Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$14.66

Service Code	NDC 00409781124
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$14.22
Rate for Payer: Cash Price	$9.53
Rate for Payer: Health Management Network Commercial	$12.46
Rate for Payer: Kaiser Permanente Commercial	$13.19
Rate for Payer: MDX Hawaii PPO	$14.22

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$15.29

Service Code	NDC 00338105548
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$14.83
Rate for Payer: Cash Price	$9.94
Rate for Payer: Health Management Network Commercial	$13.00
Rate for Payer: Kaiser Permanente Commercial	$13.76
Rate for Payer: MDX Hawaii PPO	$14.83

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$15.29

Service Code	NDC 00338105548
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$14.83
Rate for Payer: AlohaCare Medicaid	$7.64
Rate for Payer: AlohaCare Medicare	$7.64
Rate for Payer: Cash Price	$9.94
Rate for Payer: Devoted Health Medicare	$8.41
Rate for Payer: Hawaii Medical Service Association Medicare	$7.64
Rate for Payer: Hawaii Western Management Group Commercial	$14.53
Rate for Payer: Health Management Network Commercial	$13.00
Rate for Payer: Humana Medicare	$7.64
Rate for Payer: Kaiser Permanente Commercial	$13.76
Rate for Payer: Kaiser Permanente Medicaid	$7.80
Rate for Payer: Kaiser Permanente Medicare	$7.64
Rate for Payer: MDX Hawaii PPO	$14.83
Rate for Payer: Ohana Health Plan Medicaid	$7.64
Rate for Payer: Ohana Health Plan Medicare	$7.64
Rate for Payer: UnitedHealthcare Medicaid	$9.17
Rate for Payer: UnitedHealthcare Medicare	$7.64
Rate for Payer: University Health Alliance Commercial	$11.14

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$12.14

Service Code	NDC 00409781110
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$11.78
Rate for Payer: UnitedHealthcare Medicaid	$7.28
Rate for Payer: AlohaCare Medicaid	$6.07
Rate for Payer: AlohaCare Medicare	$6.07
Rate for Payer: Cash Price	$7.89
Rate for Payer: Devoted Health Medicare	$6.68
Rate for Payer: Hawaii Medical Service Association Medicare	$6.07
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$10.32
Rate for Payer: Humana Medicare	$6.07
Rate for Payer: Kaiser Permanente Commercial	$10.93
Rate for Payer: Kaiser Permanente Medicaid	$6.19
Rate for Payer: Kaiser Permanente Medicare	$6.07
Rate for Payer: MDX Hawaii PPO	$11.78
Rate for Payer: Ohana Health Plan Medicaid	$6.07
Rate for Payer: Ohana Health Plan Medicare	$6.07
Rate for Payer: UnitedHealthcare Medicare	$6.07
Rate for Payer: University Health Alliance Commercial	$8.85

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$12.81

Service Code	NDC 00409015224
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$12.43
Rate for Payer: AlohaCare Medicaid	$6.41
Rate for Payer: AlohaCare Medicare	$6.41
Rate for Payer: Cash Price	$8.33
Rate for Payer: Devoted Health Medicare	$7.05
Rate for Payer: Hawaii Medical Service Association Medicare	$6.41
Rate for Payer: Hawaii Western Management Group Commercial	$12.17
Rate for Payer: Health Management Network Commercial	$10.89
Rate for Payer: Humana Medicare	$6.41
Rate for Payer: Kaiser Permanente Commercial	$11.53
Rate for Payer: Kaiser Permanente Medicaid	$6.53
Rate for Payer: Kaiser Permanente Medicare	$6.41
Rate for Payer: MDX Hawaii PPO	$12.43
Rate for Payer: Ohana Health Plan Medicaid	$6.41
Rate for Payer: Ohana Health Plan Medicare	$6.41
Rate for Payer: UnitedHealthcare Medicaid	$7.69
Rate for Payer: UnitedHealthcare Medicare	$6.41
Rate for Payer: University Health Alliance Commercial	$9.34

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$12.14

Service Code	NDC 00409781110
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$11.78
Rate for Payer: Cash Price	$7.89
Rate for Payer: Health Management Network Commercial	$10.32
Rate for Payer: Kaiser Permanente Commercial	$10.93
Rate for Payer: MDX Hawaii PPO	$11.78

MG Breast Biopsy w/ Stereo Guide Left

Facility

$2,871.00

Service Code	HCPCS 19081 LT
Hospital Charge Code	2425835
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,435.50
Rate for Payer: AlohaCare Medicare	$1,435.50
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Devoted Health Medicare	$1,579.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1,435.50
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Humana Medicare	$1,435.50
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,435.50
Rate for Payer: MDX Hawaii PPO	$2,784.87
Rate for Payer: Ohana Health Plan Medicaid	$1,435.50
Rate for Payer: Ohana Health Plan Medicare	$1,435.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,435.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

MG Breast Biopsy w/ Stereo Guide Left

Facility

$2,871.00

Service Code	HCPCS 19081 LT
Hospital Charge Code	2425835
Hospital Revenue Code	361
Min. Negotiated Rate	$2,440.35
Max. Negotiated Rate	$2,784.87
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: MDX Hawaii PPO	$2,784.87

MG Breast Biopsy w/ Stereo Guide Left.

Facility

$2,871.00

Service Code	HCPCS 19081 LT
Hospital Charge Code	8033157
Hospital Revenue Code	361
Min. Negotiated Rate	$2,440.35
Max. Negotiated Rate	$2,784.87
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: MDX Hawaii PPO	$2,784.87

MG Breast Biopsy w/ Stereo Guide Left.

Facility

$2,871.00

Service Code	HCPCS 19081 LT
Hospital Charge Code	8033157
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,435.50
Rate for Payer: AlohaCare Medicare	$1,435.50
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Devoted Health Medicare	$1,579.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1,435.50
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Humana Medicare	$1,435.50
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,435.50
Rate for Payer: MDX Hawaii PPO	$2,784.87
Rate for Payer: Ohana Health Plan Medicaid	$1,435.50
Rate for Payer: Ohana Health Plan Medicare	$1,435.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,435.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

MG Breast Biopsy w/ Stereo Guide Left - Report

Professional

Both

$2,299.00

Service Code	HCPCS 19081 26
Hospital Charge Code	2425837
Hospital Revenue Code	975
Min. Negotiated Rate	$160.43
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$160.43
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Hawaii Medical Service Association ABD	$160.43
Rate for Payer: Hawaii Medical Service Association Commercial	$277.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.43
Rate for Payer: Hawaii Western Management Group Commercial	$758.42
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Ohana Health Plan Medicaid	$160.43
Rate for Payer: UnitedHealthcare Medicaid	$160.43
Rate for Payer: University Health Alliance Commercial	$275.00

MG Breast Biopsy w/ Stereo Guide Left. - Report

Professional

Both

$2,299.00

Service Code	HCPCS 19081 26
Hospital Charge Code	8033159
Hospital Revenue Code	975
Min. Negotiated Rate	$160.43
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$160.43
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Hawaii Medical Service Association ABD	$160.43
Rate for Payer: Hawaii Medical Service Association Commercial	$277.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.43
Rate for Payer: Hawaii Western Management Group Commercial	$758.42
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Ohana Health Plan Medicaid	$160.43
Rate for Payer: UnitedHealthcare Medicaid	$160.43
Rate for Payer: University Health Alliance Commercial	$275.00

MG Breast Biopsy w/ Stereo Guide Right

Facility

$2,871.00

Service Code	HCPCS 19081 RT
Hospital Charge Code	2425838
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,435.50
Rate for Payer: AlohaCare Medicare	$1,435.50
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Devoted Health Medicare	$1,579.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1,435.50
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Humana Medicare	$1,435.50
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,435.50
Rate for Payer: MDX Hawaii PPO	$2,784.87
Rate for Payer: Ohana Health Plan Medicaid	$1,435.50
Rate for Payer: Ohana Health Plan Medicare	$1,435.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,435.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

MG Breast Biopsy w/ Stereo Guide Right

Facility

$2,871.00

Service Code	HCPCS 19081 RT
Hospital Charge Code	2425838
Hospital Revenue Code	361
Min. Negotiated Rate	$2,440.35
Max. Negotiated Rate	$2,784.87
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: MDX Hawaii PPO	$2,784.87

MG Breast Biopsy w/ Stereo Guide Right.

Facility

$2,871.00

Service Code	HCPCS 19081 RT
Hospital Charge Code	8033160
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,435.50
Rate for Payer: AlohaCare Medicare	$1,435.50
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Devoted Health Medicare	$1,579.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1,435.50
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Humana Medicare	$1,435.50
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,435.50
Rate for Payer: MDX Hawaii PPO	$2,784.87
Rate for Payer: Ohana Health Plan Medicaid	$1,435.50
Rate for Payer: Ohana Health Plan Medicare	$1,435.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,435.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

MG Breast Biopsy w/ Stereo Guide Right.

Facility

$2,871.00

Service Code	HCPCS 19081 RT
Hospital Charge Code	8033160
Hospital Revenue Code	361
Min. Negotiated Rate	$2,440.35
Max. Negotiated Rate	$2,784.87
Rate for Payer: Cash Price	$1,866.15
Rate for Payer: Health Management Network Commercial	$2,440.35
Rate for Payer: Kaiser Permanente Commercial	$2,583.90
Rate for Payer: MDX Hawaii PPO	$2,784.87

MG Breast Biopsy w/ Stereo Guide Right - Report

Professional

Both

$2,299.00

Service Code	HCPCS 19081 26
Hospital Charge Code	2425840
Hospital Revenue Code	975
Min. Negotiated Rate	$160.43
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$160.43
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Hawaii Medical Service Association ABD	$160.43
Rate for Payer: Hawaii Medical Service Association Commercial	$277.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.43
Rate for Payer: Hawaii Western Management Group Commercial	$758.42
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Ohana Health Plan Medicaid	$160.43
Rate for Payer: UnitedHealthcare Medicaid	$160.43
Rate for Payer: University Health Alliance Commercial	$275.00

MG Breast Biopsy w/ Stereo Guide Right. - Report

Professional

Both

$2,299.00

Service Code	HCPCS 19081 26
Hospital Charge Code	8033162
Hospital Revenue Code	975
Min. Negotiated Rate	$160.43
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$160.43
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Hawaii Medical Service Association ABD	$160.43
Rate for Payer: Hawaii Medical Service Association Commercial	$277.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.43
Rate for Payer: Hawaii Western Management Group Commercial	$758.42
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Ohana Health Plan Medicaid	$160.43
Rate for Payer: UnitedHealthcare Medicaid	$160.43
Rate for Payer: University Health Alliance Commercial	$275.00

MG Breast Needle Localization

Facility

$5,146.00

Service Code	HCPCS 19281
Hospital Charge Code	8127564
Hospital Revenue Code	361
Min. Negotiated Rate	$4,374.10
Max. Negotiated Rate	$4,991.62
Rate for Payer: Cash Price	$3,344.90
Rate for Payer: Health Management Network Commercial	$4,374.10
Rate for Payer: Kaiser Permanente Commercial	$4,631.40
Rate for Payer: MDX Hawaii PPO	$4,991.62

MG Breast Needle Localization

Facility

$5,146.00

Service Code	HCPCS 19281
Hospital Charge Code	8127564
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$4,991.62
Rate for Payer: AlohaCare Medicaid	$2,573.00
Rate for Payer: AlohaCare Medicare	$2,573.00
Rate for Payer: Cash Price	$3,344.90
Rate for Payer: Cash Price	$3,344.90
Rate for Payer: Cash Price	$3,344.90
Rate for Payer: Devoted Health Medicare	$2,830.30
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$2,573.00
Rate for Payer: Health Management Network Commercial	$4,374.10
Rate for Payer: Humana Medicare	$2,573.00
Rate for Payer: Kaiser Permanente Commercial	$4,631.40
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,573.00
Rate for Payer: MDX Hawaii PPO	$4,991.62
Rate for Payer: Ohana Health Plan Medicaid	$2,573.00
Rate for Payer: Ohana Health Plan Medicare	$2,573.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,573.00
Rate for Payer: University Health Alliance Commercial	$2,881.76

MG Breast Needle Localization - Report

Professional

Both

$2,299.00

Service Code	HCPCS 19281
Hospital Charge Code	8127566
Hospital Revenue Code	972
Min. Negotiated Rate	$82.10
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$97.09
Rate for Payer: AlohaCare Medicare	$82.10
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$90.31
Rate for Payer: Hawaii Medical Service Association ABD	$97.09
Rate for Payer: Hawaii Medical Service Association Commercial	$153.89
Rate for Payer: Hawaii Medical Service Association Medicare	$82.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$97.09
Rate for Payer: Hawaii Western Management Group Commercial	$270.14
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$98.52
Rate for Payer: Kaiser Permanente Medicaid	$98.52
Rate for Payer: Kaiser Permanente Medicare	$98.52
Rate for Payer: Ohana Health Plan Medicaid	$97.09
Rate for Payer: Ohana Health Plan Medicare	$82.10
Rate for Payer: UnitedHealthcare Medicaid	$97.09
Rate for Payer: UnitedHealthcare Medicare	$82.10
Rate for Payer: University Health Alliance Commercial	$105.35

MG Breast Tissue Specimen Surgical Left

Facility

$4,054.00

Service Code	HCPCS 76098
Hospital Charge Code	969777
Hospital Revenue Code	320
Min. Negotiated Rate	$3,445.90
Max. Negotiated Rate	$3,932.38
Rate for Payer: Cash Price	$2,635.10
Rate for Payer: Health Management Network Commercial	$3,445.90
Rate for Payer: Kaiser Permanente Commercial	$3,648.60
Rate for Payer: MDX Hawaii PPO	$3,932.38

MG Breast Tissue Specimen Surgical Left

Facility

$4,054.00

Service Code	HCPCS 76098
Hospital Charge Code	969777
Hospital Revenue Code	320
Min. Negotiated Rate	$16.29
Max. Negotiated Rate	$3,932.38
Rate for Payer: AlohaCare Medicaid	$2,027.00
Rate for Payer: AlohaCare Medicare	$2,027.00
Rate for Payer: Cash Price	$2,635.10
Rate for Payer: Cash Price	$2,635.10
Rate for Payer: Devoted Health Medicare	$2,229.70
Rate for Payer: Hawaii Medical Service Association ABD	$16.47
Rate for Payer: Hawaii Medical Service Association Commercial	$697.81
Rate for Payer: Hawaii Medical Service Association Medicare	$2,027.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.29
Rate for Payer: Hawaii Western Management Group Commercial	$558.25
Rate for Payer: Health Management Network Commercial	$3,445.90
Rate for Payer: Humana Medicare	$2,027.00
Rate for Payer: Kaiser Permanente Commercial	$3,648.60
Rate for Payer: Kaiser Permanente Medicaid	$2,067.54
Rate for Payer: Kaiser Permanente Medicare	$2,027.00
Rate for Payer: MDX Hawaii PPO	$3,932.38
Rate for Payer: Ohana Health Plan Medicaid	$2,027.00
Rate for Payer: Ohana Health Plan Medicare	$2,027.00
Rate for Payer: UnitedHealthcare Medicaid	$16.47
Rate for Payer: UnitedHealthcare Medicare	$2,027.00
Rate for Payer: University Health Alliance Commercial	$42.66

MG Breast Tissue Specimen Surgical Left - Report

Professional

Both

$60.00

Service Code	HCPCS 76098 26
Hospital Charge Code	969779
Hospital Revenue Code	972
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicaid	$28.10
Rate for Payer: AlohaCare Medicare	$14.96
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$16.46
Rate for Payer: Hawaii Medical Service Association Medicare	$14.96
Rate for Payer: Hawaii Western Management Group Commercial	$27.19
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$17.95
Rate for Payer: Kaiser Permanente Medicaid	$17.95
Rate for Payer: Kaiser Permanente Medicare	$17.95
Rate for Payer: Ohana Health Plan Medicaid	$28.10
Rate for Payer: Ohana Health Plan Medicare	$14.96
Rate for Payer: UnitedHealthcare Medicaid	$28.10
Rate for Payer: UnitedHealthcare Medicare	$14.96

MG Breast Tissue Specimen Surgical Right

Facility

$4,054.00

Service Code	HCPCS 76098 RT
Hospital Charge Code	969780
Hospital Revenue Code	320
Min. Negotiated Rate	$16.29
Max. Negotiated Rate	$3,932.38
Rate for Payer: AlohaCare Medicaid	$2,027.00
Rate for Payer: AlohaCare Medicare	$2,027.00
Rate for Payer: Cash Price	$2,635.10
Rate for Payer: Cash Price	$2,635.10
Rate for Payer: Devoted Health Medicare	$2,229.70
Rate for Payer: Hawaii Medical Service Association ABD	$16.47
Rate for Payer: Hawaii Medical Service Association Medicare	$2,027.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.29
Rate for Payer: Hawaii Western Management Group Commercial	$3,851.30
Rate for Payer: Health Management Network Commercial	$3,445.90
Rate for Payer: Humana Medicare	$2,027.00
Rate for Payer: Kaiser Permanente Commercial	$3,648.60
Rate for Payer: Kaiser Permanente Medicaid	$2,067.54
Rate for Payer: Kaiser Permanente Medicare	$2,027.00
Rate for Payer: MDX Hawaii PPO	$3,932.38
Rate for Payer: Ohana Health Plan Medicaid	$2,027.00
Rate for Payer: Ohana Health Plan Medicare	$2,027.00
Rate for Payer: UnitedHealthcare Medicaid	$16.47
Rate for Payer: UnitedHealthcare Medicare	$2,027.00
Rate for Payer: University Health Alliance Commercial	$42.66

Know your out-of-pocket cost for care.

All Charges