Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

MRI LE Non Joint w/ + w/o Contrast Rt

Facility

$2,524.00

Service Code	HCPCS 73720 RT
Hospital Charge Code	1169010
Hospital Revenue Code	610
Min. Negotiated Rate	$645.58
Max. Negotiated Rate	$2,448.28
Rate for Payer: AlohaCare Medicaid	$1,262.00
Rate for Payer: AlohaCare Medicare	$1,262.00
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Devoted Health Medicare	$1,388.20
Rate for Payer: Hawaii Medical Service Association ABD	$645.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,262.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,397.80
Rate for Payer: Health Management Network Commercial	$2,145.40
Rate for Payer: Humana Medicare	$1,262.00
Rate for Payer: Kaiser Permanente Commercial	$2,271.60
Rate for Payer: Kaiser Permanente Medicaid	$1,287.24
Rate for Payer: Kaiser Permanente Medicare	$1,262.00
Rate for Payer: MDX Hawaii PPO	$2,448.28
Rate for Payer: Ohana Health Plan Medicaid	$1,262.00
Rate for Payer: Ohana Health Plan Medicare	$1,262.00
Rate for Payer: UnitedHealthcare Medicaid	$645.58
Rate for Payer: UnitedHealthcare Medicare	$1,262.00
Rate for Payer: University Health Alliance Commercial	$1,285.82

MRI LE Non Joint w/ + w/o Contrast Rt - Report

Professional

Both

$473.00

Service Code	HCPCS 73720 26,RT
Hospital Charge Code	631168
Hospital Revenue Code	972
Min. Negotiated Rate	$230.62
Max. Negotiated Rate	$574.00
Rate for Payer: AlohaCare Medicaid	$230.62
Rate for Payer: Cash Price	$307.45
Rate for Payer: Cash Price	$307.45
Rate for Payer: Hawaii Western Management Group Commercial	$574.00
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Ohana Health Plan Medicaid	$230.62
Rate for Payer: UnitedHealthcare Medicaid	$230.62

MRI Lower Extremity w/o Contrast Left

Facility

$2,322.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	8207927
Hospital Revenue Code	610
Min. Negotiated Rate	$1,973.70
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34

MRI Lower Extremity w/o Contrast Left

Facility

$2,322.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	8207927
Hospital Revenue Code	610
Min. Negotiated Rate	$318.66
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$1,161.00
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Devoted Health Medicare	$1,277.10
Rate for Payer: Hawaii Medical Service Association ABD	$318.66
Rate for Payer: Hawaii Medical Service Association Medicare	$1,161.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$396.79
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.90
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$1,161.00
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$1,161.00
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$1,161.00
Rate for Payer: Ohana Health Plan Medicare	$1,161.00
Rate for Payer: UnitedHealthcare Medicaid	$318.66
Rate for Payer: UnitedHealthcare Medicare	$1,161.00
Rate for Payer: University Health Alliance Commercial	$837.87

MRI Lower Extremity w/o Contrast Right

Facility

$2,322.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	8207930
Hospital Revenue Code	610
Min. Negotiated Rate	$1,973.70
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34

MRI Lower Extremity w/o Contrast Right

Facility

$2,322.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	8207930
Hospital Revenue Code	610
Min. Negotiated Rate	$318.66
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$1,161.00
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Devoted Health Medicare	$1,277.10
Rate for Payer: Hawaii Medical Service Association ABD	$318.66
Rate for Payer: Hawaii Medical Service Association Medicare	$1,161.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$396.79
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.90
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$1,161.00
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$1,161.00
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$1,161.00
Rate for Payer: Ohana Health Plan Medicare	$1,161.00
Rate for Payer: UnitedHealthcare Medicaid	$318.66
Rate for Payer: UnitedHealthcare Medicare	$1,161.00
Rate for Payer: University Health Alliance Commercial	$837.87

MRI Lower Extremity w/ + w/o Cnt Left

Facility

$2,524.00

Service Code	HCPCS 73720 LT
Hospital Charge Code	8207921
Hospital Revenue Code	610
Min. Negotiated Rate	$645.58
Max. Negotiated Rate	$2,448.28
Rate for Payer: AlohaCare Medicaid	$1,262.00
Rate for Payer: AlohaCare Medicare	$1,262.00
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Devoted Health Medicare	$1,388.20
Rate for Payer: Hawaii Medical Service Association ABD	$645.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,262.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,397.80
Rate for Payer: Health Management Network Commercial	$2,145.40
Rate for Payer: Humana Medicare	$1,262.00
Rate for Payer: Kaiser Permanente Commercial	$2,271.60
Rate for Payer: Kaiser Permanente Medicaid	$1,287.24
Rate for Payer: Kaiser Permanente Medicare	$1,262.00
Rate for Payer: MDX Hawaii PPO	$2,448.28
Rate for Payer: Ohana Health Plan Medicaid	$1,262.00
Rate for Payer: Ohana Health Plan Medicare	$1,262.00
Rate for Payer: UnitedHealthcare Medicaid	$645.58
Rate for Payer: UnitedHealthcare Medicare	$1,262.00
Rate for Payer: University Health Alliance Commercial	$1,285.82

MRI Lower Extremity w/ + w/o Cnt Left

Facility

$2,524.00

Service Code	HCPCS 73720 LT
Hospital Charge Code	8207921
Hospital Revenue Code	610
Min. Negotiated Rate	$2,145.40
Max. Negotiated Rate	$2,448.28
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Health Management Network Commercial	$2,145.40
Rate for Payer: Kaiser Permanente Commercial	$2,271.60
Rate for Payer: MDX Hawaii PPO	$2,448.28

MRI Lower Extremity w/ + w/o Cnt Right

Facility

$2,524.00

Service Code	HCPCS 73720 RT
Hospital Charge Code	8207924
Hospital Revenue Code	610
Min. Negotiated Rate	$645.58
Max. Negotiated Rate	$2,448.28
Rate for Payer: AlohaCare Medicaid	$1,262.00
Rate for Payer: AlohaCare Medicare	$1,262.00
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Devoted Health Medicare	$1,388.20
Rate for Payer: Hawaii Medical Service Association ABD	$645.58
Rate for Payer: Hawaii Medical Service Association Medicare	$1,262.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,397.80
Rate for Payer: Health Management Network Commercial	$2,145.40
Rate for Payer: Humana Medicare	$1,262.00
Rate for Payer: Kaiser Permanente Commercial	$2,271.60
Rate for Payer: Kaiser Permanente Medicaid	$1,287.24
Rate for Payer: Kaiser Permanente Medicare	$1,262.00
Rate for Payer: MDX Hawaii PPO	$2,448.28
Rate for Payer: Ohana Health Plan Medicaid	$1,262.00
Rate for Payer: Ohana Health Plan Medicare	$1,262.00
Rate for Payer: UnitedHealthcare Medicaid	$645.58
Rate for Payer: UnitedHealthcare Medicare	$1,262.00
Rate for Payer: University Health Alliance Commercial	$1,285.82

MRI Lower Extremity w/ + w/o Cnt Right

Facility

$2,524.00

Service Code	HCPCS 73720 RT
Hospital Charge Code	8207924
Hospital Revenue Code	610
Min. Negotiated Rate	$2,145.40
Max. Negotiated Rate	$2,448.28
Rate for Payer: Cash Price	$1,640.60
Rate for Payer: Health Management Network Commercial	$2,145.40
Rate for Payer: Kaiser Permanente Commercial	$2,271.60
Rate for Payer: MDX Hawaii PPO	$2,448.28

MRI UE Joint w/ Contrast Left

Facility

$3,679.00

Service Code	HCPCS 73222 LT
Hospital Charge Code	8211761
Hospital Revenue Code	610
Min. Negotiated Rate	$3,127.15
Max. Negotiated Rate	$3,568.63
Rate for Payer: Cash Price	$2,391.35
Rate for Payer: Health Management Network Commercial	$3,127.15
Rate for Payer: Kaiser Permanente Commercial	$3,311.10
Rate for Payer: MDX Hawaii PPO	$3,568.63

MRI UE Joint w/ Contrast Left

Facility

$3,679.00

Service Code	HCPCS 73222 LT
Hospital Charge Code	8211761
Hospital Revenue Code	610
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$3,568.63
Rate for Payer: AlohaCare Medicaid	$1,839.50
Rate for Payer: AlohaCare Medicare	$1,839.50
Rate for Payer: Cash Price	$2,391.35
Rate for Payer: Cash Price	$2,391.35
Rate for Payer: Devoted Health Medicare	$2,023.45
Rate for Payer: Hawaii Medical Service Association ABD	$382.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,839.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$3,495.05
Rate for Payer: Health Management Network Commercial	$3,127.15
Rate for Payer: Humana Medicare	$1,839.50
Rate for Payer: Kaiser Permanente Commercial	$3,311.10
Rate for Payer: Kaiser Permanente Medicaid	$1,876.29
Rate for Payer: Kaiser Permanente Medicare	$1,839.50
Rate for Payer: MDX Hawaii PPO	$3,568.63
Rate for Payer: Ohana Health Plan Medicaid	$1,839.50
Rate for Payer: Ohana Health Plan Medicare	$1,839.50
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: UnitedHealthcare Medicare	$1,839.50
Rate for Payer: University Health Alliance Commercial	$973.95

MRI UE Joint w/ Contrast Left - Report

Professional

Both

$1,091.00

Service Code	HCPCS 73222 26,LT
Hospital Charge Code	8211763
Hospital Revenue Code	972
Min. Negotiated Rate	$215.80
Max. Negotiated Rate	$927.35
Rate for Payer: AlohaCare Medicaid	$215.80
Rate for Payer: Cash Price	$709.15
Rate for Payer: Cash Price	$709.15
Rate for Payer: Hawaii Western Management Group Commercial	$666.83
Rate for Payer: Health Management Network Commercial	$927.35
Rate for Payer: Ohana Health Plan Medicaid	$215.80
Rate for Payer: UnitedHealthcare Medicaid	$215.80

MRI UE Joint w/ Contrast Right

Facility

$3,679.00

Service Code	HCPCS 73222 RT
Hospital Charge Code	8211764
Hospital Revenue Code	610
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$3,568.63
Rate for Payer: AlohaCare Medicaid	$1,839.50
Rate for Payer: AlohaCare Medicare	$1,839.50
Rate for Payer: Cash Price	$2,391.35
Rate for Payer: Cash Price	$2,391.35
Rate for Payer: Devoted Health Medicare	$2,023.45
Rate for Payer: Hawaii Medical Service Association ABD	$382.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,839.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$3,495.05
Rate for Payer: Health Management Network Commercial	$3,127.15
Rate for Payer: Humana Medicare	$1,839.50
Rate for Payer: Kaiser Permanente Commercial	$3,311.10
Rate for Payer: Kaiser Permanente Medicaid	$1,876.29
Rate for Payer: Kaiser Permanente Medicare	$1,839.50
Rate for Payer: MDX Hawaii PPO	$3,568.63
Rate for Payer: Ohana Health Plan Medicaid	$1,839.50
Rate for Payer: Ohana Health Plan Medicare	$1,839.50
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: UnitedHealthcare Medicare	$1,839.50
Rate for Payer: University Health Alliance Commercial	$973.95

MRI UE Joint w/ Contrast Right

Facility

$3,679.00

Service Code	HCPCS 73222 RT
Hospital Charge Code	8211764
Hospital Revenue Code	610
Min. Negotiated Rate	$3,127.15
Max. Negotiated Rate	$3,568.63
Rate for Payer: Cash Price	$2,391.35
Rate for Payer: Health Management Network Commercial	$3,127.15
Rate for Payer: Kaiser Permanente Commercial	$3,311.10
Rate for Payer: MDX Hawaii PPO	$3,568.63

MRI UE Joint w/ Contrast Right - Report

Professional

Both

$1,091.00

Service Code	HCPCS 73222 26,RT
Hospital Charge Code	8211766
Hospital Revenue Code	972
Min. Negotiated Rate	$215.80
Max. Negotiated Rate	$927.35
Rate for Payer: AlohaCare Medicaid	$215.80
Rate for Payer: Cash Price	$709.15
Rate for Payer: Cash Price	$709.15
Rate for Payer: Hawaii Western Management Group Commercial	$666.83
Rate for Payer: Health Management Network Commercial	$927.35
Rate for Payer: Ohana Health Plan Medicaid	$215.80
Rate for Payer: UnitedHealthcare Medicaid	$215.80

MRI UE Joint w/o Contrast Left

Facility

$2,322.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	8211767
Hospital Revenue Code	610
Min. Negotiated Rate	$415.68
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$1,161.00
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Devoted Health Medicare	$1,277.10
Rate for Payer: Hawaii Medical Service Association ABD	$415.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,161.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$426.65
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.90
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$1,161.00
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$1,161.00
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$1,161.00
Rate for Payer: Ohana Health Plan Medicare	$1,161.00
Rate for Payer: UnitedHealthcare Medicaid	$415.68
Rate for Payer: UnitedHealthcare Medicare	$1,161.00
Rate for Payer: University Health Alliance Commercial	$837.57

MRI UE Joint w/o Contrast Left

Facility

$2,322.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	8211767
Hospital Revenue Code	610
Min. Negotiated Rate	$1,973.70
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34

MRI UE Joint w/o Contrast Left - Report

Professional

Both

$332.00

Service Code	HCPCS 73221 26,LT
Hospital Charge Code	8211769
Hospital Revenue Code	972
Min. Negotiated Rate	$138.58
Max. Negotiated Rate	$565.39
Rate for Payer: AlohaCare Medicaid	$138.58
Rate for Payer: Cash Price	$215.80
Rate for Payer: Cash Price	$215.80
Rate for Payer: Hawaii Western Management Group Commercial	$565.39
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Ohana Health Plan Medicaid	$138.58
Rate for Payer: UnitedHealthcare Medicaid	$138.58

MRI UE Joint w/o Contrast Right

Facility

$2,322.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	8211770
Hospital Revenue Code	610
Min. Negotiated Rate	$415.68
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$1,161.00
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Devoted Health Medicare	$1,277.10
Rate for Payer: Hawaii Medical Service Association ABD	$415.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,161.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$426.65
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.90
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$1,161.00
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$1,161.00
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$1,161.00
Rate for Payer: Ohana Health Plan Medicare	$1,161.00
Rate for Payer: UnitedHealthcare Medicaid	$415.68
Rate for Payer: UnitedHealthcare Medicare	$1,161.00
Rate for Payer: University Health Alliance Commercial	$837.57

MRI UE Joint w/o Contrast Right

Facility

$2,322.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	8211770
Hospital Revenue Code	610
Min. Negotiated Rate	$1,973.70
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,509.30
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34

MRI UE Joint w/o Contrast Right - Report

Professional

Both

$332.00

Service Code	HCPCS 73221 26,RT
Hospital Charge Code	8211772
Hospital Revenue Code	972
Min. Negotiated Rate	$138.58
Max. Negotiated Rate	$565.39
Rate for Payer: AlohaCare Medicaid	$138.58
Rate for Payer: Cash Price	$215.80
Rate for Payer: Cash Price	$215.80
Rate for Payer: Hawaii Western Management Group Commercial	$565.39
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Ohana Health Plan Medicaid	$138.58
Rate for Payer: UnitedHealthcare Medicaid	$138.58

MRI UE Joint w/ + w/o Contrast Left

Facility

$2,934.00

Service Code	HCPCS 73223 LT
Hospital Charge Code	8211755
Hospital Revenue Code	610
Min. Negotiated Rate	$952.52
Max. Negotiated Rate	$2,845.98
Rate for Payer: AlohaCare Medicaid	$1,467.00
Rate for Payer: AlohaCare Medicare	$1,467.00
Rate for Payer: Cash Price	$1,907.10
Rate for Payer: Cash Price	$1,907.10
Rate for Payer: Devoted Health Medicare	$1,613.70
Rate for Payer: Hawaii Medical Service Association ABD	$983.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,467.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$952.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,787.30
Rate for Payer: Health Management Network Commercial	$2,493.90
Rate for Payer: Humana Medicare	$1,467.00
Rate for Payer: Kaiser Permanente Commercial	$2,640.60
Rate for Payer: Kaiser Permanente Medicaid	$1,496.34
Rate for Payer: Kaiser Permanente Medicare	$1,467.00
Rate for Payer: MDX Hawaii PPO	$2,845.98
Rate for Payer: Ohana Health Plan Medicaid	$1,467.00
Rate for Payer: Ohana Health Plan Medicare	$1,467.00
Rate for Payer: UnitedHealthcare Medicaid	$983.00
Rate for Payer: UnitedHealthcare Medicare	$1,467.00
Rate for Payer: University Health Alliance Commercial	$1,285.53

MRI UE Joint w/ + w/o Contrast Left

Facility

$2,934.00

Service Code	HCPCS 73223 LT
Hospital Charge Code	8211755
Hospital Revenue Code	610
Min. Negotiated Rate	$2,493.90
Max. Negotiated Rate	$2,845.98
Rate for Payer: Cash Price	$1,907.10
Rate for Payer: Health Management Network Commercial	$2,493.90
Rate for Payer: Kaiser Permanente Commercial	$2,640.60
Rate for Payer: MDX Hawaii PPO	$2,845.98

MRI UE Joint w/ + w/o Contrast Left - Report

Professional

Both

$546.00

Service Code	HCPCS 73223 26,LT
Hospital Charge Code	8211757
Hospital Revenue Code	972
Min. Negotiated Rate	$266.19
Max. Negotiated Rate	$1,201.84
Rate for Payer: AlohaCare Medicaid	$266.19
Rate for Payer: Cash Price	$354.90
Rate for Payer: Cash Price	$354.90
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.84
Rate for Payer: Health Management Network Commercial	$464.10
Rate for Payer: Ohana Health Plan Medicaid	$266.19
Rate for Payer: UnitedHealthcare Medicaid	$266.19

Know your out-of-pocket cost for care.

All Charges