Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

PAIN & SPINE: MEDTRONIC IMPLANTABLE NEUROSTIMULATOR

Facility

$20,193.00

Service Code	HCPCS C1767
Hospital Charge Code	8743138
Hospital Revenue Code	278
Min. Negotiated Rate	$11,308.08
Max. Negotiated Rate	$19,587.21
Rate for Payer: Cash Price	$13,125.45
Rate for Payer: Hawaii Western Management Group Commercial	$14,135.10
Rate for Payer: Health Management Network Commercial	$17,164.05
Rate for Payer: Kaiser Permanente Commercial	$18,173.70
Rate for Payer: MDX Hawaii PPO	$19,587.21
Rate for Payer: University Health Alliance Commercial	$11,308.08

PAIN & SPINE: MEDTRONIC IMPLANTABLE NEUROSTIMULATOR

Facility

$20,193.00

Service Code	HCPCS C1767
Hospital Charge Code	8743138
Hospital Revenue Code	278
Min. Negotiated Rate	$10,096.50
Max. Negotiated Rate	$19,587.21
Rate for Payer: AlohaCare Medicaid	$10,096.50
Rate for Payer: AlohaCare Medicare	$10,096.50
Rate for Payer: Cash Price	$13,125.45
Rate for Payer: Devoted Health Medicare	$11,106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$10,096.50
Rate for Payer: Hawaii Western Management Group Commercial	$14,135.10
Rate for Payer: Health Management Network Commercial	$17,164.05
Rate for Payer: Humana Medicare	$10,096.50
Rate for Payer: Kaiser Permanente Commercial	$18,173.70
Rate for Payer: Kaiser Permanente Medicaid	$10,298.43
Rate for Payer: Kaiser Permanente Medicare	$10,096.50
Rate for Payer: MDX Hawaii PPO	$19,587.21
Rate for Payer: Ohana Health Plan Medicaid	$10,096.50
Rate for Payer: Ohana Health Plan Medicare	$10,096.50
Rate for Payer: UnitedHealthcare Medicare	$10,096.50
Rate for Payer: University Health Alliance Commercial	$11,308.08

PAIN & SPINE: MEDTRONIC KYPHOPLASTY 15MM FIRST FRACTURE KIT

Facility

$11,514.00

Hospital Charge Code	9390095
Hospital Revenue Code	278
Min. Negotiated Rate	$5,757.00
Max. Negotiated Rate	$11,168.58
Rate for Payer: AlohaCare Medicaid	$5,757.00
Rate for Payer: AlohaCare Medicare	$5,757.00
Rate for Payer: Cash Price	$7,484.10
Rate for Payer: Devoted Health Medicare	$6,332.70
Rate for Payer: Hawaii Medical Service Association Medicare	$5,757.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,059.80
Rate for Payer: Health Management Network Commercial	$9,786.90
Rate for Payer: Humana Medicare	$5,757.00
Rate for Payer: Kaiser Permanente Commercial	$10,362.60
Rate for Payer: Kaiser Permanente Medicaid	$5,872.14
Rate for Payer: Kaiser Permanente Medicare	$5,757.00
Rate for Payer: MDX Hawaii PPO	$11,168.58
Rate for Payer: Ohana Health Plan Medicaid	$5,757.00
Rate for Payer: Ohana Health Plan Medicare	$5,757.00
Rate for Payer: UnitedHealthcare Medicare	$5,757.00
Rate for Payer: University Health Alliance Commercial	$6,447.84

PAIN & SPINE: MEDTRONIC KYPHOPLASTY 15MM FIRST FRACTURE KIT

Facility

$11,514.00

Hospital Charge Code	9390095
Hospital Revenue Code	278
Min. Negotiated Rate	$6,447.84
Max. Negotiated Rate	$11,168.58
Rate for Payer: Cash Price	$7,484.10
Rate for Payer: Hawaii Western Management Group Commercial	$8,059.80
Rate for Payer: Health Management Network Commercial	$9,786.90
Rate for Payer: Kaiser Permanente Commercial	$10,362.60
Rate for Payer: MDX Hawaii PPO	$11,168.58
Rate for Payer: University Health Alliance Commercial	$6,447.84

PAIN & SPINE: MEDTRONIC OSTEOCOOL ABLATION KIT DUAL PROBES SZ TIP 10MM 160MM 10G

Facility

$10,414.00

Hospital Charge Code	9561552
Hospital Revenue Code	272
Min. Negotiated Rate	$8,851.90
Max. Negotiated Rate	$10,101.58
Rate for Payer: Cash Price	$6,769.10
Rate for Payer: Health Management Network Commercial	$8,851.90
Rate for Payer: Kaiser Permanente Commercial	$9,372.60
Rate for Payer: MDX Hawaii PPO	$10,101.58

PAIN & SPINE: MEDTRONIC OSTEOCOOL ABLATION KIT DUAL PROBES SZ TIP 10MM 160MM 10G

Facility

$10,414.00

Hospital Charge Code	9561552
Hospital Revenue Code	272
Min. Negotiated Rate	$5,207.00
Max. Negotiated Rate	$10,101.58
Rate for Payer: AlohaCare Medicaid	$5,207.00
Rate for Payer: AlohaCare Medicare	$5,207.00
Rate for Payer: Cash Price	$6,769.10
Rate for Payer: Devoted Health Medicare	$5,727.70
Rate for Payer: Hawaii Medical Service Association Medicare	$5,207.00
Rate for Payer: Hawaii Western Management Group Commercial	$9,893.30
Rate for Payer: Health Management Network Commercial	$8,851.90
Rate for Payer: Humana Medicare	$5,207.00
Rate for Payer: Kaiser Permanente Commercial	$9,372.60
Rate for Payer: Kaiser Permanente Medicaid	$5,311.14
Rate for Payer: Kaiser Permanente Medicare	$5,207.00
Rate for Payer: MDX Hawaii PPO	$10,101.58
Rate for Payer: Ohana Health Plan Medicaid	$5,207.00
Rate for Payer: Ohana Health Plan Medicare	$5,207.00
Rate for Payer: UnitedHealthcare Medicare	$5,207.00
Rate for Payer: University Health Alliance Commercial	$7,590.76

PAIN & SPINE: MEDTRONIC RECHARGER

Facility

$2,774.00

Service Code	HCPCS L8681
Hospital Charge Code	8743136
Hospital Revenue Code	278
Min. Negotiated Rate	$1,553.44
Max. Negotiated Rate	$2,690.78
Rate for Payer: Cash Price	$1,803.10
Rate for Payer: Hawaii Western Management Group Commercial	$1,941.80
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Kaiser Permanente Commercial	$2,496.60
Rate for Payer: MDX Hawaii PPO	$2,690.78
Rate for Payer: University Health Alliance Commercial	$1,553.44

PAIN & SPINE: MEDTRONIC RECHARGER

Facility

$2,774.00

Service Code	HCPCS L8681
Hospital Charge Code	8743136
Hospital Revenue Code	278
Min. Negotiated Rate	$92.36
Max. Negotiated Rate	$2,690.78
Rate for Payer: AlohaCare Medicaid	$1,387.00
Rate for Payer: AlohaCare Medicare	$1,387.00
Rate for Payer: Cash Price	$1,803.10
Rate for Payer: Cash Price	$1,803.10
Rate for Payer: Devoted Health Medicare	$1,525.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,387.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,941.80
Rate for Payer: Health Management Network Commercial	$2,357.90
Rate for Payer: Humana Medicare	$1,387.00
Rate for Payer: Kaiser Permanente Commercial	$2,496.60
Rate for Payer: Kaiser Permanente Medicaid	$1,414.74
Rate for Payer: Kaiser Permanente Medicare	$1,387.00
Rate for Payer: MDX Hawaii PPO	$2,690.78
Rate for Payer: Ohana Health Plan Medicaid	$1,387.00
Rate for Payer: Ohana Health Plan Medicare	$1,387.00
Rate for Payer: UnitedHealthcare Medicaid	$92.36
Rate for Payer: UnitedHealthcare Medicare	$1,387.00
Rate for Payer: University Health Alliance Commercial	$1,553.44

PAIN & SPINE: MEDTRONIC SPINAL BONE CEMENT AND KYPHON MIXER PACK

Facility

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	8855862
Hospital Revenue Code	278
Min. Negotiated Rate	$770.56
Max. Negotiated Rate	$1,334.72
Rate for Payer: Cash Price	$894.40
Rate for Payer: Hawaii Western Management Group Commercial	$963.20
Rate for Payer: Health Management Network Commercial	$1,169.60
Rate for Payer: Kaiser Permanente Commercial	$1,238.40
Rate for Payer: MDX Hawaii PPO	$1,334.72
Rate for Payer: University Health Alliance Commercial	$770.56

PAIN & SPINE: MEDTRONIC SPINAL BONE CEMENT AND KYPHON MIXER PACK

Facility

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	8855862
Hospital Revenue Code	278
Min. Negotiated Rate	$688.00
Max. Negotiated Rate	$1,334.72
Rate for Payer: AlohaCare Medicaid	$688.00
Rate for Payer: AlohaCare Medicare	$688.00
Rate for Payer: Cash Price	$894.40
Rate for Payer: Devoted Health Medicare	$756.80
Rate for Payer: Hawaii Medical Service Association Medicare	$688.00
Rate for Payer: Hawaii Western Management Group Commercial	$963.20
Rate for Payer: Health Management Network Commercial	$1,169.60
Rate for Payer: Humana Medicare	$688.00
Rate for Payer: Kaiser Permanente Commercial	$1,238.40
Rate for Payer: Kaiser Permanente Medicaid	$701.76
Rate for Payer: Kaiser Permanente Medicare	$688.00
Rate for Payer: MDX Hawaii PPO	$1,334.72
Rate for Payer: Ohana Health Plan Medicaid	$688.00
Rate for Payer: Ohana Health Plan Medicare	$688.00
Rate for Payer: UnitedHealthcare Medicare	$688.00
Rate for Payer: University Health Alliance Commercial	$770.56

PAIN & SPINE: MEDTRONIC SPINAL KYPHOPLASTY 10MM TRAY FIRST FRACTURE

Facility

$10,810.00

Service Code	HCPCS C1713
Hospital Charge Code	8848268
Hospital Revenue Code	278
Min. Negotiated Rate	$6,053.60
Max. Negotiated Rate	$10,485.70
Rate for Payer: Cash Price	$7,026.50
Rate for Payer: Hawaii Western Management Group Commercial	$7,567.00
Rate for Payer: Health Management Network Commercial	$9,188.50
Rate for Payer: Kaiser Permanente Commercial	$9,729.00
Rate for Payer: MDX Hawaii PPO	$10,485.70
Rate for Payer: University Health Alliance Commercial	$6,053.60

PAIN & SPINE: MEDTRONIC SPINAL KYPHOPLASTY 10MM TRAY FIRST FRACTURE

Facility

$10,810.00

Service Code	HCPCS C1713
Hospital Charge Code	8848268
Hospital Revenue Code	278
Min. Negotiated Rate	$5,405.00
Max. Negotiated Rate	$10,485.70
Rate for Payer: AlohaCare Medicaid	$5,405.00
Rate for Payer: AlohaCare Medicare	$5,405.00
Rate for Payer: Cash Price	$7,026.50
Rate for Payer: Devoted Health Medicare	$5,945.50
Rate for Payer: Hawaii Medical Service Association Medicare	$5,405.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,567.00
Rate for Payer: Health Management Network Commercial	$9,188.50
Rate for Payer: Humana Medicare	$5,405.00
Rate for Payer: Kaiser Permanente Commercial	$9,729.00
Rate for Payer: Kaiser Permanente Medicaid	$5,513.10
Rate for Payer: Kaiser Permanente Medicare	$5,405.00
Rate for Payer: MDX Hawaii PPO	$10,485.70
Rate for Payer: Ohana Health Plan Medicaid	$5,405.00
Rate for Payer: Ohana Health Plan Medicare	$5,405.00
Rate for Payer: UnitedHealthcare Medicare	$5,405.00
Rate for Payer: University Health Alliance Commercial	$6,053.60

PAIN & SPINE: MEDTRONIC WIRELESS EXTERNAL NEUROSTIMULATOR

Facility

$2,145.00

Service Code	HCPCS L9900
Hospital Charge Code	8743134
Hospital Revenue Code	270
Min. Negotiated Rate	$1,072.50
Max. Negotiated Rate	$2,080.65
Rate for Payer: AlohaCare Medicaid	$1,072.50
Rate for Payer: AlohaCare Medicare	$1,072.50
Rate for Payer: Cash Price	$1,394.25
Rate for Payer: Devoted Health Medicare	$1,179.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,072.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,037.75
Rate for Payer: Health Management Network Commercial	$1,823.25
Rate for Payer: Humana Medicare	$1,072.50
Rate for Payer: Kaiser Permanente Commercial	$1,930.50
Rate for Payer: Kaiser Permanente Medicaid	$1,093.95
Rate for Payer: Kaiser Permanente Medicare	$1,072.50
Rate for Payer: MDX Hawaii PPO	$2,080.65
Rate for Payer: Ohana Health Plan Medicaid	$1,072.50
Rate for Payer: Ohana Health Plan Medicare	$1,072.50
Rate for Payer: UnitedHealthcare Medicare	$1,072.50
Rate for Payer: University Health Alliance Commercial	$1,563.49

PAIN & SPINE: MEDTRONIC WIRELESS EXTERNAL NEUROSTIMULATOR

Facility

$2,145.00

Service Code	HCPCS L9900
Hospital Charge Code	8743134
Hospital Revenue Code	270
Min. Negotiated Rate	$1,823.25
Max. Negotiated Rate	$2,080.65
Rate for Payer: Cash Price	$1,394.25
Rate for Payer: Health Management Network Commercial	$1,823.25
Rate for Payer: Kaiser Permanente Commercial	$1,930.50
Rate for Payer: MDX Hawaii PPO	$2,080.65

PAIN & SPINE: MINUTEMAN INTERLAMINAR FUSION DEVICE-SIZE 10

Facility

$34,000.00

Service Code	HCPCS C1831
Hospital Charge Code	11117385
Hospital Revenue Code	278
Min. Negotiated Rate	$19,040.00
Max. Negotiated Rate	$32,980.00
Rate for Payer: Cash Price	$22,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$23,800.00
Rate for Payer: Health Management Network Commercial	$28,900.00
Rate for Payer: Kaiser Permanente Commercial	$30,600.00
Rate for Payer: MDX Hawaii PPO	$32,980.00
Rate for Payer: University Health Alliance Commercial	$19,040.00

PAIN & SPINE: MINUTEMAN INTERLAMINAR FUSION DEVICE-SIZE 10

Facility

$34,000.00

Service Code	HCPCS C1831
Hospital Charge Code	11117385
Hospital Revenue Code	278
Min. Negotiated Rate	$17,000.00
Max. Negotiated Rate	$32,980.00
Rate for Payer: AlohaCare Medicaid	$17,000.00
Rate for Payer: AlohaCare Medicare	$17,000.00
Rate for Payer: Cash Price	$22,100.00
Rate for Payer: Devoted Health Medicare	$18,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$17,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$23,800.00
Rate for Payer: Health Management Network Commercial	$28,900.00
Rate for Payer: Humana Medicare	$17,000.00
Rate for Payer: Kaiser Permanente Commercial	$30,600.00
Rate for Payer: Kaiser Permanente Medicaid	$17,340.00
Rate for Payer: Kaiser Permanente Medicare	$17,000.00
Rate for Payer: MDX Hawaii PPO	$32,980.00
Rate for Payer: Ohana Health Plan Medicaid	$17,000.00
Rate for Payer: Ohana Health Plan Medicare	$17,000.00
Rate for Payer: UnitedHealthcare Medicare	$17,000.00
Rate for Payer: University Health Alliance Commercial	$19,040.00

PAIN & SPINE:PAINTEQ LINQ SI JOINT ALLOGRAFT SPACER 22MM

Facility

$25,000.00

Hospital Charge Code	11808916
Hospital Revenue Code	278
Min. Negotiated Rate	$14,000.00
Max. Negotiated Rate	$24,250.00
Rate for Payer: Cash Price	$16,250.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,500.00
Rate for Payer: Health Management Network Commercial	$21,250.00
Rate for Payer: Kaiser Permanente Commercial	$22,500.00
Rate for Payer: MDX Hawaii PPO	$24,250.00
Rate for Payer: University Health Alliance Commercial	$14,000.00

PAIN & SPINE:PAINTEQ LINQ SI JOINT ALLOGRAFT SPACER 22MM

Facility

$25,000.00

Hospital Charge Code	11808916
Hospital Revenue Code	278
Min. Negotiated Rate	$12,500.00
Max. Negotiated Rate	$24,250.00
Rate for Payer: AlohaCare Medicaid	$12,500.00
Rate for Payer: AlohaCare Medicare	$12,500.00
Rate for Payer: Cash Price	$16,250.00
Rate for Payer: Devoted Health Medicare	$13,750.00
Rate for Payer: Hawaii Medical Service Association Medicare	$12,500.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,500.00
Rate for Payer: Health Management Network Commercial	$21,250.00
Rate for Payer: Humana Medicare	$12,500.00
Rate for Payer: Kaiser Permanente Commercial	$22,500.00
Rate for Payer: Kaiser Permanente Medicaid	$12,750.00
Rate for Payer: Kaiser Permanente Medicare	$12,500.00
Rate for Payer: MDX Hawaii PPO	$24,250.00
Rate for Payer: Ohana Health Plan Medicaid	$12,500.00
Rate for Payer: Ohana Health Plan Medicare	$12,500.00
Rate for Payer: UnitedHealthcare Medicare	$12,500.00
Rate for Payer: University Health Alliance Commercial	$14,000.00

PAIN & SPINE PROBE APSC01 50MM 10MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586297
Hospital Revenue Code	272
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: AlohaCare Medicaid	$930.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Devoted Health Medicare	$1,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: Kaiser Permanente Medicaid	$948.60
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$1,804.20
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,355.75

PAIN & SPINE PROBE APSC01 50MM 10MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586297
Hospital Revenue Code	272
Min. Negotiated Rate	$1,581.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: MDX Hawaii PPO	$1,804.20

PAIN & SPINE: PROBE APSC02 100MM 10MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586298
Hospital Revenue Code	272
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: AlohaCare Medicaid	$930.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Devoted Health Medicare	$1,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: Kaiser Permanente Medicaid	$948.60
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$1,804.20
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,355.75

PAIN & SPINE: PROBE APSC02 100MM 10MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586298
Hospital Revenue Code	272
Min. Negotiated Rate	$1,581.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: MDX Hawaii PPO	$1,804.20

PAIN & SPINE: PROBE APSC03 150MM 10MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586299
Hospital Revenue Code	272
Min. Negotiated Rate	$1,581.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: MDX Hawaii PPO	$1,804.20

PAIN & SPINE: PROBE APSC03 150MM 10MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586299
Hospital Revenue Code	272
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: AlohaCare Medicaid	$930.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Devoted Health Medicare	$1,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: Kaiser Permanente Medicaid	$948.60
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$1,804.20
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,355.75

PAIN & SPINE: PROBE APSC04 50MM 12MM ENHANCED

Facility

$1,860.00

Hospital Charge Code	9586300
Hospital Revenue Code	272
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,804.20
Rate for Payer: AlohaCare Medicaid	$930.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,209.00
Rate for Payer: Devoted Health Medicare	$1,023.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.00
Rate for Payer: Health Management Network Commercial	$1,581.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$1,674.00
Rate for Payer: Kaiser Permanente Medicaid	$948.60
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$1,804.20
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,355.75

Know your out-of-pocket cost for care.

All Charges