Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG BARTONELLA ANTIBODY

Facility

$125.00

Service Code	HCPCS 86611
Hospital Charge Code	H3021003
Hospital Revenue Code	302
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$10.18
Rate for Payer: AlohaCare Medicare	$10.18
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$11.20
Rate for Payer: Hawaii Medical Service Association ABD	$14.22
Rate for Payer: Hawaii Medical Service Association Commercial	$12.72
Rate for Payer: Hawaii Medical Service Association Medicare	$10.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.93
Rate for Payer: Hawaii Western Management Group Commercial	$10.18
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$10.18
Rate for Payer: Kaiser Permanente Commercial	$78.75
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$10.18
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$11.20
Rate for Payer: Ohana Health Plan Medicare	$10.18
Rate for Payer: UnitedHealthcare Medicaid	$14.22
Rate for Payer: UnitedHealthcare Medicare	$10.18
Rate for Payer: University Health Alliance Commercial	$26.31

HCHG BASIC DOSIMETRY CALC

Facility

$858.00

Service Code	HCPCS 77300
Hospital Charge Code	H3330250
Hospital Revenue Code	333
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$158.78
Rate for Payer: AlohaCare Medicare	$158.78
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$174.66
Rate for Payer: Hawaii Medical Service Association ABD	$47.25
Rate for Payer: Hawaii Medical Service Association Commercial	$198.47
Rate for Payer: Hawaii Medical Service Association Medicare	$158.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.61
Rate for Payer: Hawaii Western Management Group Commercial	$158.78
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Humana Medicare	$158.78
Rate for Payer: Kaiser Permanente Commercial	$540.54
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$158.78
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$174.66
Rate for Payer: Ohana Health Plan Medicare	$158.78
Rate for Payer: UnitedHealthcare Medicaid	$47.25
Rate for Payer: UnitedHealthcare Medicare	$158.78
Rate for Payer: University Health Alliance Commercial	$152.87

HCHG BASIC DOSIMETRY CALC

Facility

$858.00

Service Code	HCPCS 77300
Hospital Charge Code	H3330250
Hospital Revenue Code	333
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: MDX Hawaii PPO	$832.26

HCHG BASIC METABOLIC PROFILE

Facility

$135.00

Service Code	HCPCS 80048
Hospital Charge Code	H3010262
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$8.46
Rate for Payer: AlohaCare Medicare	$8.46
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Devoted Health Medicare	$9.31
Rate for Payer: Hawaii Medical Service Association ABD	$11.70
Rate for Payer: Hawaii Medical Service Association Commercial	$10.57
Rate for Payer: Hawaii Medical Service Association Medicare	$8.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.29
Rate for Payer: Hawaii Western Management Group Commercial	$8.46
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$8.46
Rate for Payer: Kaiser Permanente Commercial	$85.05
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$8.46
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$9.31
Rate for Payer: Ohana Health Plan Medicare	$8.46
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: UnitedHealthcare Medicare	$8.46
Rate for Payer: University Health Alliance Commercial	$21.89

HCHG BASIC METABOLIC PROFILE

Facility

$135.00

Service Code	HCPCS 80048
Hospital Charge Code	H3010262
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: MDX Hawaii PPO	$130.95

HCHG B BURGDORFERI AMP PROB SO

Facility

$718.00

Service Code	HCPCS 87476
Hospital Charge Code	K3060035
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$696.46
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$466.70
Rate for Payer: Cash Price	$466.70
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$29.42
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$610.30
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$452.34
Rate for Payer: Kaiser Permanente Medicaid	$366.18
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$696.46
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$29.42
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG B BURGDORFERI AMP PROB SO

Facility

$718.00

Service Code	HCPCS 87476
Hospital Charge Code	K3060035
Hospital Revenue Code	306
Min. Negotiated Rate	$610.30
Max. Negotiated Rate	$696.46
Rate for Payer: Cash Price	$466.70
Rate for Payer: Health Management Network Commercial	$610.30
Rate for Payer: MDX Hawaii PPO	$696.46

HCHG BCR-ABL1 P210 SO

Facility

$882.00

Service Code	HCPCS 81206
Hospital Charge Code	K3090005
Hospital Revenue Code	309
Min. Negotiated Rate	$65.02
Max. Negotiated Rate	$855.54
Rate for Payer: AlohaCare Medicaid	$163.96
Rate for Payer: AlohaCare Medicare	$163.96
Rate for Payer: Cash Price	$573.30
Rate for Payer: Cash Price	$573.30
Rate for Payer: Devoted Health Medicare	$180.36
Rate for Payer: Hawaii Medical Service Association ABD	$219.48
Rate for Payer: Hawaii Medical Service Association Commercial	$204.95
Rate for Payer: Hawaii Medical Service Association Medicare	$163.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$219.48
Rate for Payer: Hawaii Western Management Group Commercial	$163.96
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Humana Medicare	$163.96
Rate for Payer: Kaiser Permanente Commercial	$555.66
Rate for Payer: Kaiser Permanente Medicaid	$449.82
Rate for Payer: Kaiser Permanente Medicare	$163.96
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: Ohana Health Plan Medicaid	$180.36
Rate for Payer: Ohana Health Plan Medicare	$163.96
Rate for Payer: UnitedHealthcare Medicaid	$65.02
Rate for Payer: UnitedHealthcare Medicare	$163.96
Rate for Payer: University Health Alliance Commercial	$200.48

HCHG BCR-ABL1 P210 SO

Facility

$882.00

Service Code	HCPCS 81206
Hospital Charge Code	K3090005
Hospital Revenue Code	309
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$573.30
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: MDX Hawaii PPO	$855.54

HCHG BCR/ABL GENE REARRANGEMENT

Facility

$882.00

Service Code	HCPCS 81206
Hospital Charge Code	H3100162
Hospital Revenue Code	310
Min. Negotiated Rate	$65.02
Max. Negotiated Rate	$855.54
Rate for Payer: AlohaCare Medicaid	$163.96
Rate for Payer: AlohaCare Medicare	$163.96
Rate for Payer: Cash Price	$573.30
Rate for Payer: Cash Price	$573.30
Rate for Payer: Devoted Health Medicare	$180.36
Rate for Payer: Hawaii Medical Service Association ABD	$219.48
Rate for Payer: Hawaii Medical Service Association Commercial	$204.95
Rate for Payer: Hawaii Medical Service Association Medicare	$163.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$219.48
Rate for Payer: Hawaii Western Management Group Commercial	$163.96
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Humana Medicare	$163.96
Rate for Payer: Kaiser Permanente Commercial	$555.66
Rate for Payer: Kaiser Permanente Medicaid	$449.82
Rate for Payer: Kaiser Permanente Medicare	$163.96
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: Ohana Health Plan Medicaid	$180.36
Rate for Payer: Ohana Health Plan Medicare	$163.96
Rate for Payer: UnitedHealthcare Medicaid	$65.02
Rate for Payer: UnitedHealthcare Medicare	$163.96
Rate for Payer: University Health Alliance Commercial	$200.48

HCHG BCR/ABL GENE REARRANGEMENT

Facility

$882.00

Service Code	HCPCS 81206
Hospital Charge Code	H3100162
Hospital Revenue Code	310
Min. Negotiated Rate	$749.70
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$573.30
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: MDX Hawaii PPO	$855.54

HCHG BEHAVIOR CHANGE SMOKING > 10 MINS

Facility

$170.00

Service Code	HCPCS 99407
Hospital Charge Code	H9420118
Hospital Revenue Code	942
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: MDX Hawaii PPO	$164.90

HCHG BEHAVIOR CHANGE SMOKING > 10 MINS

Facility

$170.00

Service Code	HCPCS 99407
Hospital Charge Code	H9420118
Hospital Revenue Code	942
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$164.90
Rate for Payer: AlohaCare Medicaid	$44.26
Rate for Payer: AlohaCare Medicare	$44.26
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Devoted Health Medicare	$48.69
Rate for Payer: Hawaii Medical Service Association Commercial	$55.33
Rate for Payer: Hawaii Medical Service Association Medicare	$44.26
Rate for Payer: Hawaii Western Management Group Commercial	$161.50
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Humana Medicare	$44.26
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$86.70
Rate for Payer: Kaiser Permanente Medicare	$44.26
Rate for Payer: MDX Hawaii PPO	$164.90
Rate for Payer: Ohana Health Plan Medicaid	$48.69
Rate for Payer: Ohana Health Plan Medicare	$44.26
Rate for Payer: UnitedHealthcare Medicaid	$19.82
Rate for Payer: UnitedHealthcare Medicare	$44.26
Rate for Payer: University Health Alliance Commercial	$123.91

HCHG BEHAVIOR CHANGE SMOKING 3 TO 10 MINS

Facility

$188.00

Service Code	HCPCS 99406
Hospital Charge Code	H9420115
Hospital Revenue Code	942
Min. Negotiated Rate	$9.63
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$44.26
Rate for Payer: AlohaCare Medicare	$44.26
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Devoted Health Medicare	$48.69
Rate for Payer: Hawaii Medical Service Association Commercial	$55.33
Rate for Payer: Hawaii Medical Service Association Medicare	$44.26
Rate for Payer: Hawaii Western Management Group Commercial	$178.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$44.26
Rate for Payer: Kaiser Permanente Commercial	$118.44
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$44.26
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$48.69
Rate for Payer: Ohana Health Plan Medicare	$44.26
Rate for Payer: UnitedHealthcare Medicaid	$9.63
Rate for Payer: UnitedHealthcare Medicare	$44.26
Rate for Payer: University Health Alliance Commercial	$137.03

HCHG BEHAVIOR CHANGE SMOKING 3 TO 10 MINS

Facility

$188.00

Service Code	HCPCS 99406
Hospital Charge Code	H9420115
Hospital Revenue Code	942
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$122.20
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: MDX Hawaii PPO	$182.36

HCHG BEHAVRAL QUALIT ANALYS VOICE

Facility

$608.00

Service Code	HCPCS 92524
Hospital Charge Code	H4400351
Hospital Revenue Code	444
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$589.76
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Hawaii Western Management Group Commercial	$577.60
Rate for Payer: Health Management Network Commercial	$516.80
Rate for Payer: Kaiser Permanente Commercial	$383.04
Rate for Payer: Kaiser Permanente Medicaid	$310.08
Rate for Payer: MDX Hawaii PPO	$589.76
Rate for Payer: UnitedHealthcare Medicaid	$114.94
Rate for Payer: University Health Alliance Commercial	$443.17

HCHG BEHAVRAL QUALIT ANALYS VOICE

Facility

$608.00

Service Code	HCPCS 92524
Hospital Charge Code	H4400351
Hospital Revenue Code	444
Min. Negotiated Rate	$516.80
Max. Negotiated Rate	$589.76
Rate for Payer: Cash Price	$395.20
Rate for Payer: Health Management Network Commercial	$516.80
Rate for Payer: MDX Hawaii PPO	$589.76

HCHG BETA-2 GLYCOPROTEIN 1 AB EA

Facility

$344.00

Service Code	HCPCS 86146
Hospital Charge Code	H3050108
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$333.68
Rate for Payer: AlohaCare Medicaid	$25.45
Rate for Payer: AlohaCare Medicare	$25.45
Rate for Payer: Cash Price	$223.60
Rate for Payer: Cash Price	$223.60
Rate for Payer: Devoted Health Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association ABD	$35.54
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$25.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.32
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Kaiser Permanente Commercial	$216.72
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: Kaiser Permanente Medicare	$25.45
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$25.45
Rate for Payer: UnitedHealthcare Medicaid	$35.54
Rate for Payer: UnitedHealthcare Medicare	$25.45
Rate for Payer: University Health Alliance Commercial	$65.75

HCHG BETA-2 GLYCOPROTEIN 1 AB EA

Facility

$344.00

Service Code	HCPCS 86146
Hospital Charge Code	H3050108
Hospital Revenue Code	302
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$223.60
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: MDX Hawaii PPO	$333.68

HCHG BETA-2 GLYCOPROTEIN 1 AB EA

Facility

$227.00

Service Code	HCPCS 86146
Hospital Charge Code	H3050104
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$220.19
Rate for Payer: AlohaCare Medicaid	$25.45
Rate for Payer: AlohaCare Medicare	$25.45
Rate for Payer: Cash Price	$147.55
Rate for Payer: Cash Price	$147.55
Rate for Payer: Devoted Health Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association ABD	$35.54
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$25.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.32
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Kaiser Permanente Commercial	$143.01
Rate for Payer: Kaiser Permanente Medicaid	$115.77
Rate for Payer: Kaiser Permanente Medicare	$25.45
Rate for Payer: MDX Hawaii PPO	$220.19
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$25.45
Rate for Payer: UnitedHealthcare Medicaid	$35.54
Rate for Payer: UnitedHealthcare Medicare	$25.45
Rate for Payer: University Health Alliance Commercial	$65.75

HCHG BETA-2 GLYCOPROTEIN 1 AB EA

Facility

$227.00

Service Code	HCPCS 86146
Hospital Charge Code	H3050104
Hospital Revenue Code	302
Min. Negotiated Rate	$192.95
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$147.55
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: MDX Hawaii PPO	$220.19

HCHG BETA-2 MICROGLOBULIN

Facility

$200.00

Service Code	HCPCS 82232
Hospital Charge Code	H3010272
Hospital Revenue Code	301
Min. Negotiated Rate	$16.18
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$16.18
Rate for Payer: AlohaCare Medicare	$16.18
Rate for Payer: Cash Price	$130.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$17.80
Rate for Payer: Hawaii Medical Service Association ABD	$22.36
Rate for Payer: Hawaii Medical Service Association Commercial	$20.23
Rate for Payer: Hawaii Medical Service Association Medicare	$16.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.48
Rate for Payer: Hawaii Western Management Group Commercial	$16.18
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$16.18
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$16.18
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$17.80
Rate for Payer: Ohana Health Plan Medicare	$16.18
Rate for Payer: UnitedHealthcare Medicaid	$22.36
Rate for Payer: UnitedHealthcare Medicare	$16.18
Rate for Payer: University Health Alliance Commercial	$41.83

HCHG BETA-2 MICROGLOBULIN

Facility

$200.00

Service Code	HCPCS 82232
Hospital Charge Code	H3010272
Hospital Revenue Code	301
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: MDX Hawaii PPO	$194.00

HCHG BETA-2 MICROGLOBULIN

Facility

$200.00

Service Code	HCPCS 82232
Hospital Charge Code	H3010270
Hospital Revenue Code	301
Min. Negotiated Rate	$16.18
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$16.18
Rate for Payer: AlohaCare Medicare	$16.18
Rate for Payer: Cash Price	$130.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$17.80
Rate for Payer: Hawaii Medical Service Association ABD	$22.36
Rate for Payer: Hawaii Medical Service Association Commercial	$20.23
Rate for Payer: Hawaii Medical Service Association Medicare	$16.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.48
Rate for Payer: Hawaii Western Management Group Commercial	$16.18
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$16.18
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$16.18
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$17.80
Rate for Payer: Ohana Health Plan Medicare	$16.18
Rate for Payer: UnitedHealthcare Medicaid	$22.36
Rate for Payer: UnitedHealthcare Medicare	$16.18
Rate for Payer: University Health Alliance Commercial	$41.83

HCHG BETA-2 MICROGLOBULIN

Facility

$200.00

Service Code	HCPCS 82232
Hospital Charge Code	H3010270
Hospital Revenue Code	301
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: MDX Hawaii PPO	$194.00

Know your out-of-pocket cost for care.

All Charges