Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

US Thoracentesis

Facility

$1,792.00

Service Code	HCPCS 32555
Hospital Charge Code	1169881
Hospital Revenue Code	361
Min. Negotiated Rate	$1,523.20
Max. Negotiated Rate	$1,738.24
Rate for Payer: Cash Price	$1,164.80
Rate for Payer: Health Management Network Commercial	$1,523.20
Rate for Payer: Kaiser Permanente Commercial	$1,612.80
Rate for Payer: MDX Hawaii PPO	$1,738.24

US Thoracentesis - Report

Professional

Both

$873.00

Service Code	HCPCS 32555
Hospital Charge Code	661687
Hospital Revenue Code	972
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$742.05
Rate for Payer: AlohaCare Medicaid	$106.83
Rate for Payer: AlohaCare Medicare	$92.50
Rate for Payer: Cash Price	$567.45
Rate for Payer: Cash Price	$567.45
Rate for Payer: Devoted Health Medicare	$101.75
Rate for Payer: Hawaii Medical Service Association ABD	$106.83
Rate for Payer: Hawaii Medical Service Association Commercial	$169.92
Rate for Payer: Hawaii Medical Service Association Medicare	$92.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$106.83
Rate for Payer: Health Management Network Commercial	$742.05
Rate for Payer: Kaiser Permanente Commercial	$111.00
Rate for Payer: Kaiser Permanente Medicaid	$111.00
Rate for Payer: Kaiser Permanente Medicare	$111.00
Rate for Payer: Ohana Health Plan Medicaid	$106.83
Rate for Payer: Ohana Health Plan Medicare	$92.50
Rate for Payer: UnitedHealthcare Medicaid	$106.83
Rate for Payer: UnitedHealthcare Medicare	$92.50
Rate for Payer: University Health Alliance Commercial	$132.55

US Thyroid Biopsy

Facility

$1,156.00

Service Code	HCPCS 60100
Hospital Charge Code	8211782
Hospital Revenue Code	361
Min. Negotiated Rate	$982.60
Max. Negotiated Rate	$1,121.32
Rate for Payer: Cash Price	$751.40
Rate for Payer: Health Management Network Commercial	$982.60
Rate for Payer: Kaiser Permanente Commercial	$1,040.40
Rate for Payer: MDX Hawaii PPO	$1,121.32

US Thyroid Biopsy

Facility

$1,156.00

Service Code	HCPCS 60100
Hospital Charge Code	8211782
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$578.00
Rate for Payer: AlohaCare Medicare	$578.00
Rate for Payer: Cash Price	$751.40
Rate for Payer: Cash Price	$751.40
Rate for Payer: Cash Price	$751.40
Rate for Payer: Devoted Health Medicare	$635.80
Rate for Payer: Hawaii Medical Service Association Commercial	$904.34
Rate for Payer: Hawaii Medical Service Association Medicare	$578.00
Rate for Payer: Health Management Network Commercial	$982.60
Rate for Payer: Humana Medicare	$578.00
Rate for Payer: Kaiser Permanente Commercial	$1,040.40
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$578.00
Rate for Payer: MDX Hawaii PPO	$1,121.32
Rate for Payer: Ohana Health Plan Medicaid	$578.00
Rate for Payer: Ohana Health Plan Medicare	$578.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$578.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

US Thyroid Biopsy - Report

Professional

Both

$986.00

Service Code	HCPCS 60100
Hospital Charge Code	8211784
Hospital Revenue Code	972
Min. Negotiated Rate	$64.31
Max. Negotiated Rate	$838.10
Rate for Payer: AlohaCare Medicaid	$75.37
Rate for Payer: AlohaCare Medicare	$64.31
Rate for Payer: Cash Price	$640.90
Rate for Payer: Cash Price	$640.90
Rate for Payer: Devoted Health Medicare	$70.74
Rate for Payer: Hawaii Medical Service Association ABD	$75.37
Rate for Payer: Hawaii Medical Service Association Commercial	$118.74
Rate for Payer: Hawaii Medical Service Association Medicare	$64.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.37
Rate for Payer: Hawaii Western Management Group Commercial	$92.82
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: Kaiser Permanente Commercial	$77.17
Rate for Payer: Kaiser Permanente Medicaid	$77.17
Rate for Payer: Kaiser Permanente Medicare	$77.17
Rate for Payer: Ohana Health Plan Medicaid	$75.37
Rate for Payer: Ohana Health Plan Medicare	$64.31
Rate for Payer: UnitedHealthcare Medicaid	$75.37
Rate for Payer: UnitedHealthcare Medicare	$64.31
Rate for Payer: University Health Alliance Commercial	$93.26

US Transcranial Doppler Complete

Facility

$1,386.00

Service Code	HCPCS 93886
Hospital Charge Code	1169885
Hospital Revenue Code	921
Min. Negotiated Rate	$1,178.10
Max. Negotiated Rate	$1,344.42
Rate for Payer: Cash Price	$900.90
Rate for Payer: Health Management Network Commercial	$1,178.10
Rate for Payer: Kaiser Permanente Commercial	$1,247.40
Rate for Payer: MDX Hawaii PPO	$1,344.42

US Transcranial Doppler Complete

Facility

$1,386.00

Service Code	HCPCS 93886
Hospital Charge Code	1169885
Hospital Revenue Code	921
Min. Negotiated Rate	$168.52
Max. Negotiated Rate	$1,344.42
Rate for Payer: AlohaCare Medicaid	$693.00
Rate for Payer: AlohaCare Medicare	$693.00
Rate for Payer: Cash Price	$900.90
Rate for Payer: Cash Price	$900.90
Rate for Payer: Devoted Health Medicare	$762.30
Rate for Payer: Hawaii Medical Service Association ABD	$168.52
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$693.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$201.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.70
Rate for Payer: Health Management Network Commercial	$1,178.10
Rate for Payer: Humana Medicare	$693.00
Rate for Payer: Kaiser Permanente Commercial	$1,247.40
Rate for Payer: Kaiser Permanente Medicaid	$706.86
Rate for Payer: Kaiser Permanente Medicare	$693.00
Rate for Payer: MDX Hawaii PPO	$1,344.42
Rate for Payer: Ohana Health Plan Medicaid	$693.00
Rate for Payer: Ohana Health Plan Medicare	$693.00
Rate for Payer: UnitedHealthcare Medicaid	$168.52
Rate for Payer: UnitedHealthcare Medicare	$693.00
Rate for Payer: University Health Alliance Commercial	$776.16

US Transcranial Doppler Limited

Facility

$708.00

Service Code	HCPCS 93888
Hospital Charge Code	7822548
Hospital Revenue Code	921
Min. Negotiated Rate	$106.46
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
Rate for Payer: Hawaii Medical Service Association ABD	$106.46
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$111.78
Rate for Payer: Hawaii Western Management Group Commercial	$672.60
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$106.46
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$396.48

US Transcranial Doppler Limited

Facility

$708.00

Service Code	HCPCS 93888
Hospital Charge Code	7822548
Hospital Revenue Code	921
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

US Transvaginal Non-OB

Facility

$758.00

Service Code	HCPCS 76830
Hospital Charge Code	1169889
Hospital Revenue Code	402
Min. Negotiated Rate	$50.35
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$379.00
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$416.90
Rate for Payer: Hawaii Medical Service Association ABD	$50.35
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.65
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$379.00
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$379.00
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$379.00
Rate for Payer: Ohana Health Plan Medicare	$379.00
Rate for Payer: UnitedHealthcare Medicaid	$50.35
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$230.73

US Transvaginal Non-OB

Facility

$758.00

Service Code	HCPCS 76830
Hospital Charge Code	1169889
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

US Transvaginal Non-OB - Report

Professional

Both

$179.00

Service Code	HCPCS 76830 26
Hospital Charge Code	630829
Hospital Revenue Code	972
Min. Negotiated Rate	$33.03
Max. Negotiated Rate	$152.15
Rate for Payer: AlohaCare Medicaid	$79.51
Rate for Payer: AlohaCare Medicare	$33.03
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Devoted Health Medicare	$36.33
Rate for Payer: Hawaii Medical Service Association Medicare	$33.03
Rate for Payer: Hawaii Western Management Group Commercial	$105.25
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$39.64
Rate for Payer: Kaiser Permanente Medicaid	$39.64
Rate for Payer: Kaiser Permanente Medicare	$39.64
Rate for Payer: Ohana Health Plan Medicaid	$79.51
Rate for Payer: Ohana Health Plan Medicare	$33.03
Rate for Payer: UnitedHealthcare Medicaid	$79.51
Rate for Payer: UnitedHealthcare Medicare	$33.03

US Upper Ext Arterial Duplex Bilateral

Facility

$1,386.00

Service Code	HCPCS 93930
Hospital Charge Code	1169895
Hospital Revenue Code	921
Min. Negotiated Rate	$138.35
Max. Negotiated Rate	$1,344.42
Rate for Payer: AlohaCare Medicaid	$693.00
Rate for Payer: AlohaCare Medicare	$693.00
Rate for Payer: Cash Price	$900.90
Rate for Payer: Cash Price	$900.90
Rate for Payer: Devoted Health Medicare	$762.30
Rate for Payer: Hawaii Medical Service Association ABD	$138.35
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$693.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$165.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.70
Rate for Payer: Health Management Network Commercial	$1,178.10
Rate for Payer: Humana Medicare	$693.00
Rate for Payer: Kaiser Permanente Commercial	$1,247.40
Rate for Payer: Kaiser Permanente Medicaid	$706.86
Rate for Payer: Kaiser Permanente Medicare	$693.00
Rate for Payer: MDX Hawaii PPO	$1,344.42
Rate for Payer: Ohana Health Plan Medicaid	$693.00
Rate for Payer: Ohana Health Plan Medicare	$693.00
Rate for Payer: UnitedHealthcare Medicaid	$138.35
Rate for Payer: UnitedHealthcare Medicare	$693.00
Rate for Payer: University Health Alliance Commercial	$776.16

US Upper Ext Arterial Duplex Bilateral

Facility

$1,386.00

Service Code	HCPCS 93930
Hospital Charge Code	1169895
Hospital Revenue Code	921
Min. Negotiated Rate	$1,178.10
Max. Negotiated Rate	$1,344.42
Rate for Payer: Cash Price	$900.90
Rate for Payer: Health Management Network Commercial	$1,178.10
Rate for Payer: Kaiser Permanente Commercial	$1,247.40
Rate for Payer: MDX Hawaii PPO	$1,344.42

US Upper Ext Arterial Duplex Bilateral - Report

Professional

Both

$332.00

Service Code	HCPCS 93930 26
Hospital Charge Code	630818
Hospital Revenue Code	972
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$282.20
Rate for Payer: AlohaCare Medicaid	$221.07
Rate for Payer: AlohaCare Medicare	$37.28
Rate for Payer: Cash Price	$215.80
Rate for Payer: Cash Price	$215.80
Rate for Payer: Devoted Health Medicare	$41.01
Rate for Payer: Hawaii Medical Service Association Medicare	$37.28
Rate for Payer: Hawaii Western Management Group Commercial	$154.23
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Kaiser Permanente Commercial	$44.74
Rate for Payer: Kaiser Permanente Medicaid	$44.74
Rate for Payer: Kaiser Permanente Medicare	$44.74
Rate for Payer: Ohana Health Plan Medicaid	$221.07
Rate for Payer: Ohana Health Plan Medicare	$37.28
Rate for Payer: UnitedHealthcare Medicaid	$221.07
Rate for Payer: UnitedHealthcare Medicare	$37.28

US Upper Ext Arterial Duplex Left

Facility

$708.00

Service Code	HCPCS 93931 LT
Hospital Charge Code	1169897
Hospital Revenue Code	921
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

US Upper Ext Arterial Duplex Left

Facility

$708.00

Service Code	HCPCS 93931 LT
Hospital Charge Code	1169897
Hospital Revenue Code	921
Min. Negotiated Rate	$90.01
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
Rate for Payer: Hawaii Medical Service Association ABD	$90.01
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$107.47
Rate for Payer: Hawaii Western Management Group Commercial	$672.60
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$90.01
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$396.48

US Upper Ext Arterial Duplex Left - Report

Professional

Both

$145.00

Service Code	HCPCS 93931 26,LT
Hospital Charge Code	630814
Hospital Revenue Code	972
Min. Negotiated Rate	$102.55
Max. Negotiated Rate	$138.05
Rate for Payer: AlohaCare Medicaid	$138.05
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Hawaii Western Management Group Commercial	$102.55
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Ohana Health Plan Medicaid	$138.05
Rate for Payer: UnitedHealthcare Medicaid	$138.05

US Upper Ext Arterial Duplex Right

Facility

$708.00

Service Code	HCPCS 93931 RT
Hospital Charge Code	1169899
Hospital Revenue Code	921
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: MDX Hawaii PPO	$686.76

US Upper Ext Arterial Duplex Right

Facility

$708.00

Service Code	HCPCS 93931 RT
Hospital Charge Code	1169899
Hospital Revenue Code	921
Min. Negotiated Rate	$90.01
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$354.00
Rate for Payer: AlohaCare Medicare	$354.00
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$389.40
Rate for Payer: Hawaii Medical Service Association ABD	$90.01
Rate for Payer: Hawaii Medical Service Association Medicare	$354.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$107.47
Rate for Payer: Hawaii Western Management Group Commercial	$672.60
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$354.00
Rate for Payer: Kaiser Permanente Commercial	$637.20
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$354.00
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$354.00
Rate for Payer: Ohana Health Plan Medicare	$354.00
Rate for Payer: UnitedHealthcare Medicaid	$90.01
Rate for Payer: UnitedHealthcare Medicare	$354.00
Rate for Payer: University Health Alliance Commercial	$396.48

US Upper Ext Arterial Duplex Right - Report

Professional

Both

$145.00

Service Code	HCPCS 93931 26,RT
Hospital Charge Code	630810
Hospital Revenue Code	972
Min. Negotiated Rate	$102.55
Max. Negotiated Rate	$138.05
Rate for Payer: AlohaCare Medicaid	$138.05
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Hawaii Western Management Group Commercial	$102.55
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Ohana Health Plan Medicaid	$138.05
Rate for Payer: UnitedHealthcare Medicaid	$138.05

US Upper Extrem Non Vasc Comp LT POC

Facility

$758.00

Service Code	HCPCS 76881
Hospital Charge Code	10239195
Hospital Revenue Code	320
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

US Upper Extrem Non Vasc Comp LT POC

Facility

$758.00

Service Code	HCPCS 76881
Hospital Charge Code	10239195
Hospital Revenue Code	320
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$379.00
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$416.90
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$379.00
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$379.00
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$379.00
Rate for Payer: Ohana Health Plan Medicare	$379.00
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$246.33

US Upper Extrem Non Vasc Comp RT POC

Facility

$758.00

Service Code	HCPCS 76881
Hospital Charge Code	10239196
Hospital Revenue Code	320
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

US Upper Extrem Non Vasc Comp RT POC

Facility

$758.00

Service Code	HCPCS 76881
Hospital Charge Code	10239196
Hospital Revenue Code	320
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$379.00
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$416.90
Rate for Payer: Hawaii Medical Service Association ABD	$61.93
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$379.00
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$379.00
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$379.00
Rate for Payer: Ohana Health Plan Medicare	$379.00
Rate for Payer: UnitedHealthcare Medicaid	$61.93
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$246.33

Know your out-of-pocket cost for care.

All Charges