Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG LAMBDA LT CHAINS QUANT U

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011336
Hospital Revenue Code	301
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

HCHG LAMBDA LT CHAINS QUANT U

Facility

$175.00

Service Code	HCPCS 83883
Hospital Charge Code	H3011336
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$13.60
Rate for Payer: AlohaCare Medicare	$13.60
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$14.96
Rate for Payer: Hawaii Medical Service Association ABD	$18.79
Rate for Payer: Hawaii Medical Service Association Commercial	$17.00
Rate for Payer: Hawaii Medical Service Association Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.73
Rate for Payer: Hawaii Western Management Group Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$13.60
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$14.96
Rate for Payer: Ohana Health Plan Medicare	$13.60
Rate for Payer: UnitedHealthcare Medicaid	$18.79
Rate for Payer: UnitedHealthcare Medicare	$13.60
Rate for Payer: University Health Alliance Commercial	$35.15

HCHG LAMOTRIGNINE

Facility

$169.00

Service Code	HCPCS 80175
Hospital Charge Code	H3011341
Hospital Revenue Code	301
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$109.85
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: MDX Hawaii PPO	$163.93

HCHG LAMOTRIGNINE

Facility

$169.00

Service Code	HCPCS 80175
Hospital Charge Code	H3011341
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$13.25
Rate for Payer: Cash Price	$109.85
Rate for Payer: Cash Price	$109.85
Rate for Payer: Devoted Health Medicare	$14.57
Rate for Payer: Hawaii Medical Service Association ABD	$11.11
Rate for Payer: Hawaii Medical Service Association Commercial	$16.56
Rate for Payer: Hawaii Medical Service Association Medicare	$13.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.75
Rate for Payer: Hawaii Western Management Group Commercial	$13.25
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Humana Medicare	$13.25
Rate for Payer: Kaiser Permanente Commercial	$106.47
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: Kaiser Permanente Medicare	$13.25
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: Ohana Health Plan Medicaid	$14.57
Rate for Payer: Ohana Health Plan Medicare	$13.25
Rate for Payer: UnitedHealthcare Medicaid	$10.85
Rate for Payer: UnitedHealthcare Medicare	$13.25
Rate for Payer: University Health Alliance Commercial	$33.47

HCHG LARYNGOSCOPY DIR DIAG EX NB

Facility

$5,243.00

Service Code	HCPCS 31525
Hospital Charge Code	H4500554
Hospital Revenue Code	450
Min. Negotiated Rate	$4,456.55
Max. Negotiated Rate	$5,085.71
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Health Management Network Commercial	$4,456.55
Rate for Payer: MDX Hawaii PPO	$5,085.71

HCHG LARYNGOSCOPY DIR DIAG EX NB

Facility

$5,243.00

Service Code	HCPCS 31525
Hospital Charge Code	H4500554
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,085.71
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Devoted Health Medicare	$2,312.94
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	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,980.85
Rate for Payer: Health Management Network Commercial	$4,456.55
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Commercial	$3,303.09
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$5,085.71
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG LARYNGOSCOPY DIR REMOVE FB

Facility

$5,243.00

Service Code	HCPCS 31530
Hospital Charge Code	H4500852
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Devoted Health Medicare	$2,312.94
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	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$4,980.85
Rate for Payer: Health Management Network Commercial	$4,456.55
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Commercial	$3,303.09
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: MDX Hawaii PPO	$5,085.71
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG LARYNGOSCOPY DIR REMOVE FB

Facility

$5,243.00

Service Code	HCPCS 31530
Hospital Charge Code	H4500852
Hospital Revenue Code	450
Min. Negotiated Rate	$4,456.55
Max. Negotiated Rate	$5,085.71
Rate for Payer: Cash Price	$3,407.95
Rate for Payer: Health Management Network Commercial	$4,456.55
Rate for Payer: MDX Hawaii PPO	$5,085.71

HCHG LARYNGOSCOPY FLEX DX

Facility

$1,207.00

Service Code	HCPCS 31575
Hospital Charge Code	H4500556
Hospital Revenue Code	450
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$235.80
Rate for Payer: AlohaCare Medicare	$235.80
Rate for Payer: Cash Price	$784.55
Rate for Payer: Cash Price	$784.55
Rate for Payer: Cash Price	$784.55
Rate for Payer: Cash Price	$784.55
Rate for Payer: Devoted Health Medicare	$259.38
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	$235.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,146.65
Rate for Payer: Health Management Network Commercial	$1,025.95
Rate for Payer: Humana Medicare	$235.80
Rate for Payer: Kaiser Permanente Commercial	$760.41
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$235.80
Rate for Payer: MDX Hawaii PPO	$1,170.79
Rate for Payer: Ohana Health Plan Medicaid	$259.38
Rate for Payer: Ohana Health Plan Medicare	$235.80
Rate for Payer: UnitedHealthcare Medicare	$235.80
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG LARYNGOSCOPY FLEX DX

Facility

$1,207.00

Service Code	HCPCS 31575
Hospital Charge Code	H4500556
Hospital Revenue Code	450
Min. Negotiated Rate	$1,025.95
Max. Negotiated Rate	$1,170.79
Rate for Payer: Cash Price	$784.55
Rate for Payer: Health Management Network Commercial	$1,025.95
Rate for Payer: MDX Hawaii PPO	$1,170.79

HCHG LDH

Facility

$103.00

Service Code	HCPCS 83615
Hospital Charge Code	H3010814
Hospital Revenue Code	301
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: MDX Hawaii PPO	$99.91

HCHG LDH

Facility

$103.00

Service Code	HCPCS 83615
Hospital Charge Code	H3010814
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$6.04
Rate for Payer: AlohaCare Medicare	$6.04
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Devoted Health Medicare	$6.64
Rate for Payer: Hawaii Medical Service Association ABD	$8.35
Rate for Payer: Hawaii Medical Service Association Commercial	$7.55
Rate for Payer: Hawaii Medical Service Association Medicare	$6.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.77
Rate for Payer: Hawaii Western Management Group Commercial	$6.04
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$6.04
Rate for Payer: Kaiser Permanente Commercial	$64.89
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$6.04
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$6.64
Rate for Payer: Ohana Health Plan Medicare	$6.04
Rate for Payer: UnitedHealthcare Medicaid	$8.35
Rate for Payer: UnitedHealthcare Medicare	$6.04
Rate for Payer: University Health Alliance Commercial	$15.61

HCHG LDH BODY FLUID

Facility

$103.00

Service Code	HCPCS 83615
Hospital Charge Code	H3010816
Hospital Revenue Code	301
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: MDX Hawaii PPO	$99.91

HCHG LDH BODY FLUID

Facility

$103.00

Service Code	HCPCS 83615
Hospital Charge Code	H3010816
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$6.04
Rate for Payer: AlohaCare Medicare	$6.04
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Devoted Health Medicare	$6.64
Rate for Payer: Hawaii Medical Service Association ABD	$8.35
Rate for Payer: Hawaii Medical Service Association Commercial	$7.55
Rate for Payer: Hawaii Medical Service Association Medicare	$6.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.77
Rate for Payer: Hawaii Western Management Group Commercial	$6.04
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$6.04
Rate for Payer: Kaiser Permanente Commercial	$64.89
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$6.04
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$6.64
Rate for Payer: Ohana Health Plan Medicare	$6.04
Rate for Payer: UnitedHealthcare Medicaid	$8.35
Rate for Payer: UnitedHealthcare Medicare	$6.04
Rate for Payer: University Health Alliance Commercial	$15.61

HCHG LDH CSF

Facility

$44.00

Service Code	HCPCS 83615
Hospital Charge Code	H3010818
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$6.04
Rate for Payer: AlohaCare Medicare	$6.04
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Devoted Health Medicare	$6.64
Rate for Payer: Hawaii Medical Service Association ABD	$8.35
Rate for Payer: Hawaii Medical Service Association Commercial	$7.55
Rate for Payer: Hawaii Medical Service Association Medicare	$6.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.77
Rate for Payer: Hawaii Western Management Group Commercial	$6.04
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$6.04
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$6.04
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$6.64
Rate for Payer: Ohana Health Plan Medicare	$6.04
Rate for Payer: UnitedHealthcare Medicaid	$8.35
Rate for Payer: UnitedHealthcare Medicare	$6.04
Rate for Payer: University Health Alliance Commercial	$15.61

HCHG LDH CSF

Facility

$44.00

Service Code	HCPCS 83615
Hospital Charge Code	H3010818
Hospital Revenue Code	301
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

HCHG LEAD BLOOD

Facility

$85.00

Service Code	HCPCS 83655
Hospital Charge Code	H3010822
Hospital Revenue Code	301
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$55.25
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: MDX Hawaii PPO	$82.45

HCHG LEAD BLOOD

Facility

$85.00

Service Code	HCPCS 83655
Hospital Charge Code	H3010822
Hospital Revenue Code	301
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$12.11
Rate for Payer: AlohaCare Medicare	$12.11
Rate for Payer: Cash Price	$55.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Devoted Health Medicare	$13.32
Rate for Payer: Hawaii Medical Service Association ABD	$16.72
Rate for Payer: Hawaii Medical Service Association Commercial	$15.14
Rate for Payer: Hawaii Medical Service Association Medicare	$12.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.56
Rate for Payer: Hawaii Western Management Group Commercial	$12.11
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$12.11
Rate for Payer: Kaiser Permanente Commercial	$53.55
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$12.11
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$13.32
Rate for Payer: Ohana Health Plan Medicare	$12.11
Rate for Payer: UnitedHealthcare Medicaid	$16.72
Rate for Payer: UnitedHealthcare Medicare	$12.11
Rate for Payer: University Health Alliance Commercial	$31.28

HCHG LEGIONELLA AB 90

Facility

$188.00

Service Code	HCPCS 86713
Hospital Charge Code	H3020628
Hospital Revenue Code	302
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$15.30
Rate for Payer: AlohaCare Medicare	$15.30
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Devoted Health Medicare	$16.83
Rate for Payer: Hawaii Medical Service Association ABD	$21.15
Rate for Payer: Hawaii Medical Service Association Commercial	$19.12
Rate for Payer: Hawaii Medical Service Association Medicare	$15.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.21
Rate for Payer: Hawaii Western Management Group Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$15.30
Rate for Payer: Kaiser Permanente Commercial	$118.44
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$15.30
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$16.83
Rate for Payer: Ohana Health Plan Medicare	$15.30
Rate for Payer: UnitedHealthcare Medicaid	$21.15
Rate for Payer: UnitedHealthcare Medicare	$15.30
Rate for Payer: University Health Alliance Commercial	$39.57

HCHG LEGIONELLA AB 90

Facility

$188.00

Service Code	HCPCS 86713
Hospital Charge Code	H3020628
Hospital Revenue Code	302
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 LEGIONELLA AG URINE EIA

Facility

$204.00

Service Code	HCPCS 87449
Hospital Charge Code	H3060302
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$11.98
Rate for Payer: AlohaCare Medicare	$11.98
Rate for Payer: Cash Price	$132.60
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$13.18
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$11.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$11.98
Rate for Payer: Kaiser Permanente Commercial	$128.52
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$11.98
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$11.98
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$11.98
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG LEGIONELLA AG URINE EIA

Facility

$204.00

Service Code	HCPCS 87449
Hospital Charge Code	H3060302
Hospital Revenue Code	306
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: MDX Hawaii PPO	$197.88

HCHG LEGIONELLA CULT 90

Facility

$102.00

Service Code	HCPCS 87081
Hospital Charge Code	H3060304
Hospital Revenue Code	306
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$66.30
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: MDX Hawaii PPO	$98.94

HCHG LEGIONELLA CULT 90

Facility

$102.00

Service Code	HCPCS 87081
Hospital Charge Code	H3060304
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$6.63
Rate for Payer: AlohaCare Medicare	$6.63
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Devoted Health Medicare	$7.29
Rate for Payer: Hawaii Medical Service Association ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$6.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$6.63
Rate for Payer: Kaiser Permanente Commercial	$64.26
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$6.63
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$7.29
Rate for Payer: Ohana Health Plan Medicare	$6.63
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$6.63
Rate for Payer: University Health Alliance Commercial	$17.13

HCHG LEGION PNEUMO DNA AMP PROBE - 90

Facility

$238.00

Service Code	HCPCS 87541
Hospital Charge Code	H3060802
Hospital Revenue Code	306
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

Know your out-of-pocket cost for care.

All Charges