Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

IP

$75.00

Service Code	NDC 50268008811
Hospital Revenue Code	250
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: MDX Hawaii PPO	$72.75

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

IP

$75.00

Service Code	NDC 50268008815
Hospital Revenue Code	250
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: MDX Hawaii PPO	$72.75

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

OP

$81.00

Service Code	NDC 67877043103
Hospital Revenue Code	637
Min. Negotiated Rate	$41.31
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Hawaii Western Management Group Commercial	$76.95
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$51.03
Rate for Payer: Kaiser Permanente Medicaid	$41.31
Rate for Payer: MDX Hawaii PPO	$78.57
Rate for Payer: University Health Alliance Commercial	$59.04

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

OP

$75.00

Service Code	NDC 50268008815
Hospital Revenue Code	637
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$71.25
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Kaiser Permanente Commercial	$47.25
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: University Health Alliance Commercial	$54.67

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

OP

$75.00

Service Code	NDC 50268008811
Hospital Revenue Code	637
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$71.25
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Kaiser Permanente Commercial	$47.25
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: University Health Alliance Commercial	$54.67

ARIPIPRAZOLE 5 MG TABLET [36438]

Facility

IP

$81.00

Service Code	NDC 67877043103
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

ARM SLEEVE SHLDR SUS AR-1651

Facility

IP

$593.00

Hospital Revenue Code	271
Min. Negotiated Rate	$504.05
Max. Negotiated Rate	$575.21
Rate for Payer: Cash Price	$355.80
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: MDX Hawaii PPO	$575.21

ARM SLEEVE SHLDR SUS AR-1651

Facility

OP

$593.00

Hospital Revenue Code	271
Min. Negotiated Rate	$302.43
Max. Negotiated Rate	$575.21
Rate for Payer: Cash Price	$355.80
Rate for Payer: Hawaii Western Management Group Commercial	$563.35
Rate for Payer: Health Management Network Commercial	$504.05
Rate for Payer: Kaiser Permanente Commercial	$373.59
Rate for Payer: Kaiser Permanente Medicaid	$302.43
Rate for Payer: MDX Hawaii PPO	$575.21
Rate for Payer: University Health Alliance Commercial	$432.24

ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION [29071]

Facility

OP

$450.00

Service Code	HCPCS J9017
Hospital Revenue Code	636
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cash Price	$855.60
Rate for Payer: Cash Price	$855.60
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Hawaii Medical Service Association ABD	$5.86
Rate for Payer: Hawaii Medical Service Association ABD	$5.86
Rate for Payer: Hawaii Medical Service Association ABD	$5.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,354.70
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Hawaii Western Management Group Commercial	$874.00
Rate for Payer: Health Management Network Commercial	$782.00
Rate for Payer: Health Management Network Commercial	$1,212.10
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$579.60
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Commercial	$898.38
Rate for Payer: Kaiser Permanente Medicaid	$727.26
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicaid	$469.20
Rate for Payer: MDX Hawaii PPO	$1,383.22
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: MDX Hawaii PPO	$892.40
Rate for Payer: UnitedHealthcare Medicaid	$270.00
Rate for Payer: UnitedHealthcare Medicaid	$552.00
Rate for Payer: UnitedHealthcare Medicaid	$855.60
Rate for Payer: University Health Alliance Commercial	$1,039.41
Rate for Payer: University Health Alliance Commercial	$328.00
Rate for Payer: University Health Alliance Commercial	$670.59

ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION [29071]

Facility

IP

$920.00

Service Code	HCPCS J9017
Hospital Revenue Code	250
Min. Negotiated Rate	$782.00
Max. Negotiated Rate	$892.40
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$855.60
Rate for Payer: Health Management Network Commercial	$782.00
Rate for Payer: Health Management Network Commercial	$1,212.10
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: MDX Hawaii PPO	$892.40
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: MDX Hawaii PPO	$1,383.22

ART COMP OVOMOT 8HMC2-5046-A

Facility

IP

$15,252.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,541.12
Max. Negotiated Rate	$14,794.44
Rate for Payer: Cash Price	$9,151.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,676.40
Rate for Payer: Health Management Network Commercial	$12,964.20
Rate for Payer: MDX Hawaii PPO	$14,794.44
Rate for Payer: University Health Alliance Commercial	$8,541.12

ART COMP OVOMOT 8HMC2-5046-A

Facility

OP

$15,252.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,778.52
Max. Negotiated Rate	$14,794.44
Rate for Payer: Cash Price	$9,151.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,676.40
Rate for Payer: Health Management Network Commercial	$12,964.20
Rate for Payer: Kaiser Permanente Commercial	$9,608.76
Rate for Payer: Kaiser Permanente Medicaid	$7,778.52
Rate for Payer: MDX Hawaii PPO	$14,794.44
Rate for Payer: University Health Alliance Commercial	$8,541.12

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION

Facility

OP

$8,270.00

Service Code	CPT 36820
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION

Facility

OP

$8,270.00

Service Code	CPT 36819
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$6,573.58
Rate for Payer: AlohaCare Medicare	$6,573.58
Rate for Payer: Devoted Health Medicare	$7,230.94
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,573.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$6,573.58
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,573.58
Rate for Payer: Ohana Health Plan Medicaid	$7,230.94
Rate for Payer: Ohana Health Plan Medicare	$6,573.58
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,573.58
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)

Facility

OP

$8,270.00

Service Code	CPT 36821
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTERY SHUNT KIT 8888577775

Facility

IP

$156.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: MDX Hawaii PPO	$151.32

ARTERY SHUNT KIT 8888577775

Facility

OP

$156.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$93.60
Rate for Payer: Hawaii Western Management Group Commercial	$148.20
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$98.28
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: University Health Alliance Commercial	$113.71

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

OP

$4,035.20

Service Code	CPT 20610
Hospital Revenue Code	360
Min. Negotiated Rate	$48.79
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$362.62
Rate for Payer: AlohaCare Medicare	$362.62
Rate for Payer: Devoted Health Medicare	$398.88
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$362.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$362.62
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$362.62
Rate for Payer: Ohana Health Plan Medicaid	$398.88
Rate for Payer: Ohana Health Plan Medicare	$362.62
Rate for Payer: UnitedHealthcare Medicaid	$48.79
Rate for Payer: UnitedHealthcare Medicare	$362.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;

Facility

OP

$8,270.00

Service Code	CPT 26860
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$6,743.44

ARTHRODESIS, WRIST; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

Facility

OP

$14,395.00

Service Code	CPT 25825
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$14,395.00
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$11,157.19

ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT

Facility

OP

$24,500.00

Service Code	CPT 27130
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$19,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,561.00
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY

Facility

OP

$24,500.00

Service Code	CPT 23470
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))

Facility

OP

$24,500.00

Service Code	CPT 23472
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$20,713.48
Rate for Payer: AlohaCare Medicare	$20,713.48
Rate for Payer: Devoted Health Medicare	$22,784.83
Rate for Payer: Hawaii Medical Service Association ABD	$2,102.00
Rate for Payer: Hawaii Medical Service Association Commercial	$19,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20,713.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,561.00
Rate for Payer: Humana Medicare	$20,713.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$20,713.48
Rate for Payer: Ohana Health Plan Medicaid	$22,784.83
Rate for Payer: Ohana Health Plan Medicare	$20,713.48
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$20,713.48
Rate for Payer: University Health Alliance Commercial	$24,500.00

ARTHROPLASTY, INTERCARPAL OR CARPOMETACARPAL JOINTS; INTERPOSITION (EG, TENDON)

Facility

OP

$13,778.00

Service Code	CPT 25447
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$13,778.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$11,157.19

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)

Facility

OP

$24,500.00

Service Code	CPT 27447
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$24,500.00

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