Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

TROCHANTERIC NAIL, LT,11MM X 33CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007506
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 36CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007500
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 36CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007500
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 39CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007501
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 39CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007501
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 42CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007507
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 42CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007507
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 45CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007502
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, LT,11MM X 45CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007502
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 30CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007508
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 30CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007508
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 33CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007505
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 33CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13007505
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 36CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005592
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 36CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005592
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 39CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005594
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 39CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005594
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 42CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,10MM X 42CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005593
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,11MM X 33CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005601
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,11MM X 33CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005601
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,11MM X 36CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005602
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,11MM X 36CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005602
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,11MM X 39CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005598
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: AlohaCare Medicaid	$2,725.00
Rate for Payer: AlohaCare Medicare	$2,725.00
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Devoted Health Medicare	$2,997.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,725.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Humana Medicare	$2,725.00
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: Kaiser Permanente Medicaid	$2,779.50
Rate for Payer: Kaiser Permanente Medicare	$2,725.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: Ohana Health Plan Medicaid	$2,725.00
Rate for Payer: Ohana Health Plan Medicare	$2,725.00
Rate for Payer: UnitedHealthcare Medicare	$2,725.00
Rate for Payer: University Health Alliance Commercial	$3,052.00

TROCHANTERIC NAIL, RT,11MM X 39CM X 130

Facility

$5,450.00

Service Code	HCPCS C1713
Hospital Charge Code	13005598
Hospital Revenue Code	278
Min. Negotiated Rate	$3,052.00
Max. Negotiated Rate	$5,286.50
Rate for Payer: Cash Price	$3,542.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,815.00
Rate for Payer: Health Management Network Commercial	$4,632.50
Rate for Payer: Kaiser Permanente Commercial	$4,905.00
Rate for Payer: MDX Hawaii PPO	$5,286.50
Rate for Payer: University Health Alliance Commercial	$3,052.00

Know your out-of-pocket cost for care.

All Charges