Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG MRI LOW EXTREM HIP WO CONTR

Facility

$2,342.00

Service Code	HCPCS 73721
Hospital Charge Code	H6100172
Hospital Revenue Code	610
Min. Negotiated Rate	$1,990.70
Max. Negotiated Rate	$2,271.74
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Health Management Network Commercial	$1,990.70
Rate for Payer: MDX Hawaii PPO	$2,271.74

HCHG MRI LOW EXTREM HIP WO CONTR

Facility

$2,342.00

Service Code	HCPCS 73721
Hospital Charge Code	H6100172
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,271.74
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$396.10
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	$415.91
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,990.70
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,475.46
Rate for Payer: Kaiser Permanente Medicaid	$1,194.42
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,271.74
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$396.10
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.57

HCHG MRI LOW EXTREM JNT W/O CONTR

Facility

$2,342.00

Service Code	HCPCS 73721
Hospital Charge Code	H6100176
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,271.74
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$396.10
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	$415.91
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,990.70
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,475.46
Rate for Payer: Kaiser Permanente Medicaid	$1,194.42
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,271.74
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$396.10
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.57

HCHG MRI LOW EXTREM JNT W/O CONTR

Facility

$2,342.00

Service Code	HCPCS 73721
Hospital Charge Code	H6100176
Hospital Revenue Code	610
Min. Negotiated Rate	$1,990.70
Max. Negotiated Rate	$2,271.74
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Health Management Network Commercial	$1,990.70
Rate for Payer: MDX Hawaii PPO	$2,271.74

HCHG MRI LOW EXTREM JNT W/WO CONTR

Facility

$3,381.00

Service Code	HCPCS 73723
Hospital Charge Code	H6100174
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,279.57
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$707.76
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	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,873.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$2,130.03
Rate for Payer: Kaiser Permanente Medicaid	$1,724.31
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,279.57
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$707.76
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,286.32

HCHG MRI LOW EXTREM JNT W/WO CONTR

Facility

$3,381.00

Service Code	HCPCS 73723
Hospital Charge Code	H6100174
Hospital Revenue Code	610
Min. Negotiated Rate	$2,873.85
Max. Negotiated Rate	$3,279.57
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Health Management Network Commercial	$2,873.85
Rate for Payer: MDX Hawaii PPO	$3,279.57

HCHG MRI NECK WO CONTR

Facility

$1,946.00

Service Code	HCPCS 70540
Hospital Charge Code	H6110122
Hospital Revenue Code	611
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$1,887.62
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
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	$393.81
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,654.10
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,225.98
Rate for Payer: Kaiser Permanente Medicaid	$992.46
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,887.62
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.87

HCHG MRI NECK WO CONTR

Facility

$1,946.00

Service Code	HCPCS 70540
Hospital Charge Code	H6110122
Hospital Revenue Code	611
Min. Negotiated Rate	$1,654.10
Max. Negotiated Rate	$1,887.62
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Health Management Network Commercial	$1,654.10
Rate for Payer: MDX Hawaii PPO	$1,887.62

HCHG MRI NECK W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 70543
Hospital Charge Code	H6110120
Hospital Revenue Code	611
Min. Negotiated Rate	$2,636.70
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: MDX Hawaii PPO	$3,008.94

HCHG MRI NECK W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 70543
Hospital Charge Code	H6110120
Hospital Revenue Code	611
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,008.94
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$983.00
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	$952.52
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,954.26
Rate for Payer: Kaiser Permanente Medicaid	$1,582.02
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,008.94
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$983.00
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,285.82

HCHG MRI ORBITS W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 70543
Hospital Charge Code	H6110124
Hospital Revenue Code	611
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,008.94
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$983.00
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	$952.52
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,954.26
Rate for Payer: Kaiser Permanente Medicaid	$1,582.02
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,008.94
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$983.00
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,285.82

HCHG MRI ORBITS W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 70543
Hospital Charge Code	H6110124
Hospital Revenue Code	611
Min. Negotiated Rate	$2,636.70
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: MDX Hawaii PPO	$3,008.94

HCHG MRI PROSTATE

Facility

$3,102.00

Service Code	HCPCS 72197
Hospital Charge Code	H6100208
Hospital Revenue Code	610
Min. Negotiated Rate	$2,636.70
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: MDX Hawaii PPO	$3,008.94

HCHG MRI PROSTATE

Facility

$3,102.00

Service Code	HCPCS 72197
Hospital Charge Code	H6100208
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,008.94
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$709.06
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	$882.31
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,954.26
Rate for Payer: Kaiser Permanente Medicaid	$1,582.02
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,008.94
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$709.06
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,294.91

HCHG MRI UPP EXTREM JNT W CONTR

Facility

$3,391.00

Service Code	HCPCS 73222
Hospital Charge Code	H6100180
Hospital Revenue Code	610
Min. Negotiated Rate	$2,882.35
Max. Negotiated Rate	$3,289.27
Rate for Payer: Cash Price	$2,204.15
Rate for Payer: Health Management Network Commercial	$2,882.35
Rate for Payer: MDX Hawaii PPO	$3,289.27

HCHG MRI UPP EXTREM JNT W CONTR

Facility

$3,391.00

Service Code	HCPCS 73222
Hospital Charge Code	H6100180
Hospital Revenue Code	610
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$3,289.27
Rate for Payer: AlohaCare Medicaid	$926.08
Rate for Payer: AlohaCare Medicare	$926.08
Rate for Payer: Cash Price	$2,204.15
Rate for Payer: Cash Price	$2,204.15
Rate for Payer: Devoted Health Medicare	$1,018.69
Rate for Payer: Hawaii Medical Service Association ABD	$382.28
Rate for Payer: Hawaii Medical Service Association Commercial	$1,157.60
Rate for Payer: Hawaii Medical Service Association Medicare	$926.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$926.08
Rate for Payer: Health Management Network Commercial	$2,882.35
Rate for Payer: Humana Medicare	$926.08
Rate for Payer: Kaiser Permanente Commercial	$2,136.33
Rate for Payer: Kaiser Permanente Medicaid	$1,729.41
Rate for Payer: Kaiser Permanente Medicare	$926.08
Rate for Payer: MDX Hawaii PPO	$3,289.27
Rate for Payer: Ohana Health Plan Medicaid	$1,018.69
Rate for Payer: Ohana Health Plan Medicare	$926.08
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: UnitedHealthcare Medicare	$926.08
Rate for Payer: University Health Alliance Commercial	$973.95

HCHG MRI UPP EXTREM JNT W/WO CONTR

Facility

$3,073.00

Service Code	HCPCS 73223
Hospital Charge Code	H6100182
Hospital Revenue Code	610
Min. Negotiated Rate	$2,612.05
Max. Negotiated Rate	$2,980.81
Rate for Payer: Cash Price	$1,997.45
Rate for Payer: Health Management Network Commercial	$2,612.05
Rate for Payer: MDX Hawaii PPO	$2,980.81

HCHG MRI UPP EXTREM JNT W/WO CONTR

Facility

$3,073.00

Service Code	HCPCS 73223
Hospital Charge Code	H6100182
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$2,980.81
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,997.45
Rate for Payer: Cash Price	$1,997.45
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$983.00
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	$952.52
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,612.05
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,935.99
Rate for Payer: Kaiser Permanente Medicaid	$1,567.23
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$2,980.81
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$983.00
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,285.53

HCHG MRI UPP EXTREM NOT JNT WO CONTR

Facility

$1,946.00

Service Code	HCPCS 73218
Hospital Charge Code	H6100188
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$1,887.62
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$318.66
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	$396.79
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,654.10
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,225.98
Rate for Payer: Kaiser Permanente Medicaid	$992.46
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,887.62
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$318.66
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.87

HCHG MRI UPP EXTREM NOT JNT WO CONTR

Facility

$1,946.00

Service Code	HCPCS 73218
Hospital Charge Code	H6100188
Hospital Revenue Code	610
Min. Negotiated Rate	$1,654.10
Max. Negotiated Rate	$1,887.62
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Health Management Network Commercial	$1,654.10
Rate for Payer: MDX Hawaii PPO	$1,887.62

HCHG MRI UPP EXTREM NOT JNT W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 73220
Hospital Charge Code	H6100186
Hospital Revenue Code	610
Min. Negotiated Rate	$2,636.70
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: MDX Hawaii PPO	$3,008.94

HCHG MRI UPP EXTREM NOT JNT W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 73220
Hospital Charge Code	H6100186
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,008.94
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$645.58
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	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,954.26
Rate for Payer: Kaiser Permanente Medicaid	$1,582.02
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,008.94
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$645.58
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,286.62

HCHG MRI W/O FOL W/CONT, BREAST,

Facility

$3,381.00

Service Code	HCPCS 77049
Hospital Charge Code	H6100211
Hospital Revenue Code	610
Min. Negotiated Rate	$233.96
Max. Negotiated Rate	$3,279.57
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Hawaii Medical Service Association ABD	$687.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$857.66
Rate for Payer: Hawaii Western Management Group Commercial	$3,211.95
Rate for Payer: Health Management Network Commercial	$2,873.85
Rate for Payer: Kaiser Permanente Commercial	$2,130.03
Rate for Payer: Kaiser Permanente Medicaid	$1,724.31
Rate for Payer: MDX Hawaii PPO	$3,279.57
Rate for Payer: UnitedHealthcare Medicaid	$233.96
Rate for Payer: University Health Alliance Commercial	$842.71

HCHG MRI W/O FOL W/CONT, BREAST,

Facility

$3,381.00

Service Code	HCPCS 77049
Hospital Charge Code	H6100211
Hospital Revenue Code	610
Min. Negotiated Rate	$2,873.85
Max. Negotiated Rate	$3,279.57
Rate for Payer: Cash Price	$2,197.65
Rate for Payer: Health Management Network Commercial	$2,873.85
Rate for Payer: MDX Hawaii PPO	$3,279.57

HCHG MRSA AMP PROB

Facility

$450.00

Service Code	HCPCS 87641
Hospital Charge Code	K3060040
Hospital Revenue Code	306
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$436.50

Know your out-of-pocket cost for care.

All Charges