Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

TROCH NAIL, RT, 12.5MM X 42CM X 130

Facility

$5,660.00

Service Code	HCPCS C1713
Hospital Charge Code	13001003
Hospital Revenue Code	278
Min. Negotiated Rate	$3,169.60
Max. Negotiated Rate	$5,490.20
Rate for Payer: Cash Price	$3,679.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,962.00
Rate for Payer: Health Management Network Commercial	$4,811.00
Rate for Payer: Kaiser Permanente Commercial	$5,094.00
Rate for Payer: MDX Hawaii PPO	$5,490.20
Rate for Payer: University Health Alliance Commercial	$3,169.60

TROCH NAIL, RT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	13001006
Hospital Revenue Code	278
Min. Negotiated Rate	$3,522.40
Max. Negotiated Rate	$6,101.30
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: University Health Alliance Commercial	$3,522.40

TROCH NAIL, RT, 12.5MM X 45CM X 130

Facility

$6,290.00

Service Code	HCPCS C1713
Hospital Charge Code	13001006
Hospital Revenue Code	278
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$6,101.30
Rate for Payer: AlohaCare Medicaid	$3,145.00
Rate for Payer: AlohaCare Medicare	$3,145.00
Rate for Payer: Cash Price	$4,088.50
Rate for Payer: Devoted Health Medicare	$3,459.50
Rate for Payer: Hawaii Medical Service Association Medicare	$3,145.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,403.00
Rate for Payer: Health Management Network Commercial	$5,346.50
Rate for Payer: Humana Medicare	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$5,661.00
Rate for Payer: Kaiser Permanente Medicaid	$3,207.90
Rate for Payer: Kaiser Permanente Medicare	$3,145.00
Rate for Payer: MDX Hawaii PPO	$6,101.30
Rate for Payer: Ohana Health Plan Medicaid	$3,145.00
Rate for Payer: Ohana Health Plan Medicare	$3,145.00
Rate for Payer: UnitedHealthcare Medicare	$3,145.00
Rate for Payer: University Health Alliance Commercial	$3,522.40

Troponin High Sensitivity POC

Facility

$125.00

Service Code	HCPCS 84484 QW
Hospital Charge Code	12884792
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$62.50
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$68.75
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$62.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$62.50
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$62.50
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$62.50
Rate for Payer: Ohana Health Plan Medicare	$62.50
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$62.50
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin High Sensitivity POC

Facility

$125.00

Service Code	HCPCS 84484 QW
Hospital Charge Code	12884792
Hospital Revenue Code	301
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

Troponin I FSI

Facility

$161.00

Service Code	HCPCS 84484
Hospital Charge Code	8128157
Hospital Revenue Code	301
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: MDX Hawaii PPO	$156.17

Troponin I FSI

Facility

$161.00

Service Code	HCPCS 84484
Hospital Charge Code	8128157
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$80.50
Rate for Payer: AlohaCare Medicare	$80.50
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$88.55
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$80.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$80.50
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$80.50
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$80.50
Rate for Payer: Ohana Health Plan Medicare	$80.50
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$80.50
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin-I High Sensitivity

Facility

$142.00

Service Code	HCPCS 84484
Hospital Charge Code	9142423
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin-I High Sensitivity

Facility

$142.00

Service Code	HCPCS 84484
Hospital Charge Code	9142423
Hospital Revenue Code	301
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Troponin I, High Sensitivity FSI

Facility

$142.00

Service Code	HCPCS 84484
Hospital Charge Code	9583208
Hospital Revenue Code	301
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Troponin I, High Sensitivity FSI

Facility

$142.00

Service Code	HCPCS 84484
Hospital Charge Code	9583208
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin I (iStat TnI) FSI

Facility

$141.00

Service Code	HCPCS 84484
Hospital Charge Code	12317992
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$70.50
Rate for Payer: Cash Price	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$77.55
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$70.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$70.50
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$70.50
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$70.50
Rate for Payer: Ohana Health Plan Medicare	$70.50
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$70.50
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin I (iStat TnI) FSI

Facility

$141.00

Service Code	HCPCS 84484
Hospital Charge Code	12317992
Hospital Revenue Code	301
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

Troponin I (POCT)

Facility

$135.00

Service Code	HCPCS 84484
Hospital Charge Code	12514707
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$67.50
Rate for Payer: AlohaCare Medicare	$67.50
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Devoted Health Medicare	$74.25
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$67.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$67.50
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$67.50
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$67.50
Rate for Payer: Ohana Health Plan Medicare	$67.50
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$67.50
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin I (POCT)

Facility

$135.00

Service Code	HCPCS 84484
Hospital Charge Code	12514707
Hospital Revenue Code	301
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$87.75
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: MDX Hawaii PPO	$130.95

Troponin iSTAT

Facility

$125.00

Service Code	HCPCS 84484 QW
Hospital Charge Code	8293270
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$62.50
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$68.75
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$62.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$62.50
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$62.50
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$62.50
Rate for Payer: Ohana Health Plan Medicare	$62.50
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$62.50
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin iSTAT

Facility

$125.00

Service Code	HCPCS 84484 QW
Hospital Charge Code	8293270
Hospital Revenue Code	301
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

Troponin T Gen5 ng/L FSI

Facility

$130.00

Service Code	HCPCS 84484
Hospital Charge Code	8225278
Hospital Revenue Code	301
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

Troponin T Gen5 ng/L FSI

Facility

$130.00

Service Code	HCPCS 84484
Hospital Charge Code	8225278
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$65.00
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Devoted Health Medicare	$71.50
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$65.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$65.00
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$65.00
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$65.00
Rate for Payer: Ohana Health Plan Medicare	$65.00
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$65.00
Rate for Payer: University Health Alliance Commercial	$25.44

TSH FSI

Facility

$170.00

Service Code	HCPCS 84443
Hospital Charge Code	8118067
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$164.90
Rate for Payer: AlohaCare Medicaid	$85.00
Rate for Payer: AlohaCare Medicare	$85.00
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Devoted Health Medicare	$93.50
Rate for Payer: Hawaii Medical Service Association ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$85.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.37
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Humana Medicare	$85.00
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: Kaiser Permanente Medicaid	$86.70
Rate for Payer: Kaiser Permanente Medicare	$85.00
Rate for Payer: MDX Hawaii PPO	$164.90
Rate for Payer: Ohana Health Plan Medicaid	$85.00
Rate for Payer: Ohana Health Plan Medicare	$85.00
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$85.00
Rate for Payer: University Health Alliance Commercial	$43.42

TSH FSI

Facility

$170.00

Service Code	HCPCS 84443
Hospital Charge Code	8118067
Hospital Revenue Code	301
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$110.50
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$164.90

TSH Receptor Antibody FSI

Facility

$148.00

Service Code	HCPCS 83520
Hospital Charge Code	10368490
Hospital Revenue Code	301
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$96.20
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: MDX Hawaii PPO	$143.56

TSH Receptor Antibody FSI

Facility

$148.00

Service Code	HCPCS 83520
Hospital Charge Code	10368490
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$143.56
Rate for Payer: AlohaCare Medicaid	$74.00
Rate for Payer: AlohaCare Medicare	$74.00
Rate for Payer: Cash Price	$96.20
Rate for Payer: Cash Price	$96.20
Rate for Payer: Devoted Health Medicare	$81.40
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$74.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$74.00
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$74.00
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$74.00
Rate for Payer: Ohana Health Plan Medicare	$74.00
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$74.00
Rate for Payer: University Health Alliance Commercial	$33.47

TSH w/ Reflex FT4 FSI

Facility

$170.00

Service Code	HCPCS 84443
Hospital Charge Code	8118068
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$164.90
Rate for Payer: AlohaCare Medicaid	$85.00
Rate for Payer: AlohaCare Medicare	$85.00
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Devoted Health Medicare	$93.50
Rate for Payer: Hawaii Medical Service Association ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$85.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.37
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Humana Medicare	$85.00
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: Kaiser Permanente Medicaid	$86.70
Rate for Payer: Kaiser Permanente Medicare	$85.00
Rate for Payer: MDX Hawaii PPO	$164.90
Rate for Payer: Ohana Health Plan Medicaid	$85.00
Rate for Payer: Ohana Health Plan Medicare	$85.00
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$85.00
Rate for Payer: University Health Alliance Commercial	$43.42

TSH w/ Reflex FT4 FSI

Facility

$170.00

Service Code	HCPCS 84443
Hospital Charge Code	8118068
Hospital Revenue Code	301
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$110.50
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$164.90

Know your out-of-pocket cost for care.

All Charges