Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG MYCOPLASMA PNEU IGG AB 90

Facility

$172.00

Service Code	HCPCS 86738
Hospital Charge Code	H3020644
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 IGG AB 90

Facility

$172.00

Service Code	HCPCS 86738
Hospital Charge Code	H3020644
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

HCHG MYCOPLASMA PNEUMONIAE, PCR, QUAL - 90

Facility

$431.00

Service Code	HCPCS 87581
Hospital Charge Code	H3060755
Hospital Revenue Code	306
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
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	$366.35
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$271.53
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$418.07
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 MYCOPLASMA PNEUMONIAE, PCR, QUAL - 90

Facility

$431.00

Service Code	HCPCS 87581
Hospital Charge Code	H3060755
Hospital Revenue Code	306
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$280.15
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: MDX Hawaii PPO	$418.07

HCHG MYD88 MUTATION ANALYSIS MOD 90

Facility

$964.00

Service Code	HCPCS 81305
Hospital Charge Code	H3100231
Hospital Revenue Code	310
Min. Negotiated Rate	$105.24
Max. Negotiated Rate	$935.08
Rate for Payer: AlohaCare Medicaid	$175.40
Rate for Payer: AlohaCare Medicare	$175.40
Rate for Payer: Cash Price	$626.60
Rate for Payer: Cash Price	$626.60
Rate for Payer: Devoted Health Medicare	$192.94
Rate for Payer: Hawaii Medical Service Association ABD	$175.87
Rate for Payer: Hawaii Medical Service Association Commercial	$219.25
Rate for Payer: Hawaii Medical Service Association Medicare	$175.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$175.87
Rate for Payer: Hawaii Western Management Group Commercial	$175.40
Rate for Payer: Health Management Network Commercial	$819.40
Rate for Payer: Humana Medicare	$175.40
Rate for Payer: Kaiser Permanente Commercial	$607.32
Rate for Payer: Kaiser Permanente Medicaid	$491.64
Rate for Payer: Kaiser Permanente Medicare	$175.40
Rate for Payer: MDX Hawaii PPO	$935.08
Rate for Payer: Ohana Health Plan Medicaid	$192.94
Rate for Payer: Ohana Health Plan Medicare	$175.40
Rate for Payer: UnitedHealthcare Medicaid	$105.24
Rate for Payer: UnitedHealthcare Medicare	$175.40
Rate for Payer: University Health Alliance Commercial	$702.66

HCHG MYD88 MUTATION ANALYSIS MOD 90

Facility

$964.00

Service Code	HCPCS 81305
Hospital Charge Code	H3100231
Hospital Revenue Code	310
Min. Negotiated Rate	$819.40
Max. Negotiated Rate	$935.08
Rate for Payer: Cash Price	$626.60
Rate for Payer: Health Management Network Commercial	$819.40
Rate for Payer: MDX Hawaii PPO	$935.08

HCHG MYELIN BASIC PROTEIN

Facility

$211.00

Service Code	HCPCS 83873
Hospital Charge Code	H3010952
Hospital Revenue Code	301
Min. Negotiated Rate	$14.42
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$17.20
Rate for Payer: AlohaCare Medicare	$17.20
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$18.92
Rate for Payer: Hawaii Medical Service Association ABD	$14.42
Rate for Payer: Hawaii Medical Service Association Commercial	$21.50
Rate for Payer: Hawaii Medical Service Association Medicare	$17.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.76
Rate for Payer: Hawaii Western Management Group Commercial	$17.20
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$17.20
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$17.20
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$18.92
Rate for Payer: Ohana Health Plan Medicare	$17.20
Rate for Payer: UnitedHealthcare Medicaid	$14.42
Rate for Payer: UnitedHealthcare Medicare	$17.20
Rate for Payer: University Health Alliance Commercial	$44.47

HCHG MYELIN BASIC PROTEIN

Facility

$211.00

Service Code	HCPCS 83873
Hospital Charge Code	H3010950
Hospital Revenue Code	301
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG MYELIN BASIC PROTEIN

Facility

$211.00

Service Code	HCPCS 83873
Hospital Charge Code	H3010950
Hospital Revenue Code	301
Min. Negotiated Rate	$14.42
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$17.20
Rate for Payer: AlohaCare Medicare	$17.20
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$18.92
Rate for Payer: Hawaii Medical Service Association ABD	$14.42
Rate for Payer: Hawaii Medical Service Association Commercial	$21.50
Rate for Payer: Hawaii Medical Service Association Medicare	$17.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.76
Rate for Payer: Hawaii Western Management Group Commercial	$17.20
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$17.20
Rate for Payer: Kaiser Permanente Commercial	$132.93
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$17.20
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$18.92
Rate for Payer: Ohana Health Plan Medicare	$17.20
Rate for Payer: UnitedHealthcare Medicaid	$14.42
Rate for Payer: UnitedHealthcare Medicare	$17.20
Rate for Payer: University Health Alliance Commercial	$44.47

HCHG MYELIN BASIC PROTEIN

Facility

$211.00

Service Code	HCPCS 83873
Hospital Charge Code	H3010952
Hospital Revenue Code	301
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: MDX Hawaii PPO	$204.67

HCHG MYELOGRAPHY LUMBAR LUMBOSACRAL

Facility

$3,419.00

Service Code	HCPCS 62304
Hospital Charge Code	H3610628
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,316.43
Rate for Payer: AlohaCare Medicaid	$926.08
Rate for Payer: AlohaCare Medicare	$926.08
Rate for Payer: Cash Price	$2,222.35
Rate for Payer: Cash Price	$2,222.35
Rate for Payer: Cash Price	$2,222.35
Rate for Payer: Devoted Health Medicare	$1,018.69
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	$926.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,906.15
Rate for Payer: Humana Medicare	$926.08
Rate for Payer: Kaiser Permanente Commercial	$2,153.97
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$926.08
Rate for Payer: MDX Hawaii PPO	$3,316.43
Rate for Payer: Ohana Health Plan Medicaid	$1,018.69
Rate for Payer: Ohana Health Plan Medicare	$926.08
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$926.08
Rate for Payer: University Health Alliance Commercial	$2,492.11

HCHG MYELOGRAPHY LUMBAR LUMBOSACRAL

Facility

$3,419.00

Service Code	HCPCS 62304
Hospital Charge Code	H3610628
Hospital Revenue Code	361
Min. Negotiated Rate	$2,906.15
Max. Negotiated Rate	$3,316.43
Rate for Payer: Cash Price	$2,222.35
Rate for Payer: Health Management Network Commercial	$2,906.15
Rate for Payer: MDX Hawaii PPO	$3,316.43

HCHG MYELOPEROXIDASE AB

Facility

$156.00

Service Code	HCPCS 83516
Hospital Charge Code	K3010036
Hospital Revenue Code	301
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

HCHG MYELOPEROXIDASE AB

Facility

$156.00

Service Code	HCPCS 83516
Hospital Charge Code	K3010036
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$11.53
Rate for Payer: AlohaCare Medicare	$11.53
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$12.68
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$11.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$11.53
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$11.53
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$12.68
Rate for Payer: Ohana Health Plan Medicare	$11.53
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$11.53
Rate for Payer: University Health Alliance Commercial	$29.82

HCHG MYOCARDIAL SPECT MULTIPLE STUDIES

Facility

$5,931.00

Service Code	HCPCS 78452
Hospital Charge Code	H3410388
Hospital Revenue Code	341
Min. Negotiated Rate	$5,041.35
Max. Negotiated Rate	$5,753.07
Rate for Payer: Cash Price	$3,855.15
Rate for Payer: Health Management Network Commercial	$5,041.35
Rate for Payer: MDX Hawaii PPO	$5,753.07

HCHG MYOCARDIAL SPECT MULTIPLE STUDIES

Facility

$5,931.00

Service Code	HCPCS 78452
Hospital Charge Code	H3410388
Hospital Revenue Code	341
Min. Negotiated Rate	$164.65
Max. Negotiated Rate	$5,753.07
Rate for Payer: AlohaCare Medicaid	$1,529.43
Rate for Payer: AlohaCare Medicare	$1,529.43
Rate for Payer: Cash Price	$3,855.15
Rate for Payer: Cash Price	$3,855.15
Rate for Payer: Devoted Health Medicare	$1,682.37
Rate for Payer: Hawaii Medical Service Association ABD	$164.65
Rate for Payer: Hawaii Medical Service Association Commercial	$1,911.79
Rate for Payer: Hawaii Medical Service Association Medicare	$1,529.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$433.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,529.43
Rate for Payer: Health Management Network Commercial	$5,041.35
Rate for Payer: Humana Medicare	$1,529.43
Rate for Payer: Kaiser Permanente Commercial	$3,736.53
Rate for Payer: Kaiser Permanente Medicaid	$3,024.81
Rate for Payer: Kaiser Permanente Medicare	$1,529.43
Rate for Payer: MDX Hawaii PPO	$5,753.07
Rate for Payer: Ohana Health Plan Medicaid	$1,682.37
Rate for Payer: Ohana Health Plan Medicare	$1,529.43
Rate for Payer: UnitedHealthcare Medicaid	$164.65
Rate for Payer: UnitedHealthcare Medicare	$1,529.43
Rate for Payer: University Health Alliance Commercial	$796.17

HCHG MYOCARDIAL SPECT SINGLE STUDY

Facility

$5,695.00

Service Code	HCPCS 78451
Hospital Charge Code	H3410387
Hospital Revenue Code	341
Min. Negotiated Rate	$4,840.75
Max. Negotiated Rate	$5,524.15
Rate for Payer: Cash Price	$3,701.75
Rate for Payer: Health Management Network Commercial	$4,840.75
Rate for Payer: MDX Hawaii PPO	$5,524.15

HCHG MYOCARDIAL SPECT SINGLE STUDY

Facility

$5,695.00

Service Code	HCPCS 78451
Hospital Charge Code	H3410387
Hospital Revenue Code	341
Min. Negotiated Rate	$85.15
Max. Negotiated Rate	$5,524.15
Rate for Payer: AlohaCare Medicaid	$1,529.43
Rate for Payer: AlohaCare Medicare	$1,529.43
Rate for Payer: Cash Price	$3,701.75
Rate for Payer: Cash Price	$3,701.75
Rate for Payer: Devoted Health Medicare	$1,682.37
Rate for Payer: Hawaii Medical Service Association ABD	$85.15
Rate for Payer: Hawaii Medical Service Association Commercial	$1,911.79
Rate for Payer: Hawaii Medical Service Association Medicare	$1,529.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,529.43
Rate for Payer: Health Management Network Commercial	$4,840.75
Rate for Payer: Humana Medicare	$1,529.43
Rate for Payer: Kaiser Permanente Commercial	$3,587.85
Rate for Payer: Kaiser Permanente Medicaid	$2,904.45
Rate for Payer: Kaiser Permanente Medicare	$1,529.43
Rate for Payer: MDX Hawaii PPO	$5,524.15
Rate for Payer: Ohana Health Plan Medicaid	$1,682.37
Rate for Payer: Ohana Health Plan Medicare	$1,529.43
Rate for Payer: UnitedHealthcare Medicaid	$85.15
Rate for Payer: UnitedHealthcare Medicare	$1,529.43
Rate for Payer: University Health Alliance Commercial	$461.20

HCHG MYOGLOBIN

Facility

$167.00

Service Code	HCPCS 83874
Hospital Charge Code	H3010954
Hospital Revenue Code	301
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$12.92
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Devoted Health Medicare	$14.21
Rate for Payer: Hawaii Medical Service Association ABD	$17.84
Rate for Payer: Hawaii Medical Service Association Commercial	$16.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.73
Rate for Payer: Hawaii Western Management Group Commercial	$12.92
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$105.21
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$14.21
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicaid	$17.84
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$33.37

HCHG MYOGLOBIN

Facility

$167.00

Service Code	HCPCS 83874
Hospital Charge Code	H3010954
Hospital Revenue Code	301
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$108.55
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: MDX Hawaii PPO	$161.99

HCHG MYOGLOBIN-URINE 90

Facility

$167.00

Service Code	HCPCS 83874
Hospital Charge Code	H3010958
Hospital Revenue Code	301
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$12.92
Rate for Payer: AlohaCare Medicare	$12.92
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Devoted Health Medicare	$14.21
Rate for Payer: Hawaii Medical Service Association ABD	$17.84
Rate for Payer: Hawaii Medical Service Association Commercial	$16.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.73
Rate for Payer: Hawaii Western Management Group Commercial	$12.92
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$12.92
Rate for Payer: Kaiser Permanente Commercial	$105.21
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$12.92
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$14.21
Rate for Payer: Ohana Health Plan Medicare	$12.92
Rate for Payer: UnitedHealthcare Medicaid	$17.84
Rate for Payer: UnitedHealthcare Medicare	$12.92
Rate for Payer: University Health Alliance Commercial	$33.37

HCHG MYOGLOBIN-URINE 90

Facility

$167.00

Service Code	HCPCS 83874
Hospital Charge Code	H3010958
Hospital Revenue Code	301
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$108.55
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: MDX Hawaii PPO	$161.99

HCHG NA QUAN NOS AGENT

Facility

$285.00

Service Code	HCPCS 87799
Hospital Charge Code	H3060709
Hospital Revenue Code	306
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$185.25
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: MDX Hawaii PPO	$276.45

HCHG NA QUAN NOS AGENT

Facility

$285.00

Service Code	HCPCS 87799
Hospital Charge Code	H3060709
Hospital Revenue Code	306
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$42.84
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$185.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Devoted Health Medicare	$47.12
Rate for Payer: Hawaii Medical Service Association ABD	$35.91
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.17
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$179.55
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$35.91
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$110.72

HCHG NASAL BONES MIN 3 VIEWS

Facility

$633.00

Service Code	HCPCS 70160
Hospital Charge Code	H3200580
Hospital Revenue Code	320
Min. Negotiated Rate	$538.05
Max. Negotiated Rate	$614.01
Rate for Payer: Cash Price	$411.45
Rate for Payer: Health Management Network Commercial	$538.05
Rate for Payer: MDX Hawaii PPO	$614.01

Know your out-of-pocket cost for care.

All Charges