Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

triamcinolone 40 mg/mL Sus INJ [KMC]

Facility

$44.92

Service Code	HCPCS J3301
Hospital Revenue Code	636
Min. Negotiated Rate	$38.18
Max. Negotiated Rate	$43.57
Rate for Payer: Cash Price	$29.20
Rate for Payer: Health Management Network Commercial	$38.18
Rate for Payer: Kaiser Permanente Commercial	$40.43
Rate for Payer: MDX Hawaii PPO	$43.57

triamcinolone 40 mg/mL Sus INJ [KMC]

Facility

$44.92

Service Code	HCPCS J3301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$43.57
Rate for Payer: AlohaCare Medicaid	$22.46
Rate for Payer: AlohaCare Medicare	$18.87
Rate for Payer: Cash Price	$29.20
Rate for Payer: Cash Price	$29.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$41.33
Rate for Payer: Devoted Health Medicare	$18.87
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Medicare	$18.87
Rate for Payer: Hawaii Western Management Group Commercial	$42.67
Rate for Payer: Health Management Network Commercial	$38.18
Rate for Payer: Humana Medicare	$18.87
Rate for Payer: Kaiser Permanente Commercial	$40.43
Rate for Payer: Kaiser Permanente Medicaid	$22.91
Rate for Payer: Kaiser Permanente Medicare	$18.87
Rate for Payer: MDX Hawaii PPO	$43.57
Rate for Payer: Ohana Health Plan Medicaid	$18.87
Rate for Payer: Ohana Health Plan Medicare	$18.87
Rate for Payer: UnitedHealthcare Medicaid	$26.95
Rate for Payer: UnitedHealthcare Medicare	$18.87
Rate for Payer: University Health Alliance Commercial	$32.74

TRIAMCINOLONE ACET INJ NOS

Professional

Both

$7.00

Service Code	HCPCS J3301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$6.69
Rate for Payer: AlohaCare Medicare	$0.90
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$6.69
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$1.08
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$0.90
Rate for Payer: UnitedHealthcare Medicare	$0.90

TRIANGILAR BANDAGE 40"

Facility

$6.00

Hospital Charge Code	8365
Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$2.52
Rate for Payer: Cash Price	$3.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.52
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.52
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$2.52
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$2.52
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$2.52
Rate for Payer: Ohana Health Plan Medicare	$2.52
Rate for Payer: UnitedHealthcare Medicare	$2.52
Rate for Payer: University Health Alliance Commercial	$4.37

TRIANGILAR BANDAGE 40"

Facility

$6.00

Hospital Charge Code	8365
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.90
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

TRIFLO SUCTION CATHETHER W/CONTROL PORT 10FR

Facility

$114.00

Hospital Charge Code	8368
Hospital Revenue Code	270
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

TRIFLO SUCTION CATHETHER W/CONTROL PORT 10FR

Facility

$114.00

Hospital Charge Code	8368
Hospital Revenue Code	270
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: Cash Price	$74.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$104.88
Rate for Payer: Devoted Health Medicare	$47.88
Rate for Payer: Hawaii Medical Service Association Medicare	$47.88
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: University Health Alliance Commercial	$83.09

TRIFLO SUCTION CATHETHER W/CONTROL PORT 14FR

Facility

$486.00

Hospital Charge Code	8366
Hospital Revenue Code	270
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$471.42
Rate for Payer: Cash Price	$315.90
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: MDX Hawaii PPO	$471.42

TRIFLO SUCTION CATHETHER W/CONTROL PORT 14FR

Facility

$486.00

Hospital Charge Code	8366
Hospital Revenue Code	270
Min. Negotiated Rate	$204.12
Max. Negotiated Rate	$471.42
Rate for Payer: AlohaCare Medicaid	$243.00
Rate for Payer: AlohaCare Medicare	$204.12
Rate for Payer: Cash Price	$315.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$447.12
Rate for Payer: Devoted Health Medicare	$204.12
Rate for Payer: Hawaii Medical Service Association Medicare	$204.12
Rate for Payer: Hawaii Western Management Group Commercial	$461.70
Rate for Payer: Health Management Network Commercial	$413.10
Rate for Payer: Humana Medicare	$204.12
Rate for Payer: Kaiser Permanente Commercial	$437.40
Rate for Payer: Kaiser Permanente Medicaid	$247.86
Rate for Payer: Kaiser Permanente Medicare	$204.12
Rate for Payer: MDX Hawaii PPO	$471.42
Rate for Payer: Ohana Health Plan Medicaid	$204.12
Rate for Payer: Ohana Health Plan Medicare	$204.12
Rate for Payer: UnitedHealthcare Medicare	$204.12
Rate for Payer: University Health Alliance Commercial	$354.25

TRIFLO SUCTION CATHETHER W/CONTROL PORT 8FR

Facility

$113.00

Hospital Charge Code	8367
Hospital Revenue Code	270
Min. Negotiated Rate	$47.46
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$56.50
Rate for Payer: AlohaCare Medicare	$47.46
Rate for Payer: Cash Price	$73.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$103.96
Rate for Payer: Devoted Health Medicare	$47.46
Rate for Payer: Hawaii Medical Service Association Medicare	$47.46
Rate for Payer: Hawaii Western Management Group Commercial	$107.35
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Humana Medicare	$47.46
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: Kaiser Permanente Medicare	$47.46
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: Ohana Health Plan Medicaid	$47.46
Rate for Payer: Ohana Health Plan Medicare	$47.46
Rate for Payer: UnitedHealthcare Medicare	$47.46
Rate for Payer: University Health Alliance Commercial	$82.37

TRIFLO SUCTION CATHETHER W/CONTROL PORT 8FR

Facility

$113.00

Hospital Charge Code	8367
Hospital Revenue Code	270
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$73.45
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: MDX Hawaii PPO	$109.61

Triglycerides

Facility

$69.00

Service Code	HCPCS 84478
Hospital Charge Code	422844780
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Triglycerides

Facility

$69.00

Service Code	HCPCS 84478
Hospital Charge Code	422844780
Hospital Revenue Code	301
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.95
Rate for Payer: Hawaii Medical Service Association Commercial	$7.17
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$5.74
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$7.95
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$14.87

TRIMMING NONDYSTROPHIC NAILS ANY NUMBER

Professional

Both

$224.00

Service Code	HCPCS 11719
Hospital Revenue Code	361
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$190.40
Rate for Payer: AlohaCare Medicaid	$7.38
Rate for Payer: AlohaCare Medicare	$6.63
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Devoted Health Medicare	$6.63
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.38
Rate for Payer: Hawaii Medical Service Association Commercial	$11.70
Rate for Payer: Hawaii Medical Service Association Medicare	$6.63
Rate for Payer: Hawaii Western Management Group Commercial	$12.48
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Kaiser Permanente Commercial	$7.96
Rate for Payer: Kaiser Permanente Medicaid	$7.96
Rate for Payer: Kaiser Permanente Medicare	$7.96
Rate for Payer: Ohana Health Plan Medicaid	$7.38
Rate for Payer: Ohana Health Plan Medicare	$6.63
Rate for Payer: UnitedHealthcare Medicaid	$7.38
Rate for Payer: UnitedHealthcare Medicare	$6.63
Rate for Payer: University Health Alliance Commercial	$7.96

TR Interpretation

Facility

$395.00

Service Code	HCPCS 86078
Hospital Charge Code	422860780
Hospital Revenue Code	310
Min. Negotiated Rate	$335.75
Max. Negotiated Rate	$383.15
Rate for Payer: Cash Price	$256.75
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: MDX Hawaii PPO	$383.15

TR Interpretation

Facility

$395.00

Service Code	HCPCS 86078
Hospital Charge Code	422860780
Hospital Revenue Code	310
Min. Negotiated Rate	$52.33
Max. Negotiated Rate	$383.15
Rate for Payer: AlohaCare Medicaid	$197.50
Rate for Payer: AlohaCare Medicare	$165.90
Rate for Payer: Cash Price	$256.75
Rate for Payer: Cash Price	$256.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$363.40
Rate for Payer: Devoted Health Medicare	$165.90
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$54.97
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$165.90
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Humana Medicare	$165.90
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: Kaiser Permanente Medicaid	$201.45
Rate for Payer: Kaiser Permanente Medicare	$165.90
Rate for Payer: MDX Hawaii PPO	$383.15
Rate for Payer: Ohana Health Plan Medicaid	$165.90
Rate for Payer: Ohana Health Plan Medicare	$165.90
Rate for Payer: UnitedHealthcare Medicaid	$52.33
Rate for Payer: UnitedHealthcare Medicare	$165.90
Rate for Payer: University Health Alliance Commercial	$93.72

Troponin I

Facility

$249.00

Service Code	HCPCS 84484
Hospital Charge Code	422844840
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$104.58
Rate for Payer: Cash Price	$161.85
Rate for Payer: Cash Price	$161.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$229.08
Rate for Payer: Devoted Health Medicare	$104.58
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$104.58
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$104.58
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$104.58
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$104.58
Rate for Payer: Ohana Health Plan Medicare	$104.58
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$104.58
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin I

Facility

$249.00

Service Code	HCPCS 84484
Hospital Charge Code	422844840
Hospital Revenue Code	301
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$161.85
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

Troponin I DLS

Facility

$249.00

Service Code	HCPCS 84484
Hospital Charge Code	422844845
Hospital Revenue Code	301
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$161.85
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

Troponin I DLS

Facility

$249.00

Service Code	HCPCS 84484
Hospital Charge Code	422844845
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$104.58
Rate for Payer: Cash Price	$161.85
Rate for Payer: Cash Price	$161.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$229.08
Rate for Payer: Devoted Health Medicare	$104.58
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$104.58
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$104.58
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$104.58
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$104.58
Rate for Payer: Ohana Health Plan Medicare	$104.58
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$104.58
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin T DLS

Facility

$80.00

Service Code	HCPCS 84484
Hospital Charge Code	422844845
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$33.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$73.60
Rate for Payer: Devoted Health Medicare	$33.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Commercial	$15.59
Rate for Payer: Hawaii Medical Service Association Medicare	$33.60
Rate for Payer: Hawaii Western Management Group Commercial	$12.47
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$33.60
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$33.60
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$33.60
Rate for Payer: Ohana Health Plan Medicare	$33.60
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$33.60
Rate for Payer: University Health Alliance Commercial	$25.44

Troponin T DLS

Facility

$80.00

Service Code	HCPCS 84484
Hospital Charge Code	422844845
Hospital Revenue Code	301
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

trospium 20 mg Tab [KMC]

Facility

$11.35

Service Code	NDC 23155053006
Hospital Revenue Code	250
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$11.01
Rate for Payer: AlohaCare Medicaid	$5.67
Rate for Payer: AlohaCare Medicare	$4.77
Rate for Payer: Cash Price	$7.38
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.44
Rate for Payer: Devoted Health Medicare	$4.77
Rate for Payer: Hawaii Medical Service Association Medicare	$4.77
Rate for Payer: Hawaii Western Management Group Commercial	$10.78
Rate for Payer: Health Management Network Commercial	$9.65
Rate for Payer: Humana Medicare	$4.77
Rate for Payer: Kaiser Permanente Commercial	$10.21
Rate for Payer: Kaiser Permanente Medicaid	$5.79
Rate for Payer: Kaiser Permanente Medicare	$4.77
Rate for Payer: MDX Hawaii PPO	$11.01
Rate for Payer: Ohana Health Plan Medicaid	$4.77
Rate for Payer: Ohana Health Plan Medicare	$4.77
Rate for Payer: UnitedHealthcare Medicaid	$6.81
Rate for Payer: UnitedHealthcare Medicare	$4.77
Rate for Payer: University Health Alliance Commercial	$8.27

trospium 20 mg Tab [KMC]

Facility

$11.35

Service Code	NDC 23155053006
Hospital Revenue Code	250
Min. Negotiated Rate	$9.65
Max. Negotiated Rate	$11.01
Rate for Payer: Cash Price	$7.38
Rate for Payer: Health Management Network Commercial	$9.65
Rate for Payer: Kaiser Permanente Commercial	$10.21
Rate for Payer: MDX Hawaii PPO	$11.01

TSH DLS

Facility

$142.00

Service Code	HCPCS 84443
Hospital Charge Code	422844435
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$59.64
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$130.64
Rate for Payer: Devoted Health Medicare	$59.64
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$59.64
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$59.64
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$59.64
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$59.64
Rate for Payer: Ohana Health Plan Medicare	$59.64
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$59.64
Rate for Payer: University Health Alliance Commercial	$43.42

Know your out-of-pocket cost for care.

All Charges