Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

HCHG MRSA CULT SCRN

Facility

$102.00

Service Code	HCPCS 87081
Hospital Charge Code	H3060320
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 MRSA CULT SCRN

Facility

$102.00

Service Code	HCPCS 87081
Hospital Charge Code	H3060320
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 MRSA RAPID TEST

Facility

$38.00

Service Code	HCPCS 87147
Hospital Charge Code	H3000314
Hospital Revenue Code	306
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$5.18
Rate for Payer: AlohaCare Medicare	$5.18
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$5.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$5.18
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$5.18
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.18
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$5.18
Rate for Payer: University Health Alliance Commercial	$13.38

HCHG MRSA RAPID TEST

Facility

$38.00

Service Code	HCPCS 87147
Hospital Charge Code	H3000314
Hospital Revenue Code	306
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$24.70
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

HCHG MR UPP EXTREM JNT WO CONTR

Facility

$2,342.00

Service Code	HCPCS 73221
Hospital Charge Code	H6100124
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	$415.68
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	$426.65
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	$415.68
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.57

HCHG MR UPP EXTREM JNT WO CONTR

Facility

$2,342.00

Service Code	HCPCS 73221
Hospital Charge Code	H6100124
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 M TB AMP PROBE RIF RESIST SO

Facility

$530.00

Service Code	HCPCS 87798
Hospital Charge Code	K3060045
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$514.10
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$344.50
Rate for Payer: Cash Price	$344.50
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
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	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$450.50
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$333.90
Rate for Payer: Kaiser Permanente Medicaid	$270.30
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$514.10
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$90.72

HCHG M TB AMP PROBE RIF RESIST SO

Facility

$530.00

Service Code	HCPCS 87798
Hospital Charge Code	K3060045
Hospital Revenue Code	306
Min. Negotiated Rate	$450.50
Max. Negotiated Rate	$514.10
Rate for Payer: Cash Price	$344.50
Rate for Payer: Health Management Network Commercial	$450.50
Rate for Payer: MDX Hawaii PPO	$514.10

HCHG MTHFR (GENE ANALYSIS COMM VARIANTS)

Facility

$411.00

Service Code	HCPCS 81291
Hospital Charge Code	H3100163
Hospital Revenue Code	310
Min. Negotiated Rate	$55.75
Max. Negotiated Rate	$398.67
Rate for Payer: AlohaCare Medicaid	$65.34
Rate for Payer: AlohaCare Medicare	$65.34
Rate for Payer: Cash Price	$267.15
Rate for Payer: Cash Price	$267.15
Rate for Payer: Devoted Health Medicare	$71.87
Rate for Payer: Hawaii Medical Service Association Commercial	$81.67
Rate for Payer: Hawaii Medical Service Association Medicare	$65.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.43
Rate for Payer: Hawaii Western Management Group Commercial	$65.34
Rate for Payer: Health Management Network Commercial	$349.35
Rate for Payer: Humana Medicare	$65.34
Rate for Payer: Kaiser Permanente Commercial	$258.93
Rate for Payer: Kaiser Permanente Medicaid	$209.61
Rate for Payer: Kaiser Permanente Medicare	$65.34
Rate for Payer: MDX Hawaii PPO	$398.67
Rate for Payer: Ohana Health Plan Medicaid	$71.87
Rate for Payer: Ohana Health Plan Medicare	$65.34
Rate for Payer: UnitedHealthcare Medicaid	$55.75
Rate for Payer: UnitedHealthcare Medicare	$65.34
Rate for Payer: University Health Alliance Commercial	$110.17

HCHG MTHFR (GENE ANALYSIS COMM VARIANTS)

Facility

$411.00

Service Code	HCPCS 81291
Hospital Charge Code	H3100163
Hospital Revenue Code	310
Min. Negotiated Rate	$349.35
Max. Negotiated Rate	$398.67
Rate for Payer: Cash Price	$267.15
Rate for Payer: Health Management Network Commercial	$349.35
Rate for Payer: MDX Hawaii PPO	$398.67

HCHG MULTI- LEAF COLLIMATOR (MLC) DEVICES FOR IMRT, DESIGN AND CONSTRUCTION PER IMRT PLAN

Facility

$3,690.00

Service Code	HCPCS 77338
Hospital Charge Code	H3330213
Hospital Revenue Code	333
Min. Negotiated Rate	$138.15
Max. Negotiated Rate	$3,579.30
Rate for Payer: AlohaCare Medicaid	$442.33
Rate for Payer: AlohaCare Medicare	$442.33
Rate for Payer: Cash Price	$2,398.50
Rate for Payer: Cash Price	$2,398.50
Rate for Payer: Devoted Health Medicare	$486.56
Rate for Payer: Hawaii Medical Service Association ABD	$138.15
Rate for Payer: Hawaii Medical Service Association Commercial	$552.91
Rate for Payer: Hawaii Medical Service Association Medicare	$442.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$239.74
Rate for Payer: Hawaii Western Management Group Commercial	$442.33
Rate for Payer: Health Management Network Commercial	$3,136.50
Rate for Payer: Humana Medicare	$442.33
Rate for Payer: Kaiser Permanente Commercial	$2,324.70
Rate for Payer: Kaiser Permanente Medicaid	$1,881.90
Rate for Payer: Kaiser Permanente Medicare	$442.33
Rate for Payer: MDX Hawaii PPO	$3,579.30
Rate for Payer: Ohana Health Plan Medicaid	$486.56
Rate for Payer: Ohana Health Plan Medicare	$442.33
Rate for Payer: UnitedHealthcare Medicaid	$138.15
Rate for Payer: UnitedHealthcare Medicare	$442.33
Rate for Payer: University Health Alliance Commercial	$766.09

HCHG MULTI- LEAF COLLIMATOR (MLC) DEVICES FOR IMRT, DESIGN AND CONSTRUCTION PER IMRT PLAN

Facility

$3,690.00

Service Code	HCPCS 77338
Hospital Charge Code	H3330213
Hospital Revenue Code	333
Min. Negotiated Rate	$3,136.50
Max. Negotiated Rate	$3,579.30
Rate for Payer: Cash Price	$2,398.50
Rate for Payer: Health Management Network Commercial	$3,136.50
Rate for Payer: MDX Hawaii PPO	$3,579.30

HCHG MUMPS AB IGG

Facility

$161.00

Service Code	HCPCS 86735
Hospital Charge Code	H3021012
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.05
Rate for Payer: AlohaCare Medicare	$13.05
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.93
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.05
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.05
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$13.05
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$13.05
Rate for Payer: University Health Alliance Commercial	$33.73

HCHG MUMPS AB IGG

Facility

$161.00

Service Code	HCPCS 86735
Hospital Charge Code	H3021012
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG MUMPS AB IGG 90

Facility

$161.00

Service Code	HCPCS 86735
Hospital Charge Code	H3020638
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG MUMPS AB IGG 90

Facility

$161.00

Service Code	HCPCS 86735
Hospital Charge Code	H3020638
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.05
Rate for Payer: AlohaCare Medicare	$13.05
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.93
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.05
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.05
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$13.05
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$13.05
Rate for Payer: University Health Alliance Commercial	$33.73

HCHG MUMPS AB IGM 90

Facility

$161.00

Service Code	HCPCS 86735
Hospital Charge Code	H3020640
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$13.05
Rate for Payer: AlohaCare Medicare	$13.05
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$14.36
Rate for Payer: Hawaii Medical Service Association ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.93
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$13.05
Rate for Payer: Kaiser Permanente Commercial	$101.43
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$13.05
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$14.36
Rate for Payer: Ohana Health Plan Medicare	$13.05
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$13.05
Rate for Payer: University Health Alliance Commercial	$33.73

HCHG MUMPS AB IGM 90

Facility

$161.00

Service Code	HCPCS 86735
Hospital Charge Code	H3020640
Hospital Revenue Code	302
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: MDX Hawaii PPO	$156.17

HCHG MYASTHENIA GRAVIS PANEL 2 - 90

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3011754
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$18.40
Rate for Payer: AlohaCare Medicare	$18.40
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Devoted Health Medicare	$20.24
Rate for Payer: Hawaii Medical Service Association ABD	$18.67
Rate for Payer: Hawaii Medical Service Association Commercial	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$18.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.60
Rate for Payer: Hawaii Western Management Group Commercial	$18.40
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Kaiser Permanente Commercial	$114.66
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$18.40
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$20.24
Rate for Payer: Ohana Health Plan Medicare	$18.40
Rate for Payer: UnitedHealthcare Medicaid	$18.67
Rate for Payer: UnitedHealthcare Medicare	$18.40
Rate for Payer: University Health Alliance Commercial	$34.93

HCHG MYASTHENIA GRAVIS PANEL 2 - 90

Facility

$182.00

Service Code	HCPCS 83519
Hospital Charge Code	H3011754
Hospital Revenue Code	301
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: MDX Hawaii PPO	$176.54

HCHG MYCOPHENOLIC ACID

Facility

$133.00

Service Code	HCPCS 80180
Hospital Charge Code	H3011617
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$18.05
Rate for Payer: AlohaCare Medicare	$18.05
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$19.86
Rate for Payer: Hawaii Medical Service Association ABD	$24.95
Rate for Payer: Hawaii Medical Service Association Commercial	$22.56
Rate for Payer: Hawaii Medical Service Association Medicare	$18.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.20
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$18.05
Rate for Payer: Kaiser Permanente Commercial	$83.79
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$18.05
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$19.86
Rate for Payer: Ohana Health Plan Medicare	$18.05
Rate for Payer: UnitedHealthcare Medicaid	$14.78
Rate for Payer: UnitedHealthcare Medicare	$18.05
Rate for Payer: University Health Alliance Commercial	$96.94

HCHG MYCOPHENOLIC ACID

Facility

$133.00

Service Code	HCPCS 80180
Hospital Charge Code	H3011617
Hospital Revenue Code	301
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: MDX Hawaii PPO	$129.01

HCHG MYCOPLASMA PNEU AB IGM 90

Facility

$172.00

Service Code	HCPCS 86738
Hospital Charge Code	H3020642
Hospital Revenue Code	302
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$13.24
Rate for Payer: AlohaCare Medicare	$13.24
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$14.56
Rate for Payer: Hawaii Medical Service Association ABD	$18.31
Rate for Payer: Hawaii Medical Service Association Commercial	$16.55
Rate for Payer: Hawaii Medical Service Association Medicare	$13.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$13.24
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$13.24
Rate for Payer: Kaiser Permanente Commercial	$108.36
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$13.24
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$14.56
Rate for Payer: Ohana Health Plan Medicare	$13.24
Rate for Payer: UnitedHealthcare Medicaid	$18.31
Rate for Payer: UnitedHealthcare Medicare	$13.24
Rate for Payer: University Health Alliance Commercial	$34.24

HCHG MYCOPLASMA PNEU AB IGM 90

Facility

$172.00

Service Code	HCPCS 86738
Hospital Charge Code	H3020642
Hospital Revenue Code	302
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: MDX Hawaii PPO	$166.84

Know your out-of-pocket cost for care.

All Charges