Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ART DPLX IMAG PERIP F/U-LOW EXTREM

Facility

$708.00

Service Code	HCPCS 93926
Hospital Charge Code	H9210102
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: MDX Hawaii PPO	$686.76

HCHG ART DPLX IMAG PERIP-LOW EXTREM, BILAT STUDY

Facility

$1,335.00

Service Code	HCPCS 93925
Hospital Charge Code	H9210104
Hospital Revenue Code	921
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$1,294.95
Rate for Payer: Cash Price	$867.75
Rate for Payer: Health Management Network Commercial	$1,134.75
Rate for Payer: MDX Hawaii PPO	$1,294.95

HCHG ART DPLX IMAG PERIP-LOW EXTREM, BILAT STUDY

Facility

$1,335.00

Service Code	HCPCS 93925
Hospital Charge Code	H9210104
Hospital Revenue Code	921
Min. Negotiated Rate	$173.10
Max. Negotiated Rate	$1,294.95
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$867.75
Rate for Payer: Cash Price	$867.75
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$173.10
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$206.69
Rate for Payer: Hawaii Western Management Group Commercial	$1,268.25
Rate for Payer: Health Management Network Commercial	$1,134.75
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$841.05
Rate for Payer: Kaiser Permanente Medicaid	$680.85
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,294.95
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$173.10
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$973.08

HCHG ART DPLX IMG PERIP-UPP CMPL, BILAT STUDY

Facility

$1,450.00

Service Code	HCPCS 93930
Hospital Charge Code	H9200104
Hospital Revenue Code	920
Min. Negotiated Rate	$1,232.50
Max. Negotiated Rate	$1,406.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: MDX Hawaii PPO	$1,406.50

HCHG ART DPLX IMG PERIP-UPP CMPL, BILAT STUDY

Facility

$1,450.00

Service Code	HCPCS 93930
Hospital Charge Code	H9200104
Hospital Revenue Code	920
Min. Negotiated Rate	$138.35
Max. Negotiated Rate	$1,406.50
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$942.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$138.35
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$165.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,377.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$739.50
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,406.50
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$138.35
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$1,056.90

HCHG ART DPLX IMG PERIP-UPP LTD

Facility

$708.00

Service Code	HCPCS 93931
Hospital Charge Code	H9200106
Hospital Revenue Code	920
Min. Negotiated Rate	$90.01
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$90.01
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
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	$123.50
Rate for Payer: Kaiser Permanente Commercial	$446.04
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$90.01
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$516.06

HCHG ART DPLX IMG PERIP-UPP LTD

Facility

$708.00

Service Code	HCPCS 93931
Hospital Charge Code	H9200106
Hospital Revenue Code	920
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: MDX Hawaii PPO	$686.76

HCHG ARTERIAL CATH (ART LINE)

Facility

$273.00

Service Code	HCPCS 36620
Hospital Charge Code	H4500128
Hospital Revenue Code	450
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$177.45
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: MDX Hawaii PPO	$264.81

HCHG ARTERIAL CATH (ART LINE)

Facility

$273.00

Service Code	HCPCS 36620
Hospital Charge Code	H4500128
Hospital Revenue Code	450
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,833.00
Rate for Payer: Cash Price	$177.45
Rate for Payer: Cash Price	$177.45
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$171.99
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: University Health Alliance Commercial	$198.99

HCHG ARTERIAL PUNCTURE FOR BGA

Facility

$250.00

Service Code	HCPCS 36600
Hospital Charge Code	H4100150
Hospital Revenue Code	410
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: MDX Hawaii PPO	$242.50

HCHG ARTERIAL PUNCTURE FOR BGA

Facility

$250.00

Service Code	HCPCS 36600
Hospital Charge Code	H4100150
Hospital Revenue Code	410
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$237.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$15.16
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$182.22

HCHG ARTHROCENTESIS INTERM JNT

Facility

$1,721.00

Service Code	HCPCS 20605
Hospital Charge Code	H4500130
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.95
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$1,084.23
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,669.37
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG ARTHROCENTESIS INTERM JNT

Facility

$1,721.00

Service Code	HCPCS 20605
Hospital Charge Code	H4500130
Hospital Revenue Code	450
Min. Negotiated Rate	$1,462.85
Max. Negotiated Rate	$1,669.37
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: MDX Hawaii PPO	$1,669.37

HCHG ARTHROCENTESIS MAJOR JNT

Facility

$1,721.00

Service Code	HCPCS 20610
Hospital Charge Code	H4500132
Hospital Revenue Code	450
Min. Negotiated Rate	$1,462.85
Max. Negotiated Rate	$1,669.37
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: MDX Hawaii PPO	$1,669.37

HCHG ARTHROCENTESIS MAJOR JNT

Facility

$1,721.00

Service Code	HCPCS 20610
Hospital Charge Code	H4500132
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Cash Price	$1,118.65
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.95
Rate for Payer: Health Management Network Commercial	$1,462.85
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$1,084.23
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,669.37
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG ARTHROCENTESIS MED JT (WRIST, ELBOW, ANKLE) W/GUIDE

Facility

$1,732.00

Service Code	HCPCS 20606
Hospital Charge Code	H3610631
Hospital Revenue Code	361
Min. Negotiated Rate	$1,472.20
Max. Negotiated Rate	$1,680.04
Rate for Payer: Cash Price	$1,125.80
Rate for Payer: Health Management Network Commercial	$1,472.20
Rate for Payer: MDX Hawaii PPO	$1,680.04

HCHG ARTHROCENTESIS MED JT (WRIST, ELBOW, ANKLE) W/GUIDE

Facility

$1,732.00

Service Code	HCPCS 20606
Hospital Charge Code	H3610631
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$1,125.80
Rate for Payer: Cash Price	$1,125.80
Rate for Payer: Cash Price	$1,125.80
Rate for Payer: Devoted Health Medicare	$917.28
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,472.20
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$1,091.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$1,680.04
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$1,262.45

HCHG ARTHROCENTESIS SMALL JNT

Facility

$1,854.00

Service Code	HCPCS 20600
Hospital Charge Code	H4500134
Hospital Revenue Code	450
Min. Negotiated Rate	$362.62
Max. Negotiated Rate	$1,798.38
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.30
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Commercial	$1,168.02
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: MDX Hawaii PPO	$1,798.38
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$1,351.38

HCHG ARTHROCENTESIS SMALL JNT

Facility

$1,854.00

Service Code	HCPCS 20600
Hospital Charge Code	H4500134
Hospital Revenue Code	450
Min. Negotiated Rate	$1,575.90
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: MDX Hawaii PPO	$1,798.38

HCHG ARTHROGRAM KNEE *

Facility

$2,034.00

Service Code	HCPCS 73580
Hospital Charge Code	H3200194
Hospital Revenue Code	320
Min. Negotiated Rate	$86.14
Max. Negotiated Rate	$1,972.98
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$86.14
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$93.99
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,728.90
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,281.42
Rate for Payer: Kaiser Permanente Medicaid	$1,037.34
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,972.98
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$86.14
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$257.26

HCHG ARTHROGRAM KNEE *

Facility

$2,034.00

Service Code	HCPCS 73580
Hospital Charge Code	H3200194
Hospital Revenue Code	320
Min. Negotiated Rate	$1,728.90
Max. Negotiated Rate	$1,972.98
Rate for Payer: Cash Price	$1,322.10
Rate for Payer: Health Management Network Commercial	$1,728.90
Rate for Payer: MDX Hawaii PPO	$1,972.98

HCHG ASP BLADDER SUPRAPUB CATH INS

Facility

$6,083.00

Service Code	HCPCS 51102
Hospital Charge Code	H4500138
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Cash Price	$3,953.95
Rate for Payer: Cash Price	$3,953.95
Rate for Payer: Cash Price	$3,953.95
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$5,778.85
Rate for Payer: Health Management Network Commercial	$5,170.55
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Commercial	$3,832.29
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: MDX Hawaii PPO	$5,900.51
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$4,433.90

HCHG ASP BLADDER SUPRAPUB CATH INS

Facility

$6,083.00

Service Code	HCPCS 51102
Hospital Charge Code	H4500138
Hospital Revenue Code	450
Min. Negotiated Rate	$5,170.55
Max. Negotiated Rate	$5,900.51
Rate for Payer: Cash Price	$3,953.95
Rate for Payer: Health Management Network Commercial	$5,170.55
Rate for Payer: MDX Hawaii PPO	$5,900.51

HCHG ASPERGILLUS AB 90

Facility

$185.00

Service Code	HCPCS 86606
Hospital Charge Code	H3020286
Hospital Revenue Code	302
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$15.05
Rate for Payer: AlohaCare Medicare	$15.05
Rate for Payer: Cash Price	$120.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Devoted Health Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$18.81
Rate for Payer: Hawaii Medical Service Association Medicare	$15.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$15.05
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$15.05
Rate for Payer: Kaiser Permanente Commercial	$116.55
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$15.05
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$16.55
Rate for Payer: Ohana Health Plan Medicare	$15.05
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$15.05
Rate for Payer: University Health Alliance Commercial	$38.91

HCHG ASPERGILLUS AB 90

Facility

$185.00

Service Code	HCPCS 86606
Hospital Charge Code	H3020286
Hospital Revenue Code	302
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$120.25
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: MDX Hawaii PPO	$179.45

Know your out-of-pocket cost for care.

All Charges