Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

VOLAR DISTAL RADIUS PLATE, TI, STANDARD, RIGHT, 7H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006734
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, LEFT, 3H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006740
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, LEFT, 3H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006740
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, LEFT, 5H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006735
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, LEFT, 5H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006735
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, LEFT, 7H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006736
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, LEFT, 7H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006736
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, RIGHT, 3H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006741
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, RIGHT, 3H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006741
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, RIGHT, 5H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, RIGHT, 5H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, RIGHT, 7H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006742
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR DISTAL RADIUS PLATE, TI, WIDE, RIGHT, 7H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006742
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

VOLAR HOOK PLATE, TI, 4H

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13006745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

VOLAR HOOK PLATE, TI, 4H

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13006745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

VOLAR HOOK PLATE, TI, 6H

Facility

$2,730.00

Service Code	HCPCS C1713
Hospital Charge Code	13006737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$2,648.10
Rate for Payer: AlohaCare Medicaid	$1,365.00
Rate for Payer: AlohaCare Medicare	$1,365.00
Rate for Payer: Cash Price	$1,774.50
Rate for Payer: Devoted Health Medicare	$1,501.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,365.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Humana Medicare	$1,365.00
Rate for Payer: Kaiser Permanente Commercial	$2,457.00
Rate for Payer: Kaiser Permanente Medicaid	$1,392.30
Rate for Payer: Kaiser Permanente Medicare	$1,365.00
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: Ohana Health Plan Medicaid	$1,365.00
Rate for Payer: Ohana Health Plan Medicare	$1,365.00
Rate for Payer: UnitedHealthcare Medicare	$1,365.00
Rate for Payer: University Health Alliance Commercial	$1,528.80

VOLAR HOOK PLATE, TI, 6H

Facility

$2,730.00

Service Code	HCPCS C1713
Hospital Charge Code	13006737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,528.80
Max. Negotiated Rate	$2,648.10
Rate for Payer: Cash Price	$1,774.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Kaiser Permanente Commercial	$2,457.00
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: University Health Alliance Commercial	$1,528.80

Volume and Period FSI

Facility

$41.00

Service Code	HCPCS 81050
Hospital Charge Code	8395732
Hospital Revenue Code	307
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77

Volume and Period FSI

Facility

$41.00

Service Code	HCPCS 81050
Hospital Charge Code	8395732
Hospital Revenue Code	307
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$20.50
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$22.55
Rate for Payer: Hawaii Medical Service Association ABD	$2.70
Rate for Payer: Hawaii Medical Service Association Commercial	$4.55
Rate for Payer: Hawaii Medical Service Association Medicare	$20.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.14
Rate for Payer: Hawaii Western Management Group Commercial	$3.64
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$20.50
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$20.50
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$20.50
Rate for Payer: UnitedHealthcare Medicaid	$2.70
Rate for Payer: UnitedHealthcare Medicare	$20.50
Rate for Payer: University Health Alliance Commercial	$7.75

Von Willebrand Factor Activity (RCF) FSI

Facility

$262.00

Service Code	HCPCS 85245
Hospital Charge Code	8934463
Hospital Revenue Code	300
Min. Negotiated Rate	$222.70
Max. Negotiated Rate	$254.14
Rate for Payer: Cash Price	$170.30
Rate for Payer: Health Management Network Commercial	$222.70
Rate for Payer: Kaiser Permanente Commercial	$235.80
Rate for Payer: MDX Hawaii PPO	$254.14

Von Willebrand Factor Activity (RCF) FSI

Facility

$262.00

Service Code	HCPCS 85245
Hospital Charge Code	8934463
Hospital Revenue Code	300
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$254.14
Rate for Payer: AlohaCare Medicaid	$131.00
Rate for Payer: AlohaCare Medicare	$131.00
Rate for Payer: Cash Price	$170.30
Rate for Payer: Cash Price	$170.30
Rate for Payer: Devoted Health Medicare	$144.10
Rate for Payer: Hawaii Medical Service Association ABD	$31.72
Rate for Payer: Hawaii Medical Service Association Commercial	$28.68
Rate for Payer: Hawaii Medical Service Association Medicare	$131.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.31
Rate for Payer: Hawaii Western Management Group Commercial	$22.94
Rate for Payer: Health Management Network Commercial	$222.70
Rate for Payer: Humana Medicare	$131.00
Rate for Payer: Kaiser Permanente Commercial	$235.80
Rate for Payer: Kaiser Permanente Medicaid	$133.62
Rate for Payer: Kaiser Permanente Medicare	$131.00
Rate for Payer: MDX Hawaii PPO	$254.14
Rate for Payer: Ohana Health Plan Medicaid	$131.00
Rate for Payer: Ohana Health Plan Medicare	$131.00
Rate for Payer: UnitedHealthcare Medicaid	$31.72
Rate for Payer: UnitedHealthcare Medicare	$131.00
Rate for Payer: University Health Alliance Commercial	$59.31

V-PLATE, 2.0MM, 10 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006746
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

V-PLATE, 2.0MM, 10 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006746
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

V-PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13006747
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

V-PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13006747
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

Know your out-of-pocket cost for care.

All Charges