Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG LRT IAD 18BCT/8VIR&7ARG RNA

Facility

$1,895.00

Service Code	HCPCS 0528U
Hospital Charge Code	H3001129
Hospital Revenue Code	300
Min. Negotiated Rate	$634.84
Max. Negotiated Rate	$1,838.15
Rate for Payer: AlohaCare Medicaid	$634.84
Rate for Payer: AlohaCare Medicare	$634.84
Rate for Payer: Cash Price	$1,231.75
Rate for Payer: Cash Price	$1,231.75
Rate for Payer: Devoted Health Medicare	$698.32
Rate for Payer: Hawaii Medical Service Association Commercial	$793.55
Rate for Payer: Hawaii Medical Service Association Medicare	$634.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,800.25
Rate for Payer: Health Management Network Commercial	$1,610.75
Rate for Payer: Humana Medicare	$634.84
Rate for Payer: Kaiser Permanente Commercial	$1,193.85
Rate for Payer: Kaiser Permanente Medicaid	$966.45
Rate for Payer: Kaiser Permanente Medicare	$634.84
Rate for Payer: MDX Hawaii PPO	$1,838.15
Rate for Payer: Ohana Health Plan Medicaid	$698.32
Rate for Payer: Ohana Health Plan Medicare	$634.84
Rate for Payer: UnitedHealthcare Medicare	$634.84
Rate for Payer: University Health Alliance Commercial	$1,381.27

HCHG LRT IAD 18BCT/8VIR&7ARG RNA

Facility

$1,895.00

Service Code	HCPCS 0528U
Hospital Charge Code	H3001129
Hospital Revenue Code	300
Min. Negotiated Rate	$1,610.75
Max. Negotiated Rate	$1,838.15
Rate for Payer: Cash Price	$1,231.75
Rate for Payer: Health Management Network Commercial	$1,610.75
Rate for Payer: MDX Hawaii PPO	$1,838.15

HCHG L-SPINE 1V

Facility

$414.00

Service Code	HCPCS 72020
Hospital Charge Code	H3200919
Hospital Revenue Code	320
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$401.58
Rate for Payer: Cash Price	$269.10
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: MDX Hawaii PPO	$401.58

HCHG L-SPINE 1V

Facility

$414.00

Service Code	HCPCS 72020
Hospital Charge Code	H3200919
Hospital Revenue Code	320
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$401.58
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$14.98
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.73
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$260.82
Rate for Payer: Kaiser Permanente Medicaid	$211.14
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$401.58
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$14.98
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$48.36

HCHG L-SPINE FLEX EXT ONLY, 2-3 VIEWS

Facility

$573.00

Service Code	HCPCS 72100
Hospital Charge Code	H3200554
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
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	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$360.99
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$77.64

HCHG L-SPINE FLEX EXT ONLY, 2-3 VIEWS

Facility

$573.00

Service Code	HCPCS 72100
Hospital Charge Code	H3200554
Hospital Revenue Code	320
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: MDX Hawaii PPO	$555.81

HCHG LS SPINE 2 VIEWS

Facility

$573.00

Service Code	HCPCS 72100
Hospital Charge Code	H3200546
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
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	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$360.99
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$77.64

HCHG LS SPINE 2 VIEWS

Facility

$573.00

Service Code	HCPCS 72100
Hospital Charge Code	H3200546
Hospital Revenue Code	320
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: MDX Hawaii PPO	$555.81

HCHG LS SPINE 2 VIEWS PORT

Facility

$573.00

Service Code	HCPCS 72100
Hospital Charge Code	H3200548
Hospital Revenue Code	320
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: MDX Hawaii PPO	$555.81

HCHG LS SPINE 2 VIEWS PORT

Facility

$573.00

Service Code	HCPCS 72100
Hospital Charge Code	H3200548
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$21.96
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	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$360.99
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$77.64

HCHG LS SPINE MIN 4 VIEWS

Facility

$708.00

Service Code	HCPCS 72110
Hospital Charge Code	H3200552
Hospital Revenue Code	320
Min. Negotiated Rate	$32.35
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	$32.35
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	$33.97
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
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	$32.35
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$108.35

HCHG LS SPINE MIN 4 VIEWS

Facility

$708.00

Service Code	HCPCS 72110
Hospital Charge Code	H3200552
Hospital Revenue Code	320
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 LS SPINE MULT BENDING 2 OR 3 VIEWS

Facility

$715.00

Service Code	HCPCS 72120
Hospital Charge Code	H3200960
Hospital Revenue Code	320
Min. Negotiated Rate	$607.75
Max. Negotiated Rate	$693.55
Rate for Payer: Cash Price	$464.75
Rate for Payer: Health Management Network Commercial	$607.75
Rate for Payer: MDX Hawaii PPO	$693.55

HCHG LS SPINE MULT BENDING 2 OR 3 VIEWS

Facility

$715.00

Service Code	HCPCS 72120
Hospital Charge Code	H3200960
Hospital Revenue Code	320
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$693.55
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$464.75
Rate for Payer: Cash Price	$464.75
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$29.64
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	$32.30
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$607.75
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$450.45
Rate for Payer: Kaiser Permanente Medicaid	$364.65
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$693.55
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$29.64
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$97.90

HCHG LUMBAR PUNCTURE DIAG

Facility

$3,543.00

Service Code	HCPCS 62270
Hospital Charge Code	H3610282
Hospital Revenue Code	361
Min. Negotiated Rate	$3,011.55
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: MDX Hawaii PPO	$3,436.71

HCHG LUMBAR PUNCTURE DIAG

Facility

$3,543.00

Service Code	HCPCS 62270
Hospital Charge Code	H3610282
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
Rate for Payer: Cash Price	$2,302.95
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	$3,011.55
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,232.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,436.71
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	$4,035.20

HCHG LUMBAR SPINE MRI WO CONTR

Facility

$2,141.00

Service Code	HCPCS 72148
Hospital Charge Code	H6120108
Hospital Revenue Code	612
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,076.77
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,391.65
Rate for Payer: Cash Price	$1,391.65
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$439.71
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	$461.70
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,819.85
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,348.83
Rate for Payer: Kaiser Permanente Medicaid	$1,091.91
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,076.77
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$439.71
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$844.93

HCHG LUMBAR SPINE MRI WO CONTR

Facility

$2,141.00

Service Code	HCPCS 72148
Hospital Charge Code	H6120108
Hospital Revenue Code	612
Min. Negotiated Rate	$1,819.85
Max. Negotiated Rate	$2,076.77
Rate for Payer: Cash Price	$1,391.65
Rate for Payer: Health Management Network Commercial	$1,819.85
Rate for Payer: MDX Hawaii PPO	$2,076.77

HCHG LUMB SPINE MRI W/WO CONTR

Facility

$3,442.00

Service Code	HCPCS 72158
Hospital Charge Code	H6120106
Hospital Revenue Code	612
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,338.74
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,237.30
Rate for Payer: Cash Price	$2,237.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$819.67
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	$883.39
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,925.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$2,168.46
Rate for Payer: Kaiser Permanente Medicaid	$1,755.42
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,338.74
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$819.67
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,297.22

HCHG LUMB SPINE MRI W/WO CONTR

Facility

$3,442.00

Service Code	HCPCS 72158
Hospital Charge Code	H6120106
Hospital Revenue Code	612
Min. Negotiated Rate	$2,925.70
Max. Negotiated Rate	$3,338.74
Rate for Payer: Cash Price	$2,237.30
Rate for Payer: Health Management Network Commercial	$2,925.70
Rate for Payer: MDX Hawaii PPO	$3,338.74

HCHG LUPUS ANTICOAGULANT DRVVT

Facility

$129.00

Service Code	HCPCS 85613
Hospital Charge Code	H3050280
Hospital Revenue Code	305
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$9.58
Rate for Payer: AlohaCare Medicare	$9.58
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association ABD	$13.22
Rate for Payer: Hawaii Medical Service Association Commercial	$11.97
Rate for Payer: Hawaii Medical Service Association Medicare	$9.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.88
Rate for Payer: Hawaii Western Management Group Commercial	$9.58
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$9.58
Rate for Payer: Kaiser Permanente Commercial	$81.27
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$9.58
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$10.54
Rate for Payer: Ohana Health Plan Medicare	$9.58
Rate for Payer: UnitedHealthcare Medicaid	$13.22
Rate for Payer: UnitedHealthcare Medicare	$9.58
Rate for Payer: University Health Alliance Commercial	$24.73

HCHG LUPUS ANTICOAGULANT DRVVT

Facility

$129.00

Service Code	HCPCS 85613
Hospital Charge Code	H3050280
Hospital Revenue Code	305
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: MDX Hawaii PPO	$125.13

HCHG LUTEINIZING HORMONE

Facility

$228.00

Service Code	HCPCS 83002
Hospital Charge Code	H3010844
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$18.52
Rate for Payer: AlohaCare Medicare	$18.52
Rate for Payer: Cash Price	$148.20
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$20.37
Rate for Payer: Hawaii Medical Service Association ABD	$25.60
Rate for Payer: Hawaii Medical Service Association Commercial	$23.15
Rate for Payer: Hawaii Medical Service Association Medicare	$18.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.88
Rate for Payer: Hawaii Western Management Group Commercial	$18.52
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$18.52
Rate for Payer: Kaiser Permanente Commercial	$143.64
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$18.52
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$20.37
Rate for Payer: Ohana Health Plan Medicare	$18.52
Rate for Payer: UnitedHealthcare Medicaid	$25.60
Rate for Payer: UnitedHealthcare Medicare	$18.52
Rate for Payer: University Health Alliance Commercial	$47.88

HCHG LUTEINIZING HORMONE

Facility

$228.00

Service Code	HCPCS 83002
Hospital Charge Code	H3010844
Hospital Revenue Code	301
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: MDX Hawaii PPO	$221.16

HCHG LUTETIUM LU 177 VIPIVOTIDE TETRAXETAN, THERAPEUTIC, 1 MILLICURIE

Facility

$1,251.00

Service Code	HCPCS A9607
Hospital Charge Code	H3440151
Hospital Revenue Code	344
Min. Negotiated Rate	$1,063.35
Max. Negotiated Rate	$1,213.47
Rate for Payer: Cash Price	$813.15
Rate for Payer: Health Management Network Commercial	$1,063.35
Rate for Payer: MDX Hawaii PPO	$1,213.47

Know your out-of-pocket cost for care.

All Charges