8274158
Hospital Revenue Code	272
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$17.00
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.70
Rate for Payer: Hawaii Medical Service Association Medicare	$17.00
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$17.00
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$17.00
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$17.00
Rate for Payer: Ohana Health Plan Medicare	$17.00
Rate for Payer: UnitedHealthcare Medicare	$17.00
Rate for Payer: University Health Alliance Commercial	$24.78

GYN CURRETTE, DISPOSABLE VAGINAL 16mm CURVED

Facility

$34.00

Hospital Charge Code	8274158
Hospital Revenue Code	272
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

GYN CURRETTE, DISPOSABLE VAGINAL 6mm CURVED

Facility

$26.00

Hospital Charge Code	8274159
Hospital Revenue Code	272
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$16.90
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

GYN CURRETTE, DISPOSABLE VAGINAL 6mm CURVED

Facility

$26.00

Hospital Charge Code	8274159
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$13.00
Rate for Payer: Cash Price	$16.90
Rate for Payer: Devoted Health Medicare	$14.30
Rate for Payer: Hawaii Medical Service Association Medicare	$13.00
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$13.00
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$13.00
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$13.00
Rate for Payer: Ohana Health Plan Medicare	$13.00
Rate for Payer: UnitedHealthcare Medicare	$13.00
Rate for Payer: University Health Alliance Commercial	$18.95

GYN CURRETTE, DISPOSABLE VAGINAL 8mm CURVED

Facility

$26.00

Hospital Charge Code	8274160
Hospital Revenue Code	272
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$16.90
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

GYN CURRETTE, DISPOSABLE VAGINAL 8mm CURVED

Facility

$26.00

Hospital Charge Code	8274160
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$13.00
Rate for Payer: Cash Price	$16.90
Rate for Payer: Devoted Health Medicare	$14.30
Rate for Payer: Hawaii Medical Service Association Medicare	$13.00
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$13.00
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$13.00
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$13.00
Rate for Payer: Ohana Health Plan Medicare	$13.00
Rate for Payer: UnitedHealthcare Medicare	$13.00
Rate for Payer: University Health Alliance Commercial	$18.95

GYNECOLOGY:NEEDLE WILLIAMS CYSTOSCOPIC INJECTION 23

Facility

$159.00

Hospital Charge Code	13242247
Hospital Revenue Code	272
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$154.23
Rate for Payer: AlohaCare Medicaid	$79.50
Rate for Payer: AlohaCare Medicare	$79.50
Rate for Payer: Cash Price	$103.35
Rate for Payer: Devoted Health Medicare	$87.45
Rate for Payer: Hawaii Medical Service Association Medicare	$79.50
Rate for Payer: Hawaii Western Management Group Commercial	$151.05
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Humana Medicare	$79.50
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: Kaiser Permanente Medicaid	$81.09
Rate for Payer: Kaiser Permanente Medicare	$79.50
Rate for Payer: MDX Hawaii PPO	$154.23
Rate for Payer: Ohana Health Plan Medicaid	$79.50
Rate for Payer: Ohana Health Plan Medicare	$79.50
Rate for Payer: UnitedHealthcare Medicare	$79.50
Rate for Payer: University Health Alliance Commercial	$115.90

GYNECOLOGY:NEEDLE WILLIAMS CYSTOSCOPIC INJECTION 23

Facility

$159.00

Hospital Charge Code	13242247
Hospital Revenue Code	272
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$103.35
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: MDX Hawaii PPO	$154.23

GYN:ENSEAL X1 CURVED

Facility

$2,875.00

Hospital Charge Code	11754479
Hospital Revenue Code	272
Min. Negotiated Rate	$1,437.50
Max. Negotiated Rate	$2,788.75
Rate for Payer: AlohaCare Medicaid	$1,437.50
Rate for Payer: AlohaCare Medicare	$1,437.50
Rate for Payer: Cash Price	$1,868.75
Rate for Payer: Devoted Health Medicare	$1,581.25
Rate for Payer: Hawaii Medical Service Association Medicare	$1,437.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,731.25
Rate for Payer: Health Management Network Commercial	$2,443.75
Rate for Payer: Humana Medicare	$1,437.50
Rate for Payer: Kaiser Permanente Commercial	$2,587.50
Rate for Payer: Kaiser Permanente Medicaid	$1,466.25
Rate for Payer: Kaiser Permanente Medicare	$1,437.50
Rate for Payer: MDX Hawaii PPO	$2,788.75
Rate for Payer: Ohana Health Plan Medicaid	$1,437.50
Rate for Payer: Ohana Health Plan Medicare	$1,437.50
Rate for Payer: UnitedHealthcare Medicare	$1,437.50
Rate for Payer: University Health Alliance Commercial	$2,095.59

GYN:ENSEAL X1 CURVED

Facility

$2,875.00

Hospital Charge Code	11754479
Hospital Revenue Code	272
Min. Negotiated Rate	$2,443.75
Max. Negotiated Rate	$2,788.75
Rate for Payer: Cash Price	$1,868.75
Rate for Payer: Health Management Network Commercial	$2,443.75
Rate for Payer: Kaiser Permanente Commercial	$2,587.50
Rate for Payer: MDX Hawaii PPO	$2,788.75

GYN:HOLOGIC FLUENT

Facility

$1,397.00

Hospital Charge Code	11461982
Hospital Revenue Code	270
Min. Negotiated Rate	$698.50
Max. Negotiated Rate	$1,355.09
Rate for Payer: AlohaCare Medicaid	$698.50
Rate for Payer: AlohaCare Medicare	$698.50
Rate for Payer: Cash Price	$908.05
Rate for Payer: Devoted Health Medicare	$768.35
Rate for Payer: Hawaii Medical Service Association Medicare	$698.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,327.15
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Humana Medicare	$698.50
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: Kaiser Permanente Medicaid	$712.47
Rate for Payer: Kaiser Permanente Medicare	$698.50
Rate for Payer: MDX Hawaii PPO	$1,355.09
Rate for Payer: Ohana Health Plan Medicaid	$698.50
Rate for Payer: Ohana Health Plan Medicare	$698.50
Rate for Payer: UnitedHealthcare Medicare	$698.50
Rate for Payer: University Health Alliance Commercial	$1,018.27

GYN:HOLOGIC FLUENT

Facility

$1,397.00

Hospital Charge Code	11461982
Hospital Revenue Code	270
Min. Negotiated Rate	$1,187.45
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$908.05
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: MDX Hawaii PPO	$1,355.09

H0015 Alcohol and/or Drug Services

Professional

Both

$251.00

Service Code	HCPCS H0015
Hospital Charge Code	11414884
Hospital Revenue Code	900
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$213.35
Rate for Payer: Cash Price	$163.15
Rate for Payer: Health Management Network Commercial	$213.35

H0049 Alcohol/drug screening

Professional

Both

$55.00

Service Code	HCPCS H0049
Hospital Charge Code	9181780
Hospital Revenue Code	521
Min. Negotiated Rate	$19.03
Max. Negotiated Rate	$434.26
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Hawaii Medical Service Association ABD	$434.26
Rate for Payer: Hawaii Medical Service Association Medicare	$339.46
Rate for Payer: Hawaii Medical Service Association Medicare	$246.64
Rate for Payer: Hawaii Medical Service Association Medicare	$265.97
Rate for Payer: Hawaii Medical Service Association Medicare	$303.73
Rate for Payer: Hawaii Medical Service Association Medicare	$181.39
Rate for Payer: Hawaii Medical Service Association Medicare	$209.49
Rate for Payer: Hawaii Medical Service Association Medicare	$237.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$434.26
Rate for Payer: Hawaii Western Management Group Commercial	$19.03
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$246.64
Rate for Payer: Kaiser Permanente Commercial	$181.39
Rate for Payer: Kaiser Permanente Commercial	$209.49
Rate for Payer: Kaiser Permanente Commercial	$237.64
Rate for Payer: Kaiser Permanente Commercial	$265.97
Rate for Payer: Kaiser Permanente Commercial	$303.73
Rate for Payer: Kaiser Permanente Commercial	$339.46
Rate for Payer: Kaiser Permanente Medicaid	$434.26
Rate for Payer: Kaiser Permanente Medicare	$181.39
Rate for Payer: Kaiser Permanente Medicare	$209.49
Rate for Payer: Kaiser Permanente Medicare	$237.64
Rate for Payer: Kaiser Permanente Medicare	$246.64
Rate for Payer: Kaiser Permanente Medicare	$303.73
Rate for Payer: Kaiser Permanente Medicare	$339.46
Rate for Payer: Kaiser Permanente Medicare	$265.97
Rate for Payer: Ohana Health Plan Medicaid	$24.00
Rate for Payer: UnitedHealthcare Medicaid	$434.26
Rate for Payer: UnitedHealthcare Medicare	$303.73
Rate for Payer: UnitedHealthcare Medicare	$181.39
Rate for Payer: UnitedHealthcare Medicare	$209.49
Rate for Payer: UnitedHealthcare Medicare	$237.64
Rate for Payer: UnitedHealthcare Medicare	$246.64
Rate for Payer: UnitedHealthcare Medicare	$265.97
Rate for Payer: UnitedHealthcare Medicare	$339.46

Haemophilus influenza B, IgG FSI

Facility

$183.00

Service Code	HCPCS 86684
Hospital Charge Code	9300200
Hospital Revenue Code	300
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$118.95
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: MDX Hawaii PPO	$177.51

Haemophilus influenza B, IgG FSI

Facility

$183.00

Service Code	HCPCS 86684
Hospital Charge Code	9300200
Hospital Revenue Code	300
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$177.51
Rate for Payer: AlohaCare Medicaid	$91.50
Rate for Payer: AlohaCare Medicare	$91.50
Rate for Payer: Cash Price	$118.95
Rate for Payer: Cash Price	$118.95
Rate for Payer: Devoted Health Medicare	$100.65
Rate for Payer: Hawaii Medical Service Association ABD	$13.28
Rate for Payer: Hawaii Medical Service Association Commercial	$19.80
Rate for Payer: Hawaii Medical Service Association Medicare	$91.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.89
Rate for Payer: Hawaii Western Management Group Commercial	$15.84
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Humana Medicare	$91.50
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: Kaiser Permanente Medicaid	$93.33
Rate for Payer: Kaiser Permanente Medicare	$91.50
Rate for Payer: MDX Hawaii PPO	$177.51
Rate for Payer: Ohana Health Plan Medicaid	$91.50
Rate for Payer: Ohana Health Plan Medicare	$91.50
Rate for Payer: UnitedHealthcare Medicaid	$13.28
Rate for Payer: UnitedHealthcare Medicare	$91.50
Rate for Payer: University Health Alliance Commercial	$40.96

haloperidol 1 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 51079073420
Hospital Charge Code	2500370
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

haloperidol 1 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00378025701
Hospital Charge Code	2500370
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

haloperidol 1 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00378025701
Hospital Charge Code	2500370
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

haloperidol 1 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 51079073420
Hospital Charge Code	2500370
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

haloperidol 5mg/1ml vial [HHSC]

Facility

$44.70

Service Code	HCPCS J1630
Hospital Charge Code	2500372
Hospital Revenue Code	250
Min. Negotiated Rate	$37.99
Max. Negotiated Rate	$43.36
Rate for Payer: Cash Price	$29.06
Rate for Payer: Cash Price	$5.21
Rate for Payer: Health Management Network Commercial	$37.99
Rate for Payer: Health Management Network Commercial	$6.81
Rate for Payer: Kaiser Permanente Commercial	$40.23
Rate for Payer: Kaiser Permanente Commercial	$7.21
Rate for Payer: MDX Hawaii PPO	$7.77
Rate for Payer: MDX Hawaii PPO	$43.36

haloperidol 5mg/1ml vial [HHSC]

Facility

$44.70

Service Code	HCPCS J1630
Hospital Charge Code	2500372
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$43.36
Rate for Payer: AlohaCare Medicaid	$22.35
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$4.00
Rate for Payer: AlohaCare Medicare	$22.35
Rate for Payer: Cash Price	$5.21
Rate for Payer: Cash Price	$29.06
Rate for Payer: Cash Price	$29.06
Rate for Payer: Cash Price	$5.21
Rate for Payer: Devoted Health Medicare	$24.59
Rate for Payer: Devoted Health Medicare	$4.41
Rate for Payer: Hawaii Medical Service Association ABD	$0.84
Rate for Payer: Hawaii Medical Service Association ABD	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$4.00
Rate for Payer: Hawaii Medical Service Association Medicare	$22.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$42.47
Rate for Payer: Hawaii Western Management Group Commercial	$7.61
Rate for Payer: Health Management Network Commercial	$6.81
Rate for Payer: Health Management Network Commercial	$37.99
Rate for Payer: Humana Medicare	$22.35
Rate for Payer: Humana Medicare	$4.00
Rate for Payer: Kaiser Permanente Commercial	$40.23
Rate for Payer: Kaiser Permanente Commercial	$7.21
Rate for Payer: Kaiser Permanente Medicaid	$4.09
Rate for Payer: Kaiser Permanente Medicaid	$22.80
Rate for Payer: Kaiser Permanente Medicare	$22.35
Rate for Payer: Kaiser Permanente Medicare	$4.00
Rate for Payer: MDX Hawaii PPO	$43.36
Rate for Payer: MDX Hawaii PPO	$7.77
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: Ohana Health Plan Medicaid	$22.35
Rate for Payer: Ohana Health Plan Medicare	$22.35
Rate for Payer: Ohana Health Plan Medicare	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.81
Rate for Payer: UnitedHealthcare Medicaid	$26.82
Rate for Payer: UnitedHealthcare Medicare	$22.35
Rate for Payer: UnitedHealthcare Medicare	$4.00
Rate for Payer: University Health Alliance Commercial	$32.58
Rate for Payer: University Health Alliance Commercial	$5.84

haloperidol 5 mg tablet [HHSC]

Facility

$5.69

Service Code	NDC 68382007901
Hospital Charge Code	2500371
Hospital Revenue Code	250
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$5.52
Rate for Payer: Cash Price	$3.70
Rate for Payer: Health Management Network Commercial	$4.84
Rate for Payer: Kaiser Permanente Commercial	$5.12
Rate for Payer: MDX Hawaii PPO	$5.52

Know your out-of-pocket cost for care.

All Charges