Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

RETROGRADE FEMORAL NAIL, 11MM X 36CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991359
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 11MM X 38CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991352
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 11MM X 38CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991352
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 11MM X 40CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991353
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 11MM X 40CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991353
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 11MM X 42CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991354
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 11MM X 42CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991354
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 26CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991360
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 26CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991360
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 28CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991361
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 28CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991361
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 30CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991362
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 30CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991362
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 32CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991355
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 32CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991355
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 34CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991350
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 12MM X 34CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991350
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 26CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991364
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 26CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991364
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 28CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991373
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 28CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991373
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 30CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991374
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 30CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991374
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 32CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991375
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.80
Max. Negotiated Rate	$4,879.10
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: University Health Alliance Commercial	$2,816.80

RETROGRADE FEMORAL NAIL, 13MM X 32CM

Facility

$5,030.00

Service Code	HCPCS C1713
Hospital Charge Code	12991375
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.00
Max. Negotiated Rate	$4,879.10
Rate for Payer: AlohaCare Medicaid	$2,515.00
Rate for Payer: AlohaCare Medicare	$2,515.00
Rate for Payer: Cash Price	$3,269.50
Rate for Payer: Devoted Health Medicare	$2,766.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,521.00
Rate for Payer: Health Management Network Commercial	$4,275.50
Rate for Payer: Humana Medicare	$2,515.00
Rate for Payer: Kaiser Permanente Commercial	$4,527.00
Rate for Payer: Kaiser Permanente Medicaid	$2,565.30
Rate for Payer: Kaiser Permanente Medicare	$2,515.00
Rate for Payer: MDX Hawaii PPO	$4,879.10
Rate for Payer: Ohana Health Plan Medicaid	$2,515.00
Rate for Payer: Ohana Health Plan Medicare	$2,515.00
Rate for Payer: UnitedHealthcare Medicare	$2,515.00
Rate for Payer: University Health Alliance Commercial	$2,816.80

Know your out-of-pocket cost for care.

All Charges