Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC FLUORSCOPIC GUIDANCE SPINAL INJECTION - IR DISC ASPIRATION

Facility

$629.00

Service Code	HCPCS 77003
Hospital Charge Code	3207700301
Hospital Revenue Code	320
Min. Negotiated Rate	$534.65
Max. Negotiated Rate	$610.13
Rate for Payer: Cash Price	$377.40
Rate for Payer: Health Management Network Commercial	$534.65
Rate for Payer: MDX Hawaii PPO	$610.13

HC FLUORSCOPIC GUIDANCE SPINAL INJECTION - IR DISC ASPIRATION

Facility

$629.00

Service Code	HCPCS 77003
Hospital Charge Code	3207700301
Hospital Revenue Code	320
Min. Negotiated Rate	$34.83
Max. Negotiated Rate	$610.13
Rate for Payer: Cash Price	$377.40
Rate for Payer: Cash Price	$377.40
Rate for Payer: Hawaii Medical Service Association ABD	$34.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.17
Rate for Payer: Hawaii Western Management Group Commercial	$597.55
Rate for Payer: Health Management Network Commercial	$534.65
Rate for Payer: Kaiser Permanente Commercial	$396.27
Rate for Payer: Kaiser Permanente Medicaid	$320.79
Rate for Payer: MDX Hawaii PPO	$610.13
Rate for Payer: UnitedHealthcare Medicaid	$34.83
Rate for Payer: University Health Alliance Commercial	$131.42

HC FO W/O JOINTS CF

Facility

$769.00

Service Code	HCPCS L3933
Hospital Charge Code	274L393301
Hospital Revenue Code	274
Min. Negotiated Rate	$430.64
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

HC FO W/O JOINTS CF

Facility

$769.00

Service Code	HCPCS L3933
Hospital Charge Code	274L393301
Hospital Revenue Code	274
Min. Negotiated Rate	$91.55
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$484.47
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: UnitedHealthcare Medicaid	$91.55
Rate for Payer: University Health Alliance Commercial	$430.64

HC FULL TRAUMA RESP W/O CRIT CARE

Facility

$7,953.00

Hospital Charge Code	4500000003
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$7,714.41
Rate for Payer: Cash Price	$4,771.80
Rate for Payer: Cash Price	$4,771.80
Rate for Payer: Cash Price	$4,771.80
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,555.35
Rate for Payer: Health Management Network Commercial	$6,760.05
Rate for Payer: Kaiser Permanente Commercial	$5,010.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$7,714.41
Rate for Payer: University Health Alliance Commercial	$5,796.94

HC FULL TRAUMA RESP W/O CRIT CARE

Facility

$7,953.00

Hospital Charge Code	4500000003
Hospital Revenue Code	450
Min. Negotiated Rate	$6,760.05
Max. Negotiated Rate	$7,714.41
Rate for Payer: Cash Price	$4,771.80
Rate for Payer: Health Management Network Commercial	$6,760.05
Rate for Payer: MDX Hawaii PPO	$7,714.41

HC FUNGAL ID BY DNA SEQ SO

Facility

$968.00

Service Code	HCPCS 87153
Hospital Charge Code	3068715301
Hospital Revenue Code	306
Min. Negotiated Rate	$822.80
Max. Negotiated Rate	$938.96
Rate for Payer: Cash Price	$580.80
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: MDX Hawaii PPO	$938.96

HC FUNGAL ID BY DNA SEQ SO

Facility

$968.00

Service Code	HCPCS 87153
Hospital Charge Code	3068715301
Hospital Revenue Code	306
Min. Negotiated Rate	$115.36
Max. Negotiated Rate	$938.96
Rate for Payer: AlohaCare Medicaid	$115.36
Rate for Payer: AlohaCare Medicare	$115.36
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Devoted Health Medicare	$126.90
Rate for Payer: Hawaii Medical Service Association ABD	$165.22
Rate for Payer: Hawaii Medical Service Association Commercial	$144.20
Rate for Payer: Hawaii Medical Service Association Medicare	$115.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$150.38
Rate for Payer: Hawaii Western Management Group Commercial	$115.36
Rate for Payer: Health Management Network Commercial	$822.80
Rate for Payer: Humana Medicare	$115.36
Rate for Payer: Kaiser Permanente Commercial	$609.84
Rate for Payer: Kaiser Permanente Medicaid	$493.68
Rate for Payer: Kaiser Permanente Medicare	$115.36
Rate for Payer: MDX Hawaii PPO	$938.96
Rate for Payer: Ohana Health Plan Medicaid	$126.90
Rate for Payer: Ohana Health Plan Medicare	$115.36
Rate for Payer: UnitedHealthcare Medicaid	$165.22
Rate for Payer: UnitedHealthcare Medicare	$115.36
Rate for Payer: University Health Alliance Commercial	$300.31

HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD

Facility

$87.00

Service Code	HCPCS 87107
Hospital Charge Code	3068710701
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$10.32
Rate for Payer: AlohaCare Medicare	$10.32
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$11.35
Rate for Payer: Hawaii Medical Service Association ABD	$14.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$10.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.14
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$10.32
Rate for Payer: Kaiser Permanente Commercial	$54.81
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$10.32
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$11.35
Rate for Payer: Ohana Health Plan Medicare	$10.32
Rate for Payer: UnitedHealthcare Medicaid	$14.42
Rate for Payer: UnitedHealthcare Medicare	$10.32
Rate for Payer: University Health Alliance Commercial	$26.68

HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD

Facility

$87.00

Service Code	HCPCS 87107
Hospital Charge Code	3068710701
Hospital Revenue Code	306
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: MDX Hawaii PPO	$84.39

HC FUNGUS NES ANTIBODY - FUNGUS AB SO

Facility

$103.00

Service Code	HCPCS 86671
Hospital Charge Code	3028667101
Hospital Revenue Code	302
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$61.80
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: MDX Hawaii PPO	$99.91

HC FUNGUS NES ANTIBODY - FUNGUS AB SO

Facility

$103.00

Service Code	HCPCS 86671
Hospital Charge Code	3028667101
Hospital Revenue Code	302
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$12.25
Rate for Payer: AlohaCare Medicare	$12.25
Rate for Payer: Cash Price	$61.80
Rate for Payer: Cash Price	$61.80
Rate for Payer: Devoted Health Medicare	$13.47
Rate for Payer: Hawaii Medical Service Association ABD	$16.95
Rate for Payer: Hawaii Medical Service Association Commercial	$15.31
Rate for Payer: Hawaii Medical Service Association Medicare	$12.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.80
Rate for Payer: Hawaii Western Management Group Commercial	$12.25
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$12.25
Rate for Payer: Kaiser Permanente Commercial	$64.89
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$12.25
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$13.47
Rate for Payer: Ohana Health Plan Medicare	$12.25
Rate for Payer: UnitedHealthcare Medicaid	$16.95
Rate for Payer: UnitedHealthcare Medicare	$12.25
Rate for Payer: University Health Alliance Commercial	$31.69

HC FX CLSD M'CPAL/NOT THUMB W/MAN

Facility

$955.00

Service Code	HCPCS 26670
Hospital Charge Code	4502667001
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: MDX Hawaii PPO	$926.35

HC FX CLSD M'CPAL/NOT THUMB W/MAN

Facility

$955.00

Service Code	HCPCS 26670
Hospital Charge Code	4502667001
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$601.65
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$696.10

HC GASTRIC EMPTYING IMAGING STUDY - NM GASTRIC EMPTYING SOLID

Facility

$1,999.00

Service Code	HCPCS 78264
Hospital Charge Code	3417826401
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC GASTRIC EMPTYING IMAGING STUDY - NM GASTRIC EMPTYING SOLID

Facility

$1,999.00

Service Code	HCPCS 78264
Hospital Charge Code	3417826401
Hospital Revenue Code	341
Min. Negotiated Rate	$159.82
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$164.93
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$159.82
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$164.93
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$524.51

HC GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC

Facility

$1,239.00

Service Code	HCPCS 43753
Hospital Charge Code	4504375301
Hospital Revenue Code	450
Min. Negotiated Rate	$255.08
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,177.05
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$780.57
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,201.83
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$903.11

HC GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC

Facility

$1,239.00

Service Code	HCPCS 43753
Hospital Charge Code	4504375301
Hospital Revenue Code	450
Min. Negotiated Rate	$1,053.15
Max. Negotiated Rate	$1,201.83
Rate for Payer: Cash Price	$743.40
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: MDX Hawaii PPO	$1,201.83

HC GASTRIC MUCOSA IMAGING - NM BOWEL GASTRIC MUCOSA

Facility

$1,999.00

Service Code	HCPCS 78261
Hospital Charge Code	3417826101
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC GASTRIC MUCOSA IMAGING - NM BOWEL GASTRIC MUCOSA

Facility

$1,999.00

Service Code	HCPCS 78261
Hospital Charge Code	3417826101
Hospital Revenue Code	341
Min. Negotiated Rate	$135.14
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$135.14
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$146.67
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$135.14
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$470.01

HC GASTROESOPHAGEAL REFLUX EXAM - NM ESOPHAGUS GASTROESOPHAGEAL REFLUX

Facility

$1,999.00

Service Code	HCPCS 78262
Hospital Charge Code	3417826201
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC GASTROESOPHAGEAL REFLUX EXAM - NM ESOPHAGUS GASTROESOPHAGEAL REFLUX

Facility

$1,999.00

Service Code	HCPCS 78262
Hospital Charge Code	3417826201
Hospital Revenue Code	341
Min. Negotiated Rate	$140.13
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$140.13
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$152.26
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$140.13
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$473.30

HC GATED HEART MULTIPLE

Facility

$1,999.00

Service Code	HCPCS 78473
Hospital Charge Code	3417847301
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC GATED HEART MULTIPLE

Facility

$1,999.00

Service Code	HCPCS 78473
Hospital Charge Code	3417847301
Hospital Revenue Code	341
Min. Negotiated Rate	$271.64
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$271.64
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$295.20
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$271.64
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$778.09

HC GATED HEART PLANAR SINGLE

Facility

$1,999.00

Service Code	HCPCS 78472
Hospital Charge Code	3417847201
Hospital Revenue Code	341
Min. Negotiated Rate	$181.81
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$181.81
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$197.26
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$181.81
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$553.93

Know your out-of-pocket cost for care.

All Charges